Senaka Bibile: A revolutionary mission in healthcare

Prof. Senaka Bibile, a great Sri Lankan professor of Pharmacology, died 44 years ago on September 29, 1977, and this brief article is written in his memory. In my view he is one of Lanka’s greatest products and achievers, and all Sri Lankans, especially the young, should know what he did and endeavour to emulate him, to serve all humanity and society, regardless of personal gain or profit.

With limited means coming from rural Bibile, in Badulla district, he won a scholarship to Trinity College, Kandy (which he repaid once he became a doctor, so that another poor student would also benefit, starting a new tradition). He excelled in his studies, despite taking to sports and music. He passed out of the Medical College, Colombo with a First Class and several distinctions (surgery etc.). Instead of becoming a rich surgeon, he chose to join the Pharmacology Department to teach about the proper use of medicines, and try to prevent poor patients dying due to the high price of medicines, which was a major health problem at that time. He then obtained a Ph.D in Pharmacology in the U.K.

Back in Sri Lanka he became Professor in the Colombo Medical College for a long period before becoming the founder Professor of Pharmacology in the Medical Faculty of the University of Peradeniya, and the Dean as well. Among his many innovations was the setting up of an Institute for Research into Medical Education. He did much original research in pharmacology itself. Senaka gave all his lectures without a note in front of him and they were so clear and precise that it remained in our mind.

Lanka Sama Samaja Party (LSSP)

He joined the Lanka Sama Samaja Party (LSSP) while a student, where he became a convinced socialist interested in serving the people. Through Marxism he learnt what caused the poverty around him and the LSSPs path to eliminate it in Sri Lanka.

I met him at party meetings, doing election work etc. and we became good friends. When the language issue was at its height our Colombo Municipal member from Kuppiawatte died, and despite the racist attacks on the LSSP for supporting the use of Tamil also as an official language, the party had to put forward a candidate. When others were hesitant, Senaka volunteered to contest. I and other student supporters had to face much violence, but Senaka’s leadership inspired us to fight to the end although we lost badly. A batch of us students met at his house every week and had interesting discussions on Marxism and politics in general.

Senaka began his campaign to bring down the cost of medicines by preparing a List of Essential Medicinal Drugs. Going by their scientific names he had about 250 on his list. He found that each of those on the list was being imported under different brand names, sometimes ten or more. Each company would try to capture a larger share of the market by intensive advertising, which raised the price further. I am sorry to have to mention that some of my medical colleagues were being offered various perks (trips abroad etc.) and some succumbed and prescribed that brand. The poor patients, as the Government Hospitals were always short of drugs, had to go to private pharmacies. Many who could not afford the full course only bought two or three days’ supply. The outcome was not only no cure, but the problem of drug resistance emerging among the bacteria (e.g. antibiotics). New antibiotics had to be found to save lives. The drugs were often more costly. The poor suffered more.

State Pharmaceutical Corporation (SPC)

Senaka then established a State Pharmaceutical Corporation (SPC). Dr. N. M. Perera and T.B. Subasinghe supported Senaka’s idea of the SPC calling for worldwide tenders based on the scientific names, not only for the needs of the Government hospitals but also for the private ones. The outcome was a large number of bids with intensive competition among the powerful Multinational Corporations (MNCs) and producers of generic products (scientific name based, which supply the MNCs) which are much cheaper but of as good quality. The SPC was able to obtain good medicines at very low prices.

To give one example. The Roche MNC of Switzerland which sold “Diazepam” (generic name) under the name Valium brought the cost of a tablet from about 92 cents to 52 cents, a drop of 40 cents. But Ranbaxy of India offered a tablet at two cents (Sri Lankan). Senaka contacted international organisations that check on all product preparation procedures and give Certificates of Good Manufacturing Practices (GMPs) for a price. The report on the Ranbaxy product was good. The SPC accepted the Ranbaxy product and saved 50 cents on the bid price and 90 cents on the Roche retail price. The Government drug bill came down steeply, and State hospitals were able to give free to every patient the medicine for practically every illness free of charge. The price in private pharmacies also came down markedly. Senaka was able to achieve his ambition. Indeed Sri Lanka began to have a free health service.

Essential drugs

Senaka’s other ambition was for Sri Lanka to produce its own requirement of essential drugs and if possible export them to earn foreign exchange. What many countries do, including the rich countries like the USA is to get the tablet in powder form from the generic producers in countries like India and tablet them under their trade name and sell at a much higher price. The formulation of the powder is a lengthy, expensive process, involving much research etc..

Senaka wanted Sri Lanka to do its own formulation. He mooted the idea of establishing a State Pharmaceutical Manufacturing Corporation (SPMC) for this purpose. He started on it and prepared the foundation, but did not live to see the final outcome. Much of that work was taken on by Dr. Gladys Jayawardene. When I inquired some time before 2015 over 40 of the most widely used medicines were being produced by the SPMC.

Though it is supposed to have gone up to well over this number during the time of the Yahapalanaya Government after 2015, I have been informed that a private company in Sri Lanka is supplying the tablets to the SPMC who then sells it as an SPMC product to SPC for Government hospitals. Many hands are involved and many commissions are said to be made. Whether the formulation is done in Sri Lanka is also uncertain. It may be abroad. I am also told that this nasty practice is continuing under the present Government. This should be fully investigated and if what is being said is correct immediate corrective action must be taken. I request the new Minister of Health to do so without delay.

Senaka was in high demand to visit Third World countries to introduce his method. The night before his final visit abroad, to Guyana, while having dinner with him he said that they are trying to frighten him not to go by phone messages saying that his life is not safe and not to go to Guyana. There are suspicious circumstances about his death. I and my wife Kamini went to meet Leila at the airport to receive the ashes of this great man who was lost to the world at the age of 54. What a loss.