June 5, 2024 • 58 mins
Welcome to another episode of the Med School Minutes podcast, brought to you by Saint James School of Medicine. In this episode, we celebrate the 25th anniversary of our school with a special guest, Dr. Kallol Guha, the founder of Saint James School of Medicine. Join us as we delve into the history of Caribbean medical schools, the challenges faced, and the vision for the future of medical education.
0:00 - Introduction
0:36 - Guest Introduction: Dr. Kallol Guha
1:08 - Founding Saint James School of Medicine
3:00 - Early Career and Ross University
4:29 - Student Demographics and Quality
6:43 - Accreditation Challenges
10:10 - Improving Clinical Rotations
12:01 - Evolution of Caribbean Medical Schools
14:10 - Establishing SEBA School of Medicine
17:02 - Accreditation Efforts and Marketing Strategies
23:02 - Expanding Saint James to Anguilla and St. Vincent
30:30 - Milestones and Evolution of Saint James
38:00 - Financial Views and Sustainability
44:20 - Challenges and Lessons Learned
49:50 - Appreciation and Closing Remarks
#MedSchoolMinutes #SaintJamesSchoolOfMedicine #MedicalEducation #SJSM #CaribbeanMedicalSchool #DrKallolGuha #MedicalPodcast #25Years #InternationalStudents #MedicalJourney #FutureDoctors
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Transcript
Episode Transcript
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Speaker 1 (00:01):
Hello and welcome to another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, kaushik Guha.
Speaker 2 (00:19):
Thank you for joining us on another episode of Med
School Minutes, where we talkabout everything MD related,
with a focus on internationalschools, specifically students
from the Caribbean.
Today I have the honor ofhaving a guest who is very, very
special to not just the schoolbut to also the 800, give or
(00:42):
take practicing physicians inthe United States and Canada,
and that is the founder of ourschool, Dr Kaldur Guha.
He founded the school about 25years ago and today we are
actually celebrating or thisyear we are celebrating the 25th
anniversary.
Dr Guha started his career atRoss University around 1980,
(01:03):
1981, and he's been in the fieldsince that very day.
It is important to note that theCaribbean school as an industry
started in 1976.
So, in a field or in anindustry that is about 45 to 47
(01:24):
years old, Dr Guha has been apart of that industry for over
40 years Now.
With that comes an innerstrength and a vision that is
unparalleled, which is truly thedriving force of our
institution.
So, without further ado, let'shear from Dr Guha.
(01:46):
So welcome to our podcast, DrGuha.
We're going into the secondseason, you are the founder of
St James School of Medicine andSt James is celebrating 25 years
, so why don't you take us backto the time that you started and
(02:07):
give us some dates?
When did you get involved withCaribbean Medical Schools?
Speaker 3 (02:11):
That was in 1981.
Actually March 1981.
At that time I was in TuftsUniversity as a postdoctoral
fellow and from there I wasintroduced to this.
I was looking for a job andthen there was an advertisement
(02:34):
from Ross University, dominica,and I applied for a job and I
was called for an interview inNew York Empire State Building
and I went there for aninterview and they decided to
hire me right away withoutlooking into any kind of
(02:57):
documentation etc.
And I didn't feel verycomfortable.
So it took a very long time forme to really decide that,
whether or not it's a good ideato go to Caribbean.
What kind of place is Caribbean?
Because I only knew about WestIndies because of the cricket.
(03:18):
So from there there was a lotof.
In those days there was notmuch of a scope for doing
research about what is WestIndies or what is Caribbean,
what kind of school it is, etc.
Etc.
So anyway, after talking tosome people, I felt that maybe
(03:43):
it's a good idea to try it outand then I was given the job and
I joined Ross University aroundMarch 1981.
And that was the beginning,okay.
Speaker 2 (04:01):
And how long were you at Ross University?
Speaker 3 (04:06):
From 1981 until, well , all the way to 1995.
Okay, end of 95.
In between there was a break,but it is.
That was the time I spent atRoss University.
Speaker 2 (04:25):
Okay.
So when you were in Caribbeanmedical schools, what was the
condition?
What did you see?
How the students were treated?
Were these top quality studentsthat were coming to Ross back
in the day?
Were they?
Were you impressed by thestudents that you saw?
(04:47):
Were you impressed by the waythe school treated the students?
It?
Speaker 3 (04:49):
was a very heterogeneous group of students.
They came from many differentparts of the world.
In those days, I saw studentscoming from Pakistan, from China
.
Directly from Pakistan, yes,directly from Pakistan.
Directly from South Africa.
Directly from China.
Directly from Pakistan, yes,directly from Pakistan.
Directly from South Africa.
Directly from Taiwan, Okay so,and most of them were, of course
(05:15):
, from US, Very few from Canada.
So I met those students fromdifferent.
But this strange thing was, andvery interesting thing was,
that some of the for example, Istill remember a student from
Taiwan who couldn't speak orunderstand English, but he, that
(05:36):
student, was admitted to RossUniversity.
Speaker 2 (05:41):
Okay, and was the process more or less the same?
They come here, takes USMLE andthen become physicians.
What was the hope for these?
Speaker 3 (05:48):
Those days there was no USMLE.
There was one examination.
It was called ECFMG.
It was called After that.
Well, as time had gone by, thenwe were told that there will be
no US assembly.
There will be a VQE VisaQualifying Examination.
(06:10):
And those who took the test,they told us that it is a
political examination, not anacademic, because the failure
rate was very high, deliberatelymade students to fail.
But anyway, it's a visaqualifying examination and after
(06:33):
that that test was scrapped andthen they started what is
called USMLE.
Okay, and I think USMLE startedsometimes around late 80s or
mid 90s, early 80s, 90s, aroundthat time.
Okay, but the students'population it was a
(06:56):
heterogeneous group.
There were some very goodstudents, very bright, what we
call A grade students.
Some were very poor goodstudents, very bright, what we
call A grade students.
Some were very poor qualitystudents.
But admission was open.
Anybody could come get in well,irrespective of their grades.
Speaker 2 (07:16):
Okay, and as far as the prospects of the students
once they come from, so was themajority of students from
international geographies orwere the majority from USA,
majority from USA, and what werethe career prospects of the
students in the late 70s, early80s when they finished from?
Speaker 3 (07:37):
Ross bleak.
I particularly remember oneinstance that you see, in those
days Ross University was tryingto get accreditation from New
York, new Jersey.
In those days New Jersey alsoneeded their Department of
(08:02):
Education, approval from theDepartment of Education to let
these foreign medical studentsto get into hospitals in New
Jersey.
So New Jersey delegation camein.
We encountered them.
New York came in at least fivetimes, and then California came
in also, and then Californiacame in also, these three.
(08:24):
So we encountered those threepanels.
New York I personallyencountered at least five times,
new Jersey at least three times, because each time they were
rejected.
But California, well, they justcame, they saw whatever they
(08:48):
saw and they approved With NewYork.
I remember the students weresitting together with the
faculty and the panel on theother side of the table.
The panel was sitting and thepanel asked the student that all
the money that you are spendingin this school, what happens if
you don't get into residency orsomething?
(09:09):
What happens?
The student, without a blink,in front of the panel, in front
of the faculty, he said I willhave no other option but to
commit suicide.
The situation was so desperatethose days.
Speaker 2 (09:27):
So do you think that that situation has improved
today, dramatically improved?
Speaker 3 (09:32):
Okay, how so Dramatically improved, in the
sense that in those days it wasnext to impossible for students
to get into teaching hospitalsfor clinical rotation Out of the
question.
One instance is that we weretold that in Florida, ross
University has applied wrote toevery single hospital in Florida
(09:56):
.
I don't remember exactly thenumber of hospitals they wrote
to and that but every single.
Well, they wrote to thehospital requesting them the
possibility of accepting theRoss University student for
clinical rotation, but of course, ross University promised to
(10:21):
pay to the hospital, but everysingle one of them declined.
All right, now, that was thesituation.
Only one hospital agreed to takethe students and we were told
(10:44):
by one of the insiders of RossUniversity administration that
the one who agreed thathospitals was threatened by the
hospital association that if youaccept any student from this
institution, we will expel youfrom the UDL.
That's the situation we willexpel you from the UDL.
(11:05):
That's the situation we haveheard every now and then.
The teachers used to tell usthat they are getting frantic
requests from students that ifthey could help the students to
get into a decent hospital wherethey can learn something,
because right now, wherever theyare, they're either clinics
(11:28):
working as an orderly of thephysicians or in the hospital.
Also, they're working as amenial task, so that was the
situation there.
Speaker 2 (11:41):
So was there no ability for them to?
Or when did they start becominglicensed physicians?
Because Ross has thousands andthousands of graduates,
obviously.
So when do you think that thatparadigm changed and students
started getting physicianpositions, so Ross started?
(12:02):
I think you were in the firstinaugural year of Ross
University.
Speaker 3 (12:06):
No, ross started in 79 and I joined in 81, two years
later, but the situation wasreally very, very desperate.
But we have to accept the factthat it is one thing that one
can criticize that it was allbad, et cetera, but they are the
pioneers.
Criticized that it was all bad,etc.
(12:30):
But they are the pioneers.
So before them they didn't knowexactly that because the Ross
University, like all otheruniversities, at that time there
were three universities One wasSt George's, another was AUC,
american University of theCaribbean, and the third one was
Ross University.
These were the mainuniversities that we knew of.
There may be some other schoolsalso that we didn't know of, but
(12:53):
these schools were being run bypeople who have no academic
background whatsoever.
So they didn't know how theadministration of an educational
institution should bestructured, how they should
function, how they should beadministered.
They had no idea at all.
So they learned it through hitand run, kind of a trial and
(13:16):
error, kind of a process.
But they continued to stick tothe project and they did
everything possible to take itforward, with all the problems
they had, but they didn't giveup.
So that credit must be given tothem.
They are the pioneers.
(13:36):
All the other schools that arenow doing whatever they are
doing, like St James, forexample, has found it relatively
easy to take the institutionforward.
It is because we learned a lotof things from Ross University.
That's the reason.
Speaker 2 (13:56):
Wow, and after Ross you moved on to other Caribbean
medical schools.
Speaker 3 (14:04):
That was SEBA School of Medicine.
Okay.
Speaker 2 (14:07):
And when you were there, did you see any
difference between SEBA and Ross?
Speaker 3 (14:11):
Yes, well, seba had a much easier time.
It is because the owner of SEBAwas working in Ross University
together with me, soconsequently, he learned a lot
of things from Ross, which Rosslearned things the hard way, so
Sabah administration learned alot of things from Ross, and so
(14:35):
consequently, it was relativelyeasy for Sabah University as a
startup, because the experiencerequired as a startup came from
Ross.
Okay, that's the point.
Speaker 2 (14:50):
And in those days.
But did you see any operationaldifferences?
Like was SEWA quote unquote abetter school than Ross, or was
it kind of the same thing?
Speaker 3 (15:03):
Well, the difference was that when we first started
with Ross we saw that theydidn't have any idea as to what
should be the job description ofa dean.
They didn't know, so they hadto collect information, et
cetera.
It took them weeks to puttogether the job description.
To form a curriculum committee,for example, it took them
(15:25):
nearly three months.
But those things were not afactor for Seva University
because they acquired theexperience and creating
promotions committee, creatingcurriculum committee etc was a
routine procedure.
That was not a problem at all.
With respect to clinicalrotation, also, by then, in 1981
(15:51):
, I started and then I joinedSEWA in 1996.
So by that time the students ofCaribbean school were more or
less accepted, so not as wellaccepted as it is now, but still
they were accepted.
They didn't have really thesimilar kind of difficulty.
(16:16):
The students of SEWA did nothave the same kind of difficulty
in getting into clinicalrotation as we saw the students
of Ross University encountered.
Speaker 2 (16:29):
Okay, so during this time with Ross in the 90s and
80s, was there any concept ofaccreditation in the Caribbean
in?
Speaker 3 (16:42):
the Caribbean.
Well, yeah, the concept wasthere, yes, but there was no
well-organized what do you callthat?
Independent accrediting body.
There was none.
Speaker 2 (16:54):
Okay.
Speaker 3 (16:57):
So what came out is that Ross University, for
example, they, after whatinformation they could gather
from St George's, they workedtogether with the government of
Dominica at Ross University toput together an accrediting
(17:21):
panel, accreditation panel bymobilizing the government
officials with the bestavailable resources.
They mobilized them, puttogether an accreditation panel
and I think the Ross Universityadministration used their
(17:47):
political and economicconnection to get it recognized
by the Department of Educationof the US and this is what first
initiated in St George'sUniversity in Grenada, first
initiated in St George'sUniversity in Grenada.
And after that Ross adopted thesame technique and he succeeded
(18:12):
in getting the same kind ofaccreditation by mobilizing the
authorities of the government ofDominica.
But these independentaccrediting agencies that we are
seeing now, that didn't existat that time.
Speaker 2 (18:27):
So during those days was so today.
The competition of Caribbeanmedical schools is gutthroat.
Every year, you see three tofive students start.
Every year, you see three tofive students shut down.
Was it like that back then aswell?
Speaker 3 (18:45):
I think in those days , I think the what do you call
graduation rate was much, muchless, far less, naturally,
because they weren't acceptinganybody.
It was said that anybody whocan sign a check they can get
into the school.
That was the way of thinking inthose days.
Speaker 2 (19:04):
So but what about the competition between the schools
like Ross and St George's?
Were they amicable?
So it sounds like they competedagainst each other or never
formed a consortium or workedtogether to lobby with the
government to get DOE.
Speaker 3 (19:18):
It seems like they all did this independently,
absolutely yes, they werecutthroat competition in the
sense that, for example, it sohappened that there was a
deliberate attempt from eachschool to how to say, to spread
(19:39):
negative propaganda against theother.
And even it so happened thatone of the school would send
agents at the airport and assoon as there are, let's say,
students, new students comingfrom, coming to get admission in
(20:01):
a given school, the otherschool would do everything
possible to take those studentsand put them into their school.
That is what was going on.
That was poaching otherstudents, poaching other faculty
.
That was going on freely, therewas no barrier to that.
Speaker 2 (20:18):
Not much has changed in that regard, though we still
experience something.
But the bigger schools, like us, for example, we don't
necessarily get affected.
But smaller, new schools,that's how they get students.
Yes, what about marketing, likewhen it came to, you know,
reaching out to students?
(20:39):
How did these pioneer schoolsspread the word?
I mean, there was no internetback then.
Speaker 3 (20:49):
You see, unlike St James, those schools, like Ross
University, SEWA, they were verysecretive.
They never involved facultymembers in the process of
preparation for accreditation,Not at all.
Even when they are going to theaccreditation panel, when the
(21:14):
school is submitting applicationfor accreditation.
Those were kept strictly secret.
I don't know why, but that wasthe way things are.
Faculty like now, there arecommittees, et cetera, et cetera
.
Of course there were committeesalso in those days, but as far
(21:36):
as preparation for accreditationis concerned, there was.
Faculty had hardly anypreparation before the panel
actually physically appeared atthe campus and decided to
interview the faculty.
Before that there wasabsolutely no interaction with
(21:58):
the faculty.
Okay, that's it.
Speaker 2 (22:01):
So during that time obviously you worked at Ross and
then you worked at Seva.
Speaker 3 (22:07):
Now just a minute.
You talk about marketing Again.
As far as marketing isconcerned, we didn't know much
about how they're getting thestudents.
They were mostly what is calledtier of cards.
There was a kind of a calendarand in the calendar the tier of
cards, and in the cards all theinformation about the school was
(22:33):
printed.
And then there were agents whowould distribute those tier of
cards to different schools andcolleges and so on.
That was basically, and thenadvertisement in the newspaper,
radio and TV also used toadvertise, in that there was no
computer.
Speaker 2 (22:53):
So obviously you worked at Ross for about 15
years and Seba for about five.
Speaker 3 (23:02):
From 1996 until 2001.
Speaker 2 (23:06):
2001.
But then you so about five, soyou about 20 years.
In those 20 years you conceivedthe idea of St James and you
started St James.
Officially, st James started in1999.
With you know, we got thecharter and all of that and then
(23:27):
classes started in 2001.
But what compelled you tocreate St James?
Because there was alreadyenough like, as you said, st
George's Ross, auc, saba enoughschools.
Why did you want to start StJames?
Speaker 3 (23:44):
Well, the owner of Seba School.
Actually he how do you say hetricked me into this venture
(24:07):
Because that school was in anisland which is owned by the
Dutch and the Dutch was very,how to say, not very cooperative
.
But the fact that in a smallisland like Ceiba that was the
only school, that was the majoreconomic support to the entire
(24:29):
island.
The whole economy of the entireisland was supported by that
school.
So on one hand, the school knewthe importance and how much the
Ceiba's island is dependent.
On the other hand, thegovernment of Ceiba, even though
they were helpless but theywere very mean to the
(24:52):
administration, they were neverpolite, hardly ever they really
cooperated.
So this was a very difficultsituation for SEWA and every now
and then we used to hear, as afaculty member and the students,
we used to hear that the schoolis closing.
Why?
Because the government isasking for complaining that the
(25:16):
school is not paying tax, orschool is not paying this,
paying that, etc.
So every time there is rumorthat the school is closing,
paying this, paying that, etc.
So every time there is rumorthat the school is closing
Anyway.
So I think because of that, theadministration, mainly the
owner of SEWA, who was.
Once upon a time we werecolleagues at Ross University.
He encouraged me to go to goand find another island where we
(25:46):
can start another medicalschool so that in case something
happens to Seva, they will moveto another island.
So it is from there I startedto, with the advice and support
of Seva Universityadministration.
(26:08):
I first approached Anguilla.
That was back in 1998.
Speaker 2 (26:13):
Okay.
Speaker 3 (26:13):
And I had a long discussion with them, all the
cabinets came in, et cetera, etcetera.
But then, even though theyagreed that, yes, we would like
to start a school, but we didn'tget the charter from them,
instead they gave it to someother school.
They gave a charter it wascalled, I think I don't remember
the name of the school but theschool couldn't start because
(26:36):
they didn't have the resourcesto start the school.
So it was actually theadministration of SEWA.
They encouraged me to start.
But when I actually started,well, at that time I proposed
why not Bonaire?
Bonaire was very eager becauseno school wanted to go to
(26:56):
Bonaire, because they used tospeak not so much English but
Dutch.
So the administration of SEWAtold me me it is not a good idea
because if our students can'treally communicate with the
local people, then it will bevery difficult to get students.
But anyway, I reached out toBonnier and Bon.
(27:21):
Then after that they never leftme.
They wanted me further.
In a way they forced me tostart the school there, even
though I didn't have theresources.
But since I started in Bonnier,I wanted to start in Bonnier.
I didn't get any support fromSEVA except some verbal cues
(27:42):
that would do this, do that,don't do this, don't do that.
Speaker 2 (27:45):
In fact it was also important.
Yes, so, as far as the actualreason for starting, what was
the reason Like?
Was it better student quality,was it?
You know, this is a great wayto make money.
What was the reason to start StJames?
Speaker 3 (28:07):
When we saw how the students were treated in Ross
University, I realized and thenfrom there, when I came to SEWA,
I had no intention or plan ofstarting a school.
But from Ross, when I shiftedto SEBA, then me and the owner
(28:32):
of SEBA's university, we used todiscuss that look, we have been
working at Ross University, weknow everything about medical
education.
So if and I also pointed outthat because SEWA stood up on
(28:53):
its feet so quickly, it isbecause of this experience.
So, since we have been workingwith the medical school, it
should be very easy for us tostart something on our own and
we can do it better.
It is out of that conviction Istarted to proceed with Bonaire,
(29:13):
even though Seba told me thatthey.
I realized that Seba will notbe interested in working with me
, but so I continued that sinceI have experience in working at
the medical school, I should beable to do it faster and better.
(29:33):
But that turned out to be awrong assumption.
Speaker 2 (29:36):
So do you think St James isn't better?
Speaker 3 (29:39):
than Ross and St George's and all these.
It's not a question of whetherit is better or not, but when I
started the school, I realizedthat teaching is maybe only 5%
to 10%.
The remaining of it is law, isfinance, is management, of which
we knew very little.
But then, when we are alreadyin there, we had to do
(30:03):
everything, whatever it takes,to learn the techniques, learn
the tricks and go forward.
It was not easy, but we did it.
Speaker 2 (30:13):
So, since you started in 1999 and where we are today,
how do you think the school hasevolved in your view?
How do you think the school hasevolved in your view?
What do you think have been themost the biggest steps that the
school has taken forimprovement?
Speaker 3 (30:30):
You see, we started with 18 students back in 2002.
Well, actually the schoolstarted with students of
clinical rotation Okay, withstudents of clinical rotation.
And at that time, I think inthe year 2000 and 2001,.
(30:50):
I was still working in SEWA andI was still a member of the
SEWA faculty.
I was working there and as anemployee of SEWA, I started the
(31:13):
school, and how, by the owner ofSEWA.
I didn't do it behind his back,I continuously kept him
informed as to how, what we aredoing.
So so he proposed, or hesuggested, the best way to start
is this that you take transferstudent.
So we put an advertisement in awebsite.
The name of the website wasValueMD.
(31:37):
Ah, they're still around.
They're still around?
Yeah, I think so.
Speaker 2 (31:40):
They are still around .
Speaker 3 (31:41):
Yeah, I think so In ValueMD we advertised that we
were starting a school and wewelcome transfer students.
Relatively easily we got acouple of students, transfer
students, and they paid and theytransferred from different
places.
They transferred from differentcountries.
(32:03):
I particularly remember onestudent.
He is now a graduate of StJames and he's now practicing
family medicine somewhere inAtlanta.
He was originally from EthiopiaNot in Ethiopia, but Eritrea.
Okay, there was a war going on,so as a medical student he
(32:26):
couldn't complete his program,so on the halfway he just left.
So he came to the US and so heenrolled and we gave him credit
for everything that he has donein Eritrea.
So he straightaway started withclinical rotation.
That was our first student.
So like that we got about maybehalf a dozen students who paid
(32:50):
and this is how we started StJames Until we reached a point
where I discussed with the ownerof SEWA and he said yes, now
you can go and start your basicscience.
So there was no, really I wasnot operating behind his back
(33:11):
and it was he who actually gaveme a copy of the agreement that
they had with SEWA and that copyof the MOA, of the agreement
between SEBA University and thegovernment of SEBA.
That was the basis based onwhich we concluded the agreement
(33:37):
between St James and Bonaire.
Speaker 2 (33:41):
Okay, and have you seen any changes since the
school started in 1990?
A lot of changes.
Speaker 3 (33:48):
The first thing that happened was we acquired the
building of an old school theschool that was existing.
It shifted to a new building.
The old building was abandonedexisting.
It shifted to a new building.
The old building was abandonedand the government gave us that
building almost free, free ofcost.
(34:08):
So it was the whole facilitywas available.
But anyway we had to spend somemoney to retrofit and make it
suitable for classrooms.
But that took time.
But by the time the first groupof 18 students came in they
started their classes in a motelcalled dv flamingo.
(34:32):
In their hall the classroomstarted.
The first md1 started therewith two faculty members.
That's how things started.
And then we gradually built.
This, improved the quality ofthe classrooms and this is how
(34:52):
things improved.
But it took quite some timebefore we could really make it,
brought it to a standard whichis acceptable and presentable.
Speaker 2 (35:06):
So, along the journey , this 25-year journey, what are
the biggest highlights for youin the development of St James?
Speaker 3 (35:13):
Number one was that we could get students, place
them in clinical rotation.
It was very difficult to get intouch with the hospital
authorities and persuade them totake our student.
That was one that graduallychanged and improved and that
(35:37):
was one Then.
Second was, in those days therewas not much of a restriction
with respect to whom we canaccept, enroll as a student, and
then it was relatively easy toget faculty to teach the course.
(35:58):
Relatively easy it was.
It was, and we also had thepossibility in those days we had
the possibility of acceptingstudents who are in their, who
are PhDs.
For example, they could enrollas a medical student and at the
same time teach.
So the student teacher.
So that was a cost-cuttingdevice that we could use was a
(36:22):
cost-cutting device that wecould use.
So those were some of the stepsthat we made use of and that
helped the school to moveforward.
Speaker 2 (36:36):
Okay, any other milestones along the way?
Speaker 3 (36:43):
Well, it was not easy to get more and more students.
But our cost was also quiteless because the faculty salary,
because of the student faculty,student cum faculty, we used
quite a few of them, quite a fewof them, some of the faculty
(37:06):
member was employed to teachmultiple course like anatomy and
embryology, pathology andhistology, like that, that kind
of combination that was allowedin those days.
There was no restrictions inthat, so that way we could cut
down the cost.
And it was usually.
The classes were small,anywhere between 12 to 15
(37:26):
students in a class.
So administration was not verycomplicated either and we didn't
need a large office, many staffbecause limited number of
students.
Everybody could be accountedfor, everybody could be
accounted for.
So that way it was more easierand simpler to manage the entire
(37:49):
thing.
But then as time went on wecould see that there are more
and more students are applying.
So when we saw and ourmarketing was not because, there
(38:25):
was no online marketing, etc.
etc.
It was again the tier of cards,distribute them through agents,
etc.
The marketing has changeddramatically.
Now.
Teaching has changeddramatically also, and we are
getting better quality ofstudent also.
We are getting better qualityof students.
Speaker 2 (38:42):
Okay, and as far as hospital relationships are
concerned, do you think thatthat's improved over time?
Speaker 3 (38:50):
Yes, it has improved, but it was in those days.
Nobody knew how to reallyimprove the relationship with
the hospital, improve therelationship with the hospital.
Our first how to say encounterwas when the Dutch accreditation
(39:12):
team visited our campus inBonaire.
It was called NVAO, and whenNVAO came in after the first
encounter with the panel, werealized that we are way, way
behind the point where we canget accreditation.
(39:34):
So it is through theircriticism we learned a lot about
how to close the gap and withmeticulous care we used their
recommendations and that is howwe made relatively rapid
progress in closing the gap andthat helped us to reach the
(39:54):
point where we are now.
Speaker 2 (39:56):
Okay, if you were to look back and do things
differently, what would you dodifferent while starting St
Leo's?
Speaker 3 (40:08):
Yeah, that's a very difficult question but given the
existing circumstances,difficult question.
But given the existingcircumstances that now
everything is computerized,everything is high-tech, well,
it is not a question of what Iwould do differently, but we are
forced to adopt a differentmarketing strategy, a different
(40:30):
teaching technique, differentcounseling system.
So everything has to bedifferent.
So, whether we like it or not,but well, because of the change
in the environment, social andsocial, economic and political
environment we have to do thingsso that in order to adapt to
(40:54):
this change situation.
But in terms of relationshipbetween the student and the
faculty, I think thisrelationship is.
Now we know we have a muchbetter experience in how to
(41:15):
really help the student to goforward in reaching their goal.
We know that.
So I wouldn't say that I woulddo differently, but in those
days these things were simplynot known to us.
Speaker 2 (41:29):
Okay, and would you say that it's not known to us,
as in St James, because wedidn't have the resources?
Or was it just across the board, not an application to pedagogy
?
Speaker 3 (41:47):
Both.
Speaker 2 (41:48):
Okay.
Speaker 3 (41:48):
Yeah, I think both.
I think both because, you see,it is well, whatever experience
I inherited, it is I was ateacher, I was teaching a
subject.
It is one thing that you teacha institution where you are
responsible for not onlyteaching but finance, but
(42:24):
administration, relationshipwith the government,
relationship with marketingagencies, vendors, etc.
It's a very differentexperience altogether.
So the experience that we had,we inherited, is by no means
(42:48):
adequate in order to start aninstitution and bring it to a
point where it can becompetitive.
Speaker 2 (42:50):
So what would you have done different?
I think we would competitive.
Speaker 3 (42:55):
So what would you have done different?
I think we would deal with thegovernment in a different way,
not the way we did before.
Then we would probably domarketing in a different way.
Well, it is a wishful thinking,but I don't see how, even
though we knew that.
Well, in those days we didn'tknow how to market.
(43:17):
What do you call that onlinemarketing?
How to do that didn't exist atthat time, but so we did
whatever we could in order topromote our services.
In order to promote ourservices, and well it was.
The result was not really asgood as we expected, but in
(43:42):
those days, we thought that weare doing the best we can, okay.
Speaker 2 (43:49):
That's it.
So, just generally speaking, ifsomebody came and told you that
you need to start anotherCaribbean school tomorrow, would
you do it Tomorrow?
Tomorrow, given the currentcircumstances and climate, would
you want to do this all overagain?
Speaker 3 (44:10):
Yes.
Speaker 2 (44:11):
I would do that, okay , yes, yes, we do that, okay,
yes.
Speaker 3 (44:13):
And well, you can see that it is very clear that when
we first started Bonair it tooka long preparation and that too
we had the support of a veryexperienced individual who
actually started Sabre.
He was actually behind usgiving different kinds of
(44:36):
suggestions etc.
So that resource was available.
But for us when we started that, it took a very long time
really to stabilize and the mostdifficult part was this
poaching of students, poachingof faculty by some other
(44:58):
competitors, etc.
That was a very difficultsituation.
So by the time Bonnier Bonnierstarted in, let's say 2002,
around that time by the time wemore or less stabilized, it was
say 2010.
Speaker 2 (45:16):
Okay.
Speaker 3 (45:16):
And in 2010, we started Anguilla.
So actually it took aboutnearly six to eight years to
start Bonair, to stabilizeBonair.
Speaker 2 (45:29):
Okay.
Speaker 3 (45:30):
But then when we started Anguilla the moment we
started in 2010, it was alreadyon its feet and it hardly took
about maybe less than a year togive it a start and have a
relatively strong base Then fromAnguilla.
When we then relocated, weclosed down Bonaire and then
(45:53):
relocated to St Vincent.
St Vincent was a few weeks only.
So, as you see, bonaire took somany years, anguilla took less
than a year and St Vincent tooka few weeks.
So, as you can see, theevolution, experience and
resources definitely has itsvalue.
Speaker 2 (46:17):
Let's talk a little bit about the money.
I know St James is one of themost cost-effective programs in
North America.
What are your views on that?
Speaker 3 (46:40):
well.
Well, first of all, I alwaysfelt well I saw that when I was
at ross university that thewhole administration was
mobilized in order to squeezemoney from the students.
The way they used to threatenthe students, treat the student
to make sure that the studentspay their fees on time, I felt
(47:03):
it was very unprofessional.
But looking back, I can seethat there was no support from
any quarters.
Students' fees were the onlysource of income, so they
probably had no otheralternative.
However well, I was thinkingthat an institution, when it has
(47:29):
its expenses and this expenseincludes all the salaries and
fees, etc I never understood whyit is necessary to make profit
out of this institution and takethat profit somewhere and
invest it somewhere else andmake more money.
This I never understood.
(47:50):
So that's, that is one and thesecond, when I came to
Scandinavia, in Scandinaviaeducation is free.
It's at the expense of thestate, so there is no tuition
fee there.
That's the reason why I couldget into the Scandinavian Danish
(48:12):
University and FinnishUniversity without paying a cent
, and I could get into theScandinavian Danish university
and Finnish university withoutpaying a cent and I could get an
education which has helped meto go forward and even to make
the school so.
Right from the beginning Inever thought that the
institution should be built tomake profit no, ever thought
that the institution should bebuilt to make profit no.
(48:33):
So we will build theinstitution and train boys and
girls to become a physician, andwhatever it costs, as long as
that cost is recovered, weshould be satisfied.
It is out of that considerationI started.
It is out of that considerationI started.
But then, when I started StJames, then I realized that it
(48:57):
is necessary to generate somesurplus, not because we want to
make more profit, but with thatsurplus you never can tell there
are bad times that may come andthat surplus can be used.
And this is exactly what hashappened in the case of St James
and that fortunately, wegenerated surplus and that is
(49:20):
why, at the time of need, wecould use that surplus.
But I still think that it isnot a good idea to use an
institution like this to makeprofit by cutting corners and
maximizing profit.
I don't think that's a goodidea.
Speaker 2 (49:42):
Okay, well, thank you so much, dr Guha, for the
insight.
It is fascinating to hear thatyou have been working in
Caribbean medical schools forabout 42, 43 years.
Now the entire industry isabout 47 years old.
(50:05):
Yes, Sort of, but again, Ithink it is that guidance that
has gotten us to where we are asone of the best and one of the
biggest Caribbean schools, andwe've always taken a path that
is very different from bigbusinesses and big schools that
(50:26):
are run by private equity, andhere's a firsthand look at what
that is.
So thank you so much for yourtime.
One parting question is in theyears to come, where would you
like to see St James?
Whether it's five years, 10years, 20 years, what would you
like to see of St James?
(50:47):
How would you want St James tostand out from the rest of the
possibly 75 plus Caribbeanmedical schools?
Speaker 3 (50:56):
Well, I think that we already are doing certain
things, which is significantlythat in a way, segregates a
school like St James from others, and that is our research is
very strong.
Some other school, most of theother schools, they have no
research whatsoever, but we havedeliberately established a
(51:20):
research wing and it is workingvery well.
So that is one part of it.
It's an academic institution,so consequently it should be.
I think administration shouldrealize that.
I mean, the students should notbe seen as a source of profit.
(51:44):
That's one of the things thatyou, administration, should pay
attention to.
That's one.
And the second is thateducational institution is, and
it should be designed to notselect student but condition
(52:05):
student to do well.
Why am I saying this?
Is because it's because duringmy days in Finland and also in
Denmark, I saw that studentscome from different backgrounds
and the administration of theuniversity, they know, they
realize that students comingfrom a cosmopolitan city they
(52:32):
react and they handle theexisting education system in one
way.
But students who come fromrural background, in the deep
interior, in the villagecircumstances, they cannot be
(52:58):
put together with these urbanstudents from the urban
environment and expect them todo same kind of result, so they
have a different.
The institution has taken itfor granted that these students
from deep interior villages,their instruction should be
different and they should betreated, treated differently.
So right from the beginning,from school onwards, they have
established a system ofeducation, an inverned system of
(53:21):
education, where the studentsfrom deep interior villages are
segregated and treateddifferently, but they do pass
the same examination andultimately get into the
professional life and they dowell.
That concept is very difficultto implement in a place like
this because the mindset iscompletely different.
(53:44):
So I believe that aneducational institution should
be conditioning students.
They should institution shouldpush the student up and not
select the student as oh, yourgrade is very poor, you cannot
come in, so you are dismissed.
That's very unfortunate.
I am totally against.
(54:06):
But once I express this kind ofopinion to an accreditation
panel and they were very upsetto hear that kind of opinion
from me.
So I realized that you cannotreally express ideas which
(54:32):
doesn't fit into the rightenvironment.
So I have learned to useexpressions that fits into the
environment.
That's it.
That is one.
And the second is that I thinkthat an institution, when it is
imparting education to thepeople, and this institution, I
(54:58):
have not designed thisinstitution to make profit.
So, on the other hand, it isvery clear that one person, or
two person or a family cannotpossibly create an institution
like this.
It's a contribution, it's ateamwork.
The many people have workedtogether.
So, going forward, it would bemost appropriate and most
(55:23):
logical to consider that thisinstitution should be an
employee-owned institution andnot an individual or a
family-owned institution.
But again, I tried to implementthat kind of system in here and
in fact I also talked to theUniversity of Wisconsin.
(55:45):
They have an employee-ownedenterprise, a big department.
We had a long discussion,enterprise big department.
We had a long discussion.
They came to our office and wehad a long discussion and they
told me that, look, this ideathat you're trying to implement
is very advanced for theenvironment where you are.
(56:05):
What you need to do first thing, first step, is to introduce a
cooperative culture among youremployees.
Unless you do that, you cannotimplement this.
And well, it is like how to sayif and when that situation
(56:28):
comes.
Then you people can think inthat light.
But it's very time-consumingand it cannot be achieved in one
generation.
Speaker 2 (56:39):
Thank you so much, dr Guha, and we hope that this
particular school lives up toyour expectations.
I genuinely think that ourschool is very, very different
and, as you pointed out, thatstudents are not we are not a
profit-driven school.
We are a people-driven school,and that's largely the vision
(57:02):
that you have instilled in theentire upper management that
runs the school.
So thank you so much foreverything that you do and thank
you to all our supporters andstudents.
We really appreciate all thesupport.
We just also want to point outthat you know a lot of hard work
goes into developing thesepodcasts, and give us a like,
(57:23):
give us a follow, please.
If you like the content,download the content at Spotify,
google or wherever, whicheverplatform you choose.
Again, please remember there'sno shortcut to becoming an MD.
Speaker 1 (57:39):
Thank you so much for tuning into our show.
We hope you enjoyed anotherepisode of Med School Minutes.
If you like our content, pleasefollow us and receive
notification when a new show isposted.
This podcast is brought to youby St James School of Medicine.
For a video version of thispodcast, please check us out on
sjsmorg slash video.
Hello and welcome to another episode of the Med
School Minutes podcast, where wediscuss what it takes to attend
and successfully complete amedical program.
This show is brought to you bySt James School of Medicine.
Here is your host, kaushik Guha.
Speaker 2 (00:19):
Thank you for joining us on another episode of Med
School Minutes, where we talkabout everything MD related,
with a focus on internationalschools, specifically students
from the Caribbean.
Today I have the honor ofhaving a guest who is very, very
special to not just the schoolbut to also the 800, give or
(00:42):
take practicing physicians inthe United States and Canada,
and that is the founder of ourschool, Dr Kaldur Guha.
He founded the school about 25years ago and today we are
actually celebrating or thisyear we are celebrating the 25th
anniversary.
Dr Guha started his career atRoss University around 1980,
(01:03):
1981, and he's been in the fieldsince that very day.
It is important to note that theCaribbean school as an industry
started in 1976.
So, in a field or in anindustry that is about 45 to 47
(01:24):
years old, Dr Guha has been apart of that industry for over
40 years Now.
With that comes an innerstrength and a vision that is
unparalleled, which is truly thedriving force of our
institution.
So, without further ado, let'shear from Dr Guha.
(01:46):
So welcome to our podcast, DrGuha.
We're going into the secondseason, you are the founder of
St James School of Medicine andSt James is celebrating 25 years
, so why don't you take us backto the time that you started and
(02:07):
give us some dates?
When did you get involved withCaribbean Medical Schools?
Speaker 3 (02:11):
That was in 1981.
Actually March 1981.
At that time I was in TuftsUniversity as a postdoctoral
fellow and from there I wasintroduced to this.
I was looking for a job andthen there was an advertisement
(02:34):
from Ross University, dominica,and I applied for a job and I
was called for an interview inNew York Empire State Building
and I went there for aninterview and they decided to
hire me right away withoutlooking into any kind of
(02:57):
documentation etc.
And I didn't feel verycomfortable.
So it took a very long time forme to really decide that,
whether or not it's a good ideato go to Caribbean.
What kind of place is Caribbean?
Because I only knew about WestIndies because of the cricket.
(03:18):
So from there there was a lotof.
In those days there was notmuch of a scope for doing
research about what is WestIndies or what is Caribbean,
what kind of school it is, etc.
Etc.
So anyway, after talking tosome people, I felt that maybe
(03:43):
it's a good idea to try it outand then I was given the job and
I joined Ross University aroundMarch 1981.
And that was the beginning,okay.
Speaker 2 (04:01):
And how long were you at Ross University?
Speaker 3 (04:06):
From 1981 until, well , all the way to 1995.
Okay, end of 95.
In between there was a break,but it is.
That was the time I spent atRoss University.
Speaker 2 (04:25):
Okay.
So when you were in Caribbeanmedical schools, what was the
condition?
What did you see?
How the students were treated?
Were these top quality studentsthat were coming to Ross back
in the day?
Were they?
Were you impressed by thestudents that you saw?
(04:47):
Were you impressed by the waythe school treated the students?
It?
Speaker 3 (04:49):
was a very heterogeneous group of students.
They came from many differentparts of the world.
In those days, I saw studentscoming from Pakistan, from China
.
Directly from Pakistan, yes,directly from Pakistan.
Directly from South Africa.
Directly from China.
Directly from Pakistan, yes,directly from Pakistan.
Directly from South Africa.
Directly from Taiwan, Okay so,and most of them were, of course
(05:15):
, from US, Very few from Canada.
So I met those students fromdifferent.
But this strange thing was, andvery interesting thing was,
that some of the for example, Istill remember a student from
Taiwan who couldn't speak orunderstand English, but he, that
(05:36):
student, was admitted to RossUniversity.
Speaker 2 (05:41):
Okay, and was the process more or less the same?
They come here, takes USMLE andthen become physicians.
What was the hope for these?
Speaker 3 (05:48):
Those days there was no USMLE.
There was one examination.
It was called ECFMG.
It was called After that.
Well, as time had gone by, thenwe were told that there will be
no US assembly.
There will be a VQE VisaQualifying Examination.
(06:10):
And those who took the test,they told us that it is a
political examination, not anacademic, because the failure
rate was very high, deliberatelymade students to fail.
But anyway, it's a visaqualifying examination and after
(06:33):
that that test was scrapped andthen they started what is
called USMLE.
Okay, and I think USMLE startedsometimes around late 80s or
mid 90s, early 80s, 90s, aroundthat time.
Okay, but the students'population it was a
(06:56):
heterogeneous group.
There were some very goodstudents, very bright, what we
call A grade students.
Some were very poor goodstudents, very bright, what we
call A grade students.
Some were very poor qualitystudents.
But admission was open.
Anybody could come get in well,irrespective of their grades.
Speaker 2 (07:16):
Okay, and as far as the prospects of the students
once they come from, so was themajority of students from
international geographies orwere the majority from USA,
majority from USA, and what werethe career prospects of the
students in the late 70s, early80s when they finished from?
Speaker 3 (07:37):
Ross bleak.
I particularly remember oneinstance that you see, in those
days Ross University was tryingto get accreditation from New
York, new Jersey.
In those days New Jersey alsoneeded their Department of
(08:02):
Education, approval from theDepartment of Education to let
these foreign medical studentsto get into hospitals in New
Jersey.
So New Jersey delegation camein.
We encountered them.
New York came in at least fivetimes, and then California came
in also, and then Californiacame in also, these three.
(08:24):
So we encountered those threepanels.
New York I personallyencountered at least five times,
new Jersey at least three times, because each time they were
rejected.
But California, well, they justcame, they saw whatever they
(08:48):
saw and they approved With NewYork.
I remember the students weresitting together with the
faculty and the panel on theother side of the table.
The panel was sitting and thepanel asked the student that all
the money that you are spendingin this school, what happens if
you don't get into residency orsomething?
(09:09):
What happens?
The student, without a blink,in front of the panel, in front
of the faculty, he said I willhave no other option but to
commit suicide.
The situation was so desperatethose days.
Speaker 2 (09:27):
So do you think that that situation has improved
today, dramatically improved?
Speaker 3 (09:32):
Okay, how so Dramatically improved, in the
sense that in those days it wasnext to impossible for students
to get into teaching hospitalsfor clinical rotation Out of the
question.
One instance is that we weretold that in Florida, ross
University has applied wrote toevery single hospital in Florida
(09:56):
.
I don't remember exactly thenumber of hospitals they wrote
to and that but every single.
Well, they wrote to thehospital requesting them the
possibility of accepting theRoss University student for
clinical rotation, but of course, ross University promised to
(10:21):
pay to the hospital, but everysingle one of them declined.
All right, now, that was thesituation.
Only one hospital agreed to takethe students and we were told
(10:44):
by one of the insiders of RossUniversity administration that
the one who agreed thathospitals was threatened by the
hospital association that if youaccept any student from this
institution, we will expel youfrom the UDL.
That's the situation we willexpel you from the UDL.
(11:05):
That's the situation we haveheard every now and then.
The teachers used to tell usthat they are getting frantic
requests from students that ifthey could help the students to
get into a decent hospital wherethey can learn something,
because right now, wherever theyare, they're either clinics
(11:28):
working as an orderly of thephysicians or in the hospital.
Also, they're working as amenial task, so that was the
situation there.
Speaker 2 (11:41):
So was there no ability for them to?
Or when did they start becominglicensed physicians?
Because Ross has thousands andthousands of graduates,
obviously.
So when do you think that thatparadigm changed and students
started getting physicianpositions, so Ross started?
(12:02):
I think you were in the firstinaugural year of Ross
University.
Speaker 3 (12:06):
No, ross started in 79 and I joined in 81, two years
later, but the situation wasreally very, very desperate.
But we have to accept the factthat it is one thing that one
can criticize that it was allbad, et cetera, but they are the
pioneers.
Criticized that it was all bad,etc.
(12:30):
But they are the pioneers.
So before them they didn't knowexactly that because the Ross
University, like all otheruniversities, at that time there
were three universities One wasSt George's, another was AUC,
american University of theCaribbean, and the third one was
Ross University.
These were the mainuniversities that we knew of.
There may be some other schoolsalso that we didn't know of, but
(12:53):
these schools were being run bypeople who have no academic
background whatsoever.
So they didn't know how theadministration of an educational
institution should bestructured, how they should
function, how they should beadministered.
They had no idea at all.
So they learned it through hitand run, kind of a trial and
(13:16):
error, kind of a process.
But they continued to stick tothe project and they did
everything possible to take itforward, with all the problems
they had, but they didn't giveup.
So that credit must be given tothem.
They are the pioneers.
(13:36):
All the other schools that arenow doing whatever they are
doing, like St James, forexample, has found it relatively
easy to take the institutionforward.
It is because we learned a lotof things from Ross University.
That's the reason.
Speaker 2 (13:56):
Wow, and after Ross you moved on to other Caribbean
medical schools.
Speaker 3 (14:04):
That was SEBA School of Medicine.
Okay.
Speaker 2 (14:07):
And when you were there, did you see any
difference between SEBA and Ross?
Speaker 3 (14:11):
Yes, well, seba had a much easier time.
It is because the owner of SEBAwas working in Ross University
together with me, soconsequently, he learned a lot
of things from Ross, which Rosslearned things the hard way, so
Sabah administration learned alot of things from Ross, and so
(14:35):
consequently, it was relativelyeasy for Sabah University as a
startup, because the experiencerequired as a startup came from
Ross.
Okay, that's the point.
Speaker 2 (14:50):
And in those days.
But did you see any operationaldifferences?
Like was SEWA quote unquote abetter school than Ross, or was
it kind of the same thing?
Speaker 3 (15:03):
Well, the difference was that when we first started
with Ross we saw that theydidn't have any idea as to what
should be the job description ofa dean.
They didn't know, so they hadto collect information, et
cetera.
It took them weeks to puttogether the job description.
To form a curriculum committee,for example, it took them
(15:25):
nearly three months.
But those things were not afactor for Seva University
because they acquired theexperience and creating
promotions committee, creatingcurriculum committee etc was a
routine procedure.
That was not a problem at all.
With respect to clinicalrotation, also, by then, in 1981
(15:51):
, I started and then I joinedSEWA in 1996.
So by that time the students ofCaribbean school were more or
less accepted, so not as wellaccepted as it is now, but still
they were accepted.
They didn't have really thesimilar kind of difficulty.
(16:16):
The students of SEWA did nothave the same kind of difficulty
in getting into clinicalrotation as we saw the students
of Ross University encountered.
Speaker 2 (16:29):
Okay, so during this time with Ross in the 90s and
80s, was there any concept ofaccreditation in the Caribbean
in?
Speaker 3 (16:42):
the Caribbean.
Well, yeah, the concept wasthere, yes, but there was no
well-organized what do you callthat?
Independent accrediting body.
There was none.
Speaker 2 (16:54):
Okay.
Speaker 3 (16:57):
So what came out is that Ross University, for
example, they, after whatinformation they could gather
from St George's, they workedtogether with the government of
Dominica at Ross University toput together an accrediting
(17:21):
panel, accreditation panel bymobilizing the government
officials with the bestavailable resources.
They mobilized them, puttogether an accreditation panel
and I think the Ross Universityadministration used their
(17:47):
political and economicconnection to get it recognized
by the Department of Educationof the US and this is what first
initiated in St George'sUniversity in Grenada, first
initiated in St George'sUniversity in Grenada.
And after that Ross adopted thesame technique and he succeeded
(18:12):
in getting the same kind ofaccreditation by mobilizing the
authorities of the government ofDominica.
But these independentaccrediting agencies that we are
seeing now, that didn't existat that time.
Speaker 2 (18:27):
So during those days was so today.
The competition of Caribbeanmedical schools is gutthroat.
Every year, you see three tofive students start.
Every year, you see three tofive students shut down.
Was it like that back then aswell?
Speaker 3 (18:45):
I think in those days , I think the what do you call
graduation rate was much, muchless, far less, naturally,
because they weren't acceptinganybody.
It was said that anybody whocan sign a check they can get
into the school.
That was the way of thinking inthose days.
Speaker 2 (19:04):
So but what about the competition between the schools
like Ross and St George's?
Were they amicable?
So it sounds like they competedagainst each other or never
formed a consortium or workedtogether to lobby with the
government to get DOE.
Speaker 3 (19:18):
It seems like they all did this independently,
absolutely yes, they werecutthroat competition in the
sense that, for example, it sohappened that there was a
deliberate attempt from eachschool to how to say, to spread
(19:39):
negative propaganda against theother.
And even it so happened thatone of the school would send
agents at the airport and assoon as there are, let's say,
students, new students comingfrom, coming to get admission in
(20:01):
a given school, the otherschool would do everything
possible to take those studentsand put them into their school.
That is what was going on.
That was poaching otherstudents, poaching other faculty
.
That was going on freely, therewas no barrier to that.
Speaker 2 (20:18):
Not much has changed in that regard, though we still
experience something.
But the bigger schools, like us, for example, we don't
necessarily get affected.
But smaller, new schools,that's how they get students.
Yes, what about marketing, likewhen it came to, you know,
reaching out to students?
(20:39):
How did these pioneer schoolsspread the word?
I mean, there was no internetback then.
Speaker 3 (20:49):
You see, unlike St James, those schools, like Ross
University, SEWA, they were verysecretive.
They never involved facultymembers in the process of
preparation for accreditation,Not at all.
Even when they are going to theaccreditation panel, when the
(21:14):
school is submitting applicationfor accreditation.
Those were kept strictly secret.
I don't know why, but that wasthe way things are.
Faculty like now, there arecommittees, et cetera, et cetera
.
Of course there were committeesalso in those days, but as far
(21:36):
as preparation for accreditationis concerned, there was.
Faculty had hardly anypreparation before the panel
actually physically appeared atthe campus and decided to
interview the faculty.
Before that there wasabsolutely no interaction with
(21:58):
the faculty.
Okay, that's it.
Speaker 2 (22:01):
So during that time obviously you worked at Ross and
then you worked at Seva.
Speaker 3 (22:07):
Now just a minute.
You talk about marketing Again.
As far as marketing isconcerned, we didn't know much
about how they're getting thestudents.
They were mostly what is calledtier of cards.
There was a kind of a calendarand in the calendar the tier of
cards, and in the cards all theinformation about the school was
(22:33):
printed.
And then there were agents whowould distribute those tier of
cards to different schools andcolleges and so on.
That was basically, and thenadvertisement in the newspaper,
radio and TV also used toadvertise, in that there was no
computer.
Speaker 2 (22:53):
So obviously you worked at Ross for about 15
years and Seba for about five.
Speaker 3 (23:02):
From 1996 until 2001.
Speaker 2 (23:06):
2001.
But then you so about five, soyou about 20 years.
In those 20 years you conceivedthe idea of St James and you
started St James.
Officially, st James started in1999.
With you know, we got thecharter and all of that and then
(23:27):
classes started in 2001.
But what compelled you tocreate St James?
Because there was alreadyenough like, as you said, st
George's Ross, auc, saba enoughschools.
Why did you want to start StJames?
Speaker 3 (23:44):
Well, the owner of Seba School.
Actually he how do you say hetricked me into this venture
(24:07):
Because that school was in anisland which is owned by the
Dutch and the Dutch was very,how to say, not very cooperative
.
But the fact that in a smallisland like Ceiba that was the
only school, that was the majoreconomic support to the entire
(24:29):
island.
The whole economy of the entireisland was supported by that
school.
So on one hand, the school knewthe importance and how much the
Ceiba's island is dependent.
On the other hand, thegovernment of Ceiba, even though
they were helpless but theywere very mean to the
(24:52):
administration, they were neverpolite, hardly ever they really
cooperated.
So this was a very difficultsituation for SEWA and every now
and then we used to hear, as afaculty member and the students,
we used to hear that the schoolis closing.
Why?
Because the government isasking for complaining that the
(25:16):
school is not paying tax, orschool is not paying this,
paying that, etc.
So every time there is rumorthat the school is closing,
paying this, paying that, etc.
So every time there is rumorthat the school is closing
Anyway.
So I think because of that, theadministration, mainly the
owner of SEWA, who was.
Once upon a time we werecolleagues at Ross University.
He encouraged me to go to goand find another island where we
(25:46):
can start another medicalschool so that in case something
happens to Seva, they will moveto another island.
So it is from there I startedto, with the advice and support
of Seva Universityadministration.
(26:08):
I first approached Anguilla.
That was back in 1998.
Speaker 2 (26:13):
Okay.
Speaker 3 (26:13):
And I had a long discussion with them, all the
cabinets came in, et cetera, etcetera.
But then, even though theyagreed that, yes, we would like
to start a school, but we didn'tget the charter from them,
instead they gave it to someother school.
They gave a charter it wascalled, I think I don't remember
the name of the school but theschool couldn't start because
(26:36):
they didn't have the resourcesto start the school.
So it was actually theadministration of SEWA.
They encouraged me to start.
But when I actually started,well, at that time I proposed
why not Bonaire?
Bonaire was very eager becauseno school wanted to go to
(26:56):
Bonaire, because they used tospeak not so much English but
Dutch.
So the administration of SEWAtold me me it is not a good idea
because if our students can'treally communicate with the
local people, then it will bevery difficult to get students.
But anyway, I reached out toBonnier and Bon.
(27:21):
Then after that they never leftme.
They wanted me further.
In a way they forced me tostart the school there, even
though I didn't have theresources.
But since I started in Bonnier,I wanted to start in Bonnier.
I didn't get any support fromSEVA except some verbal cues
(27:42):
that would do this, do that,don't do this, don't do that.
Speaker 2 (27:45):
In fact it was also important.
Yes, so, as far as the actualreason for starting, what was
the reason Like?
Was it better student quality,was it?
You know, this is a great wayto make money.
What was the reason to start StJames?
Speaker 3 (28:07):
When we saw how the students were treated in Ross
University, I realized and thenfrom there, when I came to SEWA,
I had no intention or plan ofstarting a school.
But from Ross, when I shiftedto SEBA, then me and the owner
(28:32):
of SEBA's university, we used todiscuss that look, we have been
working at Ross University, weknow everything about medical
education.
So if and I also pointed outthat because SEWA stood up on
(28:53):
its feet so quickly, it isbecause of this experience.
So, since we have been workingwith the medical school, it
should be very easy for us tostart something on our own and
we can do it better.
It is out of that conviction Istarted to proceed with Bonaire,
(29:13):
even though Seba told me thatthey.
I realized that Seba will notbe interested in working with me
, but so I continued that sinceI have experience in working at
the medical school, I should beable to do it faster and better.
(29:33):
But that turned out to be awrong assumption.
Speaker 2 (29:36):
So do you think St James isn't better?
Speaker 3 (29:39):
than Ross and St George's and all these.
It's not a question of whetherit is better or not, but when I
started the school, I realizedthat teaching is maybe only 5%
to 10%.
The remaining of it is law, isfinance, is management, of which
we knew very little.
But then, when we are alreadyin there, we had to do
(30:03):
everything, whatever it takes,to learn the techniques, learn
the tricks and go forward.
It was not easy, but we did it.
Speaker 2 (30:13):
So, since you started in 1999 and where we are today,
how do you think the school hasevolved in your view?
How do you think the school hasevolved in your view?
What do you think have been themost the biggest steps that the
school has taken forimprovement?
Speaker 3 (30:30):
You see, we started with 18 students back in 2002.
Well, actually the schoolstarted with students of
clinical rotation Okay, withstudents of clinical rotation.
And at that time, I think inthe year 2000 and 2001,.
(30:50):
I was still working in SEWA andI was still a member of the
SEWA faculty.
I was working there and as anemployee of SEWA, I started the
(31:13):
school, and how, by the owner ofSEWA.
I didn't do it behind his back,I continuously kept him
informed as to how, what we aredoing.
So so he proposed, or hesuggested, the best way to start
is this that you take transferstudent.
So we put an advertisement in awebsite.
The name of the website wasValueMD.
(31:37):
Ah, they're still around.
They're still around?
Yeah, I think so.
Speaker 2 (31:40):
They are still around .
Speaker 3 (31:41):
Yeah, I think so In ValueMD we advertised that we
were starting a school and wewelcome transfer students.
Relatively easily we got acouple of students, transfer
students, and they paid and theytransferred from different
places.
They transferred from differentcountries.
(32:03):
I particularly remember onestudent.
He is now a graduate of StJames and he's now practicing
family medicine somewhere inAtlanta.
He was originally from EthiopiaNot in Ethiopia, but Eritrea.
Okay, there was a war going on,so as a medical student he
(32:26):
couldn't complete his program,so on the halfway he just left.
So he came to the US and so heenrolled and we gave him credit
for everything that he has donein Eritrea.
So he straightaway started withclinical rotation.
That was our first student.
So like that we got about maybehalf a dozen students who paid
(32:50):
and this is how we started StJames Until we reached a point
where I discussed with the ownerof SEWA and he said yes, now
you can go and start your basicscience.
So there was no, really I wasnot operating behind his back
(33:11):
and it was he who actually gaveme a copy of the agreement that
they had with SEWA and that copyof the MOA, of the agreement
between SEBA University and thegovernment of SEBA.
That was the basis based onwhich we concluded the agreement
(33:37):
between St James and Bonaire.
Speaker 2 (33:41):
Okay, and have you seen any changes since the
school started in 1990?
A lot of changes.
Speaker 3 (33:48):
The first thing that happened was we acquired the
building of an old school theschool that was existing.
It shifted to a new building.
The old building was abandonedexisting.
It shifted to a new building.
The old building was abandonedand the government gave us that
building almost free, free ofcost.
(34:08):
So it was the whole facilitywas available.
But anyway we had to spend somemoney to retrofit and make it
suitable for classrooms.
But that took time.
But by the time the first groupof 18 students came in they
started their classes in a motelcalled dv flamingo.
(34:32):
In their hall the classroomstarted.
The first md1 started therewith two faculty members.
That's how things started.
And then we gradually built.
This, improved the quality ofthe classrooms and this is how
(34:52):
things improved.
But it took quite some timebefore we could really make it,
brought it to a standard whichis acceptable and presentable.
Speaker 2 (35:06):
So, along the journey , this 25-year journey, what are
the biggest highlights for youin the development of St James?
Speaker 3 (35:13):
Number one was that we could get students, place
them in clinical rotation.
It was very difficult to get intouch with the hospital
authorities and persuade them totake our student.
That was one that graduallychanged and improved and that
(35:37):
was one Then.
Second was, in those days therewas not much of a restriction
with respect to whom we canaccept, enroll as a student, and
then it was relatively easy toget faculty to teach the course.
(35:58):
Relatively easy it was.
It was, and we also had thepossibility in those days we had
the possibility of acceptingstudents who are in their, who
are PhDs.
For example, they could enrollas a medical student and at the
same time teach.
So the student teacher.
So that was a cost-cuttingdevice that we could use was a
(36:22):
cost-cutting device that wecould use.
So those were some of the stepsthat we made use of and that
helped the school to moveforward.
Speaker 2 (36:36):
Okay, any other milestones along the way?
Speaker 3 (36:43):
Well, it was not easy to get more and more students.
But our cost was also quiteless because the faculty salary,
because of the student faculty,student cum faculty, we used
quite a few of them, quite a fewof them, some of the faculty
(37:06):
member was employed to teachmultiple course like anatomy and
embryology, pathology andhistology, like that, that kind
of combination that was allowedin those days.
There was no restrictions inthat, so that way we could cut
down the cost.
And it was usually.
The classes were small,anywhere between 12 to 15
(37:26):
students in a class.
So administration was not verycomplicated either and we didn't
need a large office, many staffbecause limited number of
students.
Everybody could be accountedfor, everybody could be
accounted for.
So that way it was more easierand simpler to manage the entire
(37:49):
thing.
But then as time went on wecould see that there are more
and more students are applying.
So when we saw and ourmarketing was not because, there
(38:25):
was no online marketing, etc.
etc.
It was again the tier of cards,distribute them through agents,
etc.
The marketing has changeddramatically.
Now.
Teaching has changeddramatically also, and we are
getting better quality ofstudent also.
We are getting better qualityof students.
Speaker 2 (38:42):
Okay, and as far as hospital relationships are
concerned, do you think thatthat's improved over time?
Speaker 3 (38:50):
Yes, it has improved, but it was in those days.
Nobody knew how to reallyimprove the relationship with
the hospital, improve therelationship with the hospital.
Our first how to say encounterwas when the Dutch accreditation
(39:12):
team visited our campus inBonaire.
It was called NVAO, and whenNVAO came in after the first
encounter with the panel, werealized that we are way, way
behind the point where we canget accreditation.
(39:34):
So it is through theircriticism we learned a lot about
how to close the gap and withmeticulous care we used their
recommendations and that is howwe made relatively rapid
progress in closing the gap andthat helped us to reach the
(39:54):
point where we are now.
Speaker 2 (39:56):
Okay, if you were to look back and do things
differently, what would you dodifferent while starting St
Leo's?
Speaker 3 (40:08):
Yeah, that's a very difficult question but given the
existing circumstances,difficult question.
But given the existingcircumstances that now
everything is computerized,everything is high-tech, well,
it is not a question of what Iwould do differently, but we are
forced to adopt a differentmarketing strategy, a different
(40:30):
teaching technique, differentcounseling system.
So everything has to bedifferent.
So, whether we like it or not,but well, because of the change
in the environment, social andsocial, economic and political
environment we have to do thingsso that in order to adapt to
(40:54):
this change situation.
But in terms of relationshipbetween the student and the
faculty, I think thisrelationship is.
Now we know we have a muchbetter experience in how to
(41:15):
really help the student to goforward in reaching their goal.
We know that.
So I wouldn't say that I woulddo differently, but in those
days these things were simplynot known to us.
Speaker 2 (41:29):
Okay, and would you say that it's not known to us,
as in St James, because wedidn't have the resources?
Or was it just across the board, not an application to pedagogy
?
Speaker 3 (41:47):
Both.
Speaker 2 (41:48):
Okay.
Speaker 3 (41:48):
Yeah, I think both.
I think both because, you see,it is well, whatever experience
I inherited, it is I was ateacher, I was teaching a
subject.
It is one thing that you teacha institution where you are
responsible for not onlyteaching but finance, but
(42:24):
administration, relationshipwith the government,
relationship with marketingagencies, vendors, etc.
It's a very differentexperience altogether.
So the experience that we had,we inherited, is by no means
(42:48):
adequate in order to start aninstitution and bring it to a
point where it can becompetitive.
Speaker 2 (42:50):
So what would you have done different?
I think we would competitive.
Speaker 3 (42:55):
So what would you have done different?
I think we would deal with thegovernment in a different way,
not the way we did before.
Then we would probably domarketing in a different way.
Well, it is a wishful thinking,but I don't see how, even
though we knew that.
Well, in those days we didn'tknow how to market.
(43:17):
What do you call that onlinemarketing?
How to do that didn't exist atthat time, but so we did
whatever we could in order topromote our services.
In order to promote ourservices, and well it was.
The result was not really asgood as we expected, but in
(43:42):
those days, we thought that weare doing the best we can, okay.
Speaker 2 (43:49):
That's it.
So, just generally speaking, ifsomebody came and told you that
you need to start anotherCaribbean school tomorrow, would
you do it Tomorrow?
Tomorrow, given the currentcircumstances and climate, would
you want to do this all overagain?
Speaker 3 (44:10):
Yes.
Speaker 2 (44:11):
I would do that, okay , yes, yes, we do that, okay,
yes.
Speaker 3 (44:13):
And well, you can see that it is very clear that when
we first started Bonair it tooka long preparation and that too
we had the support of a veryexperienced individual who
actually started Sabre.
He was actually behind usgiving different kinds of
(44:36):
suggestions etc.
So that resource was available.
But for us when we started that, it took a very long time
really to stabilize and the mostdifficult part was this
poaching of students, poachingof faculty by some other
(44:58):
competitors, etc.
That was a very difficultsituation.
So by the time Bonnier Bonnierstarted in, let's say 2002,
around that time by the time wemore or less stabilized, it was
say 2010.
Speaker 2 (45:16):
Okay.
Speaker 3 (45:16):
And in 2010, we started Anguilla.
So actually it took aboutnearly six to eight years to
start Bonair, to stabilizeBonair.
Speaker 2 (45:29):
Okay.
Speaker 3 (45:30):
But then when we started Anguilla the moment we
started in 2010, it was alreadyon its feet and it hardly took
about maybe less than a year togive it a start and have a
relatively strong base Then fromAnguilla.
When we then relocated, weclosed down Bonaire and then
(45:53):
relocated to St Vincent.
St Vincent was a few weeks only.
So, as you see, bonaire took somany years, anguilla took less
than a year and St Vincent tooka few weeks.
So, as you can see, theevolution, experience and
resources definitely has itsvalue.
Speaker 2 (46:17):
Let's talk a little bit about the money.
I know St James is one of themost cost-effective programs in
North America.
What are your views on that?
Speaker 3 (46:40):
well.
Well, first of all, I alwaysfelt well I saw that when I was
at ross university that thewhole administration was
mobilized in order to squeezemoney from the students.
The way they used to threatenthe students, treat the student
to make sure that the studentspay their fees on time, I felt
(47:03):
it was very unprofessional.
But looking back, I can seethat there was no support from
any quarters.
Students' fees were the onlysource of income, so they
probably had no otheralternative.
However well, I was thinkingthat an institution, when it has
(47:29):
its expenses and this expenseincludes all the salaries and
fees, etc I never understood whyit is necessary to make profit
out of this institution and takethat profit somewhere and
invest it somewhere else andmake more money.
This I never understood.
(47:50):
So that's, that is one and thesecond, when I came to
Scandinavia, in Scandinaviaeducation is free.
It's at the expense of thestate, so there is no tuition
fee there.
That's the reason why I couldget into the Scandinavian Danish
(48:12):
University and FinnishUniversity without paying a cent
, and I could get into theScandinavian Danish university
and Finnish university withoutpaying a cent and I could get an
education which has helped meto go forward and even to make
the school so.
Right from the beginning Inever thought that the
institution should be built tomake profit no, ever thought
that the institution should bebuilt to make profit no.
(48:33):
So we will build theinstitution and train boys and
girls to become a physician, andwhatever it costs, as long as
that cost is recovered, weshould be satisfied.
It is out of that considerationI started.
It is out of that considerationI started.
But then, when I started StJames, then I realized that it
(48:57):
is necessary to generate somesurplus, not because we want to
make more profit, but with thatsurplus you never can tell there
are bad times that may come andthat surplus can be used.
And this is exactly what hashappened in the case of St James
and that fortunately, wegenerated surplus and that is
(49:20):
why, at the time of need, wecould use that surplus.
But I still think that it isnot a good idea to use an
institution like this to makeprofit by cutting corners and
maximizing profit.
I don't think that's a goodidea.
Speaker 2 (49:42):
Okay, well, thank you so much, dr Guha, for the
insight.
It is fascinating to hear thatyou have been working in
Caribbean medical schools forabout 42, 43 years.
Now the entire industry isabout 47 years old.
(50:05):
Yes, Sort of, but again, Ithink it is that guidance that
has gotten us to where we are asone of the best and one of the
biggest Caribbean schools, andwe've always taken a path that
is very different from bigbusinesses and big schools that
(50:26):
are run by private equity, andhere's a firsthand look at what
that is.
So thank you so much for yourtime.
One parting question is in theyears to come, where would you
like to see St James?
Whether it's five years, 10years, 20 years, what would you
like to see of St James?
(50:47):
How would you want St James tostand out from the rest of the
possibly 75 plus Caribbeanmedical schools?
Speaker 3 (50:56):
Well, I think that we already are doing certain
things, which is significantlythat in a way, segregates a
school like St James from others, and that is our research is
very strong.
Some other school, most of theother schools, they have no
research whatsoever, but we havedeliberately established a
(51:20):
research wing and it is workingvery well.
So that is one part of it.
It's an academic institution,so consequently it should be.
I think administration shouldrealize that.
I mean, the students should notbe seen as a source of profit.
(51:44):
That's one of the things thatyou, administration, should pay
attention to.
That's one.
And the second is thateducational institution is, and
it should be designed to notselect student but condition
(52:05):
student to do well.
Why am I saying this?
Is because it's because duringmy days in Finland and also in
Denmark, I saw that studentscome from different backgrounds
and the administration of theuniversity, they know, they
realize that students comingfrom a cosmopolitan city they
(52:32):
react and they handle theexisting education system in one
way.
But students who come fromrural background, in the deep
interior, in the villagecircumstances, they cannot be
(52:58):
put together with these urbanstudents from the urban
environment and expect them todo same kind of result, so they
have a different.
The institution has taken itfor granted that these students
from deep interior villages,their instruction should be
different and they should betreated, treated differently.
So right from the beginning,from school onwards, they have
established a system ofeducation, an inverned system of
(53:21):
education, where the studentsfrom deep interior villages are
segregated and treateddifferently, but they do pass
the same examination andultimately get into the
professional life and they dowell.
That concept is very difficultto implement in a place like
this because the mindset iscompletely different.
(53:44):
So I believe that aneducational institution should
be conditioning students.
They should institution shouldpush the student up and not
select the student as oh, yourgrade is very poor, you cannot
come in, so you are dismissed.
That's very unfortunate.
I am totally against.
(54:06):
But once I express this kind ofopinion to an accreditation
panel and they were very upsetto hear that kind of opinion
from me.
So I realized that you cannotreally express ideas which
(54:32):
doesn't fit into the rightenvironment.
So I have learned to useexpressions that fits into the
environment.
That's it.
That is one.
And the second is that I thinkthat an institution, when it is
imparting education to thepeople, and this institution, I
(54:58):
have not designed thisinstitution to make profit.
So, on the other hand, it isvery clear that one person, or
two person or a family cannotpossibly create an institution
like this.
It's a contribution, it's ateamwork.
The many people have workedtogether.
So, going forward, it would bemost appropriate and most
(55:23):
logical to consider that thisinstitution should be an
employee-owned institution andnot an individual or a
family-owned institution.
But again, I tried to implementthat kind of system in here and
in fact I also talked to theUniversity of Wisconsin.
(55:45):
They have an employee-ownedenterprise, a big department.
We had a long discussion,enterprise big department.
We had a long discussion.
They came to our office and wehad a long discussion and they
told me that, look, this ideathat you're trying to implement
is very advanced for theenvironment where you are.
(56:05):
What you need to do first thing, first step, is to introduce a
cooperative culture among youremployees.
Unless you do that, you cannotimplement this.
And well, it is like how to sayif and when that situation
(56:28):
comes.
Then you people can think inthat light.
But it's very time-consumingand it cannot be achieved in one
generation.
Speaker 2 (56:39):
Thank you so much, dr Guha, and we hope that this
particular school lives up toyour expectations.
I genuinely think that ourschool is very, very different
and, as you pointed out, thatstudents are not we are not a
profit-driven school.
We are a people-driven school,and that's largely the vision
(57:02):
that you have instilled in theentire upper management that
runs the school.
So thank you so much foreverything that you do and thank
you to all our supporters andstudents.
We really appreciate all thesupport.
We just also want to point outthat you know a lot of hard work
goes into developing thesepodcasts, and give us a like,
(57:23):
give us a follow, please.
If you like the content,download the content at Spotify,
google or wherever, whicheverplatform you choose.
Again, please remember there'sno shortcut to becoming an MD.
Speaker 1 (57:39):
Thank you so much for tuning into our show.
We hope you enjoyed anotherepisode of Med School Minutes.
If you like our content, pleasefollow us and receive
notification when a new show isposted.
This podcast is brought to youby St James School of Medicine.
For a video version of thispodcast, please check us out on
sjsmorg slash video.
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