Medical emergency in Sri Lanka with no end in sight to economic and political crises

Government Medical Officers' Association members protest over medical shortage in Colombo, Sri Lanka, on April 6, 2022. PHOTO: EPA-EFE

BANGALORE - Sri Lanka's President Gotabaya Rajapaksa on Tuesday (April 5) revoked the state of emergency he declared last week, as protests continued across the country demanding his resignation over widespread shortages of food, fuel and now, medicine.

Sri Lanka's most powerful trade union, the Government Medical Officers' Association (GMOA), has also declared "a medical emergency" as doctors and hospitals reported a severe shortage of life-saving medication.

"The Ministry of Health and the government failed to make plans to prevent the imminent collapse of free public healthcare," said the GMOA statement on Tuesday.

Doctors, nurses and public health officials have been demonstrating in many hospitals across the island since Monday. Several public hospitals have suspended routine surgery.

Sri Lanka has a reputation of providing decent healthcare to its citizens, who receive free treatment in government hospitals. Medicine, tests, and follow-up consultations are also free.

The island nation has also been able to provide this at less cost to the government than many middle-income countries, said Dr Ravindra Rannan-Eliya, executive director at the Colombo-based Institute for Health Policy.

In 2019, the country spent 2.9 per cent of its gross domestic product on healthcare, around US$122 (S$165) per person.

In 2018, Sri Lanka's public health system provided half of all medical treatments, 95 per cent of hospitalisations, and 99 per cent of the preventive care needs of the 22 million population, the World Bank found.

Today, however, the island's famously Scandinavian-standard public healthcare system is struggling to perform even simple treatments such as giving an injection, as many medical facilities have run out of local anaesthesia, needles and gloves.

"The serious economic problems that led to a dollar shortage in Sri Lanka are to blame for the health system's problems now. Almost 90 per cent of essential medicine in Sri Lanka are imported, much of it from India, followed by Bangladesh and Malaysia, but imports stopped months ago," said Dr Palitha Abeykoon, a former top World Health Organisation (WHO) official in the region.

Mr Ajith Thilakarathna, president of the society of government pharmacists who supply state-run hospitals, said they had run out of cancer, renal and cardiac drugs, as well as the best quality blood thinners, thyroid drugs and stents.

Paracetamol was hard to find in large quantities, while surgical consumables such as syringes, tubular needles, urinary catheters, cotton swabs and gauze were almost out of stock.

"We are already in bad shape. But, in two weeks, we will have a big problem," Mr Thilakarathna said.

Hospitals and clinics are currently relying on medical supplies imported three months ago and these are being depleted quickly.

The island nation is in the grip of its worst financial crisis, with dangerously low foreign exchange reserves and record inflation which have led to severe shortages of fuel and food, and crippling 13-hour power blackouts.

President Rajapaksa declared a state of emergency on April 1 after mass protests erupted across the country calling for his resignation as well as that of several other family members who are in the government, including Prime Minister Mahinda Rajapaksa.

The economic crisis has deteriorated into a political crisis, with the entire Cabinet resigning on Monday, a newly appointed finance minister quitting within a day, and 42 legislators from the ruling coalition withdrawing support from the Prime Minister, who is the President's elder brother.

"There are no ministers in the country. As for officials, some have left, and others are transferred. We are hoping there is some way out of the political impasse, so that the urgent needs are met," said Dr Abeykoon.

Private sector hospitals are also struggling to buy drugs for paying customers.

"The private sector is also unable to import essential medicines as banks did not give them letters of credit," said Dr Rannan-Eliya.

"Shortages got progressively worse in the last six to nine months. The devalued rupee against the dollar increased drug prices, so importers bought less," he added.

In a text message on Wednesday evening, a doctor at the intensive care unit of a hospital in Colombo told The Straits Times that a patient had died as a result of the lack of albumin needed to stabilise blood pressure.

"It’s not available. Had to give an inferior alternative. Patient died," she texted.

Another doctor at the Kaluthara teaching hospital's cardiology unit told ST that more patients were being sent to the tertiary care centre from peripheral and district hospitals that do not have power supply.

"They have no generators or find it difficult to get diesel for eight to 10 hours every single day when electricity is disconnected," said the doctor.

"The government has to be thankful to doctors and nurses who are still somehow keeping the system functioning. But they have to announce a plan soon," the Kaluthara doctor said.

Apart from a US$500 million line of credit for fuel, the Indian government has also sent emergency medical supplies. The WHO and the UN children's agency Unicef are also sourcing a list of essential medical supplies requested by the Sri Lankan government, said Dr Abeykoon.

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