Lack of mobility keeps patients away

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Sri Lanka has lost her children in every crisis that she has met – whether natural or man-made. Think about it, from the 2004 Tsunami, the 2020-2021 Covid-19 pandemic, till the now-happening economic ruin which has led to crises with many faces, lives have been claimed. The fuel queue death toll by Thursday (7) had risen to 18. A sizeable number of those who died were elderly and possibly on treatment for one non-communicable disease (NCD) or another.

What is in fact a figure for the Media, a statistic for the health service, is a sign that even Sri Lanka’s patient population has been affected by the present devastation.

Pregnant mothers

There have been cases where pregnant mothers have experienced labour pains while travelling in three-wheelers and on airplanes (not in Sri Lanka though). But now Sri Lanka has reached a situation where mothers go into labour while standing in queues to receive services, as was witnessed last week when a mother developed labour pains while waiting in a queue outside the Passport Office in Battaramulla.

In addition, public health midwives have reported that there was a minute growth seen in the number of home deliveries owing to the present travel issues. 

The Health Promotion Bureau (HPB) issued instructions to pregnant women earlier last week “considering the uncertainties in the social and economic context of the country and the scarcity of transport facilities.”

Issuing instructions, the Bureau said hospitals were the best place to plan delivery. “The Health Ministry does not recommend home deliveries under any circumstance. The facilities, experience, and expertise to deliver a child safely and provide the necessary postnatal care for the mother and the baby will be available only at a hospital,” the institutions stressed.

Underlying the importance of a hospital delivery, the HPB said complications such as postpartum haemorrhage in the mother, neonatal infections, and breathing difficulties in the newborn were difficult to predict and “impossible to manage during home delivery,” therefore it requires instant attention that only a hospital can provide. The maternal and childcare system in Sri Lanka has been able to provide these services at an optimum level up to date and maintains one of the lowest maternal and neonatal death rates in the Southeast Asian region. Sri Lanka’s hospital delivery rate of 99.9 per cent maintained by the health system is one of the main factors that has contributed towards this achievement.

Any pregnant mother who is worried about finding an emergency transport mechanism to the nearest hospital should contact the Medical Officer of Health (MoH) in her particular area. They will make arrangements for these mothers to be admitted to the closest hospital closer to the due date and provide the necessary care until the delivery. “All pregnancies should be considered risk pregnancies because complications can happen at any time,” it said, pointing out that all pregnant mothers should be aware of signs of labour and signs of possible complications. The Bureau urged mothers to take immediate measures as soon as they notice any of the dangerous signs to get themselves transported to the closest hospital to be assessed by a healthcare professional. If transport is not immediately available, mothers are advised to call the 1990 Suwaseriya Service, it said.

Director of the Family Health Bureau, Dr. Chithramalee de Silva urged pregnant mothers to seek early hospital admission and not to wait till the last minute. However, pregnant women living in remote rural areas who are facing travelling difficulties during this time of crisis may have to rely on the goodwill of their extended families and communities for transport.

Rural patients

Doctors have stressed on the need for the State to develop its public transport service in a bid to assist patients living in rural areas and in need of emergency care.

The Northern Province Coordinator for the Government Medical Officers’ Association (GMOA) explained that the fuel crisis had hit patients, resulting in a decline in numbers coming to the hospital Outpatient Department (OPD). “Those living in rural parts of Sri Lanka including the Northern Province face severe difficulties.”

Dr. Gandeepan said an assessment should be conducted by the Health Ministry and the Regional Directors of Health Services (RDHS) on the number of patients arriving at the OPD, hospital admissions, and those attending clinics.

Some patients may be able to travel on a motorbike to the hospital owing to spare fuel they have at home. All cannot ride bicycles or motorbikes, while using public transport too has become a headache. Patients arriving by train are unable to get a connecting bus or three-wheeler to travel the remaining distance to the hospital, Dr. Gandeepan lamented.

This inability to travel has led to further serious issues, as patients tend to ‘watch and wait’ to see if their headache or fever or any other symptom would subside with home remedies or something purchased from the nearest grocery store. By the time they reach the hospital’s OPD, the fever has been there for more than 48 hours and they have developed complications. With diseases like dengue, influenza, and reports of Covid -19 in other countries, it is important that as difficult as things are the patient reaches the hospital, GMOA Secretary, Dr. Haritha Aluthge lamented.

It is even more unfortunate that the situation in peripheries – the interiors of Sri Lanka that hospitals are unable to even send their ambulance service to transfer the patient to hospital as they too are without fuel, he said emotionally.  

Apeksha Hospital

It is probably a blessing at this juncture that specialised hospitals like ‘Apeksha Hospital’ for patients with cancer have been able to ensure that its patients are given timely treatment despite the massive difficulties they face.

Hospital Director, Dr. Anura Jayasekara said patients who come are those who have to undergo treatment like chemotherapy at the hospital. Unlike the hospital’s health staff, they don’t have to come daily. They make the necessary arrangement to come to the hospital, get warded, receive treatment or meet their respective doctor and return home, he explained.

National Hospital Colombo

National Coordinator Training at the National Hospital, Pushpa Ramyani de Zoysa said the Accident Service of the hospital remains busy. There is an increase in the number of violence victims being brought to the Accident Service these days. Elaborating, she said they mainly comprise victims of clashes at fuel stations, on the road and domestic violence. Added to this burden are victims of road traffic and domestic accidents, she lamented.  

Access to medicine, increasing costs 

Trouble is doubled for patients – especially the middle income and poor families who have to cut their coat to suit their purse. With the rising cost of medicinal drugs, their choice is either to cut down on their nutrition or the amount of medicines they purchase. The situation greatly affects clinic patients, who in addition to the quota of medicine the hospitals provide also have to buy one or two from a private pharmacy.

Patients are being weighed down with the fuel issue and the drug shortage facing both hospitals and private pharmacies, so much so that if they don’t die of inability to purchase and take the necessary drug, they breathe their last due to the stress they face by just thinking of their situation. 

According to the All-Island Private Pharmacy Owners’ Association (AIPPOA), even the available drugs are depleting as a result of the fuel crisis. The stocks cannot be replenished as the vans or lorries which deliver the pharmaceuticals don’t have the fuel.

Simultaneously, State hospitals too are faced with the dilemma that the Medical Supplies Division (MSD), which has been receiving donations of medicinal drug stocks, cannot even distribute them to the Health Ministry’s hospital network, as even those vehicles are out of fuel.    

Government Midwifery Association

President of the Government Midwives Association, Devika Kodithuwakku said the Government at this juncture should take measures to increase the number of Family Health Service Officers (FHSOs) in a bid to reach the families and their patients. It waited till this situation erupted to start finding solutions. Hopefully, a similar strategy would not be adopted in taking urgent measure to fulfil the shortage of FHSOs to fill in the gaps which may occur during the months of crisis ahead.

With the pangs of the fuel and medicine crisis being felt even by people, the Government should hasten its recruitment process for FHSO to reach the grassroots level patients and their families. Not only pregnant mothers, but the public should be educated on maintaining their health and preventing disease at this moment. Especially those patients with NCDs need a proper balanced diet to maintain their health and not allow their sickness run haywire.

The country requires another 3,000 FHSOs at least to help reach families – especially those in rural Sri Lanka.

In search of solutions

Under the circumstances, the best shot that the Health Ministry has is to assess this drop in numbers at the OPD. It is definitely not because the Nation is healthy. Instead, it is the lack of mobility that keeps them away.

If patients cannot reach the health service, then the health service should at least attempt to reach the poor patients who don’t have the money to seek private sector treatment, let alone buy their medicines from the pharmacy.

During the height of the pandemic, in 2020 and 2021, the Government made use of resources such as the postal service to send clinic patients their medicine quota.

Mobile hospital services should also be carried out making use of the “special fuel allocations” being given to the health service by the Ministry of Power and Energy.

Urgent measures should also be taken to strengthen public transport. President Gotabaya Rajapaksa used the Security Forces during the pandemic, unfortunately at this time when the country has met its waterloo, he is using the military at fuel stations and roadsides to intimidate the public. 

During the pandemic, there were travel restrictions, while pharmaceuticals were delivered to the doorstep by hospitals using the facilities of the postal service, while private pharmacies sent their delivery serviceman on a motorbike at least to the patient’s doorstep. But now, patients living in remote parts of the country experience difficulties in reaching healthcare facilities, let alone even travelling to a pharmacy to buy their medicine.

The Government and its Ministers of Health and Power and Energy, Keheliya Rambukwella and Kanchana Wijesekera have conveniently turned a blind eye to this need. Director General of Health Services, Dr. Asela Gunawardena is tasked with finding a way to overcome the situation the way his predecessor, Dr. Anil Jasinghe did when the pandemic hit Sri Lanka and quarantine laws were implemented.

Should this situation persist, when the patient’s right to obtain services of a health institution is being violated, the State would perhaps have to consider giving fuel allocations to the hearses as the last resort, as they could be identified as ‘delivery vehicles’ which carry the dead to burial sites. 

By Dilanthi Jayamanne