By Hemali Wijerathna
COLOMBO, 11 May 2023 (IDN) — In the face of the current economic crisis, Sri Lanka’s free healthcare system, which was the envy of South Asia not long ago, is now at the brink of collapse. It is facing multiple problems with a lack of drugs, doctors migrating and the government strictly implementing a 60-year retirement policy for government doctors. (P04) HINDI | INDONESIAN | JAPANESE | THAI
Currently, there is a shortage of more than 90 essential medicines in most government hospitals in the country, according to the Government Medical Officer’s Association (GMOA).
The GMOA secretary Dr Haritha Aluthge told IDN that the hospital network in the country would collapse due to these shortages. “We have observed that the current medicine shortage seems to be on the rise daily. (In the) branch hospitals (even in) Colombo essential medicine including paracetamol, piriton and salive are in short supply.” Emergency medicine such as aspirin, which is used to prevent strokes, is in short supply even at the Colombo general hospital—the country’s largest hospital.
Another major factor threatening the collapse of the health service in Sri Lanka is the shortage of specialist doctors. Economic crisis has forced them to leave the country. Meanwhile, the policy of retiring government employees at 60 is also contributing to the problem.
The departure of specialists and other doctors from the country has affected the health service to such an extent that the children’s ward of the Anuradhapura teaching hospital had to be closed recently. It has facilities to treat 60 patients at a time, and according to hospital sources, nine doctors of the Anuradhapura teaching hospital have left the service including four pediatricians. With no doctors to treat the children, the patients there at the time had to be transferred to other wards.
The closure of the children’s ward has also prevented medical students from Rajaratha University getting clinical training. Dr Dulan Samaraweera, director of the Anuradhapura teaching hospital told IDN that the doctors had gone, but he’s unable to say how many. The childrens’ ward however, has been reopened now with government providing the necessary specialists. The child patients transferred to other wards are now back.
Since the advent of the financial crisis a year ago, nearly 500 Sri Lankan doctors, including specialists, have left the country, many not even informing the health ministry. GMOA says that in addition to leaving without notice, 52 doctors including young specialists, have been served with notice to vacate the post within the last two months as they have left the country without informing the health ministry.
While doctors are leaving, the government does not appear to have a solution to the shortage of drugs especially for severe diseases. The helpless patients and their families are constantly suffering from this crisis. The most serious ‘issue’ here is that the surgeries that should be done before certain diseases become incurable are delayed due to the shortage of drugs.
The system, it is believed, was not prepared in the face of the economic crisis in the country, to allocate dollars for the import of medicines. Under an Indian loan scheme, the government allocated the equivalent of USD 114 million to the state pharmaceutical corporation, but only USD 68.5 million was used to purchase medicines. Recently, Sri Lanka Medical Association (SLMA) revealed that it was used for non-essential medicines.
Dr Ananda Wijewickrama, a member of the National Institute of Infectious Diseases, said that 80 per cent of the drugs imported under the Indian credit facility were found to be unregistered and unassisted drug in the country. There is a risk of suspending kidney transplants, and non-emergency surgeries will also have to be stopped.
Recently, at a media conference, President of the College of Anaesthesiologists and Intensivists of Sri Lanka, Dr Anoma Perera, warned that the health system is on the brink of a collapse. The most serious issue is the shortage of aesthetic drugs in government and private hospitals, and due to this all-caesarean surgeries related to child birth will be delayed. Surgery will have to be stopped by an esthesiologists and intensive care physician she said, speculating that it would have to happen in the near futures, due to the shortage of drugs in hospitals
At present there is a situation where even some antibiotics are not available in government and private hospitals. Due to this, doctors are asking the public not to waste medicines, and to be aware of their medical conditions and take care to live carefully.
Many government doctors IDN spoke to commented on condition of anonymity. A doctor from a government hospital said that due to the shortage of a type of clip required, laparoscopic surgeries have not been performed for about three months at the hospital where he works. Due to the non-performance of the surgeries, he said that the laparoscopy machine in the hospital has not been used for more than three months. However, he said that the required clips, which are not available in the hospital, are available in private sector hospitals and pharmacies.
A doctor working in another government hospital said that due to the lack of reagents required for the creative protein test and the trooping test on heart attack patients, those test are not being performed at present. Since these tests are unavailable in government hospitals, he said that patients coming to hospitals have to go to private sector laboratories for these tests. A doctor in another leading government hospital said that there was a shortage of several types of antibiotics in the last months.
In a random survey, several patients, who came to the medical clinics of the Colombo national hospital, said that they are still not getting some medicines.
“I come to the clinic once a month. I come for treatment to skin diseases,” said Shantha Karunarathna who came from Panadura about 30 km from Colombo. “When I came last time, I was told that two medicines were not available. So, I had to take them outside. Now it is the same this time too. But that medicine is expensive. It is difficult for someone like us who don’t earn daily wages”.
Another patient, who came to get treatment for the viral fever that is spreading these days, said that some of the medicines that were prescribed for him were not available, so he was prescribed to get them from outside.
Meanwhile, GMOA spokesman Dr Haritha Aluthge told IDN that already 500 doctors have migrated within last year due to the crisis in the country and if the 60-year retirement rule were to be applied a further 800 doctors, including 300 specialists, would be on their way out by the end of the year. “This will result in in dire consequences”, he warns.
Dr Aluthge said that several provincial hospitals are already short of doctors and on the verge of collapse and the retirement rule could only aggravate the situation.
“Sending public servant abroad on no pay leave certainly is not the answer to the present problem,” he points out. He also said the doctors who had gone abroad on scholarships are not returning and so are the interns undergoing training overseas.
“The problem is not in the clinical services that are being adversely affected by specialist issues, but also the health sector administration,” notes Dr Aluthge. [IDN-InDepthNews]
Photo: Chaotic scenes at a government hospital outpatients clinic. Photo Credit: Hemali Wijerathna.