Crumbling health services: Drugs running out, surgeries cancelled in Sri Lanka  

Eight years ago, Rosanne White was stricken with cancer and lost a kidney. After her cancer reappeared five years ago, an oncologist in Colombo, Sri Lanka‘s commercial hub, started her on Bevacizumab in May of last year, and she responded well to the medication.

White, a 58-year-old retiree from Sri Lanka, claimed she receives the shots for free as part of the country’s universal government health system, which the great majority of the country’s 22 million people rely on.

However, White claims she can no longer find the injection in government facilities after 13 rounds of treatment.

In the private market, bevacizumab costs 113,000 Sri Lankan rupees ($359) every shot, and White said the prices were eating into her limited funds because she did not have insurance.

“Before going in for treatment, we have to phone the hospital to see if our medication is accessible,” White told. “However, what do you do if the nurses inform you that the hospital is out of the medication?”

White’s inability to obtain Bevacizumab in state-run facilities is an early symptom of how Sri Lanka’s healthcare system is on the verge of collapsing under the strains of the island nation’s worst economic crisis. In addition to medicine shortages, numerous operations and tests have been halted.

President Gotabaya Rajapaksa’s government has been unable to import essentials such as medications and fuel due to a lack of foreign exchange, resulting in devastating power outages and driving hundreds of demonstrators to the streets demanding his removal.

Because of a scarcity of surgical supplies, an internal memo from a major state-run hospital in Colombo stated that only emergency, casualty, and cancer surgeries will be performed from April 7 onwards.

The COVID-19 pandemic has decimated the economy, which is primarily reliant on tourism, as well as the rapid spike in oil prices in the aftermath of the Ukraine crisis, which has made importing enough gasoline prohibitive.

Rajapaksa’s administration has also been chastised by several analysts for its choice in 2019 to implement deep tax cuts and postpone discussions with the International Monetary Fund (IMF). Those talks are now moving forward.

The tax cuts, according to a close adviser to the Rajapaksas, were intended to promote the economy, but COVID-19 intervened.

Sri Lanka currently has only $1.93 billion in foreign exchange reserves, which is hardly enough to cover a month’s worth of imports, while government debt repayments of double that amount are due in 2022.

Last Monday, the Sri Lanka Medical Association, the country’s oldest professional medical organisation, wrote to Rajapaksa, warning him that even emergency procedures could be halted in the coming days.

According to the association, “this will result in a catastrophic number of deaths.”

A 70-year-old woman was taken into a government-run tertiary care hospital in a Colombo suburb in late March. Septic shock had set in, resulting in dangerously low blood pressure.

The doctor in charge of the emergency advised the patient needed to be injected with albumin as soon as possible.

“It wasn’t available in this case,” said the doctor, who did not want to be identified because hospital medical staff are not allowed to speak to the press. “Which implies I squandered a valuable five minutes.”

According to the doctor, the patient passed away.

Three life-saving medicines have totally run out of the 1,325 drugs the government gives to state-owned hospitals, and another 140 important medicines are in poor supply, according to the secretary of Sri Lanka’s pharmaceuticals ministry.

New sources of supply, on the other hand, might help alleviate immediate shortages, he said.

Some pharmaceuticals ordered through a credit line with India, which supplies 80% of the island’s needs, are expected to arrive within two weeks.

“There won’t be a problem for the next six months if this Indian credit line works,” Rathnayake added.

Sri Lanka has also approached the World Health Organization, the World Bank, and the Asian Development Bank for assistance. “Their things will arrive in six months,” he said. “That’s exactly as we intended it.”

Some doctors’ organisations have issued public pleas for donations due to a lack of supplies.

The Perinatal Society of Sri Lanka produced a list of goods that can be donated through the health ministry after running out of endotracheal (ET) tubes, which are used to aid newborn infants with respiratory distress.

In a letter circulated on social media, the society’s president, Saman Kumara, stated, “We have practically used up all the inventories, and no ET tubes will be available in a few weeks.”

“I’ve told (staff) not to throw away discarded ET tubes; instead, clean and sanitise them from now on in case we need to reuse them.”

More than 40 products were listed as out-of-stock on a list obtained by Reuters from a major state-run hospital in southern Colombo, including urethral catheters, various types of tubes, umbilical cord clamps, and glucose test strips for testing blood sugar levels.

Late last week, a swarm of patients waited in a huge, brightly illuminated hall at a major government hospital in northern Colombo on plastic seats and wooden benches.

According to an official, the hospital, which receives over 50,000 patient visits every month and employs slightly over 2,500 people, is one of the country’s major urban health centres that services numerous districts.

“We’re still struggling,” the official added, requesting anonymity for himself and the hospital. “However, I’m not sure how long we’ll be able to keep services running.”

As early indicators of a looming catastrophe were apparent in August, the official stated that the hospital halted infrastructure improvements and significant renovations, redirecting funds to bolster medical supplies.

The cost of medical supplies has jumped by 30-40 percent in recent weeks, according to the source, after Sri Lanka depreciated its currency amid increasing inflation, putting more strain on the hospital’s finances, which are already 350 million rupees ($1.11 million) in debt.

According to Rathnayake of the pharmaceutical ministry, the government owed roughly 4 billion rupees ($12.70 million) to providers of things like gloves and chemicals needed in medical tests.

According to Ravi Kumudesh, president of the Medical Laboratory Technologists Association, testing has decreased by 30%, with some high-end tests being discontinued entirely. Equipment maintenance, such as Magnetic Resonance Imaging (MRI) devices, has also been postponed.

“There is a disconnect between what a patient should receive and what they are receiving,” Kumudesh told the reporters.

“Nobody is being held responsible. People are dying despite the fact that we are not calculating the statistics “he stated

Sri Lanka’s new Finance Minister, Ali Sabry, stated that stabilising the supply of basics such as medications was his first concern.

However, sufferers like White are finding it increasingly difficult to cope with the crisis. She claims that slow-release morphine pills for pain management are frequently unavailable.

“My son went to fetch it the other day and came back empty-handed,” White explained.

“I’m feeling really powerless… I’m not even able to attend a demonstration.”

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