‘I’m on death row’: Sri Lankans forced to choose food or vital medicines | global development

Tension was written all over Sunman Senthilnathan’s face as he left the pharmacy with the essential medicine he brings, every two months, to Sri Lanka’s commercial capital, Colombo.

He was diagnosed with colon cancer three years ago, and the 56-year-old’s treatment has taken control of his life ever since. Now, however, it has become more difficult to deal with during the crippling economic crisis in Sri Lanka that has caused shortages of fuel, food and medicine and major political turmoil.

Like other people with long-term illnesses such as diabetes or high blood pressure, Synthelnathan struggled during the crisis to find and pay for his medications. The coping methods are drastic: cutting out or missing out on medication or cutting out meals and changing diets to save money.

“The prices are constantly rising and the drugs are unaffordable. There are no cheaper alternatives, so I have given up on some drugs,” says Synthelnathan, who lives on his pension. He takes a reduced dose of the medicines he can buy.

Tracy McVeigh, editor

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The human toll from non-communicable diseases (NCDs) is huge and rising. These diseases take nearly 41 million lives out of the 56 million people who die each year – three-quarters of them in the developing world.

Non-communicable diseases are simply; Unlike, say, a virus, you can’t catch them. Rather, they occur due to a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes, and cardiovascular diseases – heart attacks and strokes. Nearly 80% are preventable, and they are all on the rise, spreading unabated across the globe as population aging and lifestyles driven by economic growth and urbanization make unhealthy a global phenomenon.

Non-communicable diseases, once seen as diseases of the wealthy, are now taking over the poor. Illness, disability, and death are perfectly designed to create and widen inequality — and being poor makes you less likely to be accurately diagnosed or cured.

The investment in treating these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and societies is staggeringly high.

In low-income countries, non-communicable diseases – usually slow and debilitating diseases – see a fraction of the money needed to invest or donate. Attention remains focused on threats from infectious diseases, yet cancer death rates have long exceeded the number of deaths from malaria, tuberculosis, and HIV/AIDS combined for a long time.

A Common Case is a new Guardian series on non-communicable diseases in the developing world: their prevalence, solutions, causes and consequences, and tells the stories of people living with these diseases.

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He says he has already had to reduce the quantity and quality of his food because the scarcity of some drugs is driving up prices. “Every month, prices go up, and soon a pension will have to be spent on medicines.”

People line up outside a pharmacy on May 02, 2022 in Colombo, Sri Lanka. The country imports about 80% of its medicines. Photo: Buddhika Weerasinghe / Getty Images

Sri Lanka imports about 80% of its medicines. Nearly 200 of them, used mainly by cancer and kidney patients, are in short supply, with indirect delays in scheduling “non-urgent” surgeries.

Sri Lanka’s ruling Rajapaksa dynasty has plunged the island into economic disaster by amassing international debt to fund flashy infrastructure projects, which have been linked to corruption. With the global cost of living crisis, Sri Lanka’s lack of foreign resources has led to power cuts, queues at gas stations and people having to skip meals. The immigration office was flooded as people tried to go out to find work abroad.

Beaverton Ryan, a teacher from Colombo who suffers from type 1 diabetes says he now spends around LKR20,000 (£46) a month on insulin alone, more than double previously, and has had to wait up to three days for it to be taken. Medicine. Be available. “For people with lower incomes than me, it can be a matter of life and death,” he says.

Ryan was able to continue his medical system by borrowing from his parents. But now he needs more. The escalating cost of food means giving up a low-carb, high-protein diet. “Now I just eat anything,” he says. “When I was on a low-calorie diet, I was using less insulin, so not only is food more expensive, but since I’m eating more calories I have to take in more insulin…which is really more expensive anyway. It’s an endless loop of hell.”

People queue at a dispensary at a government-run hospital in Colombo.
People queue at a dispensary at a government-run hospital in Colombo. The lack of medicines has had an indirect effect, with those who need “non-urgent” surgery facing delays. Photo: Iranja Jayawardena/Associated Press

Swarna Gamlath, 49, a patient at the heart clinic at a general hospital in the Western District, says she doesn’t have the medicines she needs, but she can’t buy them at the pharmacy because prices have tripled. She recently had to skip her prescription for an entire month for blood-thinning medications. “I’ve been on drugs for life, and now I take one dose a day, not two, as prescribed.

“The only solution I could see was just a morning dose. I was hoping to say goodbye a little longer, for the sake of my kids, but now it’s probably faster and a lot more painful.”

Synthelnathan decides to try to replace his medications with conventional ones, but he is not confident about his future. “I don’t even know if it will work, but now I’m getting treatment. It’s my last chance.”

“I think my days are numbered. A friend of mine who had cancer died during the Covid pandemic because he could not undergo a life-saving surgery at the time. I had to postpone my checkups due to a lack of medical supplies, which increased my vulnerability to infection.

“I am on death row. Every time I stumble in pain, I fear for the future of my two daughters who are still studying. I can’t go abroad for treatment so I will be left to die.”

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