Children’s heart disease in Sri Lanka: a problem of poverty

Sri Lanka is a poor country, with an average per capita income of only Rs. 93,000 (US$ 930). Despite this, its citizens receive education and health care at State expense, resulting in literacy and public-health indicators not far off developed country standards. For example, the infant-mortality rate is 16 per 1,000 live births. The population growth rate in 2003 was just 1.2 percent, down from 1.5 percent in 1995.

However, these reassuring statistics hide a number of serious problems. Among them is that of childhood heart disease (CHD).

One Sri Lankan child in every 400 is born with a congenital heart defect which, if left untreated, can have serious, often deadly effects. The incidence of CHD in Sri Lanka is not especially high; still 1,200 Sri Lankan children are born with heart defects that are curable – if surgery or medical intervention occurs in time.

A problem of poverty

This is because the Sri Lankan State medical sector lacks both funds and facilities to treat more than half of the new CHD cases born each year. Calls on available funds are many and urgent; paediatric cardiology, a relatively minor problem compared to efficient mass killers like diarrhoea and mosquito-borne disease, must stand at the back of the queue when money is disbursed. As a result, only some 600-odd paediatric-cardiology operations are carried out in State hospitals annually – half as many as are needed. Even then, parents of the afflicted children are required to contribute towards the costs of the operation, something most can ill afford.

Only three government hospitals – the National Hospital, Sri Jayawardenapura General and Galle have facilities for carrying out surgery on children with CHD. A new Paediatric Cardiac Surgical Centre has just been opened at the Lady Ridgeway Children's Hospital. Another facility was opened in Kandy in June 2007. There is also a shortage of equipment, consumables (catheters and other devices used in surgery) and trained staff.

Private medical care is available for those who can afford it, but few Sri Lankan families can afford the Rs. 350,000 (US$ 3,500) operation.

A growing waiting list

Today, the waiting list for CHD operations in government hospitals extends up to June 2009 (on average). For certain types of operation, the waiting list can be very long. And every year the lists grow longer.

Families’ hardship and suffering

When a family learns that their child has CHD and needs an operation, it comes as a terrible shock. But this is only the beginning of the child’s and its family’s suffering. Soon they learn that the disease can be treated – but only after a potentially fatal wait of many years. Even then, the cost of treatment is so high, the family may have to impoverish itself or run up huge debts in order to afford it. For a poor family, the cost may be impossibly high.

Even if the money is found somehow, more hardship lies ahead for the child and its family. Parents from rural areas must travel to Colombo with their children for examinations, tests, etc., often at great economic cost to themselves and their families.

Finally, the child is warded at a Colombo hospital, awaiting treatment. But the operation is often put off for lack of facilities. Parents, unable to travel up and down between Colombo and their homes and too poor to rent accommodation in the city, will often stay at the hospital with the child, sleeping on the floor beside its bed, disrupting hospital routine and enduring various privations on top of their anxiety for their child. Meanwhile, their families, back at home, suffer the absence of one or both parents and breadwinners.