The story of a poor Medawachchiya youth

A healthcare system accessible to all:

by Dr. Indika Weerasinghe

Consultant Orthopaedic Surgeon Vavuniya District General Hospital.

Email : prasinwe@yahoo.com

Twenty-year-old Hashan from Kanadarawa, Medawachchiya was brought to the Accident Service of Vavuniya District General Hospital on the morning of 5thOctober 2020 following a fall from a coconut palm. He landed mostly on his back after falling from a height of 25 feet. The Suwa-Seriya free ambulance arrived at the site in five minutes and brought him to the hospital. Fortunately, there was no damage to his spinal cord, which would have paralysed his legs. But he had an unstable fracture of his spine along with multiple other injuries. His right leg was broken and the ankle dislocated. His left wrist was broken as well. This was a case of major trauma or poly-trauma, which needs multi-disciplinary care by several surgical specialities.

Despite multiple injuries, Hashan was conscious and alert as he has escaped head injury. Needless to say, his parents who were at the bedside, were devastated and in a state of shock. Hashan himself did not realise the gravity of the injury until his X-rays and other imaging was explained to him that morning. All of his fractures needed surgery as soon as he was stable enough for anaesthesia. Hashan’s father had two questions for the orthopaedic team.1) Is it possible to do all the surgeries in Vavuniya hospital? 2) How much is it going to cost him?

The answer to the first question was ‘yes’ and there was relief in his eyes upon hearing that. Transferring Heshan to Jaffna Teaching Hospital or Anuradhapura Teaching Hospital would have meant that family members would have to travel longer distances back and forth to care for Hashan. The answer to the second question was ‘the entire treatment will not cost a cent’. Hashan’s father looked skeptical hearing that as he understood that there will be multiple surgeries including one on the spine.

Two days later, after careful planning, Hashan had surgery to fix his spine. All implants and instruments were available in the hospital. Intra-operative X-ray machine was invaluable to complete the spinal surgery safely. Simultaneously, his right leg and ankle were fixed. His left wrist was not operated on that day to limit surgical stress on his body. Three days later he had his left wrist operated with a plate and screws. On post operative day 2, he was brought upright with a brace and was able to bear weight onto his left leg. After an uneventful recovery in ward 9 of Vavuniya Hospital, Hashan was discharged 10 days later.

Hashan is just another patient out of many thousands of Sri Lankans who receive free healthcare on a yearly basis fromgovernment hospitals around the island. His treatment was not groundbreaking, but what needs to be emphasized here is the cost the government bears through the Ministry of Health, to get people like Hashan back into the workforce after life changing trauma. Its easy to overlook the man-power, medicinal and equipment cost borne by the Ministry of Health to make Sri Lankan citizens like Hashan productive once again and contributing to the development of the country. The three surgeries he had and the hospital stay of two weeks would have cost around two million rupees in private hospital, which would have been much more than over what Hashan’s family would have been able to afford. But thanks to free universal healthcare in Sri Lanka, Hashan is back home today without his father having to sell his house to pay hospital bills.

To appreciate the benefit of free healthcare in Sri Lanka, it is important to compare our healthcare model with other countries. India also has a universal healthcare system but the private sector healthcare is dominant. Most health expenses are paid ‘out of pocket’ of patients and their families. Most people in rural areas does not have access to quality, affordable healthcare.

In the United Kingdom, the National Health Service (NHS) provides free healthcare to its people except for some charges associated with eye tests, dental care and prescriptions. The NHS is funded by the significant contribution tax payers make to the government. (If the annual income of a person in England is between 50,000 to 150,000 pounds, 40% is deducted as tax). It is that significant tax contribution that funds the National Health Service and its ‘free’ healthcare.

Healthcare costs in the United States are astronomically high. medical bills are the number one cause of bankruptcy in United States. This is despite the United States spending 16.9% of its GDP on health (2018).

According to Bloomberg health efficiency index, Hong Kong ranks number one as the most efficient healthcare model in the world. Hong Kong spends around 3% of its GDP on health and its citizens are provided with healthcare plans for a low cost. (Not for zero cost).It is a mixed medical economy with 43 public hospitals and 12 private hospitals.

I feel it is in that context we have to look at our free healthcare model which is unique to Sri Lanka. Like in Hong Kong, private sector contribution prevents overburdening of government healthcare delivery. But unlike in India, strong government sector healthcare delivery system reaches into rural areas like Kanadarawa, Medawachchiya where people like Hashan can get quality treatment at government hospitals absolutely free. And unlike in the United States, health costs are not over the roof expensive.

It is true that from time to time, there are shortages of medicines and equipment in government hospitals in Sri Lanka. But they are usually transient. Even for those shortages, there is a system to ‘Local Purchase’these drugs and equipment by using funds allocated to the government hospital.

So, I think it is fair to say that as a developing economy, Sri Lanka is doing its best to look after the health of its people. Therefore, it is the responsibility of all Sri Lankans to protect our universal free healthcare system and improve it further.