Surgery by flashlight, not enough drugs: Sri Lankan doctors make life-death decisions as economic crisis deepens

Across Sri Lanka, doctors are being forced to make triage decisions on who gets to live or die as the supply of essential drugs runs dangerously low amid a debilitating economic crisis.

The debt-laden country has been struggling to pay for imports, including medical supplies, due to a shortage of foreign exchange, and even financial support from India and China has failed to alleviate the situation.

The International Monetary Fund has warned the government's total foreign debt of US$35 billion is "unsustainable" and ratings agencies have warned of a potential default.

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Dr Minoli de Silva, a medical officer working in the emergency department of a teaching hospital in the country's Western Province, said she was now having to choose which patients to treat.

"In my hospital, only 10 more vials of an essential drug used for treating heart attacks and strokes are left," Dr de Silva said this week.

"So now we have to look at factors like age and prognosis and decide which patient has a better chance of surviving after taking the drug before starting treatments. If there are two patients, we may have to choose to treat one of them," she said.

Recent supply shortages led to a quota for certain essential drugs, meaning not everyone who needed them would be given them. But the current situation means even more people will be prescribed alternative, less efficacious drugs that could lead to various side effects, including the plummeting of blood pressure, the doctor said.

On Thursday, several doctors who wanted to remain anonymous confirmed a heart patient at a Colombo hospital passed away due to unavailability of this very same drug.

Dr de Silva's testimony, echoed by others interviewed by This Week in Asia, underscore the reasons behind the Government Medical Officers' Association's (GMOA) decision to declare a health emergency this week.

The organisation, with 130 branches, is widely seen as the country's most powerful professional union. The group said that along with diminishing medical supplies, daily power cuts and fuel shortages across the country were severely affecting healthcare.

Also joining the chorus of concern this week was the Sri Lanka Medical Association. It sent a letter to the nation's President Gotabaya Rajapaksa on Thursday saying hospitals were already curtailing services like routine surgeries and limiting the use of resources to treat life-threatening illnesses.

Unless supplies are urgently replenished "within a matter of weeks, if not days, emergency treatment will also not be possible. This will result in a catastrophic number of deaths", the letter said.

Currently operating without a health minister, President Rajapaksa's administration has not followed the GMOA's cue in calling for a health emergency.

The government, led by the president's brother Prime Minister Mahinda Rajapaksa lost its parliamentary majority and is barely holding onto power. During Friday's parliament session, the opposition said they would bring a no-confidence motion against the government unless the President resigns.

Following the resignation of 26 cabinet ministers in recent days, four have been reappointed ministers to "essential portfolios". The health minister portfolio remains vacant, but a "coordinator" was appointed on Saturday to facilitate uninterrupted healthcare and donor activities.

Dr Senal Fernando, the GMOA secretary, told This Week in Asia the association was imploring the government to declare a health emergency and give "priority to the health sector when allocating funds".

Dr Fernando noted his group had predicted the current state of affairs in January and sought discussions with various stakeholders so contingency plans could be drafted and resources reallocated if necessary. The health ministry had "failed" to take action, he said.

For Dr Gayani Liyanarachchi, one of the prices of official inaction is the lack of antivenin in the Padaviya Base Hospital in the island nation's historic Anuradhapura district, where bites by poisonous snakes are common. The medical facility also needs to stock up on an essential drug to treat patients brought in with heart attacks.

Ambulances, meanwhile, are plagued by fuel shortages, which means transferring patients poses a major risk due to potential long delays moving them.

"I have seen patients having heart attacks, needing specialised management including cardiac intervention suffering because they arrive at the emergency unit in a tuk-tuk with relatives, because the ambulance is out of fuel," said Dr de Silva.

In some instances, doctors are sometimes carrying out operations using mobile phone flashlights because of power cuts or complications with generators, including a lack of fuel. Images of such surgeries have been shared on social media.

Doctors in a hospital in the Northern Province can barely cope with the current power cuts, and worry they will be fighting time itself if there are prolonged outages, especially in the special care baby unit, where some children depend on ventilators. "Every second is important to a patient receiving oxygen," they say.

Across the board, hospitals are running out of saline solution, anaesthetics, chemicals for laboratory tests and other items, say doctors. The full extent of the situation will be realised later this month or in early May when all existing stocks run out, said Dr Fernando, the GMOA secretary.

He noted that the country was still using drugs bought last year. Imports of US$18 million worth of drugs is urgently required, he said, although this is yet to be approved by the government. Some 85 per cent of pharmaceutical products in the country are imported, and are mainly paid for in US dollars.

In the meantime, routine surgeries will need to be reduced as the situation unfolds. Illustrative of this was the decision last week by the Peradeniya Teaching Hospital in Kandy to postpone non-essential surgery after the facility ran out of essential drugs.

It subsequently received emergency supplies from the Ministry of Health but not before attracting the attention of India's Foreign Minister S. Jaishankar who offered Indian help in securing medical supplies. New Delhi has also supplied essential drugs to the National Eye Hospital in Colombo.

For Dr Rukshan Bellana, a medical doctor and the president of the General Medical Officers' Union, another body representing the country's doctors, the entire situation is emblematic of the overall state of governance in the country and ineptitude in the health ministry.

"Even if a country is bankrupt there are organisations such as the World Health Organization that come to the rescue," Dr Bellana said. "But we are now stuck in this calamity because of the lethargic managerial sector of the Health Ministry, who failed to forecast the situation and plan early," he said.

This article originally appeared on the South China Morning Post (SCMP).

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