North Colombo Medical College
I wish to say how pleased I am to be present at the final Convocation of the North Colombo Medical College. I am deeply grateful to Professor Carlo Fonseka, who in his capacity as the Competent Authority of the North Colombo Medical College, has given me this opportunity to be present here today and to speak about a controversial but unique educational institution which I had helped to setup when I was Chairman of the University Grants Commission and Secretary of the Ministry of Higher Education. In the kind invitation that he extended to me, Professor Carlo Fonseka assured me that I could speak “without any constraints concerning content and time”. I shall reciprocate his generosity and his trust by speaking candidly and factually about how the North Colombo Medical College, a private medical institution of promise, was created, nurtured so carefully, and sadly, destroyed.
The germ of an idea
I was teaching Soil Science at the University of Malaya in Kuala Lumpur, Malaysia in 1976 when I met Dr. G.M. Heennilame, then secretary of the College of General Practitioners, Sri Lanka, who expressed to me his concern about the urgent need for re-orientation of medical education in Sri Lanka and told me how difficult it was to accomplish this in the traditional medical faculties. For example, traditional medical faculties did not have departments of family medicine.
I returned to Sri Lanka after the parliamentary general election of July 1977. In 1978,1 was appointed Secretary of the then newly established Ministry of Higher Education and soon thereafter the Chairman of the University Grants Commission.
Government examines a proposal
In 1979, the College of General Practitioners (CGP) decided to examine the feasibility of Dr. Heennilame’s idea of a private medical college. A three-man implementation committee appointed by the College of General Practitioners had sought the blessings of the Minister of Health, Hon. Gamani Jayasuriya. At one of the meetings in the Minister’s office, at which I was also present, there were sardonic smiles as the Minister accepted the project in principle and subsequently offered a dilapidated convalescent home in Ragama to the sponsors of the private medical college. There was nothing secretive about the government’s decision to set up a private medical college. There was perfect ‘transparency” about the government’s intention even before that term came into common parlance in our country more recently.
A miracle at Talagolla
What happened from that time was nothing short of a miracle. I visited the Talagolla site in Ragama in April 1981 and saw for myself the tireless energy and infectious enthusiasm with which all concerned laboured in preparation for inauguration on 25 September 1981. I watched with great joy and pride the transformation that took place at Talagolla. I was also uneasily aware that this very success was likely to be a source of envy among those who were ideologically opposed to the idea of a fee-levying, non-profit private medical college.
The objections to the NCMC which were articulated from time to time by students, parents, doctors, academics, politicians and others were carefully examined. The government of president J.R. Jayewardene saw no reason for being apologetic about the creation of the NCMC. In view of the scarcity of available government funding for increasing the output of medical graduates, private enterprise was needed. The NCMC turned out to be an achievement. It was a trail-blazing institution which showed clearly what private enterprise could achieve if an idea was clearly formulated, its accomplish¬ment meticulously planned and expeditiously implemented by dedicated persons who were committed to a cause.
Was the free education scheme infringed upon? The argument that the idea of a private medical college violated the free education scheme is not valid. The J.R. Jayewardene government had expanded free undergraduate medical education from an annual intake of 240 in 1977 to 480, a few years later, by creating two new faculties of medicine at Ruhuna and Jaffna respectively. The NCMC did not displace a single student who would have found a place in the state system. Intake into the NCMC was in addition to the increased intake into the state faculties of medicine.
Allegation that sub-standard students were admitted
There was also the allegation that sub¬standard students, the children of the rich who had failed the GCE (A Level) Examination, were admitted to the NCMC. The UGC examined this allegation and found that there was no truth in it. However, there were two students in all of the over 800 admitted over a period of eight years who had the necessary aggregate but had failed in one subject. They had applied for re-correction in the failed subject. The re-correction showed that each of them had passed in the fourth subject and this was confirmed by the principal of the school concerned. However, five years later the originals of the principal’s letters could not be traced. These students were not allowed to sit the final examination.
Incidentally, I understand that one of these students has completed her medical education in the UK and is now a recognised consultant. One wonders whether medical faculties in Sri Lanka should not re-examine their admission procedures!.
Admissions to the NCMC had therefore been done on merit on the basis of a scheme of admission adopted by the Board of Management of the College. More than 1000 applications were received each year. Those who were very close to, just below, the admission point to the university faculties of medicine were invariably taken in Preference was given to those who had sat for the GCE (A Level) examination for the first time.
All students were interviewed prior to admission. Seventy percent of the marks were given for the candidate’s performance at the A Level examination. O Level examination results and academic distinctions fetched another 10 percent of the marks. The candidate’s performance in school extra-curricular activities was given ten percent and the interview was marked at ten percent. Proficiency in English was tested with a simple passage for comprehension. The marks were then totalled and the first 100 were selected in the order of marks attained. No student who passed the A Level examination after the third attempt was admitted. The marks obtained by those admitted have been tabled in parliament and the allegations have been shown to be false.
The students at the NCMC
There were no ethnic, religious, class or gender considerations shown in the admission process at the NCMC. Out of the 800 students who were admitted over the years, the parents of 60 percent were school teachers, those of 20 percent were professionals and 20 percent belonged to other categories. Most parents, especially the school teachers, had sold or mortgaged property or used the money set aside for a dowry or to build a house, to see their children through medical college. Eighty percent of the parents had to borrow money as an investment in their children’s education. There was not one student who came from the super-rich; for example, there was not one student who came from a gem-rich mudalali family.
Allegation that the Government unfairly provided facilities to the NCMC
The Government did not provide anything to the NCMC free of charge. True enough, the land on which a virtually abandoned home for the disabled at Talagolla, in the Ragama area, was provided by the ministry of health on a 30-year lease. But the lease was paid for. The land had to be cleared of jungle. The buildings were dilapidated. Some Rs. 2 to 3 million had to be spent to make them habitable. The payment of BTT at that stage was a heavy financial burden on the strained resources of the College. The adjoining land was purchased for another Rs. 2 million. Taxes had to be paid; BTT, PAYE, income tax, assessed rates. Nothing was given to the College free.
Building the infrastructure
Water was the biggest initial problem. Five wells were dug at 200 feet depth in search of water. Only two of these wells contained water and this too was not potable, with too much iron. Eventually the water had to be brought from Colombo in pipes donated by a generous well-wisher. Prime Minister Ranasinghe Prema-dasa presided at the ceremony to inaugurate the water supply. The water pipes in the hospital were corroded and had to be replaced. The contractor defaulted by fixing the corroded pipes after cleaning them and the pipes had to be replaced. The hospital had about fifty percent bucket latrines and inadequate water supplies to remove sewage. The bucket latrines were converted into water-sealed latrines. The roads leading to the Ragama hospital were reconstructed and considerably improved. All this was done on the initiative of the NCMC.
The telephone system in the hospital had to be upgraded. With Norwegian assistance, a new telephone system was installed and a separate room was airconditioned by the NCMC for the telephone switchboard equipment.
Medical equipment was lying unused in the hospital stores. Some 25 blood pressure meters were painstakingly repaired by the College staff for use by the students. There were no coolers in the mortuary where post-mortems were done. After representations were made to the Ministry of Health, six coolers for the Karapitiya medical school were temporarily diverted to Talagolla so that post-mortems could be done.
The building programme of the NCMC was planned so as to put up one major building each year. A 350-bed five-story hospital costing some Rs. 55 million was built by the College within one year. Other buildings followed in quick succession; a canteen for the Ragama hospital, a student canteen block, the library, the pathology laboratory block. Buildings were planned by a reputed firm of architects. Renovations to existing buildings were carried out on a delayed payment basis. Payments were made as the work proceeded. Money collected from foreign students, paying in foreign exchange, was used for capital expenditure. There was no difficulty in balancing the budget. No money was borrowed. The staff did not seek commissions. All money was banked and very strict accounting procedures were followed. Day-to-day expenditure was met from the interest on the money deposited.
Why a private medical college?
In the late 1970s, the state medical faculties were producing around 240 doctors each year. Over 40 percent of those who qualified in previous years had emigrated. In Sri Lanka the doctor population ration was 1:6000 persons at that time. The state sector would have taken several years to find the money to produce sufficient doctors in the country to meet the health needs of the people. In the USSR there was one doctor for every 300 persons, in the USA one doctor for 500 persons, in the UK one general practitioner for 2000 persons. There was no danger of a surplus of doctors in Sri Lanka.
All governments had accepted the principle of fee-levying private schools. They are not regarded as a threat to free education. In any case, not a single student who would have received a free education in an existing medical school was deprived of continuing to do so.
Dr. Heennilame has related to me the story of how the NCMC was conceived. In 1971 the College of General Practitioners was established on a suggestion made by the then Secretary of the Ministry of Health, Dr. Soma Weeratunge. Dr. G.M. Heennilame was appointed as Secretary and Mr. L.H.R. Peiris as Legal Adviser. In 1974, Hon. Ronnie de Me) M.P. proposed the Bill moved in parliament to incorporate the College and Hon. Bernard Soysa M.P. seconded it.
In 1979, the College decided, as one of its objectives, to look into the possibility of establishing a private medical college. Drs. G.M. Heennilame, Dennis Aloysius and Walter Gooneratne were appointed to establish the medical college. Mr Eric Abeysiriwardena helped to draw up the financial commitments involved. A memorandum was submitted to Mr. J.R. Jayewardene after his election victory and Dr. Heennilame met Mr. Jayewardene in 1978 after he had been sworn in as the first Executive President of Sri Lanka. The president was sympathetic to the idea and asked Dr. Heennilame to meet the Minister of Health, Hon. Gamani Jayasuriya M.P.
The Minister wanted to know how the proposed College would find the teachers necessary and wanted an assurance that no permanent teachers from the existing medical colleges would be recruited. The Minister, with an eye to helping his electorate of Homagama, suggested some land in Homagama be allocated for the medical college. The Homagama hospital was considered to be too small and too far from Colombo. Eventually Ragama was suggested and Secretary of Health B.C. Perera helped in releasing the Thalagolla Convalescent Home with about 5 acres of surrounding land adjoining the Ragama hospital. Some 40 inmates in two wards with 20 staff members were sent to Welisara and admitted to wards built by the NCMC.
President Jayewardene approved the project in July 1980 and parliamentary approval for the establishment of the College was given by Act. No 51 which was passed unanimously in December 1980 to give the College legal sanction. Earlier on 4 July, the first Board of Governors was appointed by the College of General Practitioners. The five members of the Board of Governors-Drs. G.M. Heennilame, Dennis Aloysius, Walter Gooneratne, Sathis Jayasinghe, and Shelton Cabraal – set about the formidable task of establishing a new private medical college. They appointed a clerk, a labourer and an accountant to assist them. They made a collection from among themselves to pay the staff. It was some time later that they themselves were reimbursed.
Dr. Sathis Jayasinghe was appointed Secretary to the Board and Dr. Willie Ratnavale the Director of the proposed NCMC. Dr. Ratnavale’s experience and expertise in the academic world were invaluable. He ensured that academic standards of a high order were maintained.
The small group of pioneers rented a room at the headquarters of the SLMA [the Sri Lanka Medical Association]. Furniture, crockery and cutlery, and a typewriter were brought from Dr Heennilame’s home. That was how Sri Lanka’s private medical college – the North Colombo Medical College (NCMC)- was started. There was no fanfare, no ceremonial openings, just the hard work of a dedicated band of idealists.
The NCMC was a fee-levying and non-profit undergraduate medical college. The fee structure was designed so as to minimize problems for parents. Fees were kept as low as possible in keeping with financial viability. Payment was made possible in easily affordable instalments or as a lump sum. The fees compared very favourably with those of any similar institution in South Asia.
What went wrong?.
Selecting the first 100 students from some 1150 applications from local applicants created enemies. Disappointed candidates had a grievance. The politicians to whom they complained became critical. The GMOA [Government Medical Officers Association] took up cudgels against the College thinking that state medical faculty graduates would be pushed out of employment in government hospitals. The daughter of a high office bearer of the GMOA had applied with qualifications suitable for her admission and had been admitted. When the same person’s son, whose qualifications were not adequate, was refused admission, he became an inveterate enemy of the NCMC. A number of general practitioners were disappointed when their children failed to gain admission. It was not possible to satisfy everyone.
The JVP [Janatha Vimukthi Peramuna] which was raising its head and holding the country to ransom in the mid-eighties got into the act. Their aim was to disrupt the work in all universities, cause embarrassment to the government and bring the government down. Dr. Heennilame himself received a death threat over the telephone in Sinhala. “If the money taken from the students of the NCMC is not returned your life is in danger”, said the anonymous caller. Dr. Heennilame went abroad to England. Dr. Sathis Jayasinghe too received a telephone call which he reported to president Jayewardene. Dr. Jaya¬singhe took a trip to Pakistan. In 1988, the JVP bombed the administration section of the NCMC.
During the agitation against the NCMC by university students the Board of Management decided to confer its own degree, MBBS (NCMC), instead of the MBBS (Colombo). Further, in order to maintain standards, the Board applied to the University of Aberdeen in the UK for affiliation. This was approved by the University of Aberdeen. If the NCMC was not taken over by the government, it would have had the distinction of being affiliated to the University of Aberdeen whose medical school, I am told, is the oldest in the English-speaking world.
President Jayewardene went out of office in December 1988 and president Premadasa’s government took office in 1989. Hon. A.C.S. Hameed M.P. was the new minister of higher education. President Premadasa appointed a committee consisting of presidential secretary, K.H.J. Wijedasa, former secretary Menikdiwela, Ananda Guruge and Bradman Weerakoon, to look into the NCMC issue and to advise him. Ananda Guruge had assured Dr. Heennilame and the members of the Board of Governors that the president will not take over the NCMC. And yet, a short while later, the Army was sent to Ragama to occupy the buildings at Talagolla for the ostensible reason that there was a security threat. One morning without any warning to the college authorities, the Army surrounded the buildings. When Dr. Heennilame went to the College the Army wanted to search him. A Competent Authority had been installed in his office. Neither Dr. Heennilame nor the Board of Management of the NCMC were informed that the College had been officially taken over. Dr. Heennilame returned home and never went back to the NCMC.
Dr. Heennilame and his colleagues on the Board of Governors had laboured unceasingly without a salary to achieve what they had accomplished – a fully equipped and functioning medical school for Sri Lanka. According to the Act passed by parliament for the take-over of the NCMC it -was clearly stated that compensation would be paid. Unfortunately, in spite of repeated requests, no compensation has been paid to the College of General Practitioners to date. The College of General Practitioners needs this compensation to start a vocational training programme in general medical practice.
The UNP government of 1989 must take full responsibility for the manner in which they capitulated in the face of a challenge that had only to be faced and overcome. Those directly responsible for depriving the private sector of continuing to manage the North Colombo Medical College which they had established caused, in my view, a disservice to our country.
I wish to congratulate the 95 doctors who are graduating today, indeed the 608 vho have graduated from the NCMC throughout the period of its existence. They are the private sector’s contribution to the medical profession in Sri Lanka. They can be proud to have graduated from an institution whose teachers maintained high academic standards. They will not find it difficult to compete with their peers anywhere.
A number of those who studied at the NCMC left the College in the aftermath of the civil disturbances in July 1983. Many of those who left the college have continued with their medical studies elsewhere and are serving with distinction as doctors in different parts of the world. All those who graduated from the NCMC have been a credit to their teachers and to every one of these teachers the country owes a debt of gratitude. For me it is a matter of pride and great satisfaction that I was able to be associated in this pioneering venture with a group of Sri Lankan general practitioners committed to a vision. And they, I am sure, have the satisfaction that they worked with enthusiasm, integrity and selfless devotion to realize that vision.