Oireachtas probes RCSI-Bahrain accreditation

As in Dublin, each RCSI–Bahrain graduand “proudly” recites the following declaration at their graduation ceremony, the RCSI has said: “…I will maintain the utmost respect for human life, I will not use my knowledge to violate human rights and civil liberties even under threat, I make these promises solemnly, freely and upon my honour”.

The College, which has graduated four cohorts totalling 611 graduates in its various programmes in the Kingdom of Bahrain, said as Irish companies and universities increased their activities abroad “we will find ourselves, working in countries with very different political systems and cultures from our own”.

CEO Prof Cathal Kelly, who reiterated before the Joint Oireachtas Education and Social Protection (ESP) Committee last week that the College had appealed for clemency for the doctors imprisoned in the Gulf state and continues to advocate in private, said: “To work in these countries, we must find a way to be true to ourselves, our core mission and be respectful to the cultural, judicial and political norms of the countries, in which we work.”

Human rights

He was part of a delegation from the RCSI, Medical Council, the National University of Ireland (NUI) and the Department of Education and Skills responding to human rights concerns arising in the small island country from the Arab Spring in 2011 and an associated call for the Council to refrain from accrediting the RCSI-Bahrain campus raised previously before the Committee.

Former Chairman of the Department of Medicine at RCSI-Bahrain Prof Jim Finucane also attended on behalf of the College, together with RCSI President Prof Patrick Broe. CEO Caroline Spillane and Vice President Dr Audrey Dillon represented the Medical Council, while Registrar Prof Attracta Halpin represented NUI — the RCSI is a recognised College of the NUI. Deputy Secretary General Mary Doyle spoke for the Department of Education.

Last November, the ESP Committee heard from Ceartas, an Irish lawyers for human rights group, which earlier in 2013 had requested the Medical Council to refrain from accrediting RCSI-Bahrain on the basis of what it viewed as ongoing human rights violations and alleged breaches of medical ethics in the medical facilities used to teach students.

The Council — which can recognise qualifications awarded by Irish medical schools in a third country — was originally due to carry out the visit to Bahrain in 2012, but postponed the trip in light of the political unrest.

‘No torture’ — RCSI 

Addressing the Committee Chair Deputy Joanna Tuffy, Prof Finucane denied torture ever occurred in Bahraini hospitals during the five years covering the height of the Arab Spring when he was working there.

Responding to Committee member Senator Averil Power’s rejection that standards in Bahrain could possibly be acceptable given what has been going on in the background, Prof Halpin, who pointed out that NUI’s charter promoted respect for human rights, said: “From the NUI point of view, the evidence we have is to the contrary. The overall thrust of the numerous external examiners we have had there is to the effect that standards are fine.”

Prof Kelly added: “We at RCSI are proud of our staff and students in Bahrain where we provide a high quality medical and nursing education in a non-sectarian environment. It is our intention to continue to contribute to the future of Bahrain through the provision of high quality education in the health sciences.”

He said accreditation by the Council was a mark of quality for RSCI-Bahrain’s students who had already received wide international accreditation. It conferred no legal nor underhand advantages such as improving employment access in Ireland, Prof Kelly added. “If it does not go ahead, the only people punished are our students. While we have many views in this room, I hope we are united in wanting the best outcome for our students.”

Importantly, it would help to protect and further enhance the overall reputation of Irish higher education institutions in the competitive international market where evidence of the quality of transnational activity was essential, he said.

Disclosing that RCSI-Bahrain has completed a self-assessment report based on the World Federation of Medical Education (WFME) Standards, on which accreditation by Kingram House would be based, he declared: “RCSI is confident that it meets these standards and that the resources available to staff and students meets the requirements specified.”

The College has invested heavily in Bahrain and currently has 1,240 students enrolled in Medicine, Nursing and Masters programmes drawn from more than 30 countries around the world, including the US, Australia, Canada, France, New Zealand and the UK.

Accreditation

Spillane, who revealed that the Council was planning an accreditation visit to RCSI-Bahrain later this year, said the regulator was processing a request to review the programme of basic medical education delivered by RCSI-Bahrain, stressing that Kingram House was conscious of the political developments in the Gulf state.

The former President of the Council, Prof Kieran Murphy, and the incumbent Prof Freddie Wood (who is also on the RCSI Council) have both written to a number of political leaders, including An Taoiseach, the Minister for Foreign Affairs, the Minister for Health and to the Higher Education Authority, expressing the Council’s concern at the situation there, she said.

Spillane — who indicated that an assessment team was currently being identified and pre-assessment visit information had been requested from RCSI-Bahrain — said the Council used a standard procedure in the application of globally recognised standards, in line with the Medical Practitioners Act (MPA) 2007 and Council rules, including WHO, WFME, and Global Standards for Quality Improvement in Medical Education: European Specifications 2007, to its consideration of any programme under Section 88 (2) (a) of the MPA.

Dialogue with students was a key part of accreditation visits, Spillane added. “We aim to meet students in each year of the programme and one of the key elements of the dialogue is that it is confidential, and this is emphasised to students at the start of every session.”

She said professionalism and ethical issues always featured in the discussions, particularly with students in the later stages of the course, who were experiencing in ‘real life’ (on the wards or in a general or community-practice setting) the type of scenarios they met in a more theoretical way earlier in the course.

Where education, training and professional competence standards were not met, the Council could take action in the public interest, through applying conditions or refusing to approve relevant bodies and programmes. Spillane pledged that the decision and the report based on the review that would inform it, including discussion of all issues germane to the standards and the procedure used by the Medical Council to review the programme in Bahrain, would be available for public scrutiny.

Keen not to undermine the accreditation visit, Spillane added: “At this present time, we must be careful not to pre-empt our visit and its findings, so as such we are somewhat limited in the information we can provide as we are constrained by the requirements of our work.” She offered to update the Committee after the visit.

Human rights

Senator Power queried whether the NUI and RCSI mentioned the words human rights in their opening statements, acknowledged the “shameful abuses” that reportedly continued to be perpetuated against imprisoned doctors in Bahrain, and claimed that torture does not occur while at the same time the UN Special Rapporteur is denied entry to investigate persistent accusations.

She said no one was denying the RCSI’s role in education and internationalising of education, but basic human rights abuses should not be overlooked.

Senator Power, who visited Bahrain during the recent unrest, said the hospitals in the Kingdom were militarised and not independent. She claimed that all of the 25 medical students not given access to internships from one class were Shia Muslims, whereas there had earlier been expectations that they all would get posts; there had been a reportedly sectarian attack on the RCSI-Bahrain campus; and a staff member was allegedly sacked because she was critical of the Bahraini authorities.

Bahraini society was deeply politicised and the NUI, Council and Department as Irish institutions ought to be careful that accreditation of RCSI–Bahrain does not become an endorsement of the status quo, the senator advised.

She sought assurances that the Council’s accreditation visit would be independent and the regulatory body would not be “given the students to speak to by the Bahraini authorities”. There might be scope to let an independent organisation such as Médecins Sans Frontières/Doctors Without Borders to carry out an inspection of the hospitals, Senator Power also suggested.

Human rights lawyer Gearóid Ó Cuinn, who sat through the proceedings, commented to IMT afterwards: “Ceartas welcomes the planned visit to Bahrain the Council announced, a rare instance of external oversight in a country off-limits to human rights organisations.”

He added that site visits to evaluate the suitability of hospitals, the facilities where students gain the bulk of their clinical training, including in medical ethics, were standard practice in Ireland. “Unfortunately hospitals in Bahrain continue to intersect with human rights violations as documented by numerous human rights organisations,” he commented.

Ó Cuinn added: “Overall it seems the debate was successfully diverted from a discussion on whether the learning environment of Bahrain hospitals affiliated to RCSI meet Irish standards as raised in our presentation [last November] to an unrelated discussion on whether education and the RCSI’s presence in Bahrain is a good thing.

“Our point is that the Council, as a public body bound by Irish/European human rights law, is obliged to take these into consideration when accrediting RCSI-Bahrain and to impose conditions where there is a divergence from Irish standards. Failure to do so risks validating a system that is routinely accused of torture, violations of medical neutrality and discrimination — none of which would be acceptable in Ireland.”

The lawyer added that the Council also appeared intent on applying Irish mechanisms by simply interviewing staff and students privately. This presumed that they were free from self-censorship in an RCSI environment that Ó Cuinn alleged had taken a regime-friendly stance, referring to an RCSI claim there was no torture in Bahraini hospitals — a position which he claimed was not even taken by the Bahraini government itself.

“For Ceartas, the fact that the Council wants to interview current and former students in an RCSI setting over a five-hour period without finding a neutral venue and without visiting where the students are actually trained points to a certain naïvety when it comes to dealing with a repressive environment like Bahrain,” Ó Cuinn charged, proposing that they consult with organisations more experienced in dealing with restrictive situations.

He said the NUI Registrar had cited reports from the university’s external examiners, who assess students and not hospitals, as evidence that hospitals were “fine”.

However, Spillane gave assurances the visit would be independent and Professors Kelly and Halpin expressed their confidence in the process.