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Drug shortage: State hospitals still managing, but situation may get dire soon, say sources
As the country went into a deeper economic crunch with no signs of immediate hope, state hospitals braced t.hemselves to face a medicine shortage looming closer and closer.
Mixed views were expressed by a cross-section of doctors when the Sunday Times contacted numerous hospitals.
“Denata manage karanna puluwan (for the moment, we can manage), but we may be in serious trouble in a few weeks,” was the lament of many state hospital sources across the country who declined to be named.
“We do have a samanyadrug shortage but it is not critical. We are managing by substituting medicines, if certain types are not available,” said a source at the premier National Hospital of Sri Lanka (NHSL), Colombo, explaining that they were also receiving donations from well-wishers to help them tide over the current situation.
Usually State hospitals issued two months of medications to those attending their regular clinics but now that had been cut to a month in some hospitals (file pic)
Many also reiterated that the time ‘barrier’ or gap in re-stocking due to the foreign exchange crisis could create some issues.
“A different angle is that sometimes it is only one agent who has registration with the National Medicines Regulatory Authority (NMRA) for a particular drug. If the government’s bill with that agent has not been settled because of the economic crisis that agent may not be able to secure stocks from his head office. Then registering another company to get that drug may take a long while,” a source pointed out.
When asked about drug shortages, a source at the Karapitiya Teaching Hospital said there was no “loku avulak” (big mess up) as they were using alternatives, with a similar view being expressed by a source at the Kandy National Hospital.
Some sources at major hospitals in other outstation areas said, however, that they had temporarily reduced routine surgeries, with only emergency procedures being performed. Usually they also issued two months of medications to those attending their regular clinics but now that had been cut to a month and they were hoping that the Medical Supplies Division (MSD) would do the needful to prevent a deterioration in the situation.
A doctor pointed out that when the issue of medicines at regular clinics were cut, people who were having non-communicable diseases (NCDs) such as diabetes and cardiovascular disease would prefer to remain at home as they would think it was not worth their while to spend their meagre funds to attend the clinic. They would also have no money to buy medicines from outside the hospital. A long period without these medicines would result in aggravation of NCDs and people rushing to hospital when acutely ill.
Some doctors in another outstation teaching hospital said: “We are performing only life-saving routine operations and all other routine procedures have been postponed.”
The Sunday Times heard heartrending tales from patients – one woman who needs a cataract operation said that the National Eye Hospital which usually gives the lens free had told her to buy her own lens. This daily wage earner was desperately seeking the sum of Rs. 21,000, an exorbitant and ill-affordable cost for her, to buy one lens. She may never be able to collect this amount.
From an outstation hospital comes the news that when a factory worker who had met with a work accident needed a small X-ray of three fingers, the radiographers who were making all attempts to see to the needs of patients and conserve to the maximum whatever resources were available, simply had no option but to use the big X-ray film utilized for chest images. For, no small films were in stock.
“What a waste,” grumbled a doctor, lamenting that the radiographers were in a bind to use the big films but could do nothing about it.
Similar was the information of shortages with regard to such items as strips being used to check blood sugar levels. Many doctors said that when they ordered the blood sugar test, nurses were in a quandary as they did not have stocks. So some doctors did not write these tests and this could easily endanger the lives of patients – both the doctors and nurses were facing a ‘lose-lose’ situation because they did not have the stocks required to give optimal care to patients.
An expectant mother living in the south whose baby is due in June had been asked by her doctors to stock up on paracetamol syrup and gripe water as they feared that these would go out of stock in the next two months. They were not available in her town or any town close to where she lives. Urgent calls to some of her relatives in Colombo had followed, with a search of all pharmacies in Borella which yielded one bottle of paracetamol syrup. Gripe water, of course, was available aplenty.
Another person who had cellulitis and was having high fever and chills and rigors had gone to an outstation hospital. Even though he needed admission, the hospital had turned him away apologetically on the grounds that they did not have medicines to treat him. He had then gone to another bigger outstation hospital closer to his village.
Pointing out that its position is different to both state and private hospitals, a source at the semi-state Sri Jayewardenepura General Hospital said that the hospital is managing because it can make direct purchases without the nod of approval of the MSD. This allowed them to get whatever stocks they needed, a recent example being cannula for intravenous (IV) infusions.
“Apema payments karanna puluwan hinda, podi chance ekak thiyenawa,” the source said, but a crisis in managing drug supplies in other hospitals would come about because now there is no “lead time” in ordering depleting stocks.
The source explained that when considering the three types of hospitals, in state hospitals the costs are borne by the state (of course, the funds are from taxes paid by the people); in private hospitals the costs are borne by the patients; and in a semi-state hospital like Sri Jayewardenepura, the state bears half the cost (the Treasury funds the salaries of the staff) and the patients the other half. So, the hospital is able to pass on the benefit of the Treasury funding the staff salaries, to the patients.
“This is why even when the COVID-19 pandemic was raging across the country, the Sri Jayewardenepura Hospital was able to continue charging only Rs. 4,500 for a room,” the source added.
| Priority List for drugs to treat cancer A ‘Priority List’ of essential oncology drugs for the treatment of cancer patients has been identified by the Sri Lanka College of Oncologists based at the National Cancer Institute in Maharagama. The list of drugs has been put forward on the request of the Health Ministry to facilitate purchase through credit lines or donations from well-wishers. It consists of essentials needed in cancer treatment including chemotherapy and hormonal drugs. “We made this Priority List of cancer drugs in mid-April considering the cost effectiveness, the need to treat common cancers in Sri Lanka and those included in the ‘WHO Essential Medicine List’,” states the oncologists. (See graphic) They have strongly cautioned against the circulation of different lists, other than the one compiled by them when making appeals for donations or sending requests to foreign missions. “Those lists contain many medicines outside the Priority List and cannot be classified as urgent or essential medicines,” they state, assuring that the college would provide further recommendations on the need of any additional drugs, when the economic situation improves. “Take urgent and necessary steps to make the drugs on the Priority List available sooner, as per the usual amounts of consumption in the past and ensure the continuation of uninterrupted cancer care services,” the oncologists add. Essential psychiatric and psychotropic drugs needed The Sri Lanka College of Psychiatrists has also listed out essential drugs and the quantities needed until December 2022. In a letter to the Health Ministry, the college states that the list is based on the availability of stocks at the MSD. Nineteen medicines including tablets and injections needed in the treatment of psychiatric (mental) disorders are on the list, while another list of essential psychotropics (which adjust the major chemicals in the brain) include four for rapid tranquillization; seven anti-psychotics; two mood stabilizers; four anti-depressants; three for substance misuse; two needed for child psychiatry issues; and one for old age. | |
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