• UoJ Medical Fac. Dean, Prof. R. Surenthirakumaran, on the challenges faced by the institution due to economic constraints 

From its establishment in 1978, the Medical Faculty of the University of Jaffna (UoJ) has grown into a valuable contributor to healthcare and medical education in the region. Over the decades, it has not only expanded its academic and research-related capabilities but also played a pivotal role in community health initiatives, particularly in the Northern Province.

UoJ Medical Faculty Dean, Prof. R. Surenthirakumaran, in an interview with The Daily Morning, shared insights on the multifaceted challenges faced, and the ambitious future plans of the faculty. He highlighted how the institution has navigated through periods of conflict, economic difficulties, and resource-related constraints. He also discussed the Faculty's ongoing efforts to enhance its educational programmes, foster research, and build strategic partnerships.

Following are excerpts from the interview:

Can you provide an overview of the history of medical education in the Jaffna Peninsula?

The American Dr. Samuel Fisk Green, who arrived in Jaffna in 1845, is a notable figure for establishing a medical practice and started training medical practitioners at the Manipay Hospital, later known as the Green Memorial Hospital. This marked the beginning of organised medical education in the region, long before the establishment of the Ceylon Medical College (Medical Faculty – Colombo) in 1870. In fact, this was the second oldest Teaching Hospital (TH) established in South Asia. UoJ's Medical Faculty was established in 1978. Initially, the pre-clinical course was conducted in the buildings of the Ayurvedic TH, which is now the Unit of Siddha Medicine of the UoJ at Kaithady. In 1980, the Provincial Hospital Jaffna, was declared the Teaching Hospital for the Faculty.

How has medical education evolved in this region?

During the initial period, we had about 50-60 undergraduate medical students per year. This number eventually rose to 90-100 students, and by 2010, it reached 125 students per year. Currently, we admit around 200 undergraduate medical students annually. To date, we have graduated about 4,000 medical students. While we initially focused on undergraduate medical education, our Faculty received approval for postgraduate education in the recent 2022 Budget plan. We are now developing and conducting courses for postgraduates. We are currently admitting international students and offering opportunities for elective placement programmes at our Faculty. In the future, we aim to expand further and provide well-integrated undergraduate and postgraduate medical education. We also intend to create more opportunities for both local and international students in the future.

How competitive is the admission process?

After the Medical Faculties of the Colombo and Peradeniya Universities, UoJ’s Faculty is where students prefer to apply because of several reasons – the good learning experience, other supportive services, uninterrupted teaching and learning activities, the delivery of the course in a timely manner, and the environment. These attributes make our Faculty a popular choice among students.

What kind of resources and facilities are available for medical students (e.g., laboratories, libraries, hospitals)?

Medical students have access to a wide range of resources and facilities to support their education and training. Key Hospitals include the Jaffna TH, the Base Hospital (BH) in Tellippalai, and the Family Health Centre in Kondavil. Library resources include the Medical Faculty Library, the Main University Library, and the Jaffna Medical Association Library. Laboratory facilities are extensive, featuring laboratories related to computers, skills, physiology, biochemistry, histology, parasitology, forensic, genetic and andrology. Additional facilities include the Nallur Medical Officer of Health (MOH) – Community Field Health Area, a dissection hall, a Clinical Training and Research Block (CTRB), and the Centre for Digital Epidemiology. 

Lecture halls and tutorial rooms are also well-equipped with multimedia, public address systems, fans, whiteboards, and ample seating with writing support. There is also a dedicated examination hall, a Medical Education and Audio-Visual Unit, and a conference hall with video conferencing facilities. The Hoover Auditorium provides a state of the art venue with a 550-seating capacity. Hostel accommodations are available at the Kanagasuntharam Men's Hostel and the Sivagnanasundaram Women's Hostel. Recreational and support facilities include a gymnasium, a canteen, a music room, and a hall with cluster rooms for group study.

How do the training programmes conducted by the faculty integrate theoretical knowledge with practical experience?

We have divided our training programmes for medical students in three phases. The pre-clinical subjects are taught in the first phase. The pre-professorial clinical course is conducted in the morning at the Jaffna TH during the second phase. Para-clinical subjects are taught in the Faculty premises in the afternoon. During this phase, students are adequately exposed to major clinical specialties and subspecialties. In the final year (third phase), students undergo clinical learning. The Jaffna TH treats numerous patients with various conditions and has nearly all medical subspecialties, providing ample opportunities for clinical training. We also use the Tellippalai BH for teaching and are expanding this to other hospitals as well. Additionally, we have a field teaching area in Nallur, where students have the opportunity to work in the community, schools, and other institutions. This exposure allows them to participate in community enhancement projects and research.

What extra support services are available to students (e.g., counselling, academic support)?

Students have access to a variety of support services. These include a student counsellor programme, the Students' Wellbeing Centre, and a Wellbeing Committee. The mentor programme and student peer supportive programme provide additional guidance and support. Scholarships are available for students with excellent performance, while financial assistance is provided for those facing financial difficulties. Additionally, free medical books are offered to students in need. The Faculty alumni are actively involved in supporting these initiatives, demonstrating a strong commitment to student success.

What are some of the major challenges faced by the Faculty?

Over time, the number of students has increased, but the academic staff to student ratio remains inadequate. Due to the current economic crisis, academic staff members are inclined to join the Health Ministry, which offers better opportunities and salaries. This trend is particularly notable in certain subspecialties, such as forensic medicine, anatomy and biochemistry. The shortage of academic staff adversely affects curriculum integration. Although we have a modern building for clinical training and research, we require equipment that costs more than $ 1 billion. Since the opening of the Faculty about 40 years ago, the CTRB project is the only major project funded by the Government.

How does the Faculty overcome these challenges?

We are actively seeking loans and support from alumni to fund equipment and improve resources, with additional financial support from various welfare organisations. To address the staff shortage, we have visiting lecturers from other local and international universities, as well as from the Jaffna TH. Our staff, along with all the other stakeholders, is working hard to overcome these challenges and ensure the highest level of education for our students.

How has the history of conflict in the region affected medical education in Jaffna?

During the period of conflict in the Jaffna Peninsula, the University suffered severe damage, and academic life was generally disrupted. The most critical problem for the faculty was that many academic staff members left the country. As a result, the teaching and examination of medical students were severely affected. Additionally, the Faculty did not receive any funds or grants during this period, leading to difficulties in retaining human resources. There were no opportunities to connect with other national and international universities, thus exacerbating the isolation. The infrastructure sustained significant damage, and both students and Faculty faced displacement.

What steps have been taken to rebuild and improve medical education post-conflict?

During the conflict, our focus was on surviving the crisis rather than developing our infrastructure and resources. Now, we have begun developing our infrastructure and resources, starting with major projects like the CTRB, an eight-storey building, funded by the Government with the aim of further improving clinical training and research. We need instruments and equipment worth Rs. 12 billion ($ 4 million). Before the crisis, we applied for a soft loan with the Austrian Government. We need this support immediately for the functioning of the newly opened building. This will provide many services, training and research, and therefore, now we are looking for private donations. This is our priority. 

We also need another 500-beds-strong facility inside the TH premises to improve the clinical learning and also improve the postgraduate training and advance care. We need Rs. 17 billion to develop this facility. We are planning to build a six-storey building in the Faculty premises for paraclinical departments, and laboratories. We are waiting for the approval of a philanthropy fund. We also applied for an examination and library block from the Government and are waiting for the approval. We have also acquired land in front of the Jaffna TH near the students’ hostel to expand the hostel facilities. 

We got another land donated by a family to build the facility for the student and staff welfare. To overcome the financial barriers, we are trying to get funds from local and international welfare organisations and alumni. As the Faculty develops, both the number of students and staff members has been increasing periodically, reflecting our progress and expansion.

What role does research play in medical education in Jaffna?

Research plays a crucial role in medical education in Jaffna, with significant projects primarily in clinical and community health. Research activities are integrated into the curriculum to foster a strong scientific foundation among students. Students engage in many community oriented research projects that address regional and national issues. This involvement provides them with opportunities to work and learn within the community. An annual undergraduate research symposium has been established, offering students a platform to present their research findings. We are launching a Clinical Trial Unit to foster clinical trials in the region.

Are there any notable research projects or innovations coming out of these institutions?

The Faculty has earned a national award as a centre of excellence for Global Health Research on Atrial Fibrillation Management. Notable research projects and innovations from these institutions include the Jaffna Healthy City project in collaboration with the World Health Organisation (WHO), and the implementation of Electronic Medical Records at the Family Healthcare Centre. Additionally, they are exploring the potential for establishing oesophageal cancer screening for high-risk patients, bridging gaps in primary care through community health workers, and facilitating fertility care in the North via community healthcare workers. Other significant projects include Water Security Through Participatory Action Research with the World Bank, and a detailed study on blindness, visual impairment, and causes in people aged 50 years and above in the Northern Province. Research also includes screening the diagnostic efficiency of a testicular gauge in male infertility, as well as a study on awareness among primary teachers about dyslexia and its prevalence among school children aged eight-14 years in the Chennai District, India, and the Jaffna District.

How does the Faculty contribute to the local healthcare system and community?

We contribute significantly to the local healthcare system by training healthcare professionals who serve the community. The Department of Community and Family Medicine administers the University Field Project Area in collaboration with the MOH – Nallur. It provides leadership for organising public health campaigns and other health promotion activities in the Northern Province. It also delivers primary care services through the Family Health Centre. Several field activities focused on raising awareness and improving environmental health have been conducted by students and staff of the faculty. By collaborating with administrators and policymakers, we are involved in developing strategic health system plans for the Northern Province. We also conduct capacity-building programs by offering short courses to healthcare professionals, such as perioperative care, semenology, and healthy community initiatives.

Are there any community health initiatives led by medical students or faculty?

Medical students and faculty are actively involved in several community health initiatives. These include working in the Nallur MOH area to deliver public health and preventive activities, and providing primary care services through the Family Health Centre with a community oriented primary care model. They facilitate the Community Health Care Worker Fertility Care project and run cancer control programmes, including cancer screening. 

Other initiatives focus on nutrition, women's empowerment, mental health, and substance abuse prevention and rehabilitation. In collaboration with the WHO, they are involved in the Jaffna Healthy City project, addressing waste management, healthy food and diet, physical activity, and Covid-19 prevention. Additional projects include Water Security in the Northern Province and a Women Empowerment and Violence Against Women and Children project. While students lead several impactful short-term initiatives, they also significantly contribute to these larger projects and community improvement efforts.

How do institutions such as the Medical faculty support students in their transition to professional practice?

The institutions provide robust support to students transitioning to professional practice through a variety of initiatives. Career guidance activities offer tailored advice and resources to help students plan their future careers and navigate the job market effectively. Supportive pre-intern programmes are designed to bridge the gap between academic learning and professional practice, offering hands-on experience and practical skills essential for their future roles. Additionally, the oration programme for first-year students, organised by the wellbeing society and the students’ union, helps to inspire and orient newcomers, fostering a supportive environment from the beginning of their academic journey.

What are the significant partnerships or collaborations that the faculty has with other universities or international organisations?

We have formed numerous partnerships and collaborations with both national and international universities and organisations. We work closely with prominent Universities such as the University of Birmingham, the Duke University, and the SingHealth Duke NUS. Collaborations also extend to global entities like the WHO, the World Bank, Jaffna Medical Faculty Overseas Alumni (JMFOA), the International Medical Health Organisation and other national and international organisations. These collaborations foster a rich environment of shared knowledge and research opportunities. These partnerships enhance educational and research capabilities, providing students and Faculty with access to a wide network of expertise and resources.

How do these collaborations enhance the quality of medical education in Jaffna?

These collaborations help us to understand and focus on new things in medical education and healthcare related needs and how to adopt and incorporate new things into our healthcare system and medical education. We get exposure to other things like demography, climate, technology, and artificial intelligence. Ultimately, they will help us achieve our objective of producing globally recognised undergraduates. It will also foster the development of a more innovative, student centred teaching and learning environment.

(The interview was facilitated by Senior Lecturer and Coordinator of the Student Wellbeing Committee at the UoJ’s Medical Faculty, Dr. Balasingam Balagobi)