The above caption is the title of an article written by Dr. Kamran Abbasi, Editor-in-Chief of the BMJ. In it, he laments the extremely high cost of medical training, with young UK medical students burdened by an unbearable debt of around £100,000 by the time they qualify—often before they’ve earned a single penny.”

Dr. B. J. C. Perera responded to the article on 12 April 2025 by e-mail, and his response was published promptly. (doi: https://doi.org/10.1136/bmj.r744/rapid-responses).

His response is as follows:

Re: Why we should forgive debt for poorer countries—and medical students: Another perspective from Sri Lanka

Dear Editor,

The BMJ article “Why we should forgive debt for poorer countries—and medical students” certainly gives food for thought.

The real problem is that the students have to pay for everything in Western countries. Nothing really is free. There is also the cultural norm that instigates young people to leave the homes of their parents and be independent. There is a very real cost to getting educated, and this continues with post-graduation as well.

As for our country, Sri Lanka, hardly any young doctor who qualifies is saddled with an unbearable financial burden in the form of a repayable loan. Almost the vast majority of them operate as medical students from the homes of their parents, and the latter attend to the expenses. The university education is totally free, and there are no tuition fees or any other payments to be attended to. Only a very small minority of medical students take Bank Loans, and even in those, the amounts are not even remotely close to Stg pounds 100,000 which figure was quoted in the paper.

We may have our faults, but we do look after the primary, Secondary and Tertiary education of our young people. I am also a product of our free education system. If my parents had to pay for my education or I needed to get a massive bank loan, I would not be what I am today. In return, I have stayed back in Sri Lanka and repaid in full the debt I owe to our people by providing my services in our free National Health Service.

Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed,
FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of
Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
Past President, Colombo Medical School Alumni Association (CoMSAA) – 2015
Past President, Sri Lanka Medical Association (2013).

Founder President, Sri Lanka College of Paediatricians (1996-97)