Long Wait For Medicine

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Seated in the front row of the waiting area for over five hours in one the largest hospitals in the country, desperately waiting for his turn, Punyapala, a diabetes patient, lamented in a quavering voice of the long wait for medicine.

Punyapala, a daily wage earner, speaking to Ceylon Today, said he had arrived at the Colombo South Teaching Hospital, most commonly known as the Kalubowila Hospital from Matara at 5:30 a.m. on a Wednesday, having skipped a day of work.

He patiently waited for his turn, following which the complete process, including the prescription of medicine took over five hours, as opposed to the ordinary wait which is only over 1.5 hours.

He bewailed the shortage of drugs and of how he could not afford to purchase his medicine from a private pharmacy, adding that even private pharmacies have run out of medicine required by him.

This is the plight of hospitals that have been crippled due to the persistent crisis in the country. Although medicine shortage and certain shortcomings of State hospitals were existent even prior to the present crisis due to reasons beyond the control of the management of the hospitals, it has now been aggravated, making patients fall prey.

Shortage of medicine and routine services

Health Minister Channa Jayasumana recently admitted that there would be a shortage of certain medicinal drugs in the next quarter, owing to the delay in opening Letters of Credit (LCs).

He said there is a shortage of one out of the 14 life-saving drugs, 37 out of 646 essential drugs and 48 out of non-essential drugs at the moment. While he affirmed that no death has been reported due to such shortage, the continued inconvenience caused to the public is inevitable.

The Ministry of Health also appointed a special official, Dr. Anver Hamdani to coordinate and maintain uninterrupted healthcare services and to facilitate medicinal and equipment donations to Sri Lanka to overcome drug shortages and other challenges in the sector.

Further, several State-run hospitals were also forced to temporarily halt some of their routine services and were running out of life-saving drugs, consumables and reagents – the most recent being the National Hospital of Sri Lanka (NHSL), Colombo. Teaching Hospital, Karapitiya too had called for the temporary suspension of its routine surgeries due to the shortage of the anaesthetic drug Neostigmine.

President of the Government Medical Officers’ Forum (GMOF), Dr. Rukshan Bellana observed that the medicine shortage has been a persistent issue that almost all hospitals have had to face, adding that the ongoing crisis has however further aggravated such issue.

Shortage of fuel for ambulances

Although the shortage in fuel that led to long queues to obtain fuel has now reportedly been minimised, the shortage did not spare the health sector as well and if the continuous supply of fuel is not maintained, it could further aggravate the impact on the health sector. 

Dr. Bellana previously also warned that health services are in danger of collapsing due to the shortage of fuel for ambulances and for healthcare staff.

He added, in spite of the Government declaring health services as an essential service, ambulances have to wait in long queues to obtain fuel, with no mechanism having been adopted to supply fuel for ambulances amid the fuel shortage.

Government Medical Officers’ Association (GMOA) spokesperson, Dr. Samantha Ananda said most patients from rural hospitals are commonly required to be transferred to National Hospitals, District General Hospitals, and Teaching Hospitals, adding however that this process has also been affected.

He also observed as healthcare staff operate on different shifts, many of them tend to use private modes of transportation, adding that the fuel shortage, coupled with the increase in the price of fuel has greatly inconvenienced them.

Food shortage?

Previously, Dr. Bellana also said in addition to the fuel crisis, the shortage of LP gas has affected resident doctors, who face difficulties in making arrangement for their meals, as most surrounding restaurants have also closed.

He added that there have been certain shortcomings in the delivery of essential food items to hospitals, while observing that this delay has not however immensely hampered the provision of meals to the patients as yet.

Reagents

Lakmali had reached hospital at 7:30 for her clinic day, while several tests including the haemoglobin A1C (HbA1c) had been prescribed for her. The test measures the amount of blood sugar that is attached to haemoglobin (Hemoglobin is the part of the red blood cells that carries oxygen from a person’s lungs to the rest of the body).

But due to the lack of the necessary reagent to perform the test, Lakmali said she would have to return on another day, on the next clinic date, to do the test. This is just one of the tests “Hopefully, the reagent would be available then. Having to do the test outside would cost more money,” she lamented.

Adapting to the crisis

The crisis that the state health service is faced with at present is such that currently all health professionals have no other option but to adapt.

Therefore, the patient is not given what he or she should be given to recover, but what can be, what is available is prescribed or administered to him or her, said President of the College of Medical Laboratory Science Sri Lanka, Ravi Kumudesh. He lamented that with the situation, a patient’s condition could easily swing from stage one of the illness to a critical condition.

“We do not have the dollars and at this stage we also lack the rupees to make the necessary purchases, as the Health Ministry owes a colossal Rs 12 billion to European companies from whom Sri Lanka purchased reagents. This is all because certain hospital authorities and consultants who have built up a laboratory equipment mafia,” he accused, adding that this group needlessly stresses on the need to maintain “quality,” of testing, rather than focussing on the need and the unnecessary expenditure it incurred, which had contributed to drag the health service to this state.

He said at one time medical laboratory technologists had locally produced some of the reagents required for the laboratory machines.

It would have been helpful at this time of crisis. But corrupt officials both at the Health Ministry and the state hospitals feared that they would lose the “cut” they received from purchasing reagents, he alleged. 

Hospital visitors

By 12:00 noon, visitors had queued up at the hospital gates to see their warded relatives and friends. Most of them had baskets and bags of food for their patients.

Mala from Kesbewa was visiting her son in hospital and said she had been asked not to bring food for him. “They told me not to bring any food for him,” she said.

Sumana and her daughter, who were also in the queue to enter the Hospital, said although there had been no issues regarding food for their patient, they had brought him a home-cooked lunch. “But until now doctors have not said that they were short of any medication,” they said. 

Iranganie, when approached, said her husband had been admitted to hospital for surgical intervention. “But after being admitted last Saturday (23) the doctors decided to postpone it by a few days,” she said, adding that she had come to hospital with his food.     

Shortage of reagents and mafia

Joint Convener, Health Services Trade Union Alliance (HSTUA), Ven. Tempitiye Sugathananda Thera, whose outfit had staged a protest inside the Teaching Hospital Kalubowila the previous day (Monday, 24), said in addition to the medicines the state service hospitals were short of, a large number of pharmaceuticals and devices which were required for surgery.

The shortages being experienced by the rest of the country have affected the state health service as well, he lamented. It is not the just the fuel crisis, but also the gas crisis that has impacted the health service. Large hospitals do not face the issue as much as smaller hospitals. The Health Ministry too has failed to allocate the necessary funds to purchase the food provided by hospitals for patients and staff. Earlier, the menu for the patient’s diet included a piece of chicken, fish, but the people who obtained the tenders to provide food are now unable to do so for the amount they did previously. The Ministry too has not increased the allocation to suit the times, he lamented.  

Kolakenda

Mallika comes from Ratmalana to provide Kolakenda (herbal porridge) to the visitors, hospital staff, and to some patients at the Outpatient Department (OPD) on their clinic days, as a majority of patients come early in the morning with only a cup of tea or on an empty stomach. They too patronise the Kolakenda stall for some delicious porridge. The hospital welfare society is responsible for operating the Kolakenda stall.

In conversation, Mallika lamented that the Kolakenda business at the Teaching Hospital had been affected with the Covid-19 pandemic since 2020. The restrictions that were imposed in state hospitals impacted the herbal porridge business. But the present economic crisis, which comes hard on the heels of the pandemic, has dealt a more severe blow due to increase in the price of even the ingredients that went into the porridge, she lamented.

Adding insult to injury is the present shortage of gas to cook the porridge. The outrageous price of cylinders of gas had forced her to use the sawdust stove to cook the porridge. “A person has to think twice before buying even a glass of porridge from a stall, Mallika lamented. It was not long ago when herbal porridge was Rs 40 a glass, while the sago porridge was Rs 50. But now, she said, “I have been forced to increase the price of herbal porridge to Rs 60. The Kurakkan (finger millet) is Rs 70 and a glass of sago porridge is sold for Rs 80.”

(Pic by Sarath Kumara)

By Faadhila Thassim and Dilanthi Jayamanne