Sri Lanka doctors warn of ‘catastrophe’ as medicines run low

Colombo, Sri Lanka – Doctors in Sri Lanka have warned that a catastrophic number of people could die as the crisis-hit country’s healthcare system teeters on the edge of collapse amid crippling power cuts and shortages of life-saving medications.

Drugs to treat heart attacks and tubes to help newborn babies breathe are in short supply nationwide, officials and health workers said, while blackouts are forcing doctors in rural Sri Lanka to stitch wounds and treat snakebites in the dark.

The situation is so dire that several hospitals have suspended routine surgeries and greatly reduced the number of laboratory tests, according to internal documents, forcing doctors, nurses and other healthcare workers to take to the streets in protest.

Some have also backed a growing protest movement that has been calling for President Gotabaya Rajapaksa’s resignation.

“All Sri Lankan hospitals are on the verge of collapse,” said Dr Senal Fernando, secretary at the Government Medical Officers Association. “The situation will deteriorate in the next two weeks and people will start dying if action is not taken now.”

Any patient deaths due to drug shortages could result in “riots at the hospitals”, he warned, adding that the government has failed to acknowledge or be transparent about the severity of the crisis.

“The government doesn’t care. They don’t tell the people anything.”

Sri Lanka, an island nation of 22 million people, is grappling with its worst financial crisis in decades. An economy battered by the COVID-19 pandemic has been pushed to the brink of meltdown, partly due to the Rajapaksa government dipping into the country’s foreign reserve to pay off its debts.

In less than two years, the reserve has plunged by more than 70 percent. According to central bank figures, it stood at $1.93bn by the end of March.

‘Nightmarish situation’

Unable to pay for imports, including fuel and medicines, the government has resorted to electricity cuts and asked India and China to help pay for essentials. It is also seeking a bailout from the International Monetary Fund (IMF).

Doctors say the power cuts and the medicine shortages have created “a nightmarish situation”.

In the central Nuwar Eliya highlands, one doctor at a state hospital said the blackouts have forced him to treat patients who seek help at night by torchlight.

“My hospital caters to the poor. Most of them seek treatment for accidents and alcohol-related injuries,” he told Al Jazeera. “In the past few weeks, I have cleaned, applied medicines to and stitched wounds of more than two dozen people without any electricity.

“It feels as if we are back in the 19th century.”

The doctor, who spoke on the condition of anonymity as he was not authorised to speak to the media, said his hospital does not have antibiotics and will soon run out of gauze.

Meanwhile, in the northeastern town of Polonnaruwa, where many seek medical help for snakebites, another doctor said he has had to use lanterns during blackouts.

“But diagnosing the severity of snake bites under a lantern is not easy,” he said. “People’s lives are at stake”.

He added that the state-run clinic that he works in has to send any severe cases to a bigger hospital, but a diesel shortage has meant that “it’s increasingly hard to get an ambulance”.

Hospitals in Sri Lanka’s biggest cities have been spared from the power cuts, but several have been ordered by the government to suspend routine surgeries and reduce laboratory tests, due to limited supplies of anaesthetic drugs and reagents, respectively.

The Karapitiya Teaching Hospital in the southwestern city of Galle told its staff in a March 29 memo to limit surgeries only to “life-threatening conditions” due to shortages of neostigmine, a drug used by anaesthetists.

The Peradeniya Teaching Hospital in central Kandy also briefly suspended routine surgeries at the end of March due to limited supplies of anaesthetics, according to local media, but resumed after India’s Foreign Secretary S Jaishankar pledged help.

Sri Lanka’s biggest hospital, the National Hospital in the country’s capital, Colombo, has meanwhile, limited laboratory investigations “until further notice”, according to a March 29 memo, due to interruptions in the supply of chemical reagents.

Drug shortages

Doctors have also raised the alarm over shortages of critical drugs streptokinase and tenecteplase, used to treat heart attacks and strokes.

“If you go to a hospital with a heart attack now, the chances of you dying is much higher than a few months ago,” said Dr Lakkumar Fernando, president of the Association of Medical Specialists. “All hospitals are severely affected.”

The government has not specified which drugs are out of stock, but the health ministry said last week Sri Lanka was facing severe shortages of 40 essential drugs and dwindling stocks of another 140 key medications.

Neonatalogists, meanwhile, have appealed for international help to save newborn babies, saying Sri Lanka was running out of endotracheal tubes, which are placed through the nose or mouth into the windpipe to deliver oxygen to babies’ lungs.

In a letter dated April 7, the president of the Perinatal Society of Sri Lanka, Dr LPC Saman Kumara, called the shortage “extremely critical” and said he had ordered hospitals not to discard used tubes, “but to clean and sterilise them from now onwards as we may have to reuse them as a desperate solution”.

Kumara told Al Jazeera the shortage was most acutely felt at Castle Street Teaching Hospital in the Sri Lankan capital, Colombo, but that “soon all hospitals may run out” of the tubes.

The health ministry said it was working “very fast” to try and address the situation.

Dr Saman Ratnayake, a spokesman for the ministry, told Al Jazeera that the ministry is seeking help from the Indian government, as well as the World Health Organization. He also said the Sri Lankan treasury has pledged to open credit lines for suppliers to buy some of the critical drugs, including tenecteplase, the stroke medication.

“We have ordered. The issue is now it will take another one to two months to receive goods,” he said. In the meantime, Ratnayake said, the government is asking hospitals to manage things, including by postponing any non-life-threatening procedures.

“Till then, you have to be patient and help us manage the situation,” he said.

Emergency

Sri Lankan doctors say this is neither a “sound” nor a “sustainable” policy.

In a letter addressed to the president on April 7 and made public on Sunday, the Sri Lanka Medical Association (SLMA) contended that “what is considered non-emergency situations could turn into life-threatening problems within a few hours”.

Without urgent replenishment of supplies, emergency treatment may also have to be halted within a matter of weeks, if not days, the letter said.

“This will result in a catastrophic number of deaths, which is likely to be in excess of the combined death toll of COVID, tsunami and the civil war,” the letter added, referring to the Indian Ocean tsunami of 2004 and Sri Lanka’s 26-year civil war between the military and ethnic Tamil separatists.

Some 31,229 people died during the tsunami, while an estimated 100,000 died in the civil conflict. The country’s pandemic toll is at 16,489.

The SLMA also urged the president to hold consultations with doctors, saying the “need of the hour is to be truthful, compassionate and for you to use the country’s intellectual resources in the form of expert advice and guidance from professionals”.

Sudewa Hettiarachchi, director general of the president’s media division, said Rajapaksa has not yet made a decision on the doctors’ requests. He had no comment on allegations that the government has failed to treat this situation with the seriousness it deserved.

Health workers say the government needs to act fast.

“This is a disaster situation,” said Ravi Kumdesh, president of the College of Medical Laboratory Science. “We are calling on the government to urgently declare a medical state of emergency and also appeal for humanitarian aid internationally.”

Kumdesh said what worried him most is that “we cannot calculate where the end is”.

Even if the government were to alleviate some of the critical drug shortages in the near term, the severity of the economic crisis means it was likely to face a similar situation within months.

“The effects of this are going to be very long term,” said Kumdesh. “We need to call for international humanitarian aid. Because as a country, we can compromise on other requirements, but we can’t compromise on health.”