Deteriorating Health Services In Sri Lanka

If the Doctor cures, the sun sees it, but if he kills the earth hides it.
-Anonymous-Scotch Proverb

This column, dedicated to the notion of fulfilling the aspirations of Sri Lankan society, turns its spotlight on the deteriorating health services in Sri Lanka as Sri Lankan society would aspire for an efficient health service in Sri Lanka.

The media reported last week that the Colombo District Court issued an enjoining order preventing the Government Medical Officers’ Association from launching a strike action, over transport allowances.
The enjoining order was issued by Honourable Dammika Ganepala, District Judge of Colombo after considering a petition filed by a patient admitted at the Colombo National Hospital, naming the GMOA as respondents. The petitioner had requested that the enjoining order be issued, citing that the lives of patients were in danger due to not receiving proper treatment as a result of the strike action launched by doctors. The people look up to the medical profession as a noble profession which safeguards the health of the Nation.
Those who choose to serve in the medical profession must place the interests of the patients before their personal interests as they are dealing with invaluable human lives.
This does not mean that the government can ignore the legitimate payments due to the medical practitioners. If the government neglects its duties, the doctors can resort to legal action to redress their grievances without holding the helpless patients to ransom.
In Sri Lanka free education is available for a person to qualify as a medical practitioner or to engage in other professions.
Media reported that an island-wide outbreak of dengue fever in Sri Lanka in recent months has underlined the steady deterioration of public health care and preventative measures to contain the disease.
Across the island, public hospitals are overcrowded with patients suffering from dengue and other viral fevers.
Dengue fever is a debilitating mosquito-borne disease that is potentially fatal, particularly to young children and the elderly. It was first reported in Sri Lanka in 1965 but has become a regular epidemic since 1989.
The peak incidence of the disease generally comes after the monsoon season, when the density of the two mosquito carrier species – Aedes aegypti and Aedes albopictus – is especially high.
Government and health ministry officials try to paint a picture of the dengue epidemics as an unpreventable natural disaster. But the real reasons for the spread of the disease lie in poor sanitation, ineffective government preventative measures and financial cutbacks to public health services.
‘Dengue control’ has become an annual piece of theatre aimed more at appeasing widespread concern about the disease than dealing with the underlying causes.  Special task forces and committees are set up to ‘curb’ the outbreak but each year since 1989 the number of dengue cases has risen.
Like previous governments, the ruling United Peoples Freedom Alliance (UPFA) tries to blame ordinary people for not eradicating mosquito breeding sites.
The Colombo municipal council has already filed legal action against nearly 200 housing units and institutions after issuing some 1,800 warning letters.
But local governments and municipal councils are directly responsible for many of the largest mosquito breeding areas.
There have been frequent protests against the creation of large uncovered garbage dumps near residential areas and the failure to clean stagnant canals, sewerage sites and other pits and potholes filled with polluted water.
Environment Minister A. H. M. Fouzie was recently forced to visit a garbage dump in the Colombo suburb Dehiwala after protests by local residents.
Unplanned urban development has created a large number of mosquito breeding sites. The high mosquito population is responsible for spreading not only dengue but other diseases like malaria, filaria and Japanese encephalitis.
According to Dr Amal Harsha De Silva, Sri Lankans burn on average three large containers of mosquito coils a month to try to ward off mosquito bites.
Health care has also been subject to cutbacks and privatisation. As private health operators have no interest in preventing diseases, the budget for such activities has declined sharply.
Government expenditure on health services has fallen from 2.3 percent of the gross national product in 1989 to 1.4 percent in 2003. Of that only 15.3 percent is allocated to community health services, including disease prevention.
The resultant dengue outbreaks place severe strains on public hospitals, with wards filled to overflowing with patients. Patients have to share beds with one or two others while scores of patients lie on the floor.
Even relatively simple things, such as providing a mosquito net for patients and staff at government hospitals, are not done.
In addition, government hospitals lack sufficient blood testing facilities to determine whether patients have dengue fever.
As a result, patients are forced to turn to private laboratories.
The country’s leading private laboratory service, Asiri, does more than 1,000 Full Blood Count (FBC) tests and at least 100 dengue serology tests a day.
None of the government hospitals have the facilities to carry out dengue serology tests – the only means of definitely confirming the disease. Many patients simply cannot afford the cost.
For dengue patients in a critical condition, matters are even worse.  They should be treated in Intensive Care Units but such facilities are in limited supply.
Only a few government hospitals have such units and, even where they exist, spare beds are rare. Moreover, the blood transfusion and platelet transfusion services sometimes needed for critically-ill dengue patients are not available in most of hospitals.
Despite the deterioration of public health services and preventative programs, it appears that the government has no intention of making any improvements.
As usual let me conclude with an amusing anecdote.
Two old ladies met in the street. After inquiring about each others health, the topic of conversation turned to their respective husbands.
“Oh” said one; ”Nimal died last week. He went out to the garden to dig up a manioc for dinner, but had a heart attack and dropped dead in the middle of the vegetable patch.
“Oh my” said the other, ”What did you do?”  “I opened a can of salmon instead”.