Crisis in the health sector - EDITORIAL

The recent statement by Health Minister Keheliya Rambukwella that all those who are admitted to hospitals do not return home alive is no doubt outrageous, despite it being indisputable. It is outrageous as it was made following recent controversial deaths that were suspected of being caused due to poor quality medicines which were said to have been withdrawn after the said deaths.
The minister while speaking in Parliament had stated that if a hundred thousand patients are admitted to hospitals, all of them do not return home alive. “That is why there are shops selling coffins around hospitals,” he had said, as if he had made a new finding. True, both remarks were irrefutable, but with those remarks, he seems to attempt to trivialize and justify the said controversial deaths.

Vindicating his argument, an analytical piece has been floated in social media these days which had given comparative numbers of patients admitted to government hospitals annually and the annual deaths that occurred in those hospitals. The post said that 58, 976 out of 7,418,884 patients admitted to government hospitals in 2019 died before they were discharged. Only a relatively small number of about 12,000 out of three to four million people admitted to hospitals after accidents died. Only less than one-third of the 150,000 total annual deaths in Sri Lanka occur in government hospitals, while others happen in accident and crime sites, homes and as suicides. And these statistics had been attributed to the Health Ministry and Census and Statistics Department.

In spite of these figures cannot be refuted, the circumstances of recent controversial deaths cannot be justified without a thorough, professional and independent investigation. The very withdrawal of medicine after these incidents point to the fact that the Health Ministry itself suspects the quality of them. There have been so many instances where hospital authorities were blamed for deaths by the relatives of those who died at those hospitals, but very rarely any medicine was suspended from use or withdrawn. 

The other side of the story is the extremely rare possibility of some individuals getting dangerous allergic reactions after taking certain medicines. For instance, a child in Matara died after being administered the Rubella vaccine in March 2009. Later it was established that the child had died of anaphylactic shock, which in lay terms is a very serious allergic reaction. Subsequent to this incident, the Rubella vaccination programme had to be suspended for a brief period in the country. Responding to the incident, the World Health Organization (WHO) said the batch from which the Sri Lanka vaccine was taken had been used in five other countries without a single report of a complication. Based on the WHO report, the Healthcare and Nutrition Ministry decided to resume the Rubella vaccine programme in the country after a few months.

However, allegations have been levelled against the health authorities lately, over shortage of medicine, purchasing of substandard medicines and corruption in the process of medical supplies, which could prompt the people to lose confidence in health sector authorities. For instance, following incidents of adverse reactions in patients at Peradeniya Teaching Hospital, the National Medicines Regulatory Authority (NMRA) in April also ordered the withholding of three batches of injections manufactured in India. The Medical Supplies Division (MSD) of the Health Ministry on Monday had withdrawn the use of two categories of locally-manufactured ‘Aspirin’ from all government hospitals in accordance with the recommendations of the NMRA. There was a row over Minister Rambukwella’s tour to Chennai in December last year at the invitation of a drug supplier.

Nevertheless, rarely do the authorities take responsibility for medical negligence or the poor quality of medicine. Even after a medical mishap in Sri Lanka, the relatives of the patient become helpless as the investigations are in most cases not transparent. Only in extremely rare cases, the victims are meted out justice. 

A third side of the story is the adverse media hype over mishaps in state hospitals, which might seriously affect the already damaged confidence in people in the state health service. This in turn might become a windfall for the private hospitals at the expense of the poor segment of the society.