Exhausted hospitals rely on Sri Lankan expats to steal medicine

Like Sri Lanka’s worst economic crisis in decades took hold, causing medical shortages and halting surgeries, Kavindya Thennakoon knew she had to do something. Before boarding a flight from San Francisco to Colombo, the Stanford graduate and co-founder of a digital education app posted on social media and asked those who were short on supplies to get in touch.

More than 50 requests later, Thennakoon packed three suitcases last month with 60 kilograms of over-the-counter items for a hospital that ran out of basics, including surgical masks, glucose strips and supplements for new mothers. The most distressing demands were those she could not legally meet, such as cancer drugs and injectable drugs for premature babies.

“Hearing about these complete strangers – begging and saying, ‘I’m going to run out of supplies in a week or two days’ – was very heartbreaking,” said Thennakoon, 27, a Sri Lankan who lives in California. “And to realize that the country has come to this was even worse.”

For weeks, Sri Lanka’s once-praised public health system, free for its 22 million people, came to a virtual standstill. As the country’s economic collapse drags on, surgeries are postponed and hour-long power cuts have forced doctors to operate by torchlight. With Sri Lanka’s finances hit by Asia’s worst inflation and dwindling foreign exchange reserves, hospitals, clinics and pharmacies are struggling to source life-saving drugs and medical equipment.

Without drastic measures, medical groups warn that import disruptions could lead to thousands of deaths. Public anger against the government is reaching fever pitch: Sri Lankans have taken to the streets of Colombo, the capital, protesting the lack of medicines and other goods, and demanding the resignation of embattled President Gotabaya Rajapaksa. To ease the shortages, the Sri Lankan diaspora is now airlifting supplies to patients and doctors, although Thennakoon said the gestures were still just a “band-aid”.

Last month, the government warned of dwindling stocks of more than 100 medical items. Many are subject to price controls that have not kept pace with recent local currency devaluations, making importers reluctant to ship pharmaceuticals at a loss.

Pharmacists arrange medicine for patients at Colombo South University Hospital on May 2. (Bloomberg)

Channa Jayasumana, Sri Lanka’s health minister, told parliament that some drugs could go out of stock for three months. He said the lines of credit needed to buy drugs should have been opened in January, but were not obtained until April.

Currently, about 140 kinds of drugs are largely out of stock. The figure could rise to 250 in the coming days, according to Ravi Kumudesh, president of the Academy of Health Professionals, a local union. “I have never seen this kind of situation in Sri Lanka,” he said.

Jayasumana and the country’s former health minister Keheliya Rambukwella, who resigned in April, did not respond to requests for comment.

Improvise solutions

Some Sri Lankans have devised workarounds to fill the gaps.

Nisal Periyapperuma, 26, co-founder of Watchdog, a Sri Lankan organization set up in 2019 to tackle misinformation, said he was furious with the government’s slow response to shortages. The crisis was heightened in early April, he said, when his father suffered a heart attack.

“I’m a little terrified,” Peryapperuma said. “Can we get the next set of drugs?”

Watchdog recently launched an online database called Elixir that collects and coordinates medical requests from hospitals, government and other donors. Topping the list are more than 17 million sodium valproate tablets needed to treat epilepsy and bipolar disorder, as well as chemotherapy drugs and anesthetics.

Yet the coordination of national stocks is only part of the problem. Sri Lanka imports about 85% of its medical supplies and needs cash to bring them into the country.

“We don’t have enough foreign currency to actually clear these orders,” Periyapperuma said. “If you go to a pharmacy and try to buy something simple, like paracetamol, it’s a bit difficult. It lacks basic medical supplies as most of them are not produced here.

An avoidable crisis

The shortages mean around half of all surgeries – mostly routine operations – have been postponed in Sri Lanka, according to Rukshan Bellana, chairman of the Government Medical Officers’ Forum, a union representing around 2,000 doctors.

His group blamed the government for failing to act months ago to secure emergency supplies from neighboring countries like India, which is a major supplier of pharmaceuticals to Sri Lanka. With fuel shortages, many healthcare workers cannot even get to work, he added.

Medicine bins placed on the table in a medicine dispensing counter at Colombo South Teaching Hospital on May 02, 2022 in Colombo, Sri Lanka. (Photo by Buddhika Weerasinghe/Getty Images)

“It could have been avoided,” Bellana said in an interview at Colombo South Teaching Hospital, where patients snuck around the entrance one recent morning. “You may not have the medicine, you may not have the medical staff – but the patients keep coming.”

In the short term, Sri Lanka may get some relief. President Rajapaksa announced last week that the World Bank would provide financial assistance of $600 million, in part so that the country can buy more drugs. The government also recently signed a $1 billion line of credit with India, which pledged to send medical supplies to the island soon.

But even with these infusions, Sri Lanka faces shortages of single-use items such as IV lines, catheters and chemical diagnostic reagents, according to Bellana. And with long lead times for overseas medical supplies, many clinics and hospitals are expecting a long wait.

In northern Sri Lanka, where Tamil separatists have fought a 26-year civil war, staff at Jaffna Teaching Hospital are anxiously consulting international health organizations over the depletion of stocks of around 70 medical items . With only about a month’s supply of anesthetic, the hospital postponed all surgeries except maternity and emergency operations.

Even during the war, which ended in 2009, “we didn’t have this crisis,” said C. Jamnunanantha, 53, a doctor and deputy director of the hospital.

“We don’t know how long we can do it,” he added.