11 May 2017

‘The SAITM Issue’ and the politics of misnaming

SAITM: Means different things to different people on both sides of the divide
Whoever is against SAITM should also be opposed to fee-levying institutions such as private nurseries, tuition classes, outfits that offer all kinds of certification and practices such as channeling services.  This is an argument that is widely tossed around by those opposing opposition to SAITM.  The flak that Dr Anuruddha Padeniya of the GMOA has got over the past few days has been liberally padded with such logic.  His detractors have roundly castigated him for offering consultancy services in private hospitals even as he spearheads the agitation against SAITM.  

The cause of the GMOA has not been helped by the fact that some of its fellow-travelers have waved the anti-privatization flag.  In other words, the ‘SAITM issue’ for them is but an expression of a process or even an economic policy preference they oppose, namely privatization.  

All causes have to deal with different stakeholders who have diverse outcome preferences.  The opponents have the option of picking out one or more of the claims or parties and target these.  That’s politics.  Misidentification, mislabeling, misrepresentation and such are part of the game.  

There are therefore people who are calling for the blood of the movers and shakers of GMOA, especially Dr Padeniya.  Naturally ‘the sick’ are used as grist.  The pro-SAITM or let’s say the anti-GMOA lobby would have us believe that no one cares more about the poor and the sickly of this country than them.  That again is politics.  It is useful, after all, to have the key issues shoved out of the debate.  Indeed, part of the story is to define ‘key issue’ in ways that make for easy engagement.  Everyone involved in this drama does this.

What all this helps displace is the important (let’s not say ‘THE key issue’) matter of a coherent policy with respect to education in general.   It is easy to say ‘we need more doctors’.  Of course we need more doctors, there’s no question there.  It’s easy to ask ‘if you are raising concerns about quality, can you give any guarantees about the quality of doctors produced by the state universities?’  It’s a valid question of course.  

It’s easy to take medical mishaps, inflate them, display them, throw them in the face of those who bring up the issue of standards (pertaining to SAITM) and scream ‘you don’t have a case, hoo-hoo’.  

It’s easy to say such things and raise such questions as long as you desist from talking about the realities in our hospitals — the congestion, the financial constraints, under-staffing across all categories, the consequent stress and say nothing about the incredible services rendered therein.  Easy and irresponsible.  

“The SAITM issue” is a book that has not yet been written, or rather is a book whose pages are all over the media, including Facebook, Twitter, the blogsphere and elsewhere on the internet.  This is not an abridged version of that book and neither is it a review.  What’s written above is preface and what follows will be a short note on the seeming contradiction of GMOA members engaging in ‘private practice’ with a view to separate the issue of privatization or private income-earning practices from that of regulation and accreditation.  

One of the most sober comments on this element of the debate was offered on Facebook by Dr Waruna Jayasinghe.  It is worth translation.  He called it ‘From nurseries through SAITM to channeling….”

Montessori Schools: Whether or not a child has attended a Montessori is irrelevant when being enrolled in a school. The particular child is not required to have obtained instruction on any elements of the primary curriculum.

Tuition: Tuition gives students preparing for exams a boost.  However it is not the tutor who sets and conducts the exam, but the state.  Those who attend tuition classes and those who do not are assessed by a single institution and process.  (We can define the SAITM situation as one where the tuition master himself conducts an exam and produces doctors according to a Montessori system).  

Private degrees (e.g. IT) and private medical colleges: Since many don’t see a difference, let me use an example.  I obtain an IT degree of forgettable quality.  You give me a job.  I write software programmes at a rate.  You realize that they are useless.  You sack me.  In other words, the consumer, the quality controller and the boss are all one person and someone who knows the subject well.  Now assume I get a degree from SAITM.  Even if the quality controller, the Sri Lanka Medical Council, says ‘poor quality,’ the law forces recognition. Accordingly I am recruited and sent to serve in Wanathavilluva.  I prescribe medicines like crazy.  I also engage in private practice.  The patients’ conditions get worse courtesy my treatment and prescription, but they wouldn’t know I am the cause.  Since there are very few senior doctors in such facilities they too wouldn’t notice my idiocy.  So I will remain secure and happy.  Here the consumer, the quality-controller and the boss are independent of one another.  The quality controller has been crippled.  The consumer has no knowledge of quality and no authority either.  The boss doesn’t have the means nor the mechanisms to assess the work of junior physicians.  I continue to practice.  One day you come to me for treatment.  I prescribe. You die.  Your loved ones complain to the SLMC and my registration is cancelled.  This is of no use to you, since you are dead.  My friends will continue to treat and prescribe medicine to their patients.   

Channeling: I work in a government hospital.  After I clock-out, I have the freedom to make koththu or engage in channeling.  Since I am a doctor, I choose private practice.  I have knowledge and training to offer for a price.  You come to purchase these because you find it more convenient or of greater value to obtain these in this manner rather than getting it free at a government hospital.  You have the complete freedom to obtain treatment from a government hospital or from some other individual should you feel that I am expensive or that you would not get value for money from me. 

What this shows is that although people try to put everything in one heap, it is SAITM that disempowers people from choices and that if the quality of medical degrees is not strictly monitored the outcomes could be disastrous. 

Now some may argue that (say in the USA) universities offer their own degrees.  The issue there however is that there is assessment, there are ratings, there are minimum standards that have to be met for purposes of accreditation.

‘The SAITM issue’ is about accreditation.  It’s about quality control.  One can vilify the SLMC and argue about the quality of doctors produced by state universities, but one cannot shove under the carpet the issue of coherent and comprehensive assessment.  There has to be a single authority in the business of regulation or else a coherent and comprehensive process of evaluation.  

Someone can claim that the SLMC is not perfect.  That’s fine.  The solution would be to improve the institution and the processes therein.  The Government, as of now, appears to be ill-equipped intellectually and politically to sort out the mess to which it has contributed (as did the previous regime) by being frivolous and arrogant.  

What’s evident is a scandalous disregard for regulation and a bastardization of accreditation.   The Government should rise above the politics of  misidentification, mislabeling and misrepresentation because a) it is unhealthy, and b) as things stand it could maim or kill a lot of things, including the Government itself.

This cannot be healthy. 

Malinda Seneviratne is a freelance writer.  Email: malindasenevi@gmail.com.  Twitter: malindasene.  Blog: malindawords.blogspot.com


Anonymous said...

Please translate this into Sinhala too. All aspects covered and gives clarity.

SGK.Wimal said...

Why cant implement so called ratings,assessment, accreditation system in SL?. What makes it blocked

Walter Rajaratne said...

Best evaluation of SITAM read so far. Why not published in daily papers. For instance probably the ISLAND editor would have missed if not he would have definitely found space.