At a time when Sri Lanka is struggling to get back on its feet from the grips of the economic crisis, the island could use as much help as it can in order to achieve what at the moment may seem like only a dream. Faced with the aftermath of an economic collapse, the country’s finances in disarray have even succeeded in dragging the health service down.
Yet, there is hope, as Sri Lanka’s health service too can provide solutions to the problems facing the island.
“It is high time to create a medical research culture,” President of the Medical and Civil Rights Professional Association of Doctors (MCPA), Dr. Chamal Sanjeewa said.
He explained that a majority of research conducted in medical colleges and at the Postgraduate Institute of Medicine was done with a view of getting through examinations, while others were “survey” type research studies conducted by Specialist Consultants with the aim of either gathering data, obtaining funds, or publishing research papers.
Even in well-known medical faculties, there are 20 to 30 professors, but at the end of the day, only about four or five research papers are published. Those that get published are based on establishing factors on nutrition or non-communicable disease.
But there is a serious lack of “creative research” in Sri Lanka directly aligned with the country’s development process. Many Western countries and even neighbour India have conducted research with the sole aim of production and innovation. This was seen during the many Covid-19 waves that rocked the globe. Even while being tormented by the coronavirus, India did not give up on researching an anti-Covid vaccine, he observed.
But while one section of Sri Lanka embraced even the much talked about ‘Dhammika Paniya,’ and other syrups which were concocted to battle the virus, the medical professionals of this country scoffed at these herbal concoctions.
Deputy Director General (Disaster Response and Research) Dr. Hemantha Herath, who is in charge of the Education, Training, and Research Unit of the Health Ministry, when contacted, said at present the medical research conducted in the country is fragmented.
Medical research that is being conducted needs to be given the strict nod from the Ethical Committee for even the budget to be approved, he said. However, hopefully the National Health Research Council (NHRC) would be able to streamline the process.
National Health Research Council (NHRC)
The NHRC in Sri Lanka has been set up to provide a framework for the “regulation, coordination, monitoring, development, and management of health research in the country,” the Health Research Governance Strategy, published in 2019 states.
According to it, “The 13th Amendment to the Constitution, the conduct of research is a subject that is not devolved to the provincial councils. The role, functions, and duties of NHRC in health research governance are outlined in part two of the NHRC Act. 2.2. Institutions which grant ethics clearance should have established institutional ethics review committees (IERCs) with requisite processes and procedures.”
The principles on which clearance was granted were based on the international guidelines such as those of the Council for International Organisations of Medical Sciences (CIOMS) and the World Medical Association’s Declaration of Helsinki. The NHRC at the time was in the process of formulating national guidelines for ethical research on humans.
Funds and resources
Acquiring funds for such medical research was apparently another matter, as already there were tussles between the Treasury Secretary and the Health Secretary over extra duty payments for grade medical professionals and fund allocations required for the health service.
Medical practitioners were paid an allowance for research once they received clearance from the Ethical Committee. Research could be conducted during their off-duty hours, infringing on the time which could be spent with family or engaging in private practice. Sanctioning that approval was another bone of contention, as at least one member of the Committee seemed to have a bone to pick with intended researchers and squash any attempt of researching, medical practitioners complained.
Covid-19 alone provided a fruitful source for research even in Sri Lanka. Therefore, it is unfortunate that other than at the Sri Jayewardenepura Medical Faculty and those like Dhammika Bandara, no attempt was made to conduct any type of research on it.
The Laboratory facility of the Medical Research Institute is complete with both Transmission Electron Microscopes and the Scanning Electron Microscope. But unfortunately, the two pieces of equipment too were not being put to maximum use for scientific research, so much so that they were almost non-functional. “One cannot complain that Sri Lanka does not have supportive lab facilities to cater to research, but biased attitudes and the lack of funds play key roles in preventing medical practitioners or any other professional health category in the health service from conducting any form of research.”
Much publicity was given through the media when Sri Lanka commenced manufacturing saline for its network of State hospitals.
But to date, the local manufacturers have been unable to produce adequate saline to cater to the private sector, leave alone export if there was a surplus. “We still depend on imported Metformin given to patients with diabetes, let alone experiment and research on the variety of herbs with medicinal value existing in the jungles and shrubberies of the country from which extracts could be taken to manufacture such medicines,” MCPA President, Dr. Sanjeewa said.
Instead, Western Medical Practitioners would rather bite their tongues off than accept that something could be extracted from the assortment of herbs to treat one of the many non-communicable and communicable diseases ailing the country.
President of the College of Medical Laboratory Science Sri Lanka, Ravi Kumudesh said if the country’s health service was to cater towards its development, the two things which need to be done was to research the percentage of the country’s population using the free health service. Although 90 per cent turn towards the free health service, at least 50 per cent of them have to incur out of pocket expenses carrying out various tests and purchasing medicines, he lamented.
While medical practitioners accuse Sri Lanka Administrative Service (SLAS) officers working side by side in the Health Ministry of being flies in the ointment when it comes to paying extra duty allowances, Kumudesh called for research to be conducted on the economic wastage in employing medical practitioners and other health professionals to carry out duties outside their scope.
By Dilanthi Jayamanne