Systems not sick? | Sunday Observer

Systems not sick?

1 January, 2023

The sick with Covid, and the plain sick who are down with some other malady, had a torrid time in the past two years. But at least in a technical sense while Covid has come and gone, those sick with heart disease, cancer, diabetes and so on feel the system they were used to is already not serving them the way it did.

Medicines are scarce. Cancer patients have to travel all the way to the National Cancer Hospital in Maharagama for treatment, and most cannot afford the bus fares. Meanwhile, people feel that a mere semblance of what they knew as free health care remains.

But that’s not all, they fear that what remains of health care would go down the tubes in the coming years, and they are bracing themselves in 2023. Most of all people are praying they will not fall sick.

But just as the pandemic was predatory in the sense that it affected the vulnerable most, disease and its repercussions have a predatory effect in this country. It’s the most vulnerable that suffer the most.

The prices of pharmaceutical products have skyrocketed, and those who fall sick cannot stretch their budgets. But in hospitals there are no longer any qualms about asking patients to buy their medicine, if the stuff is available that is.


The economic meltdown saw a situation of chronic non-availability of medicines. The health sector just didn’t have the dollars. The lingering effects of that period are still present, even though the authorities swear that acute scarcity of medicines no longer obtains.

The health sector methodologies still prevail. The doctors are trained and they know that patients need to be monitored. They are able to follow the routine regimens even though as far as medicinal drugs are concerned, they know things are far from back to normal.

The net result is that it has turned into a situation of survival of the fittest. A doctor this writer knows says that most patients who could afford private hospitals before the pandemic are now unable to do so and are opting for health care in State run institutions, which he says spells calamity for all patients because the State sector is already overburdened. When the middle classes check into State run hospitals the others who were used to being cared at State run hospitals don’t necessarily get edged out but are having to face longer waiting periods and greater heartache in general.

bad idea

Some may think it’s a bad idea to begin an article in the New Year that’s focussed on the subject of health-care woes. But these are the issues that people care about. If they cannot afford three square meals a day they would make do. But if they have nowhere to turn to when they are sick, that’s a different story.

Added to all that ails the system with regard to drugs and so on, there is the issue of doctors vacating-post, going abroad, and not sighting the country thereafter. It is true that they are supposed to pay up a bond if they have not served the country for a given period of time, but it’s not as if they are served Interpol Red Notices if they choose to go abroad and join the hospital-staff of a so called developed country.

A UN team has already launched a so-called joint humanitarian-needs plan precisely because the “country’s once robust health sector is now in jeopardy.”

Some of this aid materialised, but it doesn’t mean that it’s back to normal as far as health services are concerned.

What could be done about it? Nothing except that free healthcare so called turns automatically into a fee levying exercise. Hospitals tell patients that the medicines are unavailable and they have to wait, or that they have to — one way or the other — secure the medicines themselves.

In 2023 would these immediate issues be addressed so that we could as fast as possible get back to pre-pandemic conditions when healthcare may not have been perfect, but sick people had hope?

Some rich countries do not have the trained personnel that we have for instance. Comparatively their healthcare has lagged behind. It’s not so much a lack of personnel that was the problem in these countries, but the lack of systems that were geared to methodically look after the sick.

Some countries that are referred to as ‘communist’ fall into this category, though on the other hand those to the extreme left such as Cuba have excellent healthcare systems. One priority for Sri Lanka in 2023 would be to salvage our systems even though we are losing personnel at an alarming rate.

How do we address this problem? All indications are that as the year progresses, Sri Lankans would have to settle for more cutbacks because that’s the only way we could make ends meet and qualify for a bailout.

Quo vadis, the health sector under these circumstances? One positive sign is that the health sector personnel — those of them that decided to stick on — started doing selfless work with the onset of the pandemic. Perhaps they recognised that if the systems that are in place deteriorate, they would fundamentally lose it all because there would be no use for doctors within systems that do not quite function.

You could say that in the end it was the human element that eventually saved Sri Lanka’s health sector. As far as the money was concerned, we simply didn’t have the funds.

But when it came to human resources even though there was some depletion at the specialist level, those who stayed back served with extraordinary dedication. This was the case in so many countries — the UK for instance — where frontline healthcare workers did a brilliant job, even though the Government at that time the Covid pandemic began, botched it’s response spectacularly.

People want to save their systems and its not a long term survival instinct. They simply know that they cannot afford to lose what they cherished since they were born.


They are aware that it’s the public health care system that salvaged their chances when their parents were so sick and there was no other way but to depend on the nearest Government hospital, even though the facilities were woefully inadequate.

They may not have secured a bed to sleep on, but then they could count on the doctors to treat them systematically in terms of prescribing the correct medicines, ensuring that they get the follow-up treatment as they are supposed to, with the correct check-ups at the correct time.

This system is still by and large intact, and even though it’s already a reality that free healthcare is not all that it used to be, if this system of healthcare by trained personnel is impacted adversely in 2023, then we are basically at the end of an epoch in terms of how this State is run.

We would not be a welfare state anymore, and if we are, that would be by name only. It’s the last vestiges of a healthcare system that’s precariously placed that we are seeing and if it’s continued existence is in doubt, that should engage the attention of all, in civil society and the private sector.

The country may be facing unprecedented situations, but if we allow the basics to deteriorate to a point at which we become the ‘callous State’, we are done for.

There are people who want to leave and look for better prospects, but some prefer to stay because they feel that there are systems that work, whose value is underestimated by those who are in a hurry to seek a better life in places they don’t quite belong.

One day we would be able to afford the medicines as we did in the past, and perhaps yes the free healthcare system we knew is not quite recognisable anymore. But at least those cherished systems by which the bulk of the health sector functions are in place and as long as they are, we have hope. Let nothing touch those basic structures, in 2023 or beyond.