By Lasantha Pethiyagoda –
I would like to outline the horrors of most “public” hospitals even in major towns across Sri Lanka. Most of these health facilities seem to have stopped in a time warp from the mid nineteen sixties or so, except for some of the equipment used.
I studied several hospitals while purportedly visiting patients. A cardinal principle in a hospital is that it should not cause harm to a patient, especially through neglect. It was shocking to observe invasive procedures ranging from insertion of a cannula, catheter for drainage to intravenous medication, where processes are conducted almost casually and often aggressively with scant regard for patient health or comfort. The staff were usually rude, abrupt and sometimes even insulting, using mocking language etc.
Due in large part to the economic meltdown precipitated by atrocious political bungling from around 2021, most patients are quite weak on arrival, often malnourished, and therefore susceptible to infection with far reduced immune responses, in environments possibly reeking with antibiotic resistant germs that grow in areas that are never properly cleaned, as it seemed in no one’s area of responsibility.
In the apparent absence of publicly available data on rates of in-house infection, and a lack of standardised methodology or proper surveillance, patients seem to be severely compromised and at the mercy of their “destiny” when in hospital. This is when the medical staff, often aloof and arrogant, play god in the presence of hapless poor people. These uncaring individuals (many are “senior” doctors or “consultants”) often have a lucrative private practice in the major towns of the island. It is in their interests therefore, to ensure that public hospitals are hellholes, so that people will go to private hospitals, channel practices etc often sacrificing their personal assets for the privilege.
A considerable percentage of patients across several hospitals were observed to be wheezing and coughing, bringing up phlegm which is invariably emptied into open containers kept by their bedside. The stench itself is nauseating as beds are arranged less than a metre apart, most beds with frayed mattresses and paint peeled, rusting frames themselves being about a metre wide.
These feeble patients always hold on to other patients’ bed rails to proceed to and from the abhorrently disgusting squat toilets which have gaping cracks and holes with highly visible faecal matter sloshing with water. The walls of toilets have layers of deposits in different shades of brown that are never dislodged by cleaners hosing them down.
Except in a very small minority of wards in almost every single public hospital, the beds, walls, furniture or other fixtures are never wiped down with a detergent or disinfectant. Only floors are washed with buckets of water maybe once a week (according to long-stay patients), and merely swept on other days, with dust resettling on beds, patient food receptacles and clothes.
The economic meltdown aside, the cracked cement floors are pockmarked with decades-old holes and indents, obviously harbouring multitudes of pathogens. No microbiology staff were ever sighted taking swabs of cultures. No infection control audit could possibly be conducted in such appalling conditions. In most hospitals, roaming cattle eat at the bins. Unimaginably stupidly placed large open garbage bins near the wash basins and latrines are often overturned by scavenging dogs that seem to have unhindered access even in broad daylight, while feeble attempts to shoo them away are almost useless.
Hence, putrefying food remnants, discarded dressings, vomit bags and fruit peels are strewn on the wet floors, where leaking taps, blocked and overflowing wash basins spill to the floor. No colour-coded waste containers were evident in any of the hospitals visited. It seems as if bodily fluids, festering dressings and used medical supplies are all disposed in one lot.
I occasionally encountered mice scooting across the aisles with no apparent inhibitions. What seemed like antibiotics seem to be administered almost normatively, regardless of consequences to individuals’ condition or immune capabilities. Ventilation to reduce airborne infections consist of one or two fans operated at random from loose and caving fabric ceilings in many cases with multiple layers of darkened dust and cobwebs that seem to have been untouched for years. No funding seemed to have been allocated or those funds used (if any) for making these places suitable for vulnerable human beings.
Almost like in some pagan ritual, patients are routinely transferred from beds to other beds or positions under other patients’ beds in grossly overcrowded conditions with some patients sitting on visitor stools while they wait for a chance to lie down. The whole operation of these wards seem to undermine the basic respect that any human being is owed as citizens by the state. These conditions are several magnitudes worse than the upmarket private hospitals that the ruling classes of political and industrial vermin go to when sick.
Those responsible for perpetuation of this despicable state should be forced to endure these conditions first-hand so that otherwise wasted public funds can be utilised more compassionately and considerately. Those of you reading this article would probably feel distant to the woes described herein, as they themselves are not subject to these atrocious conditions. However, like in many areas of society where a similar attitude has resulted in the almost complete destruction of Sri Lanka’s economy with no one being held responsible, it will only be a matter of time before their loved ones or extended family suffer immeasurably from this deplorable state. We must therefore strive to make a paradigm change to the status quo so that at least future generations will have a better quality of healthcare more suitable for human beings.