Healthcare system short of breath!

Medics have opined that the Government should prioritise purchasing medicine and the procurement should be done in a streamlined manner  (Pix by Pradeep Dilrukshana and Kushan Pathiraja)

Right now LRH is short of 30-35 critical drugs and there’s a risk on children’s lives

The government has to prioritise issuing fuel to healthcare workers

Critics point out that without the required political and economic stability the country cannot establish health security

The death of a two day old infant reported from Diyatalawa during mid-May sent shock waves across social media platforms. This death had been the 86th autopsy conducted by Dr. Shanaka Roshan Pathirana the Judicial Medical Officer at the Diyatalawa Hospital. His account published on his Facebook wall read that the infant who had been feeding less on breast milk had turned yellow and due to a low sugar level he had to be admitted to hospital.

“However the father had been unable to find petrol for his three-wheeler for about an hour. By the time the child reached the Haldummulla Hospital the sugar level had been at 22mg/dL. The infant had been gasping for breath when they reached the Diyatalawa Hospital. If there wasn’t a one-hour delay, the child could have been saved,” the account read. Such is the plight of children and patients in Sri Lanka today. As medicine supplies are on the verge of running out of stock and Sri Lanka continues to depend on the Indian credit line, medical experts question for how long the country would be able to survive with aid and donations. 

LRH short of 30-35 critical drugs
Speaking to the Daily Mirror about the ground situation of the medicine shortage Lady Ridgeway Hospital’s Deputy Director Dr. Santhushitha Senapathi said that they need around 2500-3000 drugs at the hospital. “Out of them 90% are being imported. We require consumables for cardiothoracic and bone marrow transplants. Right now we are short of 30-35 critical drugs and there’s a risk on children’s lives.”

Dr. Senapathi said, for example, that many consumable are required for cardio-thoracic surgeries. “Already we have published a list of medicines required on our website along with the percentages, donors etc. We don’t accept donations from third parties except for donors from overseas. These donors can directly get in touch with us and send the donations. On the other hand we can’t depend on donations forever because it is a difficult period for everyone,” said Dr. Senapathi. 

The fuel shortage has also affected everybody from consultants to minor staff. “In case of an emergency a doctor will have to report to work at night, but if there’s no fuel how can he? There’s a suggestion to issue fuel for healthcare workers on Fridays, but that won’t be practical. The government has to prioritise issuing fuel to healthcare workers. Nurses and other staff cannot commute to work. Those in outstation areas are unable to come regularly and there are limited residential facilities as well. However, we don’t plan to close down operations at LRH as at now,” said Dr. Senapathi. 

“Aid alone won’t help”: Dr. Haniffa 
Confirming what Dr. Senapathi previously said, Consultant family physician and former President of the Sri Lanka Medical Association Dr. Ruvais Haniffa said that there aren’t sufficient insulin or consumables. “Hernia operations have been postponed till July and only emergencies are being attended to. Routine surgeries have been postponed as well. The shortage is becoming acute by the minute. One issue is that we haven’t paid suppliers and therefore they are unable to send medicine. On the other hand doctors cannot report to work due to the fuel shortage,” said Dr. Haniffa.

Dr. Haniffa anticipates that if the situation continues there could be some acute deaths in the coming months. “There are more road traffic accidents taking place now. There are heart patients and people with high blood pressure etc. There are no medicines in case of an emergency. Even though we had an effective healthcare system it is inefficient now. The private sector is also affected in this situation. Although there are donations coming in people are doing that out of goodwill and supporting an inefficient healthcare system to continue. However without any political and economic stability we cannot establish health security,” said Dr. Haniffa. 

Even though Sri Lanka is receiving medicine through the Indian Credit Line and in the form of humanitarian assistance from allies Dr. Haniffa opined that aid alone won’t help. “The Opposition and the Government have to get together for us to get out of this mess. Politicians should start sharing success and failures together,” said Dr. Haniffa. 

“Medicines and devices in short supply”: Dr. Bandara 
“There are two factors affecting the healthcare sector at this point, said All Ceylon Medical Officers Association Secretary Dr. Jayantha Bandara. “One is that there’s a possibility of a shortage of critical life saving drugs. On the other hand members of the hospital staff have challenges reporting to work. Hospital staff in Anuradhapura, Ratnapura and Kalutara, for instance, have found it unthinkable to commute due to the fuel shortage. Therefore the healthcare system is now at a risk,” said Dr. Bandara. 

When asked about the budget required to import medicines Dr. Bandara said that such an estimate hasn’t been given. “Even though there was an allocation of Rs. 61 billion for the health sector last year certain allocations have not been given by the treasury. But due to the dollar crisis we are unable to import now. We need around 3000 varieties of medicines, 7000 odd consumables and around 5000 reagents. The majority of medicines are being used to treat people with non-communicable diseases. As such we need a big budget, but due to limited availability of stocks these medicines and devices are now in short supply.

“Therefore what we suggest is to import raw materials with the intervention of the State Pharmaceutical Corporation,” he continued. 

“This way there won’t be an opportunity for intermediaries to make a buck. We can hold discussions with medicine manufacturing countries such as China and Russia. Through an international tender process they can then send these materials,” added Dr. Bandara. 

“Disaster management plan a must”: Kumudesh 
Another suggestion has been to compress the healthcare system while moving into a disaster management plan. “The Government now has to prioritise between essential and non-essential activities,” said Academy of Health Professionals President Ravi Kumudesh. “For example even though there are HIV awareness programmes there are limited HIV strips or condoms available. There are dengue awareness programmes but no DDT available. There are no antigen kits to perform full blood counts. People have now neglected the healthcare system because one thing is they cannot travel and the other is that they have other things to worry about other than health,” said Kumudesh. 

He said that there needs to be a proper management as well as a good output in terms of an effective and sustainable healthcare system. Kumudesh also suggested sending medical professionals for employment overseas as it would generate more foreign remittances. “There’s a dearth of caregivers following the pandemic. But when we say caregiver it’s usually a nurse. At present Sri Lanka is not in a position to send nurses overseas, but they can send other medical professionals after they receive a caregiving certificate,” said Kumudesh. 

Will people die without medicine?
“Sri Lanka is on the verge of reaching a point where people will die without medicine,” warned Government Medical Officers Association Secretary Dr. Haritha Aluthge. “There are minimum stocks available for critical life saving drugs and there aren’t at least 50% of these drugs at this point. If the stocks aren’t renewed in another two weeks time there would be a huge problem. The Government should prioritise purchasing medicine and the procurement should be done in a streamlined manner. They should setup a proper distribution chain and drug purchasing should be done via the State Ministry. Initially it was done via the state ministry, but it doesn’t function anymore. As such the entire mechanism has collapsed,” said Dr. Aluthge. 

He further said that stocks should be distributed equally. “If the Polonnaruwa Hospital has a certain drug for three months the Anuradhapura Hospital has it only for three weeks. That cannot happen. Equity of medicines is a must. On the other hand donations too need to be managed. If donors have second thoughts about donating medicines to the Health Ministry then a focal point should be setup to manage donations. A donor is usually a civilian and he wouldn’t know whom to contact. Therefore there has to be someone who can coordinate the process,’ said Dr. Aluthge. He further said that if the prevailing situation aggravates there will be a point where people will die without medicine.

St. John’s Ambulance Brigade assisting people
The St. John’s Ambulance Brigade has been at the GotaGoGama protest site since its inception. Apart from treating victims of tear gas attacks and those who were injured during the May 9 attacks, the St. John’s tent is being visited by people on a daily basis. Even amidst a medicine shortage, the health officials are determined to provide medicines to those in need. “If a patient is unable to find a certain drug and visits this tent we will make sure that they get the drug,” said Dr. Ahamed Amhar, District Medical Officer, St. John’s Ambulance Brigade. 
“We have also started visiting people at fuel and gas queues. One of them hadn’t had any food for three days and he was surviving on water. He said that he didn’t want to leave the three-wheeler and go anywhere. Pressure levels of these people have gone up to 180-200 mm/Hg. Therefore we go with a team in our ambulance, check on critical patients and provide medical assistance accordingly,” Dr. Amhar further said. 

Minister denies shortage of medicine 
However addressing a media briefing Health Minister Keheliya Rambukwella denied claims about a drug shortage and added that the situation isn’t uncontrollable. “Some have said that we are short of 14 critical life saving drugs and that people would die without them. But there’s no such issue even though we had a problem with anti-rabies medicine. However, that too has been rectified. There was a shortage of about 51 medicines out of 664 essential medicines, but this has been brought down to 49 or so. In any case there won’t be a situation where a patient will be deprived of medicine due to any shortage,” the minister said.

Long waiting queues in hospitals
A letter signed by several cardiac surgeons with the subject ‘Curtailment of Heart surgeries’ states that due to the shortage of drugs and consumables and the fuel crisis the surgeons have restricted cardio-thoracic operating lists. The letter had been addressed to the Director General of the National Hospital Sri Lanka (NHSL). However the majority of patients who visit the NHSL also happen to be heart patients and patients with non-communicable diseases. The Daily Mirror visited the OPD clinic at the NHSL to speak to patients awaiting medicines and treatments. Here’s what they had to say: 

“Waiting for 2 hours for a number”  
L.B. Somalatha from Kiribathgoda has been waiting for 2 hours to get a number for her next appointment. “I get headaches and the doctor said there are internal wounds in my head. I have to meet the doctor once a month, but today I’m still waiting to get a number. Hopefully I will get one. There is a medicine shortage as well, but so far I got my medicines from the hospital. I don’t know what the situation would be like from today,” said Somalatha. 

Somalatha

“Can’t afford medicine from the pharmacy”  
Sudarma Kumari’s husband is a heart patient. She has been standing in a queue for more than an hour, anticipating what time her husband will be taken for a checkup. “We usually got medicine from the hospital and we have to buy whatever they don’t have from the pharmacy. But it’s difficult to afford medicine from the pharmacy given the current economic situation,” said Sudarma Kumari.

Kumari

“Unable to get all prescribed medicine from the hospital”  
J. M. V. Jayaweera from Ketawalamulla is also a heart patient and was seated anticipating his turn to get medicine. “I have to come for a monthly checkup, but today there’s a long queue. I’m a heart patient, but lately I haven’t been able to get all the prescribed medicine from the hospital. But even though it’s costly I have to buy them as I have no other option,” said Jayaweera.

Jayaweera

“The wait is hectic” 
Mohamed Zunoon and his spouse from Dematagoda had been waiting to get medicine for nearly two hours. “I too have difficulty walking and this wait is hectic. Today the process is even slow perhaps because doctors cannot report to work due to the fuel issue. On the other hand it’s costly to purchase medicine from the pharmacy. But we have no option either,” said Zunoon

Zunoon

“Now I get medicines only for a month” 
Ukwattege Somapala has to visit the doctor every month to get medicines and treatments for various ailments and illnesses. “I have high blood pressure, cholesterol and I depend on medication. Initially I got medicines that are sufficient for two months, but now I get medicines only for a month. I hope the hospital would continue giving medicines because I cannot afford buying from the pharmacy,” said Somapala.

Somapala