Freedoms at the heart of medical education
February 18, 2015
Prof Eoin O’Brien is critical of the recent Medical Council report on RCSI-Bahrain following a recent accreditation visit, suggesting that it does Ireland an international disservice.
Education without freedom of speech is an oxymoron that I believe has just been upheld by the Irish Medical Council (IMC) and the Minister for Education and Skills, Jan O’Sullivan, on behalf of the Irish people.
With more than two million people supporting freedom of speech in Paris in the wake of the Charlie Hebdo murders, and supportive demonstrations throughout this country, it is timely to ask how authorities acting on behalf of the Irish public can be, in my view, so cavalier in granting what amounts to official approval of an oppressive regime.
And let’s be in no doubt but that Bahrain is a most oppressive regime, ranking 163rd out of 180 countries in the Press Freedom Index (Ireland ranks 16th), as a consequence of which it is off-limits to most human rights groups. In this small island about one million people are governed by a minority Sunni monarchy, which, with the economic backing of Saudi Arabia, oppresses the Shia majority who are denied the most basic of human rights.
Let us remind ourselves that what started as a peaceful protest for basic human rights in the Arab Spring of 2011 ended with more than 35 people killed and some 70 medical professionals, including 47 doctors, being arrested, with more than 150 medical workers suspended or dismissed from their jobs, and that Irish-trained surgeons and doctors Ali Al-Ekri, Bassim Dhaif, Ghassan Dhaif and his wife Zahraa Al-Sammak were among the tortured. Dr Al-Ekri remains incarcerated in a prison.
Freedom of speech
The question is this: can university education be provided in an environment that forbids freedom of speech and imprisons those who chose to exercise this fundamental democratic right? The President of the Irish Medical Council, Prof Freddie Wood, who until recently was a member of the Council of RCSI and Chairman of its Finance Committee, is, I would argue, of the opinion that freedom of expression is a prerequisite of medical education.
In a recent lecture, Prof Wood used a quote from Martin Luther King: “Our lives begin to end the day we start to remain silent about the things that matter.” The President went on to illustrate the righteous adherence of the IMC to such a principle: “All the international research shows that doctors who have issues at medical school are likely to continue with bad practices throughout their professional lives. If we can work to standardise the training experience for all doctors so that it is consistently high, we can make sure a reference for good practice is there throughout a doctor’s career.” Likewise, the National University of Ireland (NUI) (which awards degrees in Bahrain) is emphatic in emphasising the importance of freedom of speech in university education.
Dr Maurice Manning, the Chancellor of NUI, chaired a committee in 2013 that drafted a guiding document entitled Human Rights Principles and Code of Conduct for the National University of Ireland and its Member Institutions.
It should be noted that the RCSI, as a member institute, should be subject to the principles enumerated in this document, among which are: “The National University of Ireland and its member institutions have a special responsibility to ensure that… the human rights of their students, staff and associates are fully respected, regardless of the country where they are located. This includes but is not limited to freedoms that are necessary for the good functioning of a university, such as freedom of association, freedom of expression, and freedom from discrimination.”
It goes on to emphasise that the NUI and its member institutions must ensure that none of their activities, including partnerships they undertake with institutions in different countries, are seen as providing support for the violation of human rights.
How, one has to ask, can these Irish institutions on the one hand emphasis such laudable principles about the educational environment of medical students, and, on the other, countenance granting accreditation to RCSI-Bahrain and its associated hospitals, where torture and imprisonment of medical staff, not to say anything about suppression of freedom of speech, has been openly documented and repeatedly emphasised by medical and legal authorities?
Educators in Bahrain have also had difficulty reconciling the principles of education with the repression of basic human rights. The former President of RCSI-Bahrain, Prof Tom Collins, resigned his position because by remaining in office effectively amounted to complicity with suppressive policies of the Bahraini authorities — a resultant compromising of the very essence of higher education.
The ‘rape’ of Bahrain
Dr Mike Diboll, a former Academic Head of Continuing Professional Development at Bahrain Teachers College, University of Bahrain, and a faculty member of the University of Bahrain, who “witnessed the toxic effects of institutionalised sectarianism, the suppression of academic freedom and the violation of civil and human rights at the University of Bahrain”, has stated that: “The rape of Bahrain Polytechnic provides yet more evidence — as if more were needed — as to why no respectable international higher education institution, professional body, or accreditation agency should have anything whatsoever to do with Bahrain until fundamental social and political change has happened there.”
It is hardly surprising, therefore, that the recent announcement by the Medical Council to grant accreditation to RCSI-Bahrain has appalled many doctors, who see grave implications that extend far beyond the shores of the islands of Bahrain and Ireland.
The IMC Report on Accreditation Inspection of Royal College of Surgeons in Ireland-Bahrain Medical School, which took place on October 13 and 14, 2014, makes, in my view, disturbing reading, not so much for the recommendations it makes, but for the facts it chooses to omit in reaching its conclusions. I am not going to concern myself with the make-up of the visiting team, but rather concentrate on their failure to make any meaningful reference to human rights and the freedom of expression — issues that cannot be ignored in the context of approving a third-level institution that purports to educate doctors to practise in multicultural environments.
The only mention of human rights in the 40-page document (apart from four documents listed as ‘Background Reading’) is reference to a review document from RCSI-Bahrain that apparently “commits RCSI-B to expressing its declared ethos, including commitment to dignity and freedom for all, though the content and process of its teaching”.
The report goes on: “A stand-alone module on human rights has been introduced, with assessment explicitly linked to student progress.”
It could be argued that the report reflects an unsuitable position taken towards the institute under inspection, rather than expressing its findings in a dispassionate and factual manner. For example, from the outset the “noble purpose” of RCSI is acknowledged, whereby it enhances “human health through endeavour, innovation and collaboration in education, research and service”.
The report repeatedly “commends” RCSI-Bahrain, examples being for the sports facilities available on campus and on the range of clubs and societies available to students, the “Careers Office, which provides guidance, support and advice” and the “calibre of the administrative staff met on the accreditation inspection”.
These are important considerations in any university where fundamental existential conditions, such as academic freedom, meritocratic decision-making, freedom of association and freedom of expression are assumed, which is not necessarily the case in Bahrain.
The report deems the clinical facilities to be acceptable, not by a rigorous assessment of the hospitals, interviewing past pupils, patients and independent reports, but instead by relying on the ability of current students to speak out and exercise their freedom of speech, which has hitherto been so assiduously denied them.
There is then the time given to the IMC visit — two working days to visit and interview personnel at the RCSI-Bahrain Medical School, the King Hamad University Hospital, and the Bahrain Defence Forces Hospital, and to assess the clinical facilities.
The report suggests an important contradiction, which needs to be reconciled, namely that while it was disappointing that the Team had been unable “to meet with a greater number of students, they found that students were aware of the purpose of the meeting and had reasonable opportunity to opt-in”. Why did so few students attend, then, if they were aware of the meeting?
The final conclusion of this flawed report is that: “The Royal College of Surgeons in Ireland Bahrain’s six-year Medical Programme should be approved for a period of five years under the terms of Section 88(2)(a)(i)(I) of the Medical Practitioners Act 2007.”
This recommendation is based on the fact that RCSI-Bahrain provided “an appropriate, comprehensive and pedagogically-sound education programme, which is carefully designed to meet defined educational outcomes and is based on the well established programme at the parent institution in Dublin”.
Does this imply that the visiting team from Ireland believed that the same democratic principles that pertain in Dublin also operate in the educational environment in Bahrain?
This is not too surprising, of course, seeing that it would appear they did not interview or visit any of the people involved in upholding human rights in that country.
Rather, the IMC team has chosen to concentrate on issues of technical competence rather than the relevance of ethical principles in decision making — a dangerous course as the Irish people well know, having had to pay for this dichotomy in the failure of banking regulation in this country.
So what is the state of human rights in Bahrain today? Two examples will suffice. First, the IMC visit took place just after the women’s rights activist Ghada Jamsheer had been arrested and detained for tweeting criticism of the IMC-approved King Hamad University Hospital; she is now considered a prisoner of conscience by Amnesty International.
Second, my friend Nabeel Rajab, who is the president of the Bahrain Center for Human Rights, a founder of the Gulf Center for Human Rights and a member of the Human Rights Watch Middle East division’s advisory committee, is presently facing six months in prison — a sentence he is appealing — for issuing a tweet that offended the Bahraini authorities, which has warned that anyone who “offends by any method of expression the National Assembly or other constitutional institutions, the army, law courts, authorities or government agencies” will be sentenced to jail.
Allow me to speculate. Were the IMC delegation, who were selected for proven abilities and experience, aware of all this background, did they choose to ignore it, were they denied enquiry into the educational environment, did they in fact probe the issue, or did they see it as outside their remit — or none of the above? Only the IMC can say which, if any, of these explanations is correct.
Whatever the answer, as things stand at present, the IMC and the Minister of Education and Skills have done nothing to address the abuse of human rights in Bahrain, and have allowed it to continue by sanctioning an Irish educational institution in that island.
Perhaps, more importantly, they may be jeopardising the reputation of Irish higher education both at home and abroad in terms of its pursuit for and profession of truth.
Ireland has a proud tradition internationally in medicine by virtue of medical missionary work, its contributions to scientific medicine and the reputation for clinical excellence acquired over many years by dedicated doctors and nurses working at home and abroad.
The Minister has a responsibility not to see this reputation squandered. She has a further responsibility, which is that she must be assured that the IMC is acting in accord with the requirements of the World Federation for Medical Education (WFME), which the IMC is mandated to support. These standards stress that the locations for clinical tuition should be safe, and that academic freedom must be upheld so that there is “appropriate freedom of expression [and] freedom of inquiry” for both staff and students.
If the Minister upholds the decision of the IMC, which I believe conflicts with human rights standards in Ireland, then this issue may well be open to challenge.
Bahrain initiates criminal investigation into online content of opposition party: here.