Urgent need to review “availability, accessibility and affordability” of essential medicines | Print edition

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By Kumudini Hettiarachchi and Ruqyyaha Deane

Former SLMA president and family physician Dr Ruvaiz Haniffa paints a stark and chilling picture

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Essential medicines – shortages and their disastrous consequences are in focus the Sunday Times this week even as the COVID-19 pandemic is still here and Sri Lanka does not know what awaits it around the next bend when it comes to the novel coronavirus.

“Availability, accessibility and affordability are the basics we need to look at when focusing on essential medicines,” reiterates a former president of the Sri Lanka Medical Association (SLMA) and respected family physician , Dr Ruvaiz Haniffa.

He pointed out that for the very first time in Sri Lanka, not only essential medicines but also others are not available, let alone accessible or affordable. At any given time among the population, especially with a rapidly aging population, 20% or 1 in 5 have at least one non-communicable disease (NCD) and most often not just one but two or three. These people must take drugs for life and it is the responsibility of the State to make these drugs available to them.

Dr Ruvaiz Haniffa

If these drugs are not available, the picture Dr. Haniffa paints is harsh and frightening.

  • A person with diabetes will take medicine to control their blood sugar and prevent serious adverse effects on their kidneys, eyes and other organs. Medicines help to delay these adverse effects and reduce serious risks to his life.
  • With every NCD a person has, the risk to their life is doubled or tripled and the one and only way to deal with this danger is to use the right medicine.
  • Without these essential drugs to control NCDs such as diabetes, hypertension (high blood pressure), cardiovascular disease (including heart attack and stroke), kidney failure (severe kidney disease) and many others, some will die immediately. Others will suffer from persistent illness. This will lead to a terrible quality of life.

The lack of essential medicines will “spoil” the “quantity” and “quality” of lives, such is the diagnosis of this family doctor who sees a cross-section of patients – from babies to adolescence, passing through the middle age and old age… ….from the cradle to the grave.

It supports people with mental illness, many of whom are not hospitalized but take medication at home.

Can you even imagine the impact on home and family of having a mentally ill person without their medication, he asks, detailing how those patients would react at home, while pointing out how the abuse of those vulnerable patients could easily ensue. The family dynamic is sure to go awry and abuse could follow in its wake.

Without naming names, he says that some family members of people with mental illness have begged him to “kohe hari dala denna” their friends and relatives. It’s because the family can’t handle the pressure and that’s understandable.

Dr Haniffa also looks at other vulnerable groups –

  • Elderly people who face a terrible situation.
  • Cancer patients whose lives are cut short for lack of drugs and who die earlier than they normally would if drugs were available.
  • Disease-prone children.

Dr. Haniffa then turns to surgeries – routine and emergency. It covers a simple and routine emergency appendectomy needed if a person has acute appendicitis. This surgery is necessary to remove the appendix when it becomes infected. If the anesthetic drug neostigmine is not available, how does Sri Lanka stand? Is it back to the Stone Age? What about emergency operations after a road accident?

When it comes to accessibility, people expect the health sector, including their doctors, to meet this basic need, he says, moving on to affordability which has also become a major issue. for the people.

“Many people have suffered severe hardship after the pandemic. Some have lost their jobs and others have suffered pay cuts. Online education for their children or online facilities due to their professional requirements have also made inroads into their meager resources. Now people are grappling with shortages such as food, fuel and gas which further eat away at their resources,” he says, looking at the dire state that Sri Lanka finds itself in.

This situation is accompanied by a sharp rise in drug prices, he points out.

The example cited is of a person taking a cocktail of drugs (at least 3-4, many take more) for NCDs. Metformin, an oral drug given to control blood sugar, increased 20-30% from what it was before.

Do you know what patients will do, Dr. Haniffa asks, pointing out that if a person needs to take three pills a day, they will only take it once or twice a day. Another way for a patient to deal with rising drug prices will be to take the prescribed drug daily every other day. It is the same with medications to control high blood pressure and also high cholesterol.

He gives another example – many women are prone to urinary tract infections (UTIs). Some catch it like the common cold. The drug that was not only cost effective but also very effective in eliminating UTIs was Nitrofurantoin, which cost only seven or eight cents per pill. Now it is out of stock and availability is zero. Doctors must therefore prescribe more advanced third or fourth generation drugs for a simple disease.

The repercussions can be imagined, with Antimicrobial Resistance (AMR) being an imminent threat. AMR occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medication, making infections harder to treat.

Just this Monday, Dr. Haniffa had seen a person with intractable or long-lasting hiccups which is not a serious illness. The less expensive chlorpromazine is not available and now doctors have to prescribe gabapentin which is more expensive.

What happens then are – other urgent needs of a family like expensive food; children’s school fees, etc. will be covered first and medical needs last, he adds.

From Colombo to Beruwala, the desperate search for a father of paracetamol syrup

Heartbreakingly, Dr Ruvaiz Haniffa recalls a recent incident where he prescribed paracetamol syrup to a little one who is the ‘gold standard’ for fever. If the fever in a very young child is not controlled, the child may have febrile convulsions (convulsions) which really frighten and distress parents.

It is with great sadness that Dr Haniffa says that the syrup is now like gold as the father of one of his little patients had gone from pharmacy to pharmacy all over Colombo and then all the way to Beruwala in his desperate search.

When he asked the dad why he didn’t call him and get a substitute, which of course was pediatric paracetamol tablets, the dad said that crushing tablets and trying to give it to his child would be impossible and also getting the right dose in would be a huge challenge.

“Baba, beheth kudu karala dunnahama good ne. Beheth pethi kudu karapuwahama dose ekath waradinawa”, said this father who preferred a long trip to get a single bottle of paracetamol syrup.

What a sad state of affairs for paracetamol syrup, he adds.


Crucial for importing at least the bulk of essential medicinesWithout just pointing out the issues, Dr. Ruvaiz Haniffa talks about what doctors can and should do in this current crisis. which have been imported into the country. In these times of crisis, we were able to see if we could reduce the list to a few drugs in one variety,” he says.

It specifies that there are 52 essential medicines. Leaving aside personal gains and differences, a solid group should see, for example, if without taking a lot of drugs, we can get about three for diabetes. This would help us meet Professor Senaka Bibile’s view on availability, accessibility and affordability.

Amoxicillin is another. Do we need more than 100 brands? Can we manage with 2 to 5 brands, he asks.

“It would be about getting the bulk of essential medicines,” he says, adding that “so we too, as doctors, have been proactive in getting lifesaving medicines into people’s hands.”


Questions about viability, quality of drugs, vaccines due to power cuts

Another startling revelation comes from Dr. Ruvaiz Haniffa.

He wonders what is happening to the mandatory requirement that all pharmacies be air-conditioned to ensure drugs maintain their viability and quality.

One of his patients had to drive around town as few pharmacies stocked the tetanus toxoid injection as their refrigerators were affected by the long power cuts. Even for large pharmacies that had generators, there was no fuel to run them.

He hesitates even to think about the fate of vaccines with massive power cuts and non-working refrigerators. These vaccines include those administered under the national immunization program and also those against COVID-19.


Avoid travel to avoid even small accidents

As the New Year holidays approached, many doctors advised people to stay home and not go on a trip because even a small accident could have serious consequences as hospitals had no medicine.

Beware of road accidents as lack of medicine, especially for surgeries, could be life-threatening, many people said.

They also warned people to watch what they ate, as a simple stomach ache could have dire consequences.

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