Tag Archives: morphine

Watch the first of the Al Jazeera series on access to medical morphine

aljazeera011613I occasionally link here bits of my work with the African Palliative Care Association that I think could be interesting to a wider audience.

Here is a short Al Jazeera report on access to morphine in Uganda that I helped coordinate. It serves as a nice introduction to the subject that leaves millions suffering from perfectly preventable pain.

The film was shown on repeat last week. On Thursday they had our Executive Director, Dr Emmanuel Luyirika, on to speak about the subject. You can watch the interview here:

In Uganda, a regional leader in terms of medical morphine availability, only one in ten people who need medical morphine have access to it!

For more information:

Help out:

At the moment millions of Africans suffer terrible pain because they don’t have access to really basic pain medication that many people in Europe take for granted. If you feel like I do that no-one should be left to die in pain then please consider:

 

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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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Russia is leaving cancer patients to die in pain – where is the outrage?

An edited version of this article appeared in Liberal Conspiracy – the UK’s most popular left-of-centre political blog. 

In Russia cancer patients are left to suffer and ultimately die in pain with inadequate access to basic pain control drugs such as morphine. When one doctor defied the state’s overly restrictive laws, she was arrested. It is time for the healthcare community to speak out.

Dr. Khorinyak allegedly wrote out two prescriptions for the pain relief medication tramadol. The prescriptions were for Victor Sechin, a terminally-ill cancer patient. In the eyes of the Russian state, the medical practitioner of more than 50 years broke the law.

In 2011, it is thought that the Russian Federal Drug Control Service discovered the prescriptions at the local pharmacy, and referred the case to the prosecutor and the court. Dr. Khorinyak was then charged under:

  • Article 234 of the Criminal Code: “Trafficking potent substances in large quantities by prior agreement with the intent to sell, an organized group”;
  • Article 327 of the Criminal Code, “Forgery of documents in order to facilitate the commission of another crime.”

The online palliative care news service, ehospice, spoke out about Dr. Khorinyak’s case. Quoting Trustees of the Worldwide Palliative Care Alliance (WPCA), the ehospice article said:

“The Worldwide Palliative Care Alliance is seriously concerned to hear about the prosecution of Dr Alevtina Petrovna Khorinyak…We fully support Dr Khorinyak in attempting to provide pain relief for patients coming to her for help. We stand in defence of her professional practice and her humane response to patients in pain.”

The article finished by urging readers to sign a petition calling for the charges against Dr. Khorinyak to be reversed. The editor of the international edition of ehospice, Kate Jackson, explained her decision to run the story saying:

“Dr Khorinyak performed her professional duty and acted with compassion towards a patient in pain. If it is outside of the laws of a country for a doctor to treat a patient to the best of their ability, then there is a need for a serious and urgent re-examination of those laws.”

Indeed, Russia’s overly restrictive laws regulating access to morphine have been the focus of on-going criticism for a number of years.

In its 2012 annual report, Human Rights Watch commented on Russia’s health policy saying:

“Although over 300,000 Russians die of cancer each year, with many facing severe pain, available palliative care services remained limited. As a result, hundreds of thousands of patients die in avoidable agony each year. In much of the country, the government does not make oral morphine available through the public healthcare system, or adequately train healthcare workers on modern pain treatment methods. Existing drug regulations are excessively restrictive and limit appropriate morphine use for pain relief.”

Indeed, the UN Special Rapporteurs on the Highest Attainable Standard of Health and on Torture, Cruel, Inhuman and Degrading Treatment have said:

“The failure to ensure access to controlled medicines for the relief of pain and suffering threatens fundamental rights to health and to protection against cruel, inhuman and degrading treatment.”

Indeed, Article 21 of the Russian constitution states that:

“The dignity of the person shall be protected by the state. No circumstance may be used as a pretext for belittling it.”

Simply put, palliative care is a human right.

In Russia though, 450,000 people are diagnosed with cancer every year resulting in more than 2.5 million people suffering from the disease. Russia not only has a clear moral obligation to support these patients but also a legal human rights responsibility as well – one that it is currently neglecting.

With the noble exception of ehospice and a handful of other professionals, few have spoken out. The Russian government is standing by while thousands needlessly suffer. When one person does speak out, she is prosecuted as a criminal.

It is time for health care professionals from around the world to stand up for Dr. Khorinyak and speak out, not only against her prosecution but also against Russia’s wider neglect of patients in need of pain relief.

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