Sri Lankan parents spending hundreds on children's leukaemia meds

Nuwan (right) needs to travel 230km each way for his cancer treatment

Upali Pushpakumara, a farmer from central Sri Lanka, has to travel 230km (143 miles) every time his son, Nuwan, needs cancer treatment.

The 18-year-old was diagnosed with leukaemia last year, and since then, Mr Pushpakumara and Nuwan have had to make several trips all the way to Maharagama, a suburb of the capital Colombo, to get to the National Cancer Institute.

Sri Lanka provides universal healthcare - free health services - to its citizens. The government spends 4% of its budget on healthcare, and its state hospital system has been praised as one of the best in the region.

However, the effects of a devastating economic crisis have meant this once celebrated system is now dealing with a shortage of drugs and problems with counterfeit medicines, as well as the fact that doctors are leaving the country in droves.

Hospitals like the National Cancer Institute are a critical lifeline for millions like Mr Pushpakumara's family, who cannot afford to get treated at private healthcare institutions.

Here, patients like Nuwan are meant to receive diagnoses, chemotherapy, surgery and life-saving medicines free of cost.

But lately, that has not really been the case.

"The treatment here is fine. But most medicines are not available in the hospital. We have to buy them from private pharmacies," Mr Pushpakumara told the BBC.

He says he spends about $500 every month on medicine.

Spiralling costs

"I am borrowing from family and friends. But the prices of many drugs have gone up sharply," he said.

Hit hard by the pandemic, deadly bomb attacks on Easter Sunday in 2019 and disastrous economic policies, Sri Lanka ran out of foreign currency reserves and declared bankruptcy in April 2022.

To save money, curbs were imposed on imports of food, fuel and medicine, leading to crippling fuel and power shortages.

To boost income, the government drastically increased tax rates and brought those with lower incomes into the tax net for the first time. This means that millions of families are now struggling with an exponentially high cost of living while seeing their incomes reduce.

Among those hit hardest are the ones with a sick family member to take care of.

AMK Attanayake's five-year-old son is waiting for surgery

Niluka Sanjeevani, whose four-year-old son has leukaemia, told the BBC she spends about $600 a month on medicines for her child - a sum she can little afford as the price of food and housing have skyrocketed.

The healthcare sector itself has been hit hard too - Sri Lanka imports almost all of its medicine.

Pharmaceutical industry experts say there's still a shortage of many life-saving drugs produced by global pharmaceutical companies, as a result of pricing issues and commercial viability.

The prices of imported medicines also soared as the Sri Lankan rupee dropped by nearly 70% against the dollar in the 2022-2023 period.

"Some unscrupulous people are illegally bringing in medicines from countries like India and Turkey. They charge five or six times the original prices," a pharmaceutical executive, who didn't want to be identified, told the BBC.

Dr Ramesh Pathirana, the country's health minister, admits that there have been some shortages, but insists the government is committed to increasing funding for the healthcare system.

"Some consultants are prescribing newer molecules, expensive drugs, sometimes the government couldn't bear [the cost]," Mr Pathirana told the BBC.

However, he said the budget allocation for health has been increased this year to address the escalating costs of medicines.

But shortage is not the only issue.

"First, there's a shortage of drugs and then some of the medicines the government hospital provides are out of date," Ms Sanjeevani, who's from the central city of Anuradhapura, says.

This was echoed by AMK Athanayake, who's waiting for her five-year-old son to get surgery.

Lines to get medicines at a state hospital

"Some of the medicines provided by the hospitals are of poor quality, not original. They are not effective. Hence we have to buy medicines from outside," she said.

These concerns have been echoed by several activists and unions over the last year. They say low-quality medicines have led to poor patient care, even causing deaths and blindness.

The government has ordered an inquiry into the reported purchase of substandard medicines by the previous health administration.

Then there is the exodus of many healthcare professionals, including doctors, which is also putting huge pressure on hospitals.

Ms Sanjeevani says they are getting appointments mostly with junior doctors due to a shortage of specialist consultants.

Hospital with no surgeons

Sri Lanka's largest doctor's union, the Government Medical Officers' Association (GMOA) says about 1,500 doctors have gone abroad on leave either for higher studies or to work in the past year.

Another 3,000 more medical professionals have asked for long leave. The country of around 22.16 million people has a total of around 20,000 doctors.

In Sri Lanka, medical education is state-funded. Those who graduate are mostly absorbed into the public health system and deployed to work in different parts of the country.

For those living in rural areas, these doctors are often their only access to medical treatment.

With many, particularly specialists, leaving the country, that's having a knock-on effect on hospitals.

The problem could not be more acute than in the main hospital in Dehiattakandiya in eastern Sri Lanka. It made headlines last year after its only surgeon left the country.

The hospital caters to about 150,000 people in nearby areas.

"We haven't done any major surgery for several months," a senior doctor, who didn't want to be identified, told the BBC in January.

The main hospital in Dehiattakandiya in eastern Sri Lanka made headlines last year after its only surgeon left

"We are referring patients requiring major surgeries to other hospitals in the region which are about 50km away. It's difficult to run the facility without specialists."

A replacement specialist doctor was only appointed in February.

The shortage of specialists and other doctors has also led to long waiting times.

"I have diabetes and other age-related ailments. It takes several hours to see a doctor here. So I have now started going to a private clinic, which is costing me money," says DM Siyathu.

"Actually, it's an alarming situation at the moment," Dr Haritha Aluthge, the secretary-general of the GMOA, told the BBC.

"We have to close down 20 peripheral health stations due to the shortage of medical officers," he added.

Following a wave of anger over these allegations of mismanagement and corruption, then-health minister Keheliya Rambukwella was replaced last October.

Mr Rambukwella and several other officials were arrested in February over allegations that the government purchased counterfeit drugs when he was in charge of the health ministry. He denies the allegations but has resigned from the cabinet.

There have also been intermittent strikes by healthcare workers' unions since January demanding better pay and conditions.

Dr Aluthge says Sri Lanka is facing an alarming situation

The doctors' union says apart from the shortage of doctors, many faulty pieces of equipment such as CT scan and MRI scan machines have not yet been repaired or replaced in hospitals.

Mr Pathirana admits that there are "some lacunae or deficiencies" in relation to certain specialists like paediatricians and transplant surgeons.

"There is no acute shortage of specialists as such. Generally, yes, we need to have more surgeons in the country," Mr Pathirana, who's a doctor himself, said.

The government is aware that the health sector is on a precipice. Even as it struggles to emerge out of the crippling economic crisis, authorities know that the collapse of its highly regarded healthcare system is something they just cannot afford either.