Cash in hand but PET scanner blocked by cancer of red tape

Representatives of the government, religious leaders, 
donors, celebrities and prominent media personalities made an appeal in March this year to help raise funds to buy medical equipment for the National Cancer Hospital in Maharagama. Numerous donors responded immediately while the media took on the responsibility of creating awareness on this urgent need of the hospital. Within a matter of months, a sum of an estimated 230 million rupees was raised by the fund. Some people tirelessly campaigned for the fund. Corporate bigwigs coined it ‘social responsibility.’ The common citizens doled out whatever they could, in the hope of contributing towards the worthy cause. The officials who were tasked with the responsibility of securing a PET scanner for the hospital encouraged all parties interested in making sizable contributions to the fund, and patiently stood back awaiting the 200 million rupees to be raised. Almost three months have lapsed since the target sum was raised and yet the Maharagama Cancer Hospital is deprived of a PET scanner.

Cancer is an umbrella term used to describe a complex disease which occurs when cells in the body begin to grow abnormally. The mass of extra cells forms a growth or tumour which can be malignant. Once a patient is diagnosed with Cancer, a Positron Emission Tomography (PET) scan coupled with a Computed Tomography (CT) scan are used by doctors to determine the presence of cancerous cells in the body. These images show the existence and severity of the disease in a patient’s body while enabling oncologists to determine treatment, therapy and the detection of recurrent growth. 

In terms of Cancer, proper and timely identification of the disease is a determinant of the patient’s life span as well as the quality of life. This is why oncologists worldwide rely on the sound accuracy of a PET-CT scan to map out treatments for the deadly malady. However, the National Cancer Hospital in Maharagama, despite all its commendable efforts in the treatment of Cancer patients, still lacks a PET scanner. This does not necessarily mean that PET scans are not performed in the country. A leading private hospital in Colombo possesses Sri Lanka’s only PET scanner where one scan is performed at a whopping Rs. 150,000. Patients who cannot afford such a costly scan, which forms a majority, are thus forced to rely on the judgment and practice of experienced doctors at the ill-equipped National Cancer Institute. 

Several groups who took note of this dire need engaged in various efforts to raise funds to purchase a PET scanner for the Maharagama Hospital. After months of untiring campaigning by generous donors, both local and foreign, funds were raised to buy the much-needed scanner. However, their efforts are yet to see fruition as numerous bureaucracies have hampered the installation of the scanner. Dailymirror The   learns that although a staggering 200 million rupees was raised to assist the grim needs of the Maharagama Cancer Hospital, funds are now lying idle in the hospital account, disheartening benevolent donors who wish to see their contributions, however big or small, ease the healing of needful patients. Several months after the hospital hailed that the PET scanner fund received an excess 20 million in addition to the 200 million required, the Health Ministry is yet to call for tenders to buy the scanner. 

The Dailymirror   approached Additional Secretary to the Health Ministry Y.L.M. Navavi to inquire about the stalled project. Navavi said a Technical Evaluation Committee was appointed to look into the tender-calling procedure, adding that the committee was headed by the Secretary to the Ministry of Justice.

“Once the evaluation report is submitted to the Cabinet-appointed Procurement Committee, tenders will be called to buy the scanner,” Navavi said. When asked how long the approval of the report would take, he said according to the  guidelines set by the procurement committee, the procedure would take up to four months. 

While it is understandable that a matter dealing with public contributions has to be deliberated with precision, the lapse of four long months for a tender-calling process alone cannot be simply justified when considering the nature of the requirement. Following the hospital’s announcement that the targeted 200 million rupees was achieved, Health Minister Rajitha Senaratne was questioned by a journalist on the progress of the installation of the scanner during the Cabinet Media Briefing on June 15 this year. The minister critically responded that the journalist community was unaware of the tireless efforts of the Health Ministry, adding that the PET scanner fund was under scrutiny as a private media organization was involved in the matter. The minister stated that the government received countless donations that were much greater than 200 million rupees to assist health services in the country, and that the matter of the PET scanner was singled out unnecessarily. He also noted that another PET scanner would be installed at the National Hospital in Colombo. However, representatives of the Health Ministry were not available for comment when the  attempted to confirm this statement. 

Meanwhile, Maharagama Cancer Hospital Director Dr. M.Y.K. Wilfred, speaking to the , said all concerned parties were awaiting the approval of the Technical Evaluation Committee following a meeting scheduled to take place today (9).
The PET scan is a nuclear medicine imaging test in which a small amount of liquid radioactive material is injected into a patient’s body. Detailing the preparations of the hospital for the installation of the machine, Dr. Wilfred said a building within the hospital premises had already been approved by the Atomic Energy Authority for the assembly of the scanner. 
“Since this diagnostic technique is a branch of nuclear medicine which employs radioisotopes, the construction of the building and installation of the scanner has to be approved by the Atomic Energy Authority,” Dr. Wilfred said, implying that the installation would be further impeded.

 “The Health Ministry is handling the tender -calling procedure. Once a tender is selected, the installation procedure will commence. We are very keen to accelerate this. We expect to have the scanner installed at least by December,” he added.

The installation of PET scanners presents somewhat different design requirements to  conventional nuclear medicine departments, and therefore requires careful deliberation. However, this cannot be new information for the authorities concerned. The grounding for the installation of the scanner could have been forethought while the vendors, tenders and other discussions involved in buying the scanner could have been anticipated and prepared for. However, it is regretful that the authorities failed to do the needful when the public did not act in haste to assist the needy. 

The Dailymirror   also contacted the Deputy Director General of Health Services and the Chairman of the Tender Committee 
Dr. Sarath Amunugama.  According to 
Dr. Amunugama, the Technical Evaluation Committee last week submitted its report to the Procurement Committee appointed by the Cabinet.

“The approval of the Committee has to be sought before the tenders can be called,” he said. Nevertheless, Dr. Amunugama expressed confidence that tenders would be called for to buy the PET scanner by next week. 
As the Dailymirror    reported on a previous occasion, among the neediest of this PET scanner are children whose lives depend on the results of a PET-CT scan. Unlike in the case of adults, the spread of malignancies among child patients is considerably faster. Thus, the need to diagnose, detect and monitor the effectiveness of treatment and therapy is greatly facilitated by the information gained from a PET-CT scan. The authorities, instead of depending on intricate bureaucracies, could have expedited the process of installation, had there been appropriate measures to circumvent delays in facilitating critically-ill patients with essential care. Time waits for no one, and neither does Cancer. Countless lives are affected with each passing day that the hospital is deprived of essential facilities in the treatment of its patients. Let this note be a reminder to all parties concerned that time is of essence in saving innocent lives which have fallen prey to this deadly disease.