- Doctors forced to make difficult choices as essential drugs run out
As we all know, Sri Lanka is in the grip of a terrible financial crisis, with record inflation leading to shortages of fuel and food, and crippling hours-long power blackouts imposed. Sri Lanka’s lack of foreign currency reserves has had a devastating impact on the availability of medicine.
More than 85% of pharmaceutical products in the country are imported and these are paid for in US Dollars. If dollars are not available, then drugs cannot be bought. The Sri Lanka Chamber of Pharmaceutical Industry (SLCPI) warned last month that 5% of drugs were out of stock and the problem was likely to worsen.
The Sri Lanka Medical Association (SLMA) recently said that all hospitals in the country no longer had access to imported medical tools and vital drugs. In the last week, several facilities said they had already suspended routine surgeries since last month because they were dangerously low on anaesthetics, but the SLMA said that even emergency procedures may not be possible very soon.
“We are being made to make very difficult choices. We have to decide who gets treatment and who will not,” the SLMA stated in a letter the group sent President Gotabaya Rajapaksa recently to warn him of the situation. “If supplies are not restored within days, the casualties will be far worse than from the pandemic,” it said.
Impending collapse of medical sector?
Government Medical Officers’ Forum (GMOF) President Dr. Rukshan Bellana observed that while Sri Lanka was indeed going through a financial crisis, the medical sector would not have been affected if the health sector hierarchy had been able to predict the current situation.
“They should have predicted the situation and taken it to the WHO and other global medical agencies,” he said, adding that unfortunately, the hierarchy was headed by an Army General with experience at a military hospital and had resulted in total failure. “The entire medical faculty has communicated this issue to the Government and it has fallen on deaf ears. The administration does not get the proper information out of the health groups – the office is almost like a prisoner in the health service,” he told Brunch, stating that this official had refused to answer calls or meet with health experts.
“Many good administrators like Dr. Amal Harsha and Dr. Jayaruwan Bandara were removed from their posts,” he further charged. “This is the debacle that was predicted by senior medical staff and as we predicted, the entire healthcare system is on the verge of collapse. Drugs are not the only problem; in the months to come, all hospitals will be in disarray at this rate.”
Previously, the Ministry of Health ran the show under difficult circumstances during a 30-year war, he noted. “Even during the tsunami, there was a war-torn area in the north and east; despite that, the healthcare sector never collapsed thanks to the Director-General of Health and the Secretary of Health who were extraordinarily talented,” Dr. Bellana said, emphasising that every aspect of healthcare was carefully monitored and progressed smoothly, be it drug management or disease management.
Dr. Bellana believes that this is only the tip of the iceberg: “There is a huge iceberg under the water that is ruining the health sector, which will collapse soon. We call for the removal of the Army General immediately; that is the only means of preventing the oncoming collapse of the medical sector.”
Morale of doctors and families affected
Sharing his opinion on the crisis that the medical industry is facing, Paediatric MO Dr. Nishan Perera highlighted that things were very bad at the moment. “Sri Lanka has maintained its health sector for a long time and it has served the community well,” he observed, adding: “With the decrease in medication, it will be tough to provide optimal service and treatment, especially to those who can’t afford private hospitals.” He emphasised that this issue needed to be addressed immediately so that the elderly, babies, and adults could be treated.
As a doctor, he shared that it was absolutely heartbreaking knowing that there were certain diseases that Sri Lanka was once able to cure that they were now unable to do so because of a shortage of medicine that could have been prevented. “Having to tell a family that someone died because the medication wasn’t available is emotional torture to both the family and the doctor,” Dr. Perera said, adding that it would eventually detrimentally affect the morale of the country and its healthcare workers.
Both State and private hospitals have been hit, with cardiac drugs among the most depleted. Tenecteplase, a medicine used to dissolve blood clots, is in low supply in most hospitals. Also scarce are antihypertensive drugs such as amlodipine, enalapril, and labetalol, along with insulin for diabetes patients, sodium valproate commonly used to treat epilepsy, various antibiotics, and anti-rabies injections.
Dr. Perera pointed out that this shortage, which was preventable, was caused by uneducated leaders with hidden agendas. “We need leaders who love the country, not those who seek money out of greed. They need to get our economy back to a respectable state and if that means having to appoint someone they don’t like, then so be it. One needs to make sacrifices for the motherland and its citizens.”
Medical students dissuaded from practising in SL?
We spoke to Junior Doctor at NSW Health, Australia Dr. Amanya Jagodaarachchi who recently obtained her doctorate with the intention of returning to Sri Lanka to practise. In her understanding of the current situation in her motherland, Dr. Jagodaarachchi noted that we were facing a shortage of essential medical equipment and medication that could have been prevented by the Government had it taken the necessary preventive measures before the situation got out of hand.
“Right now, Sri Lankan hospitals have to depend on donors for funds and equipment which is usually used on a daily basis in a hospital,” she noted, adding that this equipment should not be reused and should always be in stock as they were used in emergency situations.
Sharing her personal story with Brunch, she said that she had always wanted to come back home to practise, but with the current situation, she had been forced to reconsider her decision. “As a medical practitioner, it’s very disheartening to see that one cannot help one’s patients – not because you’re not capable, but because the Government has made it so that basic and essential medicines are scarce,” she expressed. Despite the situation, she is still hopeful and yearns to return and serve her homeland, but it remains to be seen how many other students like her, who wanted to return to Sri Lanka to practise medicine, will now reconsider in light of these challenges.
As a means of bridging the gap temporarily, Dr. Jagodaarachchi urged foreigners, locals, and Sri Lankans overseas to look into resources that had been shared by trusted individuals and medical professionals on how equipment and funds could be donated. “Right now, this seems to be the only way to overcome this current predicament,” she observed, adding that she hoped the Government would take the necessary action to handle the situation instead of leaving citizens to die.
