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

Stress was written all over Sunman Senthilnathan’s face as he left the pharmacy with the crucial medicine that brings him, 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 dominated his life ever since. Now it is even more difficult to deal with during the crippling economic crisis in Sri Lanka that has caused fuel, food and medicine shortages and major political upheaval.

Like others with long-term illnesses such as diabetes or hypertension, Senthilnathan has struggled during the crisis to find – and to afford – his medication. The coping methods are drastic: cutting or completely missing out on medication or cutting out meals and changing diets to save money.

“Prices keep increasing and drugs are unaffordable. There are no cheaper alternatives so I have given up on some drugs,” says Senthilnathan, who survives on his pension. He takes a reduced dosage of the drugs he does manage to buy.

The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.

NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.

NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.

Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.

In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.

‘A common condition’ is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.

Tracy McVeigh, editor

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A common condition

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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.

NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioral factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanization make being unhealthy a global phenomenon.

NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.

Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, farming and communities is staggerly high.

In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.

‘A common condition’ is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.

Tracy McVeigh, editor

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He says he has already had to cut both quantity and quality of his food because scarcity of certain drugs is driving prices higher. “Each month, prices increase, and soon my pension will have to be spent on medicine.”

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

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

Sri Lanka’s Rajapaksa ruling dynasty drove the island to economic disaster by amassing international debt to fund showy infrastructure projects, which were associated with corruption. As the global cost of living crisis hit, Sri Lanka’s lack of foreign resources has meant blackouts, queues at fuel stations and people having to skip meals. Immigration office have been inundated as people try to get out to find work abroad.

Beverton Rayan, a teacher from Colombo with type 1 diabetes, says he is now spending about 20,000 Sri Lankan rupees (£46) a month on insulin alone, more than double previously, and has had to wait up to three days for the medication to be available. “For people on an even lower income than me, it can be a matter of life and death,” he says.

Rayan has managed to continue his medical regime by borrowing from his parents. But now he needs more. The spiraling cost of food has meant giving up on a low-carbohydrate high-protein diet. “Now I just eat whatever,” he says. “When I was on the lower calorie diet I used to dose lower in insulin, so not only is food more expensive but since I’m eating more calories I have to take more insulin… which is already 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 drug shortage has had a knock-on effect, with those needing ‘non-urgent’ surgery facing delays. Photograph: Eranga Jayawardena/AP

Swarna Gamlath, 49, a patient of the cardiology clinic at a public hospital in Western Province, says they do not have the drugs she needs, but she cannot afford to buy them from the pharmacy as prices have trebled. She recently had to skip a whole month of her prescription for blood-thinning drugs. “I was put on drugs for life, and now I take one dose a day, not two, as prescribed.

“The only solution I could see was to just have the morning dosage. I was hoping for a slightly longer goodbye, for the sake of my children, but now it’s likely to be faster and far more painful.”

Senthilnathan has decided to try to replace his drugs with traditional medicines but has little confidence in his future. “I don’t even know if it’s going to work, but now I am taking treatment. It’s my last chance.

“I think my days are numbered. A friend of mine who was a cancer patient died during the Covid pandemic because he could not undergo lifesaving surgery at that time. I had postponed my tests due to a shortage in medical supplies, increasing my vulnerability to infection.

“I am on death row. Every time I curl up in pain, I fear for the future of my two daughters who are still studying. I cannot go overseas for treatment so I’d be left to die.”

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