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Tuesday, December 8, 2015

Brain Drain

By Sanath Lamabadusuriya

In the late 1950's or early 1960's, the government decided to establish a second medical school in Peradeniya so as to solve the problem of shortage of doctors in the country. We who sat the University Entrance examination (equivalent of today's "A" levels) in December 1960 were the beneficiaries, because the intake was increased. All those who passed in all 4 subjects were selected for direct admission to Peradeniya and others like us who failed in one subject, had to follow a 6 months course in the failed subject in Colombo's Science Faculty in 1961. Of the latter group, some entered the Colombo Medical Faculty and the others the Peradeniya Medical Faculty in June 1962. As the buildings at Peradeniya were not ready, its first batch entered late and eventually qualified in January 1967. We qualified in March 1967.

After the first Peradeniya batch completed their internship, they were  informed by the Ministry of Health (MOH) that employment was not available and were offered a monthly allowance and requested to attach themselves to a GP. Few months later, all of them were offered jobs in the MOH. It is rather ironical that the Government which created a second medical faculty to solve the problem of shortage of doctors in the country was unable to offer employment to its very first batch!
 
That is the time we all started sitting for the *ECFMG because of the uncertainty of employment in Sri Lanka's MOH. Nearly all of us who sat the ECFMG passed it at the first attempt and applied for jobs in the US. As the US had a shortage of doctors at that time, all who applied for jobs were successful. By this time, the MOH was able to offer jobs to all of us. However, some of our batchmates decided to emigrate. After a few months, they wrote back saying how wonderful it is to work in the US. Most of them started in Coney Island hospital in New York. As the 'brain drain" gathered momentum in the next few years, the government introduced in 1972, a 5 year period of compulsory service.

So dear friends, that is how the "brain drain" started and is still continuing, although to a lesser extent.

PS: *ECFMG" was an examination conducted by the Educational Council for Foreign Medical Graduates. At that time, it was the sole qualifying exam to select foreign qualified medical graduates to practice as doctors in the United States.

36 comments:

  1. Sanath
    Thank you for that lucid article on the beginning and evolution of the Brain Drain of our time. I am sure it will clear the cobwebs from the minds of those who had forgotten how it all began.
    ND

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  2. Thanks Sanath. I nearly went to Coney Island too but those days my ambition was to be VP GHC! Moorthy,Nicey and a host of others left. I think the first one to go to NZ was Rasalingam and then of course Austrlia became an attractive proposition as jobs were not too difficult to get, our MBBS was sufficient to register and the climate was far better than the UK.

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  3. Speedy's ambition had been to be VP, GHC. He almost made it. But that's another story!

    My own ambition/vision was totally different. As most of you know, I never wanted to be a clinician. So, from the very beginning, I knew that I was not going to join the mad scramble to get away or to join in the brain drain.

    Looking back, it is nice to recall that I have seen the inside and outside of Coney Island Hospital. I last saw it from outside just last July when Indra Anandasabapathy drove past the hospital. In 1974 I saw it from inside and even spent a few days with Desmond Gunatilake who was occupying one of the doctors' quarters in the same hospital complex.

    As Sanath has pointed out, the brain drain still continues, but at a much slower rate. Just a couple of days ago, I was watching a late night TV debate on TNL. The subject being discussed was SAITM (Malabe private medical school of Dr. Neville Fernando. Although not directly connected to the brain drain, it certainly is related to medical education. SAITM was represented by Prof. Neville Perera and a Muslim lady (not a doctor but an administrator). GMOA was represented by two Assistant Secretaries Drs. Navin de Soysa and Aluthge. During the debate, it was revealed that Prof. Neville Perera's own son or daughter is a student in SAITM. 850 students are still there as "undergraduates" awaiting the much coveted MBBS degree. But with the present stand of the GMOA and the SLMC, I wonder whether the ambitions of these 850 students will ever materialise.

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  4. I wasn't aware that you Lucky, never wanted to be a clinician. As you say, I nearly made it but then plans don't always work out. I went to the Pharmo dept from Chest Hospital Welisera as Demonstrator as the plan was still to be VP GHC and this required the MD. While I was there, I worked mainly with Prof Lionel (although I did see Prof Kotte breezing in and out like a hurricane). Prof Lionel was doing some work on a drug with JBPieris, Consultant Neurophysician. I got to know JB and I owe it to him for changing my vision from VP GHC to Neurologist. He told me "why do you want to be a VP and do the rounds outside Colombo and come here only when you got grey hair? Why don't you do Neurology? There is only me and when you come back, you can go straight to Kandy and soon to Colombo". I always liked Neurology as a subject and I decided to take his advice and I did achieve my ambition as I got my MD--> No-pay Neuro-->UK --> MRCP --> trained in Neurology --> Neurologist Kandy! The rest as they say, is history!

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  5. Re Speedy's last comment. As a student, I didn't have any such idea. My interest in Public Health developed when I was working in the Central VD Clinic (Room 33) in GHC. More than treating patients in the clinic, I used to go out to the field with the PHIs for contact tracing, education etc. Thereafter, I was MO/OPD at Colombo South Hospital, and even before my 4 year stint was over, I not only applied and went out of Colombo as an MOH, but also opted for PH as a career.

    What JB said was quite correct. I think it was Jagath Wijesekara (the late Gamini Wijesekara's younger brother) who took over when JB retired. Gamini was my classmate at Ananda and later, was in the parallel batch in Peradeniya. Jagath was junior to us. So, you would have walked into the position of Neurologist, GHC. I don't know at what age JB got that post, but you might have been the youngest Neurologist in Colombo.

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  6. I have written to this Blog in the past how and why I ended up in England and wouldnt like to bore you with it anymore except to say Lucky, Bernard and myself belonged to the minority when we decided to remain in Sri Lanka. I am happy where I am now and do not regret the decision to spend the rest of my life in UK. I did serve my compulsory 5 years in SL and have done my time.
    ND

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  7. Lucky. Yes Jagath in fact first took over from me in Kandy when I returned to the UK and later went to Colombo.

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  8. Another interesting point that comes through after reading Lama's article is that what initiated the Brain Drain among doctors was more a "push" factor than a "pull factor" although undeniably, the attraction of working in a more economically advanced country was there. I distinctly recall being worried by the thought of not getting employed after qualification and internship. We were not too concerned or motivated by the dangling carrots abroad but more by the potential lack of rice if we remained home!

    In the Brain Drain following ethnic conflicts, it was vastly more influenced by the "push factor". Brain drain is faced not only by Developing countries but also by Developed ones although the chances of migrants returning to the Country are higher in the latter.

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  9. The Brain Drain is an interesting topic but not as crucial as it was the time we left SL.
    Leaving SL was never an easy decision for any of us. Doctors left at various stages of their careers some as early as the end of internship. Political climate, conflicts with the Department of Health, ethnic issues, economic reasons, career and family all featured in the final decision. Each and every one of us who left has his/her own story to tell. The true climate and atmosphere of the time when we made that important decision is hard to recreate due to the passage of time. We are now at a stage in our lives when the present and the immediate future is more important than what happened all those years ago. Stoking up the fire of regret and what might have been is a pointless exercise. Let us be happy with what we have achieved and look forward.
    ND

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  10. Sanath
    I am so pleased you are able to join us in this Blog. It is lovely to be in touch again. We last spoke when you were working in a hospital near Brighton many years ago.
    ND

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  11. I fully endorse the view that living in the past and living with regret is not conducive to happiness. On the other hand, there is a distinction between reflection and regret. Reflection is passive, as an observer who looks at it, recognises it but does not get emotional about it. Reflection helps us to understand ourselves and others. Regret is a poison which stunts your emotional growth and run the risk of dwelling in matters which you cannot change and therefore are fruitless and damaging. Let us Reflect but not Regret!

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  12. In this context, when we reflect we will always justify our actions. If we don't it is a regret which we all agree is pointless. Nostlagia, reflection and regret are a predominant feature of eastern culture. It has its benefits to a point. Westerners are less keen on it and prefer to get on with life than wallow in the past. I must say reflection in this particular context has the propensity to lead to regret. The "what if" scenario is bound to arise which can lead to disappointment. Well that is my personal view.
    ND

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  13. I basically agree with you ND. I am certainly not an advocate of endless speculation and analysis of what happened in your life and of all the mistakes that we have made. That is waste of time, just like spending a lot of time indulging in memories, views and opinions.What I am advocating is a dispassionate acceptance of things that have happened as givens over which you have no control over. At the same time, if these experiences have coloured our opinions on people, reflection might help us understand them better. We certainly must not get stuck in the past, we must transcend that and live in the present moment. The only other point I wish to make in this fascinating discussion is about the human tendency to personalise. Just for a moment, may I bring Buddhism into this? The First Noble Truth is that there is Dukkha in this existence. This loosely translates to "there is an unsatisfactoriness about it as there are setbacks, plans don't always come to frution, we all have to lose loved ones, we all are subject to illness and old age etc and a continuous state of "happiness"is out of our control. This is often interpreted as " I won't be happy, poor me, I am suffering" and so on, whereas the message is that "there is suffering"- it is not personal but just a statement of what is true and steps we must take to accept it and deal with it. We are not alone, all are subject to it. I think I must stop there!

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  14. Blue Scrotum Syndrome
    1. No reflection
    2. No regrets
    3. Live in the present
    4. Look to the future
    5. Agnostic
    Aetiology unknown, No known treatment, prognosis is variable
    ND

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  15. Ha! Ha! I shall drink to that!

    My modification

    Blue Scrotum Syndrome
    1. Detached reflection and learning.
    2.No regrets
    3. Live in the present
    4. Look to the future with a positive outlook
    5. Agnostic with humility

    Benefits

    Less chance of feeling blue.
    Ability to tackle problems by getting them by the goo***s!

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  16. Mahen
    Let us toast to that. Cheers!!
    Que Sera Sera
    ND

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  17. Indeed ND! When anyone refers to the BSS, we are now fully informed! I am waiting for the first female objection!

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  18. There is BSS(1) which I described and BSS(2) which is yours.
    I will get into more trouble if I describe one for the ladies. Indra is to be blamed for all this naughty business.
    ND

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  19. This comment has been removed by the author.

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  20. I hope the BSS(1&2) is not described as the Bull Shit Syndrome by our Noble colleagues! Razaque, what do you say?

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  21. how can one argue with that which is pretty close to reality

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  22. What about BALL SCRATCHING SYNDROME!!!.
    May be there is a "Thylaya" in SL for this as a cure!!

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    Replies
    1. Raz
      There is a "Thaylay" for both BSS(1) and (2). It was sold under the 'Bo' tree at Punchi Borella and I refer you to my article "Tales from beyond the fringe of the General Hospital, Colombo " published in this Blog on the 1st of January 2015. You can now order the 'thaylay' online on Ebay.
      ND

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  23. Ball Scratching Syndrome or Balls Scratching Syndrome. By the way, please refer to my post dated april 5th 2014 on "The Royal College of Copuletrics and Coitology: where the male organ is described very scenically as a "Bibolar Unipolar organ with an erector ejector function" Applying that methodology we could call this the "Bubolar Scratching Syndrome"

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  24. Dear ND. Mahendra and Razaque,
    I am utterly confused trying to figure out what Blue Scrotum Syndrome or Ball Scratching Syndrome has to do with
    'Brain Drain"!
    Sanath

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  25. Dear ND. Mahendra and Razaque,
    I am utterly confused trying to figure out what Blue Scrotum Syndrome or Ball Scratching Syndrome has to do with
    'Brain Drain"!
    Sanath

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  26. Lateral thinking Lama, lateral thinking! This is how Blog comments tend to develop.

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  27. Raz
    There is a "Thaylay" for both BSS(1) and (2). It was sold under the 'Bo' tree at Punchi Borella and I refer you to my article "Tales from beyond the fringe of the General Hospital, Colombo " published in this Blog on the 1st of January 2015. You can now order the 'thaylay' online on Ebay.
    ND

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  28. Sanath Lama's comment above is most timely. I was on the verge of commenting that the post on "Brain Drain" was showing signs of breaking the existing blog record for the number of comments. I changed my mind when Speedy and ND, joined later by Razaque, were later engaged in a light hearted debate on the two Syndromes.

    It all started when the subject of Brain Drain turned into a somewhat serious discussion on the distinction between reflection and regret. It was then that ND brought in the Blue Scrotum Syndrome (earlier referred to by Indra under his post on "Teaching Medical Students"). Other BSSs too were mentioned.

    In quoting Prof. Sinnathamby, Indra was still within justifiable limits because Prof. S referred to the BSS while lecturing medical students. But what connection BBS has to "Brain Drain" is anybody's guess.

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  29. This Post by Sanath has gone from the sublime to the ridiculous & I am partly responsible too.
    Anyway it is only harmless adult banter -- like in the Block days!!
    As for the "Thylay", I do not need it ND, but I do know somebody that does!!

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  30. Blog comments are like flowing rivers. It starts flowing in a certain direction and then it sees a nice little diversion and decides to explore that. This is usually very fruitful as newcomers join you and it all becomes one pig party with all and sundry (mainly sundry) , enjoying the experience! I think the only rules in a Blog should be do not use unacceptable language and be courteous. Just see what this post has produced, a highly philosophical discussion on, as Lucky pointed out, the difference between reflection and regret. On reflection, I have no regrets whatsoever on the direction this has taken.

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  31. Apologies Razaque, I meant one big party, not pig party!

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  32. I am sure you knew this already but just for info,

    THE BLUE SCROTUM SIGN OF BRYANT: a diagnostic clue to ruptured abdominal aortic aneurysm.

    A 73 yr old man presented with severe abdominal pain with scrotal and penile ecchymoses. After an initial urologic consultation the correct diagnosis of ruptured abdominal aortic aneurysm was made.

    So there! Blue scrotum is no laughing matter although there is no question that it has no relationship at all to Brain Drain.

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