As Sri Lanka approaches default, medically distressed hospitals decide who lives and who dies

Miro suffers from a malignant brain tumor that causes him to have frequent seizures and lose consciousness for minutes on end. The only thing that helps is an anti-seizure drug, but with the financial crisis in Sri Lanka hitting medical imports, Meru’s father, Upul Chandana, is struggling to find the drug anywhere.

“This is no longer available in the hospital,” Chandana said as his only son played on the thin mattress behind him. “Even the pharmacies nearby are out of stock.” “Now, even with money, we can’t find the medicine.”

Now, with medicines and medical equipment running out, the country is facing what the Singapore Red Cross has described as an “unprecedented humanitarian crisis”.

Doctors have reported washing and reusing medical equipment — and even performing surgery on the light of cell phones. Authorities have yet to confirm any deaths due to lack of medication – but experts warn that the death toll from the crisis could exceed the country’s death toll of more than 16,000.

“This is a crisis, we can’t predict how bad it will be,” said Athula Amarasina, secretary of the State Pharmaceutical Association of Sri Lanka which represents pharmacies across the country. But we know that we are heading towards another crisis.”

Miro’s parents worry about him getting the medicine he needs. Credit: Upendra Herath/CNN

Deplorable condition in hospitals

Every day, Wasanta Seneviratne travels from pharmacy to pharmacy in Colombo, Sri Lanka, in a desperate attempt to find topotecan, the chemotherapy drug his 7-year-old daughter needs to survive.

Both in the hospital where his daughter was admitted on April 7, and in every pharmacy he visits, the answer is the same: the drug is not available anywhere in the country.

Of the drug his daughter needs to treat neuroblastoma, a form of cancer, he said, “There is no government hospital, pharmacy or importer. It’s not anywhere in Sri Lanka.” “What should I do? My child may not live long if he does not get the medication.”

Wasantha Senvirtan is desperate to find the drugs his daughter needs to survive.

Just a few weeks ago, hospitals offered Topotecan for free, but patients’ families are now delighted with the task of getting it themselves from private pharmacies, Sneviratne said.

Even that seems impossible. And the problem is much bigger than Sanviratne.

According to a letter from the Sri Lanka Medical Association (SLMA), all hospitals across the country are short on emergency medicines and medical equipment. Several government hospitals have been ordered to suspend routine surgeries and reduce lab tests due to limited supplies of anesthetics and reagents used in the tests, according to the SLMA.

There is also a shortage of medical equipment. For example, the head of a perinatal association in Sri Lanka has instructed hospitals to sterilize and reuse endotracheal tubes used to deliver oxygen to newborns’ lungs as tube shortages become “extremely critical,” according to a letter sent to the health ministry from the community earlier this month. It was submitted to CNN.

Sri Lankan hospitals are short of supplies. Credit: Upendra Herath/CNN

The intensive care surgeon, who asked not to be identified for fear of losing her job, said vital drugs used to treat strokes and heart attacks are now in severe shortages and the hospital where she works is forced to reuse catheters.

“I know I’m putting the next patient’s life at risk. I feel so desperate and helpless,” she told CNN this week, adding that she now spends most of her time sterilizing equipment for reuse. “It goes against everything we’ve learned to do.”

Although hospitals have mostly survived blackouts, the doctor told CNN that she experienced a blackout while she and others operated on a young child for a heart condition. They were forced to continue working with torches on their mobile phones carried by other medical workers until the generators were running.

“Although there are at least two blocked cell phones, it is not easy to perform procedures or stitches in such light,” she said.

A patient waits for hospital treatment as health workers hold a strike in Colombo on February 9, 2022.

A doctor from a government hospital in the central city of Kandy, who asked not to be named for fear of losing her job, said in the hospital’s intensive care unit that their sedation is low, and she is concerned about how hospitals will perform surgeries without a pain reliever. Her hospital has reduced elective surgeries.

Like the unnamed surgeon, she has been asked to reuse catheters and tubes on patients — and although she knows they may cause harm to patients, she says there is no other option.

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

“We’ve had to make tough choices these days, especially in the ICU, like who lives and who doesn’t,” she says. “We may continue to accept patients but we will have no way of treating them.”

The surgeon faces similar concerns.

“I don’t know if half of the patients we have (intensive care unit) will survive in the coming weeks if the drug shortage continues,” she said.

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

How did this happen

Some say the government should have seen the situation coming.

According to experts, Sri Lanka’s economic crisis was caused by a combination of government mismanagement and misfortune, including the Covid-19 pandemic that has hit the country’s tourism industry.
Tax cuts and economic malaise have hit government revenues, prompting rating agencies to cut Sri Lanka’s credit rating to levels close to default – meaning the country has lost access to foreign markets. Sri Lanka has tapped into 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 International Monetary Fund filing.

The cash crunch has affected imports of fuel and other necessities – including medical equipment and medicine.

For months, medical workers warned of the impending crisis, and doctors and nurses took to the streets to protest government inaction.

Sri Lankan people protest on April 12, 2022, in front of the Presidential Secretariat office in Galle Face, Colombo.

On Wednesday, after playing down fears and claiming there was no shortage, the country’s health ministry admitted that Sri Lanka was facing shortages of some medicines and surgical equipment. According to the ministry, the government has received $10 million from the World Bank to purchase the drugs, although it is unclear when they will arrive.

“I would refer to this as a bigger challenge and not yet a crisis,” the Ministry of Health coordinator responsible for donor activities and medical supplies, Dr. Anfar Hamdani, told CNN this week.

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

But others claim that the shortage is a man-made problem that could have been avoided.

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According to Dr Rokchan Pelana, Chair of Government Medical Officials Forum (GMOF) and Director of a State Owned Hospital in Colombo, the government has not been able to pay lines of credit for the supplies.

He told CNN that there are 2,500 listed drug substances approved by the governmentAnd Of these, there is a shortage of 60.

“The president ignored the calls (to act), so what has happened is that the situation is getting worse every day,” Bilana said.

What’s Next

The government claims it is addressing the economic and medical crisis. The Ministry of Health said in a statement this week that it is in temporary talks with the World Health Organization and the Asian Development Bank for funds or medicines, and is working to obtain donations from Sri Lankans abroad.

But doctors say urgent help is needed.

In a letter addressed to the president on April 7 and published on Sunday, the Sri Lanka Medical Association said health issues in general are not considered emergencies that can become life-threatening problems.

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

This will result in a catastrophic death toll.”

Athula Amarasina, secretary of the State Pharmaceutical Association of Sri Lanka, said he did not know how bad the situation was.
The problem will get worse before it gets better, says Amarasina of the State Medicines Association. Even if Sri Lanka gets help from international organizations or other countries, it can take weeks or months for shipments to arrive – and some suppliers start making medicines as soon as an order is placed. The country does not have a health minister at the moment – a number of ministers have resigned due to the crisis.

“The specific person responsible for this is not empowered enough to make quick decisions,” Amarasina said. “We don’t have enough time.”

At the beginning of this month, Seneviratne and his family came to the capital from Kandy province, hoping that they would have a better chance to help their daughter.

“We come to hospitals with the hope that we will find a good treatment, so when we find that there is not even a medicine, we are helpless,” he said.

Meru's father, Ubol Chandana, worries about the future.

For Sniviratni, there is not much he can do to help his daughter. The economic crisis has left him without a stable job, which means that there is no way to import medicines from abroad.

“There are a lot of (parents) who are deeply saddened that they can’t find this medicine, even if they have (enough money) on their hands,” he said. “We are in a lot of pain and grief. We don’t have the money to take our daughter abroad for medical treatment.”

Back in the small room in Colombo, Meru’s father, Chandana, has similar concerns. The family left their rice farm and moved to Colombo for the Meru to be processed. When he bought his last bottle of medicine, the pharmacist who sold it to him said it was the last bottle in stock.

But now he has only a few days of treatment left. His only hope is to continue searching through to find more.