The Sri Lankan medical crisis, explained

The Sri Lankan medical crisis, explained

Over the next six months, we’ll need millions of units of medicine and equipment. Here’s introducing Elixir, and how you can help out.

@April 22, 2022

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By Yudhanjaya Wijeratne With contributions from Dr. Anver Hamdani, Ministry of Health; Kavindya Thennakoon, Sarvodaya, and Helani Galpaya 

Note: this article has been updated to be a summary of the situation as of May 4, 2022. If you’re looking for the guide on how to donate, click here.

Sri Lanka is experiencing a critical shortage of medicines and equipment. Medical staff across the country, unions like the Government Medical Officer’s Association (GMOA), and even international news outlets have been banging the drum on this.

The reason for this crisis is simple: the majority of the medicines used by the Sri Lankan healthcare system are produced elsewhere. National economic mismanagement has made it difficult for hospitals to procure what they need. Doctors from hospitals all over the country have been taking to WhatsApp, Instagram, Facebook and Twitter to raise awareness of massive shortages in critical medicines.

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Added to this, the Department of Government Information denied the unfolding crisis, prompting our factchecks.

To map out the problem, both for public record and to help donations, we built a piece of software that collects medical needs from across the country in one single, central, publicly accessible database.

It’s called Elixir (elixir.watchdog.team), and it brings together requirements from both a national level and a per-hospital level.

At a national level, we have official requirements lists sent to us from the Ministry of Health’s Coordinator for Health Care Donor Activities. At a hospital level, we have data directly from local medical staff at hospitals around the country, from the locations you see above.

Here’s a picture of some of the direst needs of the hour. There are 38 medicines from the Ministry of Health’s Urgent list.

We desperately need 17.5 million 200mg Sodium Valproate tablets. Sodium Valproate is used to treat epilepsy and bipolar disorder.

Then we need 2.5 million tablets of Potassium Chloride — used to treat low potassium levels in people, but also used for some types of heart surgery and prescribed for people after they’ve had heart surgery.

What next? Insulin, used to treat diabetes; furosemide, to treat high blood pressure and fluid build-ups in the body, especially those caused by heart failure; also used to help with liver and kidney issues.

Allopurinol to treat gout and kidney stones. Noradrenaline to maintain blood pressure. Enoxaparin, an anti-coagulant that helps prevent blood clots.

This is merely the most urgent list. The full list, including non-urgent medicines (read: things that might become urgent if this goes on) numbers another 278 types of medicines and 112 types of equipment (everything from catheters to IV bags to endotracheal tubes).

We even need neo-natal endotracheal tubes — these are the tubes they need to help babies breathe.

Over the next six months, the country needs millions of units of medicines and equipment. As we said above, the problem is that the bulk of medicines required aren’t produced in Sri Lanka.

From the data we’ve gathered on Elixir, we can say that only 9.2% are produced in Sri Lanka. The rest have to come from India, Switzerland, Germany, and a number of other countries, including Cyprus, Bangladesh, Indonesia, the USA and Argentina.

You can see every request by going to elixir.watchdog.team. Use a computer if possible; we’re still working on complete mobile responsiveness.

If you’re a medical officer, and the hospital that you work at has a shortage, you can create a new request on Elixir. We’ll review it and make it public so that your needs can be seen.

Our national healthcare system is free and universal for all citizens. With a relatively minute fraction of the spending, it has kept Sri Lankan health indicators comparative with the developed world. Whatever political crisis befell the country, medical staff have been saving lives for decades.

From the Institute for Health Metrics and Evaluation: Disability-adjusted life year (DALYs), a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Sri Lanka is roughly comparable to Australia, Spain and France in these metrics.
From the Institute for Health Metrics and Evaluation: Disability-adjusted life year (DALYs), a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. Sri Lanka is roughly comparable to Australia, Spain and France in these metrics.

Some of the questions we keep being asked is why and how this happened. Did nobody notice? Did we really let things go so far?

We have no answers for these right now; or rather, we have no energy for these questions right now. We are living through system failure, from electricity to healthcare. The hard questions will come later. The immediate priority is that this system, which takes care of us, now needs us to take care of it.

Elixir will run as long as needed.

Do what you can. We’ll do our best as well.

The data for the visualisations in this piece.

Medicine requests, urgent

Generic NameBrand NameImporterQuantity
Sodium nitroprusside Inj. 50mg Sodium Nitroprusside for Injection BP/USP 50mg
200
Cholecalciferol tablet 5000 IU (Colecalciferol) Colecalciferol Tablet BP 5000 IU
50000
Total Parenteral Nutrition in500ml ¿1,500ml collapsible bag Total Parenteral Nutrition in 500ml-1,500ml multiple component in collapsible bag (central or peripheral)
6250
Desferrioxamine Inj. 500mg DESFERRIOXAMINE MESYLATE FOR INJECTION USP 500MG
DEMOFERIDONE
Access International (Pvt) Ltd
112500
Calcium polystyrene sulphonate15g-17g powder sachet CALCIUM POLYSTYRENE SULPHONATE POWDER 15G SACHETS
K-STRYN
George Steuart Health (Pvt) Ltd
30000
Filgrastim Inj 300mcg in0.5ml/1ml, PFS/vial FILGRASTIM INJECTION 300MCG IN 1ML
NEUTROMAX
Slim Pharmaceuticals (Pvt) Ltd
42500
Potassium Chloride Tab. 600mg POTASSIUM CHLORIDE EXTENDED RELEASE 600MG
ALKAY ER
Kamazu (Pvt) Ltd
2500000
Pethidine hydrochloride Inj.75mg PETHIDINE INJECTION B.P 75MG/ 1.5ML
VERPAT 75
Leader Pharma Agency (Pvt) Ltd
45000
Morphinesul.Inj.(Presvat.free) 2mg/2ml Morphine Sulphate injection BP,(preservative free) 2mg in 2ml
1050
Potassium chloride Injection 15 % in 10ml Ampoule STERILE POTASSIUM CHLORIDE CONCENTRATE BP 15% W/W
***
Yaden International (Pvt) Ltd
117500
Liposomal Amphotericin B injection 50mg for I.V. use Liposomal form of Amphotericin B 50 mg vial
6250
Dobutamine Inj. 250mg/20ml DOBUTAMINE HYDROCHLORIDE 12.5MG/ML
DOBUTAMINE
Akbar Pharmaceuticals (Pvt) Ltd
37500
Enoxaparin Inj.60mg/0.6mlPF.Syringe ENOXAPARIN SODIUM 60MG/0.6ML
CUTENOX
ABC Pharma Services Pvt. Ltd
250000
Sodium valproate Tab. 200mg SODIUM VALPROATE TABLETS BP 100MG GASTRO RESISTANT
***
Novachem Lanka (Pvt) Ltd
17500000
Fentanyl Injection100microgram in 2ml FENTANYL CITRATE INJECTION 0.1MG/2ML
DOMSUPP
Slim Pharmaceuticals (Pvt) Ltd
180000
Fludrocortisone tablet 0.1mg FLUDROCORTISONE ACETATE TABLETS USP 100MCG
FLUDRICORT
Yaden International (Pvt) Ltd
50000
Bipha.Isoph.Insulin(Human)Inj. 30/70 BIPHASIC ISOPHANE INSULIN 30/70 BIOSYNTHETICE HUMAN INSULIN INJ. 1000IU/1ML
MIXTARD 30 PENNFILL
Sunshine Healthcare lanka Ltd
900000
Chlorpheniramine MaleateInj.10mg/1ml CHLORPHENAMINE INJECTION BP 10MG/ML
***
Ceyoka (Pvt) Ltd
60000
Propylthiouracil tablet 50mg PROPYLTHIOURACIL TABLETS BP 50MG
PTU
Pettah Pharmacy (Pvt) Ltd
62500
Phenytoin sodium Inj. 250mgin 5ml PHENYTOIN INJECTION BP 50MG/ML
VERTOIN
Leader Pharma Pvt Ltd
12000
Ergometrine maleate inj.500mcg/1ml amp ERGOMETRINE INJECTION BP 0.5MG IN 1ML
***
Ceyoka (Pvt) Ltd
8750
Enoxaparin Inj.40mg/0.4ml PF.Syringe ENOXAPARIN SODIUM INJECTION USP 40MG/0.4ML
CUTENOX
ABC Pharma Services Pvt. Ltd
200000
Ephedrine Inj. 30mg/1m amp. EPHEDRINE INJECTION BP 30MG/ML
VEREPHE
Leader Pharma Pvt Ltd
45000
Allopurinol tablet.100mg ALLOPURINOL TABLETS BP 100MG
HILAC
MAPS Pharma (Pvt) Ltd
900000
Vecuronium bromide Inj. 10mgvial VECURONIUM BROMIDE FOR INJECTION 4MG/2ML
*****
Ceyoka (Pvt) Ltd
8750
Noradrenaline Inj. 4mg/2ml NORADRENALINE INJECTION BP 4MG/2ML
***
Yaden International (Pvt) Ltd
300000
Tetanus toxoid vaccine 0.5ml(SD) amp TETANUS TOXOID VACCINE ADSORBED 40 IU in 0.5ML
***
Citihealth Imports (Pvt) Ltd
200000
Pancuronium bromide inj.4mg/2ml Pancuronium Injection BP, 4mg/2ml
1750
Lignocaine 2% + Adrenalin inj. 30ml vial LIGNOCAINE HYDROCHLORIDE GEL IP 2% w/w
CIROCATINE GEL
Ceyoka (Pvt) Ltd
45000
Calcium gluconate 10%, Inj.10ml CALCIUM GLUCONATE INJECTION 10% W/V
***
B Braun Lanka (Pvt) Ltd
75000
Morphine sulphate Inj. 15mg MORPHINE SULPHATE INJECTION BP 15MG/ML
VERMOR 15
Leader Pharma Agency (Pvt) Ltd
150000
Vasopressin Inj. 20 I.U./1mlampoule VASOPRESSIN INJECTION IP 20 UNITS/ML
VASMED
Klintas (Pvt) Ltd
5500
Midazolam inj. 5mg/1ml amp MIDAZOLAM TABLETS 7.5MG
DORMICUM
A Baur & Co (Pvt) Ltd
225000
Bupivacaine 0.5%+Glucose 8% in 4ml inj BUPIVACAINE HYDDROHLORIDE IN DEXTROSE INJECTION USP 0.5%
SAKAINE
Ceyoka (Pvt) Ltd
68750
Vancomycin Inj. 500mg vial VANCOMYCIN HYDROCHLORIDE FOR INJECTION USP 500MG
VAN-CP 500
PTC MEDIACL (PVT) LTD
48000
Furosemide (Frusemide) Inj.20mg/2ml FUROSEMIDE INJECTION BP 20MG/2ML
FRUSEX
Nation Pharma (Pvt) Ltd
625000
Furosemide oral solution USP 20mg/5ml, 150ml bottle
749
HEPARIN INJECTION BP 25,000 IU/5ML
RINHEPA 25
Klintas (Pvt) Ltd
75000

Medical requests, non-urgent

Generic NameBrand NameImporterQuantity
Paraffin yellow softWHITE SOFT PARAFFIN CREAM 0.2%
EMODERM
Glaxo Wellcome (Ceylon) Ltd
22833333
Prazosin HCl Tab. 1mgPRAZOSIN TABLLETS BP IMG
PRAZORIGHT
Chamee Chemist
15004191
Amlodipine Besylate Tab. 5mgAMLODIPINE BESYLATE TABLETS 5MG
STAMLO 5
Emerchemie NB (Ceylon) Ltd
10220100
BECLOMETHASONE DIPROPIONATE DP CAP DP400MG
BECLATE 400 DP
Breathe Free Lanka (Pvt) Ltd
8737439
Nifedipine ER Tab.20mgNIFEDIPINE TABLETS 30MG
ADALAT LA
Hemas Pharmaceuticals (Pvt) Ltd
7500000
Bisoprolol Fumarate Tab. 5mgBISOPROLOL FUMARATE TABLETS USP 5MG
CONCOR
Emerchemie NB (Ceylon) Ltd
3333333
Nicorandil Tab. 10mgNICORANDIL TABLETS BP 10MG
***
Ceyoka (Pvt) Ltd
3333333
Paraffin White SoftWHITE SOFT PARAFFIN CREAM 0.2%
EMODERM
Glaxo Wellcome (Ceylon) Ltd
3333333
Alfacalcidol Cap. 250ngALFACALCIDOL CAPSULES 0.25MCG
ONE ALPHA
Hemas Pharmaceuticals (Pvt) Ltd
2750000
Sodium bicarbonate tablet 600mgSODIUM BICARBONATE TABLETS USP 600MG
RENADIUM
Neon Pharmaceuticals (Pvt) Ltd
2407250
Salmeterol+Fluticasone DPCaps 50/500mcgSALMETEROL 50MCG + FLUTICASONE 500MCG DRY POWDER CAPSULES
FLUTIMATE 500
Emerchemie NB (Ceylon) Ltd
2073251
Metoprolol Tab. 50mgMETOPROLOL INJECTION BP 1MG/ML
XYPROL-T
Ceyoka (Pvt) Ltd
2061845
ParacetamolPARACETAMOL TABLETS 500MG
PANADOL
Smithkline Beecham (Pvt) Ltd
1666667
Codeine/ Paracetamol 8mg/500mgCODEINE PHOSPHATE 8MG+PARACETAMOL TABTETS BP 500MG
VERCOD-P
Leader Pharma Pvt Ltd
1666666
Sodium chloride for IV use 0.9% 500mlSODIUM CHLORIDE INJECTION USP 0.9 %
***
CIC Holdings PLC
1195572
Potassium Chloride Tab. 600mgPOTASSIUM CHLORIDE EXTENDED RELEASE 600MG
ALKAY ER
Kamazu (Pvt) Ltd
833334
Sertraline tablet 50mgSERTRALINE TABLETS 50MG
INOSERT 50
Emar Pharma (Pvt) Ltd
833333
Salmeterol+Fluticasone DP Cap50/250mcgSALMETEROL 50MCG, FLUTICASONE 250MCG POWDER INHALATION
SEROFLO
Breathe Free Lanka (Pvt) Ltd
745855
Levetiracetam Tablet 500 mgLEVETIRACETAM TABLES 500MG
LEVIPIL 500
Emerchemie NB (Ceylon) Ltd
500000
Tamsulosin capsule 0.4 mgTAMSULOSIN HYDROCHLORIDE CAPSULES 0.4MG
BESTFLO
Emerchemie NB (Ceylon) Ltd
500000
Topiramate Tab. 25mgTOPIRAMATE TABLETS 25MG
EPIMATE 25
Edna Medicals (Pvt) Ltd
416666
Vitamin A High dose Cap.VITAMIN A 4000IU & VITAMIN D3 400IU CAPSULES
RECTAL-4
Pharma Associates (Pvt) Ltd
383026
Cefuroxime Tab. 500mgCEFUROXIME TABLETS BP 500MG
KEFROX 500
CIC Holdings PLC
375000
Tacrolimus capsule 1mgTACROLIMUS CAPSULES 1MG
TACGRAF
CIC Holdings PLC
375000
Domperidone 10mg TabsDOMPERIDONE 10MG
VOMETA
A Baur & Co (Pvt) Ltd
333333
Famotidine Tabs 20mgFAMOTIDINE TABLETS USP 20MG
FAMOCID
Emerchemie NB (Ceylon) Ltd
333333
Calcium 500mg+Vitamin D3250IU TabCALCIUM & VITAMIN D3 CHEWABLE TABLES (500MG/400IU)
KALZANA
Hemas Pharmaceuticals (Pvt) Ltd
250000
Azathioprine tablet 50mgAZATHIOPRINE TABLETS BP 50MG
AZORAN 50
Amgen Pharmaceuticals Pvt Ltd
208333
Clobazam tablet 5mgCLOBAZAM TABLETS BP 5MG
VERCLOB
Leader Pharma Pvt Ltd
208333
Furosemide (Frusemide) Inj.20mg/2mlFUROSEMIDE INJECTION BP 20MG/2ML
FRUSEX
Nation Pharma (Pvt) Ltd
208333
Cholecalciferol capsule/tablet1000 IU(25 mcg)(Colecalciferol)CHOLECALCIFEROL SOFT GELATIN CAPSULES 25MCG (1000 D)
*****
Alaris Lanka (Pvt) Ltd
200000
Nifedipine Tablets 20mgNIFEDIPINE TABLETS 30MG
ADALAT LA
Hemas Pharmaceuticals (Pvt) Ltd
200000
Anastrozole tablet 1mgANASTROZOLE TABLETS IMG
ARIMIDEX
Hemas Pharmaceuticals (Pvt) Ltd
166666
Cefuroxime 750 IV vialsCEFUROXIME SODIUM FOR INJECTION BP 750MG VIALS
SEFUR 750MG
Yaden International (Pvt) Ltd
166666
Gentamicin 80mg IV vialsGENTAMICIN INJECTION BP 40MG/ML
GENTAWEL
Lotus Pharmaceuticals (Pvt) Ltd
166666
Ondansetron Tablets 4mgONDANSETRON INJECTION IP 8MG/4ML
PREMESIS
Tabrane Healthcare (Pvt) Ltd
166666
Oxytocin injection 5 I.U. /1ml ampOXYTOCIN INJECTION BP 5IU/ML
***
Ceyoka (Pvt) Ltd
166666
Pyridoxine HCl Tab. 25mgPYRIDOXINE TABLETS BP 25MG
***
Yaden International (Pvt) Ltd
166666
Metronidazole intravenous infusion BP 500mg/100ml
***
***
166666
Ortho-phthaladehydedisin.soln. 0.55%w/vOrtho-Phthaladehyde 0.55%w/v
***
***
125000
Sildenafil Tab. 50mgSILDENAFIL TABLETS 50MG
EROGRA 50
PharmAce (Pvt) Ltd
125000
Epoetin Inj.4000IU PF.SyrERYTHROPOIETIN INJECTION BP 4000IU/0.4ML
REPOITIN FREFILLED
Citihealth Imports (Pvt) Ltd
116666
Griseofulvin Tab. 500mgGRISEOFULVIN TABLETS BP 500MG
GRISEOFRED
George Steuart Health (Pvt) Ltd
108100
Labetalol Tablets 100mgLABETALOL TABLETS BP 100MG
***
Celogen Lanka (Pvt) Ltd
100000
Mefenamic Acid 500mgMEFENAMIC ACID TABLETS BP 500MG
MEFCOR 500
Browns & Company Plc
100000
Metformin Tablets 500mgMETFORMIN TABLETS 500MG
METFORMIN-DENK 500
Akbar Pharmaceuticals (Pvt) Ltd
100000
Misoprostol Tablet 200 microgramsMISOPROSTOL TABLETS IP 200MCG
MISOCLEAR
Population Services Lanka
100000
Norethisterone tablet 5mgNORETHISTERONE TABLETS 5MG
PRIMOLUT-N
Hemas Pharmaceuticals (Pvt) Ltd
100000
Tranexamic Tablets 500mgTRANEXAMIC ACID CAPSULES 500MG
HAEMIC
Ceyoka (Pvt) Ltd
100000

Medicines by country of production

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