Colombo, Sri Lanka: Sixty-five-year old Janaka Kumara had to visit six pharmacies to buy one vial of Fulvestrant for his wife, an essential drug needed to treat breast cancer, only to be turned away from each of them. Finally, he reached out to his brother in Kandy who sourced it from the black market for double the cost - two lakh Sri Lankan rupees.
"You need one vial in 21 days and I have only been able to source one. So I am trying to buy more so I don't run into this difficulty again," says Kumara, who couldn't find the medicine in any of the big pharmacy stores in Colombo.
Kumara runs a small clothes shop in Borella area of Colombo. "I already have taken loans for my wife's treatment and now to buy these medicines I have had to take extra loans. My shop is shut in the evenings because of power cuts and this crisis has meant not many are coming to buy clothes. How I am going to afford more medicines?" he asks.
Sri Lanka is facing the worst economic crisis in over 70 years with shortage of essential foods, fuel and medicines leading to a severe hike in its prices. The masses - mostly the middle and the lower middle classes - have been impacted with costs of dal, rice, cooking gas cylinders and fuel soaring through the roof.
At Apeksha Hospital in Maharagama, the government run Cancer Hospital, patients are anxious. "We can see the nurses and doctors whispering among themselves about the shortage of medicines, says Sanitham Dissanayake, who was at the hospital with his mother who is undergoing chemotherapy for blood cancer.
"She was supposed to have her chemotherapy session four days ago but the staff at the hospital said they had run out of an important medicine. Now it has been delayed. My mother needs regular chemotherapy, I don't know what to do," said Dissanayake, who works as an auto driver.
A worker at Omed Pharmaceuticals near Apeksha Hospital which primarily sells cancer treating medicines said they had run out of Fulvestrant vials one week ago.
"We feel bad turning away patients but what other option do we have? We have placed orders with the big wholesalers but they have also told us that stocks are low and first priority is being given to government hospital pharmacies. We now ask patients to approach the wholesalers directly in the hope that they are somehow able to source the medicine," a worker at the pharmacy said not wishing to be named.
They said that at least three patients come every day to buy Fulvestrant and Filgastrim - medicines to increase blood count in cancer patients. "We are at the last batch of Filgastrim. We don't how we will source more," the worker said.
The condition is similar at the National Hospital in Colombo, the largest government run hospital where doctors have started regulating usage of paracetamol and surgical consummables - gloves, gowns, masks, syringes, gauze etc.
"We are running extremely short on regular supplies of gowns and syringes and plasters. We can't reuse syringes but wherever we can reuse or reduce usage we have started doing so. Instead of using extra drapes or plasters, we now make do with one or two of them. The patients are inconvenienced but they also understand the situation. It is only the government which does not understand," said Harini Bandara, a nurse at the hospital.
Another nurse not wishing to be named said, "We are still getting over the COVID-19 crisis where doctors, nurses and medical staff had to suffer and struggle so much. And now another crisis is here. The government not understand that health of its citizens is the most important and if that is suffering then there is a big problem."
Speaking on the condition of anonymity, an anesthesiologist at the government run Lady Ridgeway children's hospital in Colombo said that the hospital had to postpone six surgeries in the last week because they were low on anaesthesia needed for the surgery.
"We are currently only prioritising major surgeries or extreme emergency cases because the stocks are in reserve. Even our reserves are now at a low," he said.
Patients queue up outside Apeksha Cancer Hospital in Colombo, Sri Lanka
The Government Medical Officers Association (GMOA), the largest trade body in Sri Lanka, has issued a medical emergency alert in the country.
Speaking to BOOM, Dr. Vasan Ratnasingam Media Committee Member GMOA said the body issued the medical emergency alert after not getting satisfactory responses from the government. "The Pharma ministry invited us for a meeting and revealed that there was a shortage of five vital drugs mainly used for cardiac ailments and 180 essential drugs. They wanted our help to sort out the crisis and we formed an institutional level committee which could look at redistributing drugs according to the need at specific areas and hospitals," Dr Ratnasingam explained.
The doctor said that despite taking initial steps, the ministry and government did not look to correct supply from the central source. "Many of our drugs are imported and those that are manufactured here also need ingredients which are brought from other countries. When that itself is affected, there is only so much we can do. We told the ministry to give us steps that they are taking to ensure supply but did not receive a positive response."
Dr Ratnasingam said that there is an acute shortage of anti cancer, general drugs, vaccines and insulin in addition to depleting stocks of surgical consummables. "The country is running out of anti rabies vaccines, 29 cancer drugs, 140 medicines and vaccines used for children and adults."
"Cancer drugs likes Imatinib, procrabazine and azthioprine are low," he added.
He also said that the frequent power cuts mean vaccines which require cold storage are at the risk of going bad.
The same was told to BOOM by doctors at the National Hospital who explained that they have to buy ice to store some medicines and vaccines. "We are buying at least 5 kgs of ice everyday to store medicines and vaccines since the power cuts mean the refrigerators don't work. While we do have back up, we have to regulate where we can use the power - surgical wards, essential services, kitchens need them. So we have a roster planned and that means some days refrigerators have to be kept switched off," said an administrative officer at National Hospital on the condition of anonymity.
As Sri Lanka struggles to import medicines, patients, nurses and doctors are struggling to make do with the reserve stocks. "The government needs to declare a medical emergency and ask for help from the international community. Being silent about a problem is not going to make it go away and we can only hope the government understands that," said Varshani M, a nurse at the cancer hospital.