Cellphone-light surgery and catheter reuse: Sri Lanka’s economic woes push hospitals to the brink of disaster

By Rukshana Rizwie and Julia Hollingsworth, CNN

Three-year-old Miru plays with a bright red toy car, seemingly unaware of the crisis unfolding around him.

Outside the small room where he lives with his parents, economic disaster grips Sri Lanka, causing protests, food shortages and power cuts — and leaving the medicine Miru needs in desperate short supply.

Miru has a malignant brain tumor that causes him to have frequent epileptic seizures and knocks him unconscious for minutes. The only thing that helps is anti-convulsant medicine, but with Sri Lanka’s financial crisis hitting medical imports, Miru’s father, Upul Chandana, struggled to find the medicine anywhere.

“It is no longer available at the hospital. Even nearby pharmacies are out of stock,” Chandana said, as her only son plays on the thin mattress behind him. “Now, even with money, we cannot find the medicine.”

Sri Lanka is grappling with its worst economic crisis in decades, as high foreign debt repayments and a massive trade deficit prevent the country from importing basic commodities and medicine. Sri Lankans struggle to buy essentials such as powdered milk and cooking gas, and protesters took to the streets demanding the resignation of the country’s president, Gotabaya Rajapaksa, who refused to step down. Sri Lanka has suspended repayment of its foreign debt while it works with the International Monetary Fund on a rescue plan.

Today, as medicines and medical equipment run out, the country faces what the Singapore Red Cross Society describes as a “unprecedented humanitarian crisis.”

Doctors report washing and reusing medical equipment – ​​and even performing surgery by cellphone light. Authorities have so far confirmed no deaths from the drug shortage – but experts warn the toll from the crisis could top the country’s more than 16,000 Covid deaths.

“It’s a crisis, we can’t predict how bad it will get,” said Athula Amarasena, secretary of the Sri Lanka State Pharmaceutical Association which represents pharmacies across the country. “But we are aware that we are heading towards a new crisis.”

A disastrous situation in hospitals

Every day, Wasantha Seneviratne goes from pharmacy to pharmacy in Colombo, the capital of Sri Lanka, desperate to find Topotecan, the chemotherapy drug her 7-year-old daughter needs to stay alive.

Both at the hospital where his daughter was admitted on April 7 and at every pharmacy he visits, it’s the same answer: the drug is not available anywhere in the country.

“No hospital, pharmacy or government importer has it. It’s nowhere in Sri Lanka,” he said of the drug his daughter needs to treat neuroblastoma, a form of cancer. “What should I do? My child may not live long if he does not receive the drugs.

Just a few weeks ago, Topotecan was offered free by hospitals, but families of patients are now responsible for sourcing their own supplies from private pharmacies, Seneviratne said.

Even that seems impossible. And the problem is much bigger than Seneviratne.

According to a letter released by the Sri Lanka Medical Association (SLMA), not all hospitals in the country have access to emergency drugs and medical equipment. Several public hospitals have been ordered to suspend routine surgeries and reduce lab tests due to limited stocks of anesthetics and reagents used for testing, SLMA says.

And medical equipment, too, is lacking. The president of the Perinatal Society of Sri Lanka, for example, has ordered hospitals to sterilize and reuse endotracheal tubes used to deliver oxygen to the lungs of newborns, as the shortage of tubes becomes “extremely critical”, according to a letter sent to the company’s Department of Health earlier this month and provided to CNN.

An intensive care surgeon who asked not to be named for fear of losing her job said life-saving drugs used to treat strokes and heart attacks were now in critical shortage and her hospital was forced to reuse them. catheters.

“I know I am endangering the life of the next patient. I feel hopeless and completely helpless,” she told CNN this week, adding that she now spends much of her time sanitizing equipment for reuse. “It goes against everything we’ve been taught to do.”

Although hospitals were mostly spared the power outages, the doctor told CNN they suffered a power outage while she and others performed surgery on a toddler to heart disease. They were forced to continue operating using their cellphone torches held by other medical staff until the generators were powered up.

“Despite having at least two cellphones pointed at, it’s not easy to perform procedures or sutures in such light,” she said.

A doctor at a government hospital in the central city of Kandy, who asked not to be named for fear of losing his job, told his hospital’s intensive care unit that they had run out of anesthetic and that ‘she worries about how hospitals will perform surgeries without pain relief. His hospital has reduced elective surgeries.

Like the unnamed surgeon, she was told to reuse the catheters and tubes on patients – and although she knows this could cause harm to patients, she says there is no other choice.

His team faces tough choices about who needs the drugs the most.

“We’ve had to make tough choices these days, especially in the intensive care unit, like who can live and who doesn’t,” she says. “We can continue to admit patients but we will have no way to treat them.”

The surgeon faces a similar concern.

“I don’t know if half of the patients we have in (the intensive care unit) will be alive in the coming weeks if this drug shortage continues,” she said.

How it happened

Some say the government should have seen the situation coming.

According to experts, Sri Lanka’s economic crisis has been caused by a combination of government mismanagement and misfortuneincluding the Covid-19 pandemic which has damaged the country’s tourism industry.

Tax cuts and economic malaise have affected government revenues, prompting rating agencies to downgrade Sri Lanka’s credit rating to near-default levels, meaning the country has lost access to foreign markets. Sri Lanka has dipped into its foreign exchange reserves to pay down public debt, reducing its reserves from $6.9 billion in 2018 to $2.2 billion this year, according to an IMF briefing.

The cash shortage has impacted imports of fuel and other essentials, including medical equipment and medicines.

For months, medical workers have warned of the impending crisis, and doctors and nurses have taken to the streets to protest perceived government inaction.

On Wednesday, after downplaying concerns and saying there was no shortage, the country’s health ministry admitted Sri Lanka was facing a shortage of some drugs and surgical equipment. According to the ministry, the government has received $10 million from the World Bank to purchase drugs, although it is unclear when this is due to happen.

“I would call this more of a challenge and not yet a crisis,” Health Ministry coordinator for donor activities and medical supplies, Dr. Anver Hamdani, told CNN this week.

There was no single reason behind the problem, he said, adding that the government would solve the problem behind the shortage Before the end of the month.

But others say the shortages are a man-made problem that could have been avoided.

According to Dr. Rukshan Bellana, chairman of the Government Medical Officers Forum (GMOF) and administrator of a public hospital in Colombo, the government could not afford the lines of credit for the supplies.

He told CNN there are 2,500 government-approved listed pharmaceuticals., and of these, 60 are in short supply.

“The president ignored the calls (for action), so what happened was it got worse every day,” Bellana said.

After that

The government says it is tackling both the economic and medical crisis. In a statement this week, the health ministry said it was in interim talks with the World Health Organization and the Asian Development Bank to secure funds or drugs, and is working to secure donations from Sri Lankans abroad.

But doctors say urgent help is needed.

In a letter to the president on April 7 and made public on Sunday, the Sri Lankan Medical Association said health conditions not usually considered emergencies could turn into life-threatening conditions.

“Without an urgent replenishment of supplies, emergency treatment may also have to be discontinued within weeks or even days,” the letter said.

“It will lead to a catastrophic number of deaths.”

Amarasena of the State Pharmaceutical Association says the problem will get worse before it gets better. Even though Sri Lanka receives help from international organizations or other countries, it can take weeks or months for shipments to arrive – and some suppliers only start manufacturing drugs once an order has been placed. And the country doesn’t even have a minister of health at the moment — a a series of Cabinet ministers resigned during the crisis.

“The person appointed in charge of this is not empowered enough to make quick decisions,” Amarasena said. “We don’t have enough time.”

Earlier this month, Seneviratne and her family arrived in the capital from Kandy province, hoping they would have a better chance of helping their daughter.

“We come to hospitals hoping to find a good treatment, so when we find that there is not even medicine, we are helpless,” he said.

For Seneviratne, there is not much he can do to help his daughter. The economic crisis has left him without a stable job, which means he has no way of importing medicine from abroad.

“There are many more (parents) who are also in deep sadness because they cannot find this medicine, even though they have (enough money) in their hands,” he said. . “We are holding back a lot of pain and grief. We don’t have the money to take our daughter abroad for medical treatment.

Back in the small room in Colombo, Miru’s father, Chandana, has similar fears. The family left their paddy field and moved to Colombo so that Miru could be treated. When he bought his last bottle of medicine, the pharmacist who sold it to him told him that it was his last bottle in stock.

But now he only has a few days of medicine left. His only hope is to keep looking for a way to find more.

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