As Sri Lanka approaches standard, medicine-bound hospitals decide who should live and die

Miru has a malignant brain tumor that causes him to have frequent epileptic seizures and fall unconscious for minutes on end. The only thing that helps is an anticonvulsant drug, but as Sri Lanka’s financial crisis hits drug imports, Miru’s father, Upul Chandana, has struggled to find the medicine everywhere.

“This is not available at the hospital anymore. Even nearby pharmacies have run out of stock,” Chandana said as his only son played on the thin mattress behind him. “Now, even with money, we can not find the medicine.”

Now that medical medicine and equipment are running out, the country is facing what is being described by the Singapore Red Cross as an “unprecedented humanitarian crisis.”

Doctors report that they wash and reuse medical equipment – and even perform an operation in the light of mobile phones. So far, authorities have not confirmed any deaths due to drug shortages – but experts warn that the number from the crisis could exceed the country’s more than 16,000 Covid deaths.

“This is a crisis, we can not predict how bad it will be,” said Athula Amarasena, secretary of the State Pharmaceutical Association of Sri Lanka, which represents pharmacies across the country. “But we are aware that we are heading into a further crisis.”

Miru’s parents are worried about getting him the medicine he needs. Credit: Upendra Herath / CNN

A serious situation in the hospitals

Every day, Wasantha Seneviratne goes from pharmacy to pharmacy in Sri Lanka’s capital Colombo, desperate to find Topotecan, the chemotherapy drug his 7-year-old daughter needs to stay alive.

At both the hospital where his daughter was admitted on April 7 and at every pharmacy he visits, the same answer is: The medicine is not available anywhere in the country.

“No state hospital, pharmacy or importer has it. It’s nowhere in Sri Lanka,” he said of the drug his daughter needs to treat neuroblastoma, a form of cancer. “What should I do? My child may not live long if she does not get the medicine.”

Just a few weeks ago, Topotecan was offered for free by hospitals, but patients’ families are now tasked with obtaining it themselves from private pharmacies, Seneviratne said.

Even that feels impossible. And the problem is much bigger than Seneviratne.

According to a letter published by the Sri Lanka Medical Association (SLMA), all hospitals across the country lack access to emergency medicine and medical equipment. Several public hospitals have been ordered to suspend routine surgeries and reduce laboratory tests due to limited supplies of anesthetics and reagents used for testing, the SLMA said.

And medical equipment is also in short supply. For example, the president of the Perinatal Society of Sri Lanka has ordered hospitals to sterilize and recycle endotracheal tubes used to deliver oxygen to newborn babies’ lungs, as the tube deficiency becomes “extremely critical,” according to a letter sent to the Ministry of Health earlier. on the month and given to CNN.

Sri Lanka’s hospitals are lacking supplies. Credit: Upendra Herath / CNN

An intensive care surgeon who asked not to be named for fear of losing her job said vital drugs used to treat strokes and heart attacks are now a critical shortage and her hospital is forced to reuse catheters .

“I know I’re endangering the next patient’s life. I feel hopeless and completely helpless,” she told CNN this week, adding that she now spends much of her time disinfecting equipment to be recycled. “This goes against everything we have been taught to do.”

Although hospitals have mostly been spared power outages, the doctor told CNN that they experienced a power outage while she and others performed surgery on a young child for a heart condition. They were forced to continue using torches on their cell phones, which were kept by other doctors until the generators were turned on.

“Despite keeping at least two cell phones up, it is not easy to perform procedures or sutures in such a light,” she said.

A patient is awaiting treatment at a hospital as health workers go on strike in Colombo on February 9, 2022.

A doctor from a central hospital in the central city of Kandy, who asked not to be named for fear of losing his job, said in his hospital’s intensive care unit that they lack anesthesia and she worries about how hospitals will perform operations without pain relief. . Her hospital has cut back on elective surgeries.

Like the unnamed surgeon, she has been asked to reuse catheters and tubes on patients – and although she knows it can cause harm to patients, she says there is no other choice.

Her team faces difficult choices about who needs the medicine the most.

“We’ve had to make tough choices these days, especially in the intensive care unit, like who should live and who shouldn’t,” she says. “We can continue to hospitalize patients, but will have no way of treating them.”

The surgeon faces a similar concern.

“I do not know if half of the patients we have on (intensive care unit) will be alive in the coming weeks if this medication shortage continues,” she said.

Health workers hold posters during a demonstration against the island's growing economic crisis in Colombo on April 6, 2022.

How this happened

Some say the government should have seen the situation coming.

According to experts, Sri Lanka’s economic crisis was caused by a combination of poor management and disaster, including the Covid-19 pandemic, which damaged the country’s tourism industry.
Tax cuts and economic hardship hit the state’s revenue, prompting credit rating agencies to downgrade Sri Lanka’s credit rating to close to standard levels – meaning the country lost access to overseas markets. Sri Lanka fell back on its foreign exchange reserves to pay off government debt, reducing its reserves from $ 6.9 billion in 2018 to $ 2.2 billion this year, according to an IMF briefing.

The money crisis affected the import of fuel and other significant things – including medical equipment and medicine.

For months, doctors have been warning of the impending crisis, and doctors and nurses have taken to the streets to protest the government’s perceived passivity.

The people of Sri Lanka are protesting on April 12, 2022 in front of the office of the Presidential Secretariat in Galle Face, Colombo.

On Wednesday, after downplaying concerns and claiming there was no shortage, the country’s Ministry of Health admitted that Sri Lanka is facing a shortage of certain medicines and surgical equipment. According to the ministry, the government received $ 10 million from the World Bank to buy medicine, although it is unclear when this will arrive.

“I would refer to this as more of a challenge and not yet a crisis,” said the Ministry of Health’s coordinator in charge of donor activities and medical supplies, Dr. Anver Hamdani, to CNN this week.

There was no single reason behind the problem, he said, adding that the government would solve the problem behind the shortage before the end of the month.

But others argue that the deficiency is a man-made problem that could have been averted.

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According to Dr. Rukshan Bellana, president of the Government Medical Officers Forum (GMOF) and an administrator of a state-owned hospital in Colombo, the government could not pay lines of credit for supplies.

He told CNN that there are 2,500 listed pharmaceutical items approved by the government, and of these, 60 are in short supply.

“The president has ignored the calls (for action), so what has happened is that the situation is getting worse and worse every day,” Bellana said.

What’s next

The government claims it is addressing both the economic and medical crisis. In a statement this week, the health ministry said it was in interim negotiations with the World Health Organization and the Asian Development Bank to raise funds or medicines and is working to get donations from overseas Sri Lankans.

But doctors say urgent help is needed.

In a letter addressed to the President on April 7 and published on Sunday, the Sri Lankan Medical Association said that health problems are generally not considered that emergencies can become life-threatening problems.

“Without urgent replenishment of supplies, emergency treatment may also have to stop within a few weeks, if not days,” the letter said.

“This will result in a catastrophic number of deaths.”

Athula Amarasena, secretary of the State Pharmaceutical Association of Sri Lanka, says he does not know how bad the situation will be.
State Pharmaceutical Associations Amarasena says the problem will get worse before it gets better. Although Sri Lanka receives help from international organizations or other countries, it can take weeks or months for shipments to arrive – and some suppliers only start making medicines once an order has been placed. And the country does not even have a health minister at the moment – a number of cabinet ministers resigned because of the crisis.

“The designated person responsible for this is not empowered enough to make quick decisions,” Amarasena said. “We do not have enough time.”

Earlier this month, Seneviratne and his family came to the capital from Kandy province in the hope that they would have a better chance of helping their daughter.

“We come to hospitals hoping we can find good treatment, so when we find out there is not even medicine, we are helpless,” he said.

Miru's father Upul Chandana is worried about the future.

For Seneviratne, there is not much he can do to help his daughter. The economic crisis has left him without a permanent job, which means he can not import the drugs from abroad.

“There are many more (parents) who are also in deep grief because they cannot find this medicine even though they have (enough money) in their hands,” he said. “We like a lot of pain and grief. We do not have the money to take our daughter abroad for medical treatment.”

Back in the small room in Colombo, Mirus’ father, Chandana, has similar fears. The family left their rice farm and moved to Colombo so Miru could be treated. When he bought his last bottle of medicine, the pharmacist who sold it to him said it was his last bottle in stock.

But now he has only a few days left of medication. His only hope is to keep searching for a way to find more.

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