“This is no longer available in the hospital. Even nearby pharmacies are exhausted,” Chandana said as his only son played on the thin mattress behind him. “Now, not even with money, we can not find the medicine.” Now, with medical supplies and equipment running low, the country is facing what is described by the Singapore Red Cross as an “unprecedented humanitarian crisis.” Doctors report washing and reusing medical equipment – and even surgery under the light of cell phones. Authorities have so far not confirmed any deaths from drug shortages – but experts warn that the death toll from the crisis could exceed more than 16,000 deaths from Covid in the country. “This is a crisis, we can not predict how bad it will be,” said Athula Amarasena, secretary of the Sri Lankan State Pharmaceutical Association, which represents pharmacies across the country. “But we know we are heading for a further crisis.” Miru’s parents are worried that he might get the medicine he needs. Source: Upendra Herath / CNN

Tragic situation in hospitals

Every day, Wasantha Seneviratne walks from pharmacy to pharmacy in the Sri Lankan capital, Colombo, desperate to find Topotecan, the chemotherapy drug his 7-year-old daughter needs to stay alive. 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.
“No state hospital, pharmacy or importer has it. It is nowhere in Sri Lanka,” he said of the medicine his daughter needs to treat neuroblastoma, a form of cancer. “What should I do? My child may not live long if he does not take the medicine.” Just a few weeks ago, Topotecan was offered free of charge by hospitals, but patients’ families are now in charge of getting it themselves from private pharmacies, Seneviratne said. Even that seems impossible. And the problem is much bigger than Seneviratne. According to a letter released by the Sri Lankan Medical Association (SLMA), not all hospitals across the country have access to emergency medicines and medical equipment. Many government hospitals have been ordered to suspend routine surgeries and reduce laboratory tests due to the limited supply of anesthetics and reagents used for testing, the SLMA reported. Medical equipment is also in short supply. The president of the Sri Lankan Perinatal Society, for example, has ordered hospitals to sterilize and reuse endotracheal tubes used to deliver oxygen to the lungs of newborn babies as the lack of tubing becomes “extremely critical”. Health from the community earlier this month and provided to CNN. Sri Lankan hospitals are short of supplies. Source: Upendra Herath / CNN An intensive care surgeon, who asked not to be named for fear of losing her job, said the vital drugs used to treat strokes and heart attacks were now in critical condition and her hospital was being forced to reuse catheters. “I know I’m putting the next patient’s life in danger. I feel desperate and completely helpless,” she told CNN this week, adding that she now spends much of her time disinfecting equipment to be reused. “This contradicts everything we have learned to do.” Although hospitals have largely survived power outages, the doctor told CNN that they experienced a power outage while she and others underwent surgery on a young child for heart disease. They were forced to continue operating using the torches on their cell phones held by other doctors until the generators were activated. “Despite the fact that at least two mobile phones are kept, it is not easy to perform surgeries or sutures in such a light,” he said. A doctor at a state-run hospital in central Kandy, who asked not to be named for fear of losing her job, told her hospital intensive care unit that they did not have anesthetics and was worried that hospitals would perform surgery without relief. pain. Her hospital has cut her optional surgeries. Like the anonymous surgeon, she has been told to reuse catheters and tubes in patients – and although she knows it could harm patients, she says there is no other choice. Her team is faced with difficult choices about who needs the drug the most. “We had to make difficult choices these days, especially in the intensive care unit, such as who will live and who will not,” he says. “We may continue to receive patients, but we will have no way of treating them.” The surgeon faces a similar concern. “I do not know if half of the patients we have (in the intensive care unit) will be alive in the coming weeks if this shortage of medication continues,” he said.

How did this happen

Some say the government should have seen the situation come. According to experts, the economic crisis in Sri Lanka was caused by a combination of government mismanagement and misfortune, including the Covid-19 pandemic that hit the country’s tourism industry. Tax cuts and financial woes have hit government revenues, forcing rating agencies to downgrade Sri Lanka’s creditworthiness to near-default levels – meaning the country has lost access to foreign markets. Sri Lanka has fallen short of its foreign exchange reserves to pay off its public debt, reducing its reserves from $ 6.9 billion in 2018 to $ 2.2 billion this year, according to the IMF. The cash crisis has affected imports of fuel and other commodities – including medical equipment and medicines. 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 inaction. On Wednesday, after downplaying concerns and claiming there was no shortage, the country’s health ministry acknowledged that Sri Lanka was short of certain medicines and surgical equipment. According to the ministry, the government has received $ 10 million from the World Bank to buy medicines, although it is unclear when it will arrive. “I would refer to it more as a challenge than as a crisis,” Dr. Anver Hamdani, the health ministry’s coordinator for donor activities and medical supplies, told CNN this week. There was no reason behind the issue, he said, adding that the government would resolve the issue behind the shortage before the end of the month. But others argue that shortages are a man-made issue that could have been avoided. According to Dr. Rukshan Bellana, chairman of the Government Medical Officers Forum (GMOF) and manager of a state hospital in Colombo, said the government could not pay credit lines for supplies. He told CNN that there are 2,500 listed government-approved medicines, of which 60 are in short supply. “The president ignored the calls (for action), so what happened is that the situation is getting worse and worse every day,” Belana said.

What’s next

The government claims it is facing both financial and medical crisis. In a statement this week, the Ministry of Health said it was in interim talks with the World Health Organization and the Asian Development Bank to raise funds or medicines and was working to receive donations from foreign countries in Sri Lanka. But doctors say urgent help is needed. In a letter to the president on April 7 released on Sunday, the Sri Lankan Medical Association said health issues that are generally not considered emergency could become life-threatening. “Without urgent replenishment of supplies, emergency care may also need to be stopped within a few weeks, if not days,” the letter said. “This will result in a catastrophic number of deaths.” Amarasena of the State Pharmaceutical Union says the problem will get worse before it improves. Even if 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 after an order has been placed. And the country does not even have a health minister right now – a number of cabinet ministers have resigned because of the crisis. “The person in charge of this is not empowered enough to make quick decisions,” Amarasena said. “We do not have enough time.” Earlier this month, Seneviraatne and his family came to the capital from the province of Kandy, hoping they would be more likely to help their daughter. “We come to the hospitals hoping we can find good treatment, so when we find that there is not even a cure, we are helpless,” he said. For Seneviratne, there is little he can do to help his daughter. The financial crisis has left him without a steady job, which means that there is no way he can import drugs from abroad. “There are many more (parents) who are also deeply saddened because they can not find this medicine, even if they have (enough money) in their hands,” he said. “We are in a lot of pain and sadness. We do not have the money to take our daughter abroad for medical treatment.” Back in the tiny room in Colombo, Miru’s father, Chandana, has similar fears. The family left their paddy fields and moved to Colombo so that Miru could receive care. When he bought his last bottle of the drug, the pharmacist who sold it to him said it was his last bottle in stock. But now he has only a few days of medication left. His only hope is to keep looking for a way to find more.