Upali Pushpakumara, a farmer from central Sri Lanka, has to journey 230km (143 miles) each time his son, Nuwan, wants most cancers remedy.

The 18-year-old was recognized with leukaemia final 12 months, and since then, Mr Pushpakumara and Nuwan have needed to make a number of journeys all the best way to Maharagama, a suburb of the capital Colombo, to get to the National Cancer Institute.

Sri Lanka supplies common healthcare – free well being companies – to its residents. The authorities spends 4% of its price range on healthcare, and its state hospital system has been praised as among the best within the area.

However, the results of a devastating financial disaster have meant this as soon as celebrated system is now coping with a scarcity of medication and issues with counterfeit medicines, in addition to the truth that medical doctors are leaving the nation in droves.

Hospitals just like the National Cancer Institute are a essential lifeline for thousands and thousands like Mr Pushpakumara’s household, who can not afford to get handled at personal healthcare establishments.

Here, sufferers like Nuwan are supposed to obtain diagnoses, chemotherapy, surgical procedure and life-saving medicines freed from value.

But currently, that has not likely 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 advised the BBC.

He says he spends about $500 each month on drugs.

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

Hit onerous by the pandemic, lethal bomb assaults on Easter Sunday in 2019 and disastrous financial insurance policies, Sri Lanka ran out of overseas foreign money reserves and declared chapter in April 2022.

To lower your expenses, curbs have been imposed on imports of meals, gasoline and drugs, resulting in crippling gasoline and energy shortages.

To enhance earnings, the federal government drastically elevated tax charges and introduced these with decrease incomes into the tax internet for the primary time. This signifies that thousands and thousands of households at the moment are battling an exponentially excessive value of residing whereas seeing their incomes cut back.

Among these hit hardest are those with a sick member of the family to care for.

Niluka Sanjeevani, whose four-year-old son has leukaemia, advised the BBC she spends about $600 a month on medicines for her little one – a sum she will be able to little afford as the worth of meals and housing have skyrocketed.

The healthcare sector itself has been hit onerous too – Sri Lanka imports virtually all of its drugs.

Pharmaceutical trade consultants say there’s nonetheless a scarcity of many life-saving medicine produced by world pharmaceutical corporations, on account of pricing points and industrial viability.

The costs of imported medicines additionally soared because the Sri Lankan rupee dropped by almost 70% towards the greenback within the 2022-2023 interval.

“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 government, who did not need to be recognized, advised the BBC.

Dr Ramesh Pathirana, the nation’s well being minister, admits that there have been some shortages, however insists the federal government is dedicated to growing funding for the healthcare system.

“Some consultants are prescribing newer molecules, expensive drugs, sometimes the government couldn’t bear [the cost],” Mr Pathirana advised the BBC.

However, he mentioned the price range allocation for well being has been elevated this 12 months to handle the escalating prices of medicines.

But scarcity just isn’t the one situation.

“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 metropolis of Anuradhapura, says.

This was echoed by AMK Athanayake, who’s ready for her five-year-old son to get surgical procedure.

“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 mentioned.

These issues have been echoed by a number of activists and unions over the past 12 months. They say low-quality medicines have led to poor affected person care, even causing deaths and blindness.

The authorities has ordered an inquiry into the reported buy of substandard medicines by the earlier well being administration.

Then there’s the exodus of many healthcare professionals, together with medical doctors, which can be placing large stress on hospitals.

Ms Sanjeevani says they’re getting appointments principally with junior medical doctors attributable to a scarcity of specialist consultants.

Sri Lanka’s largest physician’s union, the Government Medical Officers’ Association (GMOA) says about 1,500 medical doctors have gone overseas on go away both for larger research or to work prior to now 12 months.

Another 3,000 extra medical professionals have requested for lengthy go away. The nation of round 22.16 million folks has a complete of round 20,000 medical doctors.

In Sri Lanka, medical schooling is state-funded. Those who graduate are principally absorbed into the general public well being system and deployed to work in numerous components of the nation.

For these residing in rural areas, these medical doctors are sometimes their solely entry to medical remedy.

With many, significantly specialists, leaving the nation, that is having a knock-on impact on hospitals.

The downside couldn’t be extra acute than in the principle hospital in Dehiattakandiya in japanese Sri Lanka. It made headlines final 12 months after its solely surgeon left the nation.

The hospital caters to about 150,000 folks in close by areas.

“We haven’t done any major surgery for several months,” a senior physician, who did not need to be recognized, advised the BBC in January.

“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 substitute specialist physician was solely appointed in February.

The scarcity of specialists and different medical doctors has additionally led to lengthy ready instances.

“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, advised 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 changed final October.

Mr Rambukwella and a number of other different officers have been arrested in February over allegations that the federal government bought counterfeit medicine when he was answerable for the well being ministry. He denies the allegations but has resigned from the cabinet.

There have additionally been intermittent strikes by healthcare employees’ unions since January demanding higher pay and circumstances.

The medical doctors’ union says other than the scarcity of medical doctors, many defective items of kit similar to CT scan and MRI scan machines haven’t but been repaired or changed in hospitals.

Mr Pathirana admits that there are “some lacunae or deficiencies” in relation to sure 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 physician himself, mentioned.

The authorities is conscious that the well being sector is on a precipice. Even because it struggles to emerge out of the crippling financial disaster, authorities know that the collapse of its extremely regarded healthcare system is one thing they only can not afford both.