Health

Beyond the Call of Duty: Dr. Hamdani’s Inspiring Journey in Sri Lanka’s Medical Landscape

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A Note from Our Health Affairs Desk

“A sound mind in a sound body is a short but full description of a happy state in this world.” – John Locke (1632-1704)

Many among us have dedicated their lives to making others comfortable, working tirelessly and selflessly without seeking recognition or fame. Their contributions often go unnoticed, and they pursue a noiseless life by prioritising common responsibilities. The COVID-19 pandemic has been a powerful reminder of the depth of humanity, and the importance of recognizing and celebrating those who work tirelessly to make the world a better place.

Throughout this difficult time, there have been countless men and women who have worked tirelessly to keep the country running and provide life-saving care to those in need. They are the unsung heroes, the backbone of our communities who give their time, talent, and resources to help others. They work in challenging and demanding conditions, often putting their own health and safety on the line to care for others.

The COVID-19 pandemic was yet another event which highlighted the importance of these unsung heroes, and the critical role they play in our society. It has shown us that it is not only the doctors, nurses, and other healthcare professionals who are on the front lines, but also the police constables, intelligence officers, grocery store clerks, delivery drivers, and other essential workers who keep our society functioning. These unsung heroes remind us that service to others is a noble and valued pursuit and that the selfless actions of a few can have a profound impact on the lives of many.

Needless to say, the COVID-19 pandemic has been a powerful lesson in the importance of recognizing and celebrating the unsung heroes in our society. Their contributions are often unseen and underappreciated, but they play a critical role in making the world a better place. We owe it to these individuals to acknowledge their efforts and show our gratitude and appreciation for their selfless service.

This medical expert has a warm and generous spirit and is always willing to lend a helping hand to those in need. He is a larger-than-life figure, known for his dedication and tireless efforts to improve public health. Despite his impressive credentials and expertise, this medical expert remains humble and focused on the needs of his patients and community. He has always believed that public healthcare is a vital service that should be accessible to all, and he has dedicated his career to uplifting the standards of care for everyone, regardless of their background or means.

While some medical experts may prioritize private practice or focus on high-end treatments, this individual has always felt that his calling is to serve the public and improve the health of the community as a whole. He has made it his life’s work to promote access to quality healthcare for all, and his efforts have touched countless lives. In short, this medical expert’s warm and giving nature, combined with his unwavering commitment to public health, make him a true hero in the eyes of many. His selfless dedication to improving the lives of others is an inspiration to us all. He is a man who works beyond the call of duty.

Dr. Anver Hamdani is a name that resonates with people, particularly in the medical community. He is a medical doctor and administrator who has served the people of Sri Lanka with great distinction. Before leaving the country for higher education in medical science he worked with Mr Lakshman Kadirgamar, PC, the slain Foreign Minister, who enabled many channels for Sri Lanka to work with other countries and develop a comprehensive foreign policy. “That was an exceptional opportunity for me”, Dr. Hamdani says while recalling many good memories of Kadirgamar. “He wanted me to study law, in fact he visited our home in Kandy and asked my mother to encourage me for law. But my destiny was different,” he added.

“1996 saw a young boy walk out of the doors of Trinity ready to brace the future and what it holds. I spent 5 years pursuing medicine at Dow Medical College, Karachi, Pakistan following which I returned to the country ready to put whatever I had been taught to use,” he says while recalling his student life.

As a former student of Trinity College in Kandy, Dr. Hamdani was well-versed in the values of teamwork and collaboration. “The most important thing in healthcare is teamwork and collaboration,” he said. These qualities became evident when he spearheaded the fight against the Covid-19 pandemic in Sri Lanka. He was a driving force in controlling the spread of the virus and was tireless in his efforts to provide medical assistance to those in need.

“Healthcare is a fundamental human right, and it is our responsibility to ensure that everyone has access to quality care,” he believed. “We are all human. And we all want a chance. My mission is to impact as many lives as possible. Trinity has taught me that you just do whatever you can to help in any way that you can. All you need to do is help one person, expecting nothing in return. To me, that is being a humanitarian,” he added.

One of Dr. Hamdani’s most significant contributions was the establishment of an intermediary treatment centre for Covid-19 infected patients. This centre was essential in providing prompt medical assistance to those who were affected by the virus. Dr. Hamdani also played a key role in the vaccination drive against the plague, which was critical in reducing the number of Covid-19 cases in the country.

Dr. Hamdani’s exceptional leadership skills were evident not only throughout the pandemic but his remarkable journey as a medical doctor who worked in many remote areas in the island. He worked closely with medical professionals and other stakeholders to devise effective strategies to combat the virus. His ability to collaborate and work as a team was instrumental in bringing about positive results in the fight against the pandemic.

He is also an accomplished administrator. He has held various leadership positions in Sri Lanka’s medical institutions, where he has played an active role in reforming the healthcare system. Dr. Hamdani’s efforts have resulted in the establishment of modern medical facilities and the improvement of the overall quality of healthcare in Sri Lanka. “As a healthcare professional, it is our duty to serve the people with dedication and commitment,” he said.

In addition to his outstanding efforts in controlling the Covid-19 pandemic, Dr. Anver Hamdani also played a critical role in securing essential medicines for Sri Lanka during a period of economic crisis. As a Director of Medical Technology services and Coordinator in charge of Covid-19 operations of the Ministry, he was in charge of coordinating with various international organizations and donors to ensure that Sri Lanka had access to essential medicines and medical supplies. “In times of crisis, it is important to work together and find solutions,” he said.

Dr. Hamdani’s efforts in this regard were particularly noteworthy during the period when Sri Lanka was facing an acute shortage of medicines and medical supplies due to a severe economic downturn. He worked tirelessly to reach out to various countries and international organizations, seeking their support in providing essential medicines to Sri Lanka. His efforts bore fruit, and Sri Lanka was able to secure critical medicines and medical supplies from various sources, including countries such as China, India, and Pakistan, and organizations such as the World Health Organization.

Dr. Hamdani’s work in securing essential medicines for Sri Lanka during an economic crisis was a testament to his exceptional leadership skills and deep commitment to serving the people of Sri Lanka. His tireless efforts in this regard were critical in ensuring that Sri Lanka’s healthcare system was able to continue providing essential services to the people of the country, even in the face of severe economic challenges. His contributions to the healthcare system in Sri Lanka, both during the Covid-19 pandemic and the economic crisis, have been truly exceptional, and his legacy will continue to inspire future generations of healthcare professionals in Sri Lanka and beyond.

As we reflect on the remarkable achievements of this individual and the impact he has made on our nation, let us express our gratitude and admiration for his exceptional dedication to service. Let us also bless him with more courage and enthusiasm as he continues his important work. We are blessed to have such an extraordinary individual in our midst, and we owe him a debt of gratitude for all he has done to uplift our nation. May he continue to be blessed with the strength, courage, and enthusiasm he needs to pursue his exceptional national endeavour and make a lasting impact on the lives of many.

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Sweden discards 8.5 mln doses COVID-19 vaccines

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Sweden has discarded nearly 8.5 million doses of vaccines against COVID-19, local media reported on Sunday.The discarded doses equal to about 20 percent of vaccine doses Sweden has procured, according to Swedish Public Health Agency’s statistics, Radio Sweden reported. Richard Bergstrom, Sweden’s former national vaccine coordinator, told Radio Sweden that the total value of the discarded doses was 1.5 billion Swedish kronor (143 million U.S. dollars).

The main reason for doses being discarded was the fact that individuals had not had their booster doses as expected, Bergstrom explained.

“The bulk is doses that people have chosen not to take, in other words, the third, fourth, or fifth (booster) dose. These were already purchased and now have to be destructed,” said Bergstrom.

As of Thursday, 88.2 percent of all individuals aged 18 or over have received at least one dose, while 86.4 percent have received two doses or more, Swedish Public Health Agency’s statistics show.

Addressing the global COVID-19 vaccine disparity already in 2021, World Health Organization Director-General Tedros Adhanom Ghebreyesus said that six times more COVID-19 boosters were administered a day globally than primary doses in low-income countries. Countries with the highest vaccine coverage “continue to stockpile more vaccines,” while “low-income countries continue to wait” for the shots — “a scandal that must stop now.”

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Drug shortages and impact on health outcomes; Is it only the tip of the iceberg?

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On the night of April 14, 1912, though, only a few days into the Titanic’s maiden voyage, its Achilles’ heel was exposed. The ship wasn’t nimble enough to avoid an iceberg that lookouts spotted (the only way to detect icebergs at the time) at the last minute in the darkness. As the ice bumped along its starboard side, it punched holes in the ship’s steel plates, flooding six compartments. In a little over two hours, the Titanic filled with water and sank- The Secret of How the Titanic Sank ~ Justin Ewers

Although the mystery surrounding the sinking of the Titanic is yet to be fully unraveled, logically, the fact that the extent of the iceberg below the water and which was not visible, compared to what was above the surface, and the underestimation of or not knowing the extent below the surface was the primary cause for the sinking cannot be denied or disputed.

This article attempts to present a point of view that the current drug shortages arising from possible shortfalls in funding maybe likened to the tip of an iceberg, where in fact, underlying medical supply chain issues, the part of the iceberg below the surface, could be a very significant contributor to the shortages.

Health outcomes will get affected whenever critical drugs are out of stock or in short supply. However, even prior to the COVID invasion and the global economic and health destabilization it caused, medicine and medical supply shortages have been a common occurrence in most developing countries. Sri Lanka was no exception and no doubt experienced this although such situations did not attract headlines in the media and politicians did not raise this as a critical issue that affects health outcomes, except when it suited them do so for political gain.

International agencies including the WHO, ADB, Global Fund, World Bank, and development entities like USAID, UK AID, Australian AID, spend considerable amounts of funds to address this issue in developing countries.  The emphasis of such donor funded programs is to strengthen health systems while in some instances, material assistance is provided for some commodities to overcome acute situations that would otherwise exacerbate health outcomes.

For example, the Global Fund is a leading international entity that supports health systems strengthening while providing financial assistance for procuring drugs needed for Malaria, TB and HIV AIDS patients. Other agencies also provide similar support to a lesser or greater degree and based on country needs and their willingness to address common reasons that result in drug and medical supply shortages. Such reasons are manyfold. Systemic, structural, shortfalls in funding and capacity issues are commonplace in many countries, and the lack of a strategic approach arising from SWOT analysis (strengths, weaknesses, opportunities and threats) is often not considered as a necessity as it is not understood or misunderstood or ignored in favour of short term stop gap measures.

A common thread also weaves around the system and its shortcomings, that being the corruption element prevalent in these countries. Perversely, the “opportunities” component in a SWOT analysis becomes the opportunity that a systemic failure provides for corrupt activity. In this context, one does not have to be an Einstein to understand that corruption feeds on systemic shortcomings and therefore addressing such shortcomings would be counterproductive and detrimental to those engaged in corruption.This is one of the reasons why some influential figures within many dysfunctional country systems do not want shortcomings addressed as they benefit personally within such dysfunctional systems through corrupt activity.

Fundamentally, shortages are often the creation of those who stand to benefit from them, such as emergency procurement at exorbitant prices by doing away with standard procurement procedures on account of the “emergency”.  Contrary to the belief that these activities are in the domain of relative small timers in the system, the long arm of corruption extends very far, and to senior officials and ministers or even more highly placed politicians.

Development partners naturally would not go into these areas and to act as spies or policemen and policewomen to expose corruption.  Their task would be to carry out SWOT analysis of existing systems, structures, capacity issues, resource issues, and to submit their assessments and findings and submit recommendations as to how gaps identified may be addressed.

No doubt such assessments may have been carried out in Sri Lanka, and efforts taken to address gaps that may have been identified. However, some doubts exist whether adequate attention has been given to the overall systemic, structural, and capacity issues considering the misconception that the current headline grabbing publicity about drugs and medical supply shortages have all been entirely consequential to the current economic crisis and the resulting lack of funds to procure these items. 

Sri Lanka has a mixed system of public and private sector stakeholder participation in the drugs and medical supplies importation and local manufacture to serve the needs of the public.

Going back in history, in 1972, the government of Sirimavo Bandaranaike entrusted the task of reforming the pharmaceutical policy of Sri Lanka to Pharmacologist Professor Senaka Bibile and Parliamentarian Dr S A Wickremasinghe, and consequently, far reaching reforms were introduced including the rationalization of the drug formulary from some 3000 plus items (many brands of the same item) to less than 700, introduction of the ABC classification to identify essential items (lifesaving and mostly without alternatives), important items (with availability of at least a few alternatives) and less important drugs(with several alternative formulations), the formation of the State Pharmaceuticals Corporation (SPC) and assigning the task of undertaking all imports of pharmaceuticals, both for the State and private sector, to the SPC and a quality assurance process under an institution for all imports of drugs.  A State sponsored local manufacturing program was commenced by the SPC, and this was the precursor to the State Pharmaceuticals Manufacturing Corporation in (SPMC) in later years.

Professor Bibile died under mysterious circumstances in 1977 while on a mission to introduce his policies in the Caribbean through UNCTAD. Despite this setback, his policies however internationalized and over the years, and institutions like the WHO have adopted many of his policies.

In Sri Lanka much of Professor Bibile’s policies have been reversed since the advent of the open economy policies of the government elected in 1977, and once again, the private sector has become a large scale of importer of drugs today with questionable drug quality assurance processes, and a proliferation of brands of the same generic drug. Although the State sector is supplied primarily by the SPC and the SPMC, it is no secret that it has had funding issues to procure its requirements, and it has, time and again, resorted to directing patients who patronize public hospitals to obtain their drug requirements from the private sector.

Clearly, besides policy dilution over the years, structural issues, logistics issues, capacity issues, forecasting & quantification issues and of course corrupt activities have impacted on the overall system. While the economic factor has contributed significantly to the shortages being experienced now, underlying factors that were there prior to the economic downturn and which are still there, contributes to shortages of drugs and medical supplies. This is particularly so in the public sector.

While urgent funding is required to source drugs, particularly the A and B types of items, pouring more money into a system that is dysfunctional to lesser or greater extents in different State institutions, will not address a recurrence of shortages, and an avoidance of shortages, in a consistent manner.

Globally, the pharmaceutical industry (or as some refer to it, the “pharmaceutical mafia”), is a very powerful industry and a very powerful lobby group. Internationally, the pharmaceutical industry is rated as the second biggest one in the world next to the arms industry, and it wields considerable power and influence over governance issues. (Note; as per the link noted here, the world pharmaceutical market was worth an estimated $1.2 trillion at ex-factory prices in 2020)

Sri Lanka is not immune to the power of this industry considering the reversal of far-reaching policy and process reforms introduced during the time of Professor Senaka Bibile.

Essential drug shortages will have an impact on health outcomes, and it is therefore important to address such shortages with an adequate supply of such items. However, this could be just a short-termband aid solution unless a thorough assessment is done of the medical supply chain in Sri Lanka to identify gaps in it, and then find effective and efficient mechanisms to address any such gaps.

Firstly, as a structural issue, pharmaceutical policy settings related to rational use, importation and manufacture will have to be reviewed. While health outcomes of the public should be key objective in determining policy settings, the efficacy and efficiency of the existing policy in the context of Sri Lanka’s economy also needs to be a priority consideration in any assessment of the medical supply chain.

One of the factors that drove Professor Bibile’s policy perspective on drug rationalization would have been the questionable need for a plethora of brands of the same drug, and the need for several pharmacologically similar drugsto be in the drug formulary in relation to the objective of health outcomes.

Perhaps a relook at drug rationalization and the drug formulary maybe timely to assess the efficacy of the current policy in a general sense, and specifically on account of the economic challenges faced by the country. Considering that some 9 million people are reportedly in poverty now, with more likely on the edge of poverty, coupled with an increasing malnutrition rate, it is very likely that health outcomes will get adversely affected if those in poverty or at the edge of it are unable to obtain their drug requirements from public hospitals, and they are forced go to private pharmacies where they may either forego buying the drugs prescribed or buy half or one third of a prescription due to the very high prices of drugs and medical supplies.

Secondly, a study will have to assess the accuracy of the quantification and forecasting of demand for drugs as this one single factor that perhaps maybe identified as the commencement point of a medical supply chain although such a point does not exist in a chain. Quantification requires reliable usage data that should be supported by morbidity data. Accurate quantification is a major factor for a medical supply chain to function without interruption.

Thirdly, the methodology used to assess the quality of drugs imported, and the credentials of the suppliers will have to be assessed as substandard drugs could have adverse effects on health outcomes. It is not certain how the private sector as well as the public sector assesses the quality of drugs imported and what quality assurance processes are in place.

Fourthly, the prices paid for drugs imported, and raw materials imported for the local manufacture of drugs, are also key factors that effect the budgets allocated for imports. Whether procurement procedures are adequately competitive in the State sector, and whether large scale emergency procurement has been done at high prices are factors that will have to be investigated. It is unclear whether private sector imports are subject to a pricing mechanism such as a pricing formula or whether they are free to determine their market prices. The high retail prices of many drugs are perhaps indicative of the latter.

Last but not least, the environmental impact on drugs during transportation and storage is a key area that needs to be looked at as adverse environmental conditions could affect the efficacy of drugs and therefore health outcomes.

In some countries, waste that occurs due to some of the above-mentioned factors has amounted to anything between 20-30 % of the annual expenditure on drugs. Hopefully, this has been minimal in Sri Lanka. However, this and all above mentioned areas should be investigated as the immediate drug shortage issue and possible impact on health outcomes could be just the tip of an iceberg and underlying factors mentioned above could be the hidden part of the iceberg that has been creating shortages and an impact on health outcomes for a long time.

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The shifting demands faced by the NHS

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Nobody talks of the ageing population in UK, they think it is only applicable in Japan. Nobody contemplates of the workforce in UK is reducing while the population is growing, especially after the mass exodus of migrant labour from Europe after Brexit. People are needing more care with GP’s unable to cope at their practice surgeries. People are needing more care this winter, allowing for more strike action disrupting ordinary life.

Prevention of disease, illness, according to the adage, is better than cure. Care, not only of older people, but of society is a necessity. Of course, we have a responsibility to help order people to live healthier lives, but we also have a “duty to protect” the young who are unable to cope with the stresses of life after COVID-19. They are at the forefront of depression, unable to find suitable employment opportunities. To put it simply, they are finding it near difficult, “to secure connected lives”.

The challenges faced by the NHS today are many. The main problem being lack of proper communication, or rather, a breakdown in communication. As the saying goes, “water, water, everywhere, but nothing to drink”. During the last decade the NHS has had workforce cuts, shortage of nurses, doctors, consultants, but at the same time an increase in hospital patrol security officers, to quell any disturbances, with an equally decrease in the hospital beds. No one, neither the Medics; the Hospital Administrators; the NHS; the Government; or even social media, have had the courage of their conviction, to state that better communication is needed, both within the service and external, to explain the “system malaise”.  

Why has there been a lack of communication?

The irony is that with the growth of digital technology, the internet, the apps, and the mobile, people of all ages across society around the world, seem to be more lonelier and isolated in their problems. The NHS is not an exception in this respect.  Have we ripped the heart out of our lives? Has Covid-19 and remote working made us “lose our humanity” or the need for personal interaction, on every level? Have we lost the need to care for others? Have our GP’s lost the human touch in remote consultation?

Undoubtedly, the biggest challenge in communication over the past 18 months has been adjustment in terms of logistics, technology, working practice, making cultural alignment. In many, if not most cases, it ultimately turned out to be feasible, productive, and somewhat popular work pattern, as flexible working, at present, suited both worker and employer. With the growth of new ways of working, as new technologies emerge, the NHS must also adopt and adapt technology that improves service for patients, as well as help their staff, at every level to do their jobs efficiently and efficaciously.

Why is change in the NHS so difficult?

The issue to highlight is that technology must be patient appropriate. New ways of working in patient care must not exclude old people who need the “language of kindness” in health service. Is time or cost of delivery a constraint? As we age, as we get older, we tend to get long term conditions and need more social care. The number people over 60 according to ONS, is expected to increase to 18.5 million in 2025; 75% of 73 year olds need care. There is more than one (1) long term condition, rising to 82% of 85 year olds. Selling a family home to pay for Care Home treatment, should not the sole criteria of Care. The Government must provide some funding for volunteer care services and to Local Bodies.

Change needs to be locally led with role of NHS England to support those delivering care.

NHS Trusts must make this change happen. Of course there may be performance limitations.

Optimising wellbeing of the young is another area of concern. Paul Farmer, CEO MIND, a mental charity, has highlighted challenges including mental health and wellbeing of the young millennials, caused largely by the sudden change in the way we work, after COVID- 19.  A recent study by NHS reported in Glamour magazine stated,  a quarter of 17-19 year olds have a probable mental disorder. Mental health has failed to recover since the pandemic among the young. The new generation Application Tracking System (ATS) and how employers utilise technology, how they advertise jobs, the language they use and process they follow, may cause mental stress to the young and needs scrutiny?

The vision for the future

The vision for the future is greater focus in prevention, patients more in control of Health Care and the spread of compassion and kindness in delivery of care services to both young and old. In this respect NHS Trusts to act firmly and fairly, with the provision of service delivery in Hospitals and GP Surgeries. Para Medics and Pharmacies to help GP’s with Government legislation put in place soon in health assessments and prescription of medication for people.

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