COLOMBO, Sri Lanka – Being bullied by senior health officials was bad enough. Feeling betrayed by government officials during the COVID-19 outbreak made it even worse. But the economic crisis that hit Sri Lanka in the wake of the pandemic was the breaking point for Lahiru Praboda Gamage.
The 35-year-old Sri Lankan doctor left Sri Lanka in January 2023 to take up a position in the UK after six years working at a public hospital in Hatton, a remote town 120km east of the capital Colombo. He is currently a senior trainee doctor in the UK's National Health Service (NHS).
It wasn't an easy decision. “I really love my country, that will never change,” Gamazi told Al Jazeera. “But no matter how much I earned, I had to pay back huge loans.” And with the economy collapsing and prices soaring, with inflation hitting a record 73% in late 2022, Gamazi felt he had no choice but to leave the country.
He is not alone. More than 1,700 doctors have left the country in the past two years, mostly for financial reasons, according to the Government Medical Association (GMOA), Sri Lanka's largest union of civil servant doctors. They make up almost 10 percent of Sri Lanka's physician workforce.
The impact on the country's already fragile health system is clear: Last April, the district general hospital in Embilipitiya, about 200 kilometers south of Colombo, canceled all emergency surgeries for several weeks after two anaesthesiologists left the country. As a temporary measure, another anaesthesiologist was transferred to the hospital from a nearby hospital, but that doctor has since left for training abroad.
The paediatric ward at Anuradhapura Teaching Hospital, about 200 kilometres northeast of Colombo, was also forced to temporarily close after all three of the hospital's paediatricians emigrated, and India's Ministry of Health has warned Minister Ramesh Pathirana that nearly 100 local hospitals are at risk of closure because of the exodus of doctors.
Doctors say all of this could have been avoided.
Sri Lankans block an intersection in Colombo, Sri Lanka, Saturday, May 7, 2022, demanding cooking gas cylinders amid the country's worst economic crisis in history. [Eranga Jayawardena/AP Photo]
What's missing: Money and respect
Mr. Gamage's base salary was 64,000 Sri Lankan rupees ($213), which with overtime came to about 220,000 rupees ($730).
“I had to pay for my car, food, rent, loans and take care of my parents,” he recalls. “After all this, I was left with just Rs 20,000. [$67]So if you go to a party, that's it. You're all done.”
But the disrespect he received from government officials only increased his frustration.
Gamage, who organized health camps after hours as a medical intern in remote villages, and who, along with another doctor, developed a contact-tracing app during the COVID-19 pandemic, says that rather than recognizing their efforts, the government of then-President Gotabaya Rajapaksa offered the contract to a private company.
“We gave a presentation to the President's COVID-19 Task Force. They listened carefully and took notes about our app. After some time, we suddenly learned that our app was produced by a private company, with some flaws.”
Eranda Ranasinghe Arathithi, a cardiologist at Colombo's National Hospital, who now works in Northern Ireland, cited three factors that led to his decision to leave the country.
“The first factor, of course, is basically economic reasons. The second is better working conditions. The third is to have a better future,” the 35-year-old told Al Jazeera.
He said he felt there was a lack of respect from society at large, especially after the hardships of the pandemic.
“We have been extremely busy during the COVID-19 pandemic but have tried our best to save as many lives as possible,” said Dr Ranasinghe Arathithi. “Like many other doctors, there were times when I could not go home for days due to the heavy workload and the fear of spreading the infection to my elderly parents at home.”
Sri Lanka's economy was plunged into an unprecedented crisis in the wake of the pandemic, with people forced to queue for hours for food, medicine, fuel and many other essentials, including doctors.
But when the GMOA called for special fuel allocations for doctors, public opposition erupted. “I myself spent hours queuing for days, time that could have been used to treat patients, but many people refused to listen,” Dr Ranasinghe Arathithi told Al Jazeera.
On April 6, 2022, Sri Lankan government doctors protested against the government near the National Hospital in Colombo, Sri Lanka, holding placards that read “No medicines” and “Health services are in crisis.” [Eranga Jayawardena/AP Photo]
A Better Future
Soaring inflation, unpayable foreign debt and shortages of fuel, medicines and food sparked nationwide protests and led to President Rajapaksa's ouster in July 2022. Gotabaya and his brothers Mahinda Rajapaksa and Basil Rajapaksa were convicted by the country's Supreme Court in November 2023 of financial mismanagement that crippled the country's economy.
But Ranasinghe Arathithi, the eldest of three siblings who has to look after his retired parents, could not afford to wait that long.
He left Sri Lanka in August 2022.
“As a mid-level doctor in Sri Lanka, I was earning around £400. [$508] A similar doctor would earn at least £3,000 a month. [$3,800] “In a country like the UK, it would cost around $100 a month,” he says, adding that Sri Lanka was experiencing runaway inflation at the time, so his expenses were roughly the same back home and in the UK.
Meanwhile, Gamazi has managed to repay some of his debts over the past few months.
“I paid back Rs 1.5 lakh within a year. [$4,630] “I'm not looking to take out a loan, but that would have been unthinkable in Sri Lanka,” he said.
As patients and hospitals face the consequences, doctors' union GMOA has submitted a series of recommendations to the government to try to stop the bleeding of healthcare workers.
“They are [doctors] “We believe that their salaries are grossly inadequate and the contribution they make to the country is grossly undervalued. This is a major issue that we are aware of,” GMOA executive committee member Hansamar Weerasooriya told Al Jazeera.
Lack of a proper career development system and lack of incentives for doctors working in remote parts of the country also contributed to doctors' disappointment, Weerasooriya said.
Deeper social prejudices also affect some doctors. “In Sri Lanka, some doctors won't sit or eat with nurses because of the egocentric and hierarchical system,” says Gamage. “But here in the UK, no one criticises anyone, so this critical thinking really hurts.”
“I was fed up with the system.”
Still, if conditions improve sufficiently (for example, inflation falls dramatically), some doctors may want to return to Sri Lanka.
“I have visited many countries in a short period of time and I have found there is no other country like Sri Lanka,” Ranasinghe Arathithi said. “If the country improves and our work is recognised and we are well paid, I would be very happy to come back.”
But Ranasinghe Arathithi doesn't see all that happening anytime soon and for the time being, Northern Ireland will have to be his home.
