• Health service seekers urge Govt. to consider the adverse impacts of the decision to halt non-urgent surgeries over resource limitations

Even though certain aspects of the economy such as exports and inflation are supposedly recovering, some aspects such as the health and education sectors appear to be on a downward trajectory. While various attempts are underway to improve those sectors, the general idea is that those attempts do not look very promising.

The situation of the health sector made national headlines recently due to a policy decision taken by the Government. It was announced that all non-essential, or non-urgent, surgeries would be postponed in order to prioritise essential, or urgent, surgeries. This decision came under fire from both the general public, who raised concerns about their right to free healthcare, and medical professionals, who questioned how scientific this decision is. 

To discuss the people’s side of this situation, The Daily Morning spoke to several health service seekers, most of whom acknowledged the economic issues that hinder the health sector but claimed that the Government’s approach to overcoming that challenge is questionable, and that it may affect the people. In discussion with The Daily Morning, they noted that the Government should pay attention to not only the decisions it has to take to manage insufficient resources but also to the adverse impacts of those decisions. If saving the life of one party reduces the attention another party is in need of, they opined, that is an issue.

Essentialness of non-essential services 

The most common question raised by health service seekers in this regard is, how the essential surgeries are defined and are differentiated from non-essential surgeries. Many of them were also concerned about how long non-essential surgeries would be postponed for. According to service seekers, unlike in the case of consumer goods, when it comes to medical treatment, deciding what surgeries are essential and what surgeries are not is an extremely sensitive and serious matter. 

“No person undergoes surgeries because it is fun. People have to undergo surgeries because it is essential to them in some way and because their doctor has recommended it. I think it is up to each person to decide how essential a surgery is, because it is their lives that either benefit or get affected from that decision,” 34-year-old mobile phone technician, Chamath Iranga, said, adding that for example, even a cosmetic plastic surgery could be extremely essential to a person and may have a significant impact on their mental health.

Meanwhile, several persons opined that categorising surgeries as essential and non-essential sets a dangerous precedent. They claimed that all health services, including surgeries, are essential regardless of the reason, and that it is essential to provide them through the health sector, or at the very least, provide an alternative solution to ensure the provision of the same through some sector.

Sharing the same opinion and adding that this move will set a bad example by providing a ground for future Governments to categorise essential services as essential and non-essential when they cannot provide these services, he added: “The Government should be respectful to the taxpayers, because, none of these so-called free services, including the health service, are really free because the tax money is what keeps them running. If the Government has to restrict certain services based on justifiable reasons, I would respect that decision. However, labelling people’s health needs as essential and non-essential is a shameful act, and the Government has no right to label people’s needs in that manner.”

In addition, several persons claimed that the Government should have employed a more lenient and different approach to achieve what it wants, such as getting the support of the private sector to perform surgeries, and that restricting access to an essential, free service could be dangerous.

Meanwhile, a 42-year-old school teacher who has been obtaining treatment for a cardiovascular disease since 2015, Namal Anjula (name changed on request), stressed that although the Government’s decision is understandable, many find it unacceptable. He opined that the said decision would place at risk the lives of many people whose health situation could be successfully improved through surgeries. 

“This is not merely a matter of the current situation of the health sector or the people who are in the waiting list (a reference to the process of prioritising surgeries based on the severity of a patient’s health situation) for essential surgeries. First of all, although this could be a good short-term measure, no party, not even the Government, knows how long this restriction would have to be continued. Therefore, even if this is not seen as a major issue now, in a couple of months, we will get to see how this pans out,” he said, opining that limiting surgeries to essential ones should be a decision that does not last more than a month or two.

A ‘solution’ that creates issues?

The repercussions of the Government’s decision, according to Anjula, could be long term and even extend to the overall national health rankings. Adding that many patients who are in critical situations would be saved, he warned that many people who are living in the initial stages of chronic illnesses would face the adverse impacts of this decision. 

“The Government’s decision aims to prioritise the lives of those who are in critical situations. Many of them are old or are physically unfit to work. On the other hand, among those who do not require surgeries urgently are young and/or working people. I feel that this decision, if implemented in the long run, would result in saving the lives of more old and physically weak people than young and physically fit people. That is not a good thing for a country with a collapsing economy and is in need of the contribution of its working people. This is the bitter truth,” he opined, adding that although he has no objection against saving a person’s life, if the health sector has to underestimate the lives of others whose health situation is not as serious, that is an issue.

Meanwhile, 58-year-old former tourist sector professional, Sarathsiri Weerendra, noted that the Government’s decision does not appear to be a solution, but rather, controlling the nature and magnitude of the issue to match the available, obvious solutions. He blamed the Government’s lack of what he called tactfulness. “I understand the issue. We, as a nation, are too poor to produce or purchase medicines and medical equipment and I admit that we need a solution. However, I do not see any solutions in the Government’s decision to postpone surgeries that it considers are not essential. This decision is more like adjusting to live with the issue than resolving it,” he said. Adding that he does not see any genuine effort or sacrifice on the part of the Government in this decision, Weerendra said that this decision barely qualifies as a solution and cannot be identified as the efficient management of the prevailing situation. He suggested that instead of telling the people to tighten their belts to cover up its weaknesses, the Government should seek international assistance for the health sector’s revival, reallocate resources to provide more resources to the health sector, find ways to prevent and reduce the need for surgeries, and enter into agreements with international health service providers for Sri Lankans to obtain medical services including surgeries at a concessional rate.

In addition, several health service seekers claimed that this decision would result in long lifespans for the wealthy and short lifespans for those who are not economically strong. Their argument was that this situation would restrict access to surgeries in the public health sector, and will create a bigger demand for surgeries conducted at private hospitals or abroad, which are expensive. They further explained that in a context where only a small percentage of the population has the financial resources to obtain services from private hospitals and foreign hospitals, which has been further decreased by the economic collapse, they, the said small percentage of the affluent, will have a bigger chance of preventing certain diseases from worsening. They claimed that the lives of many economically disadvantaged groups will however, be at risk in the near future.

Forty-four-year-old housewife, R.A. Ayanthi (name changed on request), explained her experience in this regard: “I have been taking treatment for heart disease, and I am due to undergo a surgery at a leading public hospital in four months. However, since I have a feeling that my health is deteriorating faster than I expected, I tried to have my surgery preponed but I did not get any positive response. I do not want to wait until it is too late to manage my health through a surgery. I am now looking into the possibility of getting the same surgery done from a private hospital. However, I know a number of people whose health situation is no better than mine but do not have the money to even see a doctor of a private hospital.”

As the Government is ready to proceed with its plans to postpone surgeries it identifies as non-essential or non-urgent, many who spoke with The Daily Morning were of the opinion that the Government’s solutions should not lead to bigger health issues but should instead be effective.

“People have to undergo surgeries because it is essential to them in some way; it is up to each person to decide how essential a surgery is.”

“The Govt. should have employed a different and more lenient approach to achieve what it wants; restricting access to an essential, free service could be dangerous.”