Medical/Health Education: Mauritius missed the boat – twice!

‘Prevention is better than cure’ is a well-known saying, and is quoted by both health professionals and lay people in equal measure.

Its equivalent in running a country is ‘gouverner c’est prévoir.’

In the matter of the medical hub which Mauritius was supposed to become, one aspect of which was medical and health education, woefully the saying went unheeded. This is all the more ironical and unfortunate because the hub pertained to medicine, and a solid opportunity to position Mauritius that could not have been spelt out more clearly was passed by. Because of no prévoir then, and of lamentable gouverner in this matter subsequently, in particular of the tertiary sector in recent times, we have landed in a pass regarding a medical institution offering post-graduate courses. If we had played our cards properly then, this situation would never have arisen.

Because, like all countries which were in a similar situation to ours at the time of their independence, such as Singapore, Nigeria and Uganda among others, we would have had an outstanding fleuron in the field of medical and health education which would have been the driver in and of the sector in Mauritius, a pride for both the public sector and the country.

At their very beginnings as independent nations, and facing the acute challenge of human resources in health, Uganda and Nigeria came up with medical colleges at Makerere and Ibadan respectively. To this day, these two colleges hold high the flag of Africa in matters of medical and health education, and to them have been added several more which have equally prestigious ratings and standards.

World Bank Report 1997

As far back as 1997, the World Bank submitted a comprehensive report recommending the setting up of a ‘College of Medical and Health Sciences’ in Mauritius. It made a thorough analysis of the local situation and identified the existing institutions considered fit to make up the core of that College, based on the known and anticipated roles that such an entity was expected to play. They were the Mauritius Institute of Health at Pamplemousses, which was already running post-graduate medical courses, in association with the University of Bordeaux, as well as courses in the allied medical professions such as radiography, speech therapy, etc; the Central Nursing School campus located next to the MIH; and the SSRN Hospital which had all the major departments and specialities (including the Cardiac Center next door) and which would be the teaching hospital attached to the College. For a country of our size, it would eventually have morphed into the Teaching Hospital. Looking ahead, it would then develop capacity and guide the setting up of other teaching hospitals as the medical and health scene evolved.

The report comprehensively explained the rationale for the project that would support a policy decision, and outlined a planning schedule in phases. From the time of the submission of the report to get the proposed College up and running would have taken about 3-4 years if the recommendation had been followed through.

It wasn’t, like practically all the other recommendations of the report especially about the organizational aspects of an in-depth reform.

We missed this first opportunity. Soit.

But repeating the blunder?

Second opportunity missed…

Following a failed initiative by a Gulf-based group of Nigerian-Americans, whose academic and financial soundness was an issue, to partner with UOM in setting up a medical college, UOM set up a high-powered committee (HPC) chaired by a very experienced person and involving all the stakeholders concerned to consider setting up a full-fledged faculty of medicine at UOM. Given that the UOM was already running a BSc Medical Sciences course and had proven capacity in this regard as well as general academic capacity to support any academic programme, essentially it was matter of scaling up.

The HPC’s report took up and refined the World Bank idea of 1997, and made due recommendations but obviously taking the changed context and regional realities into consideration. It even went further by making a sound and detailed cost and funding analysis, which the World Bank had not done, and came up with viable, cogent recommendations.

But this report too met the same fate as the World Bank’s, and the country lost a second opportunity to establish a medical hub on solid grounding.

As Donald McKinnon said…

Speaking in another context when he was Secretary-General of the Commonwealth, Donald McKinnon said that ‘you cannot prosper by beggaring your neighbour.’

But in this country, we did even worse: there was in-house emasculating – for the sake of decency we have avoided the use of a word that sounds like ‘beggaring’ – of the regulatory body that has most to do with medical education: the Medical Council. After all, it is also an arm of good governance for the country and, had the commitment regarding the medical hub been as serious as officially declared, then the Medical Council ought to have been given the necessary wherewithal and means to carry out its function of setting professional standards and overseeing their implementation. Instead, potshots were regularly fired at it by those who had not the foggiest idea about the why, how and what of a professional regulatory body. A trend that has increased rather than decreased over the years.

By the same token, the medical hub was relegated further away when precious time was repeatedly wasted by high officials who were forced to consider dubious applications such as from another Gulf-based expat-led entity, and University of Seychelles – American Institute of Medicine (USAIM) claiming to want to delocalize from Seychellles whereas it had been booted out by the government there. There was also the saga of the so-called ‘Ecole de Medecine Louis Pasteur’, where government eventually had to find a solution for the poor students left in the lurch, effectively being forced to clear up the mess left to its charge.

What to speak of academia! The non-stop tug-of-war between the ministry and TEC, which was regularly aired in the public domain, and the subsequent stepping down of its chairman, did not do honour to the country and its institutions. The resignation of ex-Vice-Chancellor Professor Konrad Morgan, someone with impeccable credentials and totally neutral i.e. completely objective, because of what he considered to be an undue interference in the functional autonomy of the University, put the nail in the coffin of institutional integrity. Luckily UOM managed to retrieve the UOM Trust from the claws of active political meddling’.

As regards the DY Patil students, will they too be victims of official ineptitude, like their counterparts of the aforementioned ‘Ecole…’? We learn that the two Indian students who swore the affidavits have been gone for over a month, having secured seats in China. Will they be recalled to be cross-examined about their statements? Who or what pushed them to do what they did?

With so many premonitory signs of dysfunction in the tertiary and medical education sectors spanning a number for years, it is to be asked why did we wait for the situation to get out of control before action was taken? The auditors will produce yet another report, and we will not make a guess as to its fate.

With the lack of a proper mindset and the appropriate resource to plan and direct medical and health education in Mauritius, no amount of departmental enquiring or other auditing will dynamise the sector to take it to par with what obtains elsewhere, or at least seriously engage on such a path. We have already embarked on the 21st century, and we cannot navigate in so vital a sector with knee-jerk responses to crises that we ought to have seen coming. New thinking is urgently needed so as to make up for the lost opportunities – hopefully.

* Published in print edition on 28 February 2014