Tag Archives: Africa

Channel 4 looks at Africa’s scandalous shortage of pain medications

“without the political will to change, vulnerable people remain deprived of humane treatment and an end to life free of pain.” 

This is the conclusion of the Channel 4 documentary, ‘Africa’s Drug Scandal’ that I helped to coordinate through my work – the African Palliative Care Association. The documentary is due to be broadcast on Channel 4 in the UK at 7:35pm on Friday 30th May 2014.

I am posting about it here because it strikes me as a rare opportunity to get a large number of people thinking about an issue that is incredibly important to me.

The documentary focuses in on the issue of access to pain medications – predominantly oral morphine. Having access to such medication is something that most people in the UK take for granted. If you were diagnosed with a life-threatening illness tomorrow you would assume that you would be given the appropriate pain control that would firstly enable you to live your life to the full but secondly, would enable you to die a peaceful death.

For the majority of people in the world this is simply not the case. Indeed, as ehospice reported last November, due to a lack of access to inexpensive and effective essential opioids more than 4 billion people, over half the world population, live in countries where regulatory barriers leave cancer patients suffering excruciating pain.

In countries like Senegal where the documentary is set the situation is dire. Last October Human Rights Watch found that the government only imports about one kilogram of morphine each year – enough to treat about 200 cancer patients when there is an estimated need in the tens of thousands of patients!

And so, this is one of the corner stones of my organisations work – to lobby, offer training, educate and empower people to ensure that everyone has access to the pain medications they need.

unreported world

It might seem like an abstract issue, but as Krishnan Guru-Murthy, the renowned Channel 4 reporter finds out, once you see a patient suffering in unbearable but perfectly treatable pain you instantly understand the importance of the issue.

Guru-Murthy concludes the situation amounts to “needless cruelty”.

I find it impossible to see how anyone, when faced with this reality could conclude anything different.

The programme can be watched live online here, on 4OD for 30 days after broadcast here, and you can read a preview in the Radio Times here.

Let me know what you think of it in the comments below.

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Millions in Africa do not have access to morphine and suffer unnecessary preventable pain

This article was originally published on Left Foot Forward, Britain’s No 1 left-wing blog

Palliative care

Palliation – literally, the removing of symptoms of life-limiting illnesses such as pain – has been brought sharply into focus in Africa due to the dual burden of an ageing population and an increased disease burden.

To give just one example, 70 per cent of people living with HIV worldwide live inside sub-Saharan Africa, a region which constitutes only 12 per cent of the global population.

Millions of these people in sub-Saharan Africa require palliative care to address the medical/physical, social psychological and spiritual challenges as a result of the life-limiting illnesses.

Despite the large demand, there is still little palliative care provision across much of Africa. Many countries do not have any element of palliative care: no hospices, no formal training for medical professionals, no or little integration of palliative care into national health systems and often little public awareness.

It is estimated that only 9 per cent of countries in Africa have palliative care integrated into mainstream health services.

One of the largest challenges facing pain relief efforts in Africa is the availability of, and access to, oral morphine. It is thought that Hospice Africa Uganda, a centre of excellence of palliative care in Uganda, can mix a three week supply for a patient for ‘less than a loaf of bread’.

Despite this, oral morphine is still not widely available to most Ugandans, let alone the rest of Africa.

Bernadette Basemera, a palliative care nurse based in Kampala, explains part of the problem:

“Morphine wrongly incites fear: Doctors wrongly fear patients becoming addicted, the police wrongly fear drug related crime, and members of the government fear falling short of international drug control frameworks.”

As a result of this fear, millions do not have access to morphine and suffer unnecessary preventable pain.

In recent years however, there have been signs that this might be a thing of the past. In the last two years alone four countries – Rwanda, Swaziland, Tanzania and Mozambique – have all adopted stand alone palliative care policies.

Although policy development does not immediately translate into oral morphine availability, a number of countries such as Kenya, Nigeria, Zambia, Namibia Ethiopia and a few others have improved access to oral morphine. Meanwhile Hospice Africa Uganda, in a partnership with the Ministry of Health of Uganda, continues to produce and distribute oral morphine whilst at the same time offering training courses to practitioners from all over Africa.

At the heart of these developments are passionate workers like Bernadette. Once again working late, Bernadette describes why she wants to work in palliative care, saying:

“Palliative care is the sort of care that you would hope you and everyone you care about receives. No one wants to think of a loved one suffering unnecessarily.”

Bernadette offers a simple motivation for her work in palliative care. This simple motivation, however, could benefit millions of Africans. Palliative care needs to be rolled out, and people like Bernadette might just be the way to make it happen.

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Reflections from a palliative care conference

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Delegates at the joint APCA/HPCA palliative care conference

I have just returned from the African Palliative Care Association and Hospice Palliative Care Association of South Africa joint regional conference in Johannesburg, South Africa and I am inspired.

This was my first palliative care conference. A year ago I didn’t even know what these words even meant. Before the conference started I could have told you about palliative care and perhaps more importantly why it is important. I would quite possibly have waxed lyrical about it being everyone’s right to live a life free from preventable pain. I might even have told you about someone inspiring that I’ve met who has spoken about the importance of palliative care to them.

But, if I am being honest, before this conference I wouldn’t have really felt it.

Something in the way I think about palliative care has changed over the last few days though. Trying to put my finger on exactly what is difficult – so much has happened. It could have though been the moment when a Ugandan journalist who I was sharing a stage with let a single tear drop roll down her cheek as she talked about her Aunty being unable to access basic pain medication in her dying days.

It could also have been when a complete stranger, who I still don’t know the name of, approached me and talked to me about the burden of feeding her bed bound mother every day as she was too frail to feed herself and that the local hospital would not accept her because, so they said, “there was nothing wrong with her”.

It might even have been that unspoken moment when a delegate was asked if she had children and after a moment’s pause she responded that, she “used to”.

But of course it was a cocktail of this and more. It was spending 4 days in close confines with inspirational people who were dedicating their lives to ensuring as many people as possible experience the palliative care that they need.

People who had talked the Bush administration into setting up a fund for palliative care in their HIV response programme. People who had pioneered palliative care in Africa 2 decades ago and were still as passionate and articulate as they ever were. People who felt a guilt for attending a palliative care conference because it meant that they were away from their patients bedsides for just under a week.

The passion and empathy of so many of the delegates from around the world touched me in a way that I didn’t necessarily expect it would.

On the final evening of the conference there was a diner reception. As I was standing watching delegates dance, joke and chatter, I thought to myself that it felt just like a family reunion. There was a tacit acknowledgement that everyone understood, at least on some level, why everyone else was there. Just like a family is bound by the bond of blood so at this conference it felt like there was an unspoken bond in the knowledge of, and passion for, palliative care.

As with all families though, there also exists unspoken traumas that rest just beneath the surface. But standing watching delegates dance I reflected on what I felt to be the strength of this “palliative care family”. Palliative care gave each member the opportunity to be able to share these traumas that we all have with each other. Everyone was accepting and expecting to offer a ear when someone needed to talk about losing a patient, friend or loved one.

During one of the workshops Reverend Rick Bauer made a comment that stuck with me. He said, “When you are talking to a patient the most important thing you can do is be there 100% with them at that moment.” I think what made the atmosphere at this conference so special was that, almost without realising, delegates were 100% attentive to those around them and to others commitment to rolling out palliative care to all those who need it.

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Ageing Mandela reminds us of importance of palliative care in Africa

This article was originally published in The South African.

Whilst wishing Mandela a full recovery we can, and indeed must, use this opportunity to talk about the importance of palliative care – a taboo across much of the world including most of Africa.

Left: A 1961 photo of Nelson Mandela (AP); Centre: Mr Mandela and his then-wife on his release from prison in 1990 (AFP); Right: Mr Mandela pictured in 2007 (AP)

In 1999 Nelson Mandela famously said, “A society that does not value its older people denies its roots and endangers its future. Let us strive to enhance their capacity to support themselves for as long as possible and, when they cannot do so anymore, to care for them.”

Ever self-effacing, Mandela would have said these words to offer support to other South Africans and indeed other Africans who needed this care. Now however, approaching his 95th birthday, it is clear that Mandela needs this support for himself.

People from across the world have come together to wish Mandela a recovery from his latest lung infection – a legacy of the tuberculosis he suffered from when he was imprisoned on Robben Island. Prayers have been said and fingers have been crossed as anxious individuals wait for next bulletin of news to come from Pretoria’s Mediclinic Heart Hospital.

As difficult as it is to say, it would appear that Nelson Mandela is moving closer to the inevitability of death that faces us all at some point.

Writing in the Independent, Jeremy Lawrence comments on Mandela’s ill health saying, “The dilemma his doctors face – when to stop “striving officiously” as the Hippocratic oath has it, and switch focus from curing to caring – is all too familiar to palliative care specialists. Recognising that the end is approaching and broaching the subject with the patient and their family demands strength and delicacy – and is often avoided.”

Whilst wishing Mandela a full recovery we can, and indeed must, use this opportunity to talk about the importance of palliative care – a taboo across much of the world including most of Africa.

Mandela’s support and care that he is receiving at Pretoria Mediclinic Heart Hospital sets him out as unusual. The vast majority of African’s do not have access to basic palliative care provision. The African Palliative Care Association summarizes the scale of the challenges when they say:

“A survey of hospice and palliative care services on the continent found that 45 per cent of African countries had no identified hospice or palliative care activity, and only nine per cent could be classified as having services approaching some measure of integration with mainstream health provision.”

The WHO estimates that about 1% of the Africa’s population requires palliative care – this is approximately 9.67 million people across the continent – approximately half a million of whom live in South Africa.

Death is never an easy thing to contemplate. This is especially true when we are talking about someone we love and above all an anti-apartheid hero such as Nelson Mandela. When the inevitable comes closer however, it is not only the patient who can benefit from effective palliative care, but also the family, friends, and loved ones.

In the case of Mandela, it is not just his friends, family and loved ones who suffer the pain of uncertainty but his nation, his continent and, it is not over-stating it to say, most of the world. As Mandela faces the challenges of illness and hospitalisation, the support he receives will not only ease his pain, but also the pain that others around the world feel.

Mandela is in hospital for the fourth time this year already. We stand united wishing him the quickest and fullest recovery possible. We know that his medical team will look out for any indication of suffering that may be physical, social, spiritual or psychological and deal with it.

It is important that palliative care providers in Africa follow this example, and integrate the needs of the aged and the ageing.

Mandela is a man who has inspired a generation. In his later years, hopefully the quality palliative care that he receives will continue to inspire people from across Africa.

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On World Blood Donor Day: Donate blood, you could save someone’s life

An edited version of this article was published in the Daily Monitor – Uganda’s best selling independent newspaper. 

To mark the WHO’s annual Blood Donor Day, Steve Hynd from the African Palliative Care Association  urges everyone eligible to go and give blood as it might save someone’s life!

On the WHO’s World Blood Donor Day (14th June) it seems pertinent to highlight the on-going challenges facing blood banks, not just across Uganda but across Africa in general.

The limited supply of blood in Africa is a serious problem. The WHO reports that out of the “75 countries [that] report collecting fewer than 10 donations per 1 000 population….38…are in WHO’s African Region…and all are low- or middle-income countries.”

To put this in other words, in 75 countries less than 1% of the population is donating blood.

Despite this low supply, the demand for blood transfusion in Sub-Saharan Africa is high because of the high prevalence of anemia, especially due to malaria and pregnancy-related complications.

Blood transfers are also an important, but often forgotten, aspect of palliative care. For example, some Cancer patients require blood transfusion both as a direct result of the disease but also, at times, because of the palliative treatment the patient may receive.

Equally, the WHO organization estimates that 5-10 % of HIV/AIDS infections in Africa occur from unsafe blood transfusions and as such, safe blood transfusions are a key issue in terms of preventing life-limiting diseases as well.

Uganda is a leading light in palliative care but is also one of the countries with a severe shortage of blood and is a country where less than 1% of the population is donating blood.

This is having serious consequences. In the last month it is thought that at least 12 people in the eastern region have died because of lack of access to blood transfusions. IRIN reports that Uganda has an annual demand of approximately 300,000 units of blood per year but collects just 250,000.

Bernadette Basemera, a palliative care nurse who works for the African Palliative Care Association based in Kampala commented on the blood shortage in Uganda saying, “Although the shortage of blood in Uganda has been difficult recently, the problem is a systemic one. All across Africa there is a consistent shortage of donors coupled with a high demand for blood transfusions.”

She continued, “The only way this issue is going to be tackled is by increasing public awareness to ensure a consistent supply of blood is donated. I would urge everyone eligible to find their nearest centre and go and give blood. This simple action that costs you nothing could save someone’s life.”

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We are still haunted by the legacy of colonialism

We have to reclaim our history, however vile!

The modern western world has colonialism and imperialism entrenched into its history.  The racial and ethnic tensions that are apparent in contemporary society can be traced through history back to the time of colonialism and imperialism.  To pretend it is not there is to play into the hands of the modern far right.

Colonialism refers to the political authority of the European powers over some of the areas of Asia, Africa, Australasia and the Americas.  Broadly it is the time when there was a political economy based around the slave trade By the end of the 19th century nearly all Africa had been colonised by one or other of the Great Powers.

Modern racist discourse can be traced back to the slave trade.  Although, it is important to remember that racism and slavery did not always go hand-in-hand (think of the ancient Greeks!).  Why then, in our murky colonial history did race become such a big deal? From the earliest recordings of British involvement in Africa (large scale in 17th century) the exaggerated term “black” was used to describe the very obviously different skin colour between British and the (at first) West Africans.  However the colour ‘black’ came with some deeply ingrained values; it was associated pre 16th century with dirt and death.  It had connotations of evil and wickedness.  This is illustrated in the distinction between black and white magic and as well, the Black Death.  This all came at a time when the ideal of beauty in Britain was very much of a pale white face.

Throughout the Colonial period the appearance of the African was stretched and exaggerated through European discourse.  Their nakedness was often highlighted to illustrate their difference from the ‘civilised’ European.   To start with people were content to comment on skin colour to describe their difference; during the 17th and 18th centuries however a number of other characteristics were attributed to them.  Soon African men were considered to have potent sexuality.  The men were considered to have a larger penis and to be extremely lusty.  Some Europeans at the time speculated on the sexual intercourse that might have occurred between apes and Africans.  Indeed increasingly Europeans would compare the Africans that they ‘discovered’ to the apes that they “discovered” at a similar time. Indeed, other characteristics were recorded at this time such as laziness and superstition.  After meeting Africans as neutrals (pre slave trade), the colonial legacy slowly degenerated into a deeply racist discourse.

Towards the end of the 19th century a movement developed to legitimise Imperialism.  Social-Darwinism was used to justify the colonial power’s actions in Africa.  There was a belief that there was a natural hierarchy of races.  These were predominantly European ideas and as such Europeans were normally ranked as the ‘highest being’.  This is an almost laughable idea today, but at the time was considered gospel by many.  It is important to note that such broad biological assumptions are still made and believed in modern racist belief.  For example Charles Murray’s book ‘The Bell Curve’ (1994) is still used by extremists to argue that White people have a higher I.Q than black people. Stereotypes still persist in main stream society in many western countries as the mass of the population still see Black Afro-Caribbean’s consistently performing low skilled manual jobs (a changing but lingering phenomena).

Although the dark days of our colonial past, are just that, our past.  It is worth taking a moment to reflect the impact that they are still having on our society.  There are some very clear ethnic tensions that can be directly linked to European colonial past.  The continued conflict in the Democratic Republic of Congo demonstrates some extreme racial tensions that have a clear link to the Belgium legacy there for example.  The racism that we see most regularly today however is a lot more subtle.

Modern conflicts, especially in the West appear to be increasingly more complex than simply a reflection of race.  Ethnicity is a wider term that can describe a group of people beyond their inherent characteristics.  For example the Muslim community in the U.K could easily describe themselves as an ethnic group.  No longer does it simply describe your skin colour. This leads to a more complex system of discrimination where culture, religion and race all become intertwined.  In the UK there is no simple way of defining what it exactly is that people discriminate against. However appearance still plays a large part in social discrimination in contemporary society.  This is reflected in police stop and search figures; increasingly Arabs have been subjected to a greater number of searches.

Despite conflicts growing increasingly more complex, there are still racial elements to most conflicts in the western world.  In November 2005 large-scale riots broke out throughout France.  The BBC described these as ‘race riots’ as it was predominantly members of the black community rioting.  However a more accurate way to try and have one term to describe these riots would perhaps have been to describe them as socio-economic deprivation boiling over.  It is no coincidence that these riots took place in some of the poorest neighbourhoods across France.  However these riots were portrayed across the world more as race riots.

Today we can see the BNP riding a roller coaster of popularity (for whenever they have risen high they have very soon plunged in public opinion).  The peaks of the BNP’s popularity however should worry us.  The BNP often attack a way of life opposed to a specific “race” (although the racist undertones are clear).  For example their leader Nick Griffin was cleared of the charge ‘inciting racial hatred’ for describing Islam as a ‘wicked faith’.  In his trial he argued he did not hate Muslims or any ethnicity but purely the faith they followed.  However what the B.N.P does illustrate is that there is still interest and small support for such extreme right-wing politics.  They often play on fundamental fears that are still apparent in society; for example they argue that these ‘migrants’ are stealing British jobs.  It is apparent that there is interest in these ‘racial’ issues in the main stream even if there is not much support for it.  A lot of the discourse they use is similar to that of colonial times.  For example the B.N.P campaigned for many months about the Asian ‘sexual predators’ that were coming after ‘our girls’.  This is a clear link back to colonial stereotypes that play into the discriminative discourse that the B.N.P wishes to capitalise from.

To forget our colonial past, in all it’s ugliness, is to give the modern racist a free use of a deeply ingrained sub-conscious tool.  Regardless of whether we would like to admit it or not, racism still exists in this country.  We have to acknowledge that it has a long history.  If we do not acknowledge this history, then those outdated images of the black man as a sexual predator, or the monkey chants across football grounds will continue to be used.  We have to reclaim our history, however vile it is! At least we have the decency to acknowledge it to be vile!

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