Unlike Russia’s invasion of Ukraine and the recent hurricane batterings of Puerto Rico and Florida, Sri Lanka’s crisis grew slowly and has garnered few international headlines. But Sri Lankans are suffering amid the harshest economic crisis the country has confronted since gaining independence from the British empire in 1948.

With the country’s foreign reserves depleted, the nationalized healthcare system cannot afford to import medicine and medical supplies in sufficient quantities. Sri Lanka relies on imports for about 85% of its pharmaceutical needs and about 80% of its medical supplies. The country imported $815 million in medicine in 2021, but by May had only about $25 million in foreign reserves to pay for imports of any kind.

Direct Relief to Sri Lanka

Last week in Sri Lanka, Direct Relief staff participated in an extensive series of meetings with Prime Minister Dinesh Gunawardena and much of the country’s healthcare leadership while overseeing the arrival of what may be the largest donation of medicine to the country since the crisis began.

The 3,500-bed National Hospital of Sri Lanka in Columbo, which usually has 1,300 medicines in stock, is now down to requesting only the 60 most essential medicines.

With anesthesia in short supply, most general surgeries in the country have ceased, including kidney transplants. Cancer patients have lost access to medications needed to fight the deadly disease. Diabetes patients must secure and bring their own glucose meters for blood sugar checkups.

Many hospitals are stocked out of basic items like bandages and cotton balls. The stockouts are forcing rural clinics to close their doors and refer patients to larger facilities in urban areas, which also are overwhelmed by the flow of patients.

Due to a severe fuel shortage, the country’s fishing fleets cannot go far out to sea, slashing the supply of fish that is a significant source of protein in the country, including at its largest children’s hospital.

In addition to Sri Lanka’s Prime Minister and the Ministery of Health, Direct Relief staff met with the chairs of the country’s medical universities, including the colleges of oncology, psychiatry, nephrology, hematology, endocrinology, critical care medicine, anesthesiology, and maternal & child health.

Sri Lanka is also losing clinicians as they migrate to other countries with more opportunities, while its medical colleges see the number of applicants for medical education decline sharply.

“Every one of the medical college leaders informed us that they are in a dire situation, with major shortages across the board for everything,” said Chris Alleway, Direct Relief’s manager of emergency response and new initiatives. “A lot of them were very emotional in our conversations. You could tell that they’re holding together the health care system to the best of their abilities with limited to no resources.”

Responding to the crisis spurred by Sri Lanka’s default in June of this year, Direct Relief has delivered eight humanitarian shipments totaling 27 tons and 16 million defined daily doses of donated medicine.

The largest shipment from Direct Relief to Sri Lanka—36,600 lbs. (18 tons) of medicine and medical supplies requested explicitly by Sri Lanka’s government—arrived in recent weeks.

“Direct Relief’s donation of $10 million worth of medicine will save many lives,” Prime Minister Gunawardena said in a statement.

The 18-ton shipment included medications to treat infections, wounds, seizures, mental health conditions, glaucoma, cardiovascular disease and respiratory issues.

These products were donated to Direct Relief by companies including Accord Healthcare, Apotex, Baxter International, Teva Pharmaceuticals and Viatris. One particularly considerable contribution from Accord included nearly 200,000 defined daily doses of IV furosemide, which is used to treat edema from heart failure and liver and kidney disease.

Other companies contributing donated medicine to Sri Lanka include AbbVie, Boehringer Ingelheim Cares Foundation, Eli Lilly & Co., Hikma Pharmaceuticals, Integra LifeSciences, Meitheal Pharmaceuticals, and Merck.

Partnering with Sri Lanka’s College of Endocrinologists and the Life for a Child program, Direct Relief has also donated and delivered two shipping containers of insulin that went to 25 health facilities for the benefit of patients under the age of 14 with diabetes.

Direct Relief works closely with Sri Lanka’s Ministry of Health, Ministry of Foreign Affairs, the Sri Lankan Embassy in the United States, the Medical Supply Division, and the National Medicines Regulatory Authority to deliver supplies and will continue to do so.

Direct Relief has also received invaluable assistance from Medical Help Sri Lanka, an organization formed by Sri Lankans in the United States.

“Direct Relief has established trusted relationships at all levels of the government and will continue to provide support as needed,” Alleway said.

In April, Sri Lanka suspended repayment of nearly $7 billion in foreign debt due this year out of a total foreign debt of more than $51 billion. On Sept. 1, the International Monetary Fund announced $2.9 billion in loans “to restore macroeconomic stability and debt sustainability while safeguarding financial stability, reducing corruption vulnerabilities and unlocking Sri Lanka’s growth potential.”

The loans, however, are not expected to restore Sri Lanka’s ability to import medicine quickly. In the meantime, Direct Relief will continue assisting the country to the fullest extent possible, with additional medical aid shipments already underway.

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With the substantial decrease in new Ebola cases in recent weeks, the airlift represents a pivot toward helping local health facilities deal with both the pre-existing health challenges exacerbated by the outbreak as well as the still serious threats that Ebola presents.

Dozens of primary care facilities shuttered during the crisis; malaria and other conditions went untreated; vaccination programs were suspended, prompting a recent measles outbreak; and pregnancy-related complications saw an uptick as more women gave birth at home.

“As the focus shifts to long-term health systems strengthening in West Africa, these items will help restore confidence in health care for both providers and people seeking care,” said Andrew MacCalla, Director of Emergency Response and International Programs at Direct Relief.

Each module contains 36 of the essential supplies needed to operate a functional medical clinic for two months, including items such as surgical gowns, gloves, masks, lanterns, medical disposal bins, and non-contact thermometers. The contents were developed in consultation with the Centers for Disease Control and Prevention, the Ministry of Health of Liberia, and Last Mile Health.

The supplies contained in the modules were donated, in part, by the City of Yokohama, 3M, BD, California Nurses Foundation, and One Million Lights. Additional supplies were purchased through a grant from The Paul G. Allen Family Foundation.

Another 17 modules will ship later in the month for a total of 100 modules. In Liberia, 40 modules will be distributed by Last Mile Health. In Sierra Leone, 10 modules will be distributed by Wellbody Alliance and 50 modules will be distributed by Medical Research Centre. Prescription medicines contained on the airlift will also be delivered to all three of these partners, as well as to Africare in Liberia.

The pharmaceutical supplies were made possible by Accord Healthcare, Inc., Actavis Pharma, Inc., Bayer Corporation – USA, Baxter International, Inc., GSK, Hospira, Inc., Mylan Inc., Prestige Brands, and Teva Pharmaceuticals.

Since Direct Relief began responding to the Ebola outbreak last spring, the organization has sent 40 shipments of Ebola relief aid valued at $25 million (wholesale), which have been distributed to more than 1,000 clinics and health centers in West Africa, in coordination with partner agencies.

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