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Sri Lanka: Doctors scramble for basic medicines as economic crisis engulfs nation

BMJ 2022; 377 doi: (Published 12 April 2022) Cite this as: BMJ 2022;377:o968

Rapid Response:

Re: Sri Lanka: Doctors scramble for basic medicines as economic crisis engulfs nation

Dear editor,

I would like to begin by thanking you for highlighting the perilous challenges confronting the Sri Lankan healthcare system at present. It is crucial to raise awareness of both the short- and long-term effects of the humanitarian crisis in Sri Lanka on the country's healthcare sector.

In April and May of this year, I completed my elective at one of the country's largest hospitals, where I was placed primarily in the Emergency Treatment Unit (Emergency Department), but also in Critical Care and Paediatrics. This experience was nothing short of life-changing, and was able to pick up on many of the challenges your article clearly describes.

The implications of the economic crisis on the hospital's functionality were undeniable. Firstly, it was not uncommon for healthcare professionals to be unable to commute to the hospital after spending their days off work queuing hours for petrol, only to reach the front of the line and discover that there was no more fuel.

The Emergency Treatment Unit's inventory of antibiotics was clearly visible in the centre of department. When I first noticed this inventory, the scarcity of antibiotics was startling, and unfortunately these lifesaving medications were depleting rapidly though my elective. Although the hospital was aware of this issue, it simply did not have the funds to replenish the supplies. Furthermore, as Sri Lanka had ceased importing certain medications, the hospital was unsure if it was even possible for them to acquire more.

The power cuts that you mention disrupting surgery also disrupted basic human-human communication and made obtaining a patient's medical history and conducting an examination (particularly intimate examinations) considerably more difficult. On numerous occasions, I observed Sri Lankan medical students holding torches for nurses while they attempted to insert a cannula or deliver medication correctly.

Due to a shortage of functioning continuous observation machines, it was common to find three patients connected to the same continuous observation machine. This made it extremely difficult to follow each patient's hemodynamic status, and early signs of deterioration were harder to spot.

The national shortage of food and water, and queues for basic commodities that ran for miles resulted in an increased number of citizens presenting to the Emergency Treatment Unit with starvation, dehydration, and heatstroke. It was evident that the political upheaval was placing further strain on an already overburdened healthcare system due to the lack of employees and poor availability of resources.

There was no doubt that the healthcare system had reached a point of crisis as national supplies of anti-rabies immunoglobulins were fully depleted and snake venom antidote stocks were dwindling.

I was astounded to observe the doctors' optimistic attitudes and resilience in the face of all these challenges, as they told me "The only thing we can guarantee our patients is a smile". Discussing the political climate in their country brought many of them to tears as they were clearly overworked, understaffed, and under-resourced. They felt their voices unheard, and many of them took to peaceful protests in their breaks to express their views.
The hours they worked and conditions that they worked in were truly challenging, but their adaptive approaches to minimise wastage, fully utilise available resources, and provide patients with the absolute best care possible were incredible.

Competing interests: No competing interests

05 August 2022
Melissa C Drake
Final year medical student
University of Birmingham
Medical School, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT