The country continues to suffer severe shortfalls of food and other essentials ranging from fuel to electricity. But health experts caution that the emergency in the medical system could drive an escalation in deaths if immediate steps are not taken to replenish supplies.
“The government was warned about the impending shortage of drugs and other equipment at least three months ago,” a visibly irritated senior doctor in Colombo told Nikkei Asia. “Their continuous excuse was that they don’t have dollars to make the purchases. This government has failed to uphold the basic human right of health for all.”
Both state and private hospitals have been hit. Cardiac drugs are among the most depleted. Tenectaplase, a medicine used to dissolve blood clots, is barely available in most hospitals.
Also scarce are anti-hypertension 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.
The lack of drugs has forced some hospitals to halt surgeries, stoking fears the medical crisis could spiral out of control.
In one disturbing incident, Natalia Gunasena was dumbstruck after her friend underwent surgery in a leading private hospital in Colombo, only to be told that there was no morphine available and the patient would have to “endure” the pain. “There was no warning issued in advance saying the painkiller was unavailable,” she said.
In a letter sent to President Gotabaya Rajapaksa last week, the Sri Lanka Medical Association warned that without immediate action, the shortage of essential drugs, reagents, equipment and consumables would have catastrophic consequences. It said the death toll was likely to exceed the combined number from Covid-19, the 2004 Indian Ocean tsunami and the country’s civil war.
From Covid alone, Sri Lanka has lost over 16,400 people. The tsunami killed over 30,000, while the war killed tens of thousands more.
The medical crisis comes at a time when Sri Lanka does not have a health minister, amid continuing protests across the country demanding the Rajapaksa-led administration resign. Critics blame the government for gross economic mismanagement that has driven the country virtually to its knees.
Ravi Rannan-Eliya, executive director at the Institute for Health Policy, said the health crisis is one of the most obvious symptoms of a disorder that has its origins outside the medical system.
“The root problem is the underlying fiscal and foreign exchange crises. Those are the consequences of policy errors made by successive administrations,” he said, adding that the problems were exacerbated by 2019 tax cuts, a futile effort to prop up the rupee, a government directive to switch to only organic fertilizer and a decision to favour the tourism sector over export industries when relaxing Covid controls.
With the medical supplies division of the health ministry restricting the issuing of some drugs owing to the shortage, there is a dire need for at least 230 essential drugs and some 15 crucial consumables. Highly placed sources told Nikkei Asia that existing stocks could fall to zero in two months without urgent action.
Meanwhile, the Government Medical Officers Association is seeking support from Sri Lankans and non-Sri Lankans living overseas to help source drugs and other items to compensate for the government’s inaction. Blaming “poor financial and economic management,” the association said in an appeal, “We need your generous support at this crucial time to continue patient care in Sri Lanka.”
Dr Thenuwan Wickramasinghe, who is coordinating the appeal, told Nikkei Asia that the response has so far been “very good.”
“We have also launched a website, which will facilitate Sri Lankans overseas and the international community to donate toward this project, before it goes from bad to worse,” he said.
The situation is so desperate that hospitals have been compelled to reuse neonatal endotracheal tubes for ventilating new-born babies, although they are meant only for a single use. Just hours after circulating a WhatsApp message among colleagues, Dr LPC Samankumara, a leading neonatal paediatrician, said that he had received assurances from overseas donors that 13,500 tubes would be provided.
Before Covid, Sri Lanka’s total pharmaceutical import bill was around US$50 million a month. In March, the nation’s official foreign reserves stood at just US$1.93 billion, after the government insisted on continuing to service debt.
With Sri Lanka finally moving toward to a debt restructuring path, Chayu Damsinghe, product head of macroeconomic and thematic research at Colombo-based Frontier Research, is optimistic the country can rebuild international confidence.
“We need to continue moving with the debt restructuring talks and International Monetary Fund (IMF) negotiations as fast as possible, and clearly communicate our aims and our progress on this internationally,” he said.
“This should bring confidence that Sri Lanka is finally taking steps to get out of the crisis, which can be a bargaining chip in negotiating short-term relief from our bilateral partners like India, China, Japan, or even the US and the EU.”
Talks between the Sri Lankan government and the IMF are scheduled for next week, eyeing a possible bailout apart from assistance on restructuring foreign debt.
In the meantime, considering the health crisis, well-placed sources said the government is also looking at using US$200 million of a US$1 billion credit line from India to purchase essential drugs from Indian suppliers – one of the country’s biggest suppliers. But one source stressed, “Nothing has … been finalised.”