Priyantha Kumarasinghe starts his day in the small Sri Lankan town of Maharagama with a breakfast of two biscuits and a small glass of tea, followed by a round of cancer medicines.
The 32-year-old vegetable farmer was diagnosed with lung cancer in 2021 and started receiving treatment earlier this year just as Sri Lanka's economy went into free-fall.
Amid crippling fuel scarcity and weeks of unrest, Mr Kumarasinghe said he was unable to travel the 155 kilometres between his home and Sri Lanka's main cancer hospital on the outskirts of the country's largest city, Colombo, for treatment.
"If I had been able to get treatment properly during June, July and August there is a good possibility I could have reduced the lung cancer," he told Reuters.
"Because that was not possible that may be the reason why the cancer has grown."
Mr Kumarasinghe is among hundreds of cancer patients who have had their treatment up-ended by Sri Lanka's worst economic crisis since independence from Britain in 1948.
Hospitals countrywide have struggled to contend with severe drug shortages, which have worsened over the last eight months, a representative of Sri Lanka's largest doctors union told Reuters.
"All hospitals are experiencing shortages. There is difficulty in even sourcing basics like paracetamol, vitamin C and saline for outpatient services," said Vasan Ratnasingam, a spokesperson for the Government Medical Officers' Association.
Specialist facilities like cancer and eye hospitals are running on donations, Dr Ratnasingam said.
Sri Lanka's health ministry and senior health officials did not respond to calls from Reuters.
Battered by the loss of tourism and remittance earnings because of the pandemic, alongside an ill-timed tax cut, Sri Lanka slid into crisis in early 2022 after its foreign exchange reserves dried up, leaving it short of dollars to pay for fuel, food, cooking gas and medicines.
For months, the country of 22 million people faced hours-long power cuts and severe fuel shortages.
The economic hardship triggered protests, which in July ousted former President Gotabaya Rajapaksa after thousands took to the streets and occupied his official residence.
Currency depreciation and record inflation have pushed middle-class families like Mr Kumarasinghe's to the brink as they scrambled to meet higher living costs.
But the family has another crisis to contend with.
Doctors are now worried the cancer has spread to Mr Kumarasinghe's neck and spine, said his wife, Shashini Chamilka Maduhansi, 23.
The couple are awaiting results of an MRI scan that will direct future treatment, and have temporarily moved in with Mr Kumarasinghe's aunt whose rented home is close to the hospital.
Their five-year-old son has been left in the care of other family members.
Mr Kumarasinghe used to make a living growing leeks, carrots and cabbages, which are now being tended to by his parents.
Besides inflation, his income has been badly hit by a chemical fertiliser ban implemented last year, which has since been reversed, but led to the price of fertilisers jumping to about 30,000 Sri Lankan rupee ($119.96) a bag from about 1,600 rupees previously, Kumarasinghe said.
"Every month I need about 70,000 rupees for expenses but it is hard to meet the costs," he said.
"Medicine is not available at the hospital so it has to be bought from pharmacies. Every single type of medication is over 1000 rupees. I'm doing my best but it's very hard."
For decades Sri Lankans have benefited from a universal public healthcare system that subsidises treatment, including medicine for serious illnesses.
But services have been hampered by the dollar shortage, which has restricted imports of medicines, and limited public funds available to hospitals to provide care.
President Ranil Wickremesinghe has pledged to restore economic stability but has warned reforms will be painful as the country strives to increase taxes to put its public finances in order and work with creditors including India, Japan and China to restructure debt.
In September, the country entered a preliminary agreement with the International Monetary Fund (IMF) for a $US2.9 billion ($4.2 billion) bailout but has to put its huge debt burden on a sustainable track before disbursement can begin.
The economic hardship remains crushing for many.
Sathiyaraj Silaksana 27, has come to visit her five-year-old son S Saksan suffering from leukaemia, travelling 350 km with her husband to feed him.
"Due to the current crisis in Sri Lanka, we are facing severe problems in transport and food," said Ms Silaksana, who is pregnant with her second child.
"I have no option but to pay for my son's needs. My husband, is a construction worker. In order to pay for all these expenses we pawned our jewellery."
Reuters
