Dying in pain a reality for most Africans
DAR ES SALAAM – People living with cancer are dying on the African continent in terrible pain as they present too late with advanced cancers that are mostly incurable by the time they reach a health worker and if they do reach help most of them find that effective pain medication not available.
Lucy Finch, a stately Malawian nurse who worked in Uganda most of her life, shared with delegates at the African Organisation for Research and Training in Cancer her reason for becoming a palliative care worker which led to the establishment of the Ndi Moyo palliative care centre, 100 km east of Lilongwe.
‘In 1998 my younger sister had AIDS and was dying of cryptococcal meningitis and I came home to Malawi from Uganda to nurse her at the military hospital. There was a soldier in the next room who was dying in pain. The young man screamed and cried for three days and when I pleaded for pain medication I was told that they only had paracetamol.
‘Here we were in the main military hospital in Malawi and they had no morphine,’ said an exasperated Fincg.
There and then Finch made a promise to herself that she would dedicate the rest of her life to promoting palliative care and ‘prevent others from suffering the same fate as the soldier’. Malawi currently has 18 palliative care centres, but not a single oncologist, no cancer centre which means no radio- or chemotherapy treatment for adults.
Uganda’s first palliative care nurse Rose Kiwanuka revealed that her country had one cancer unit for 32-million people. This unit also sees patients from Rwanda and the DRC.
‘How many people can afford to reach treatment? This is why many people ask to stay at home and die comfortably,’ she says. Kiwanuka said despite the service being available they constantly struggle with power outages which could last anything from a day to a week.
Jim Cleary told delegates that 80% of the world’s morphine was consumed by 10 countries in the world with the United States dispensing an average of 60mg of morphine per person per year compared to Africa with 0,0002mg per person per year.
Low and middle income countries ‘ which host 80% of the world’s population, more than half of the world’s cancer patients, and more than 95% of people living with HIV ‘ account for just six percent of morphine consumption.
Credited with promoting palliative care and access to morphine in many Africa countries, Dr Anne Merriman said ‘no African should suffer severe pain’.
She said there was a huge need in the francophone countries, adding that 57% of Ugandans and a staggering 85% of Ethiopians never sawa healthcare worker in their lives.
A country assessment presented by Merriman showed that 10 000 people in Sierra Leone were currently in desperate need of palliative care.
She said there was a ‘big problem’ in Cameroon where there is only one site providing morphine. ‘People are very poor and have to pay for their healthcare,’ she said. Almost 100 000 people are in need of palliative care in this country.
Morphine arrived in Ethiopia this year where 180 000 people are thought to be in need of palliative care. ‘The suffering in terrible and many people are members of the orthodox church which believes you have to suffer if you wish to get to heaven,’ says Merriman.
In Malawi, an AIDS-related cancer – Kaposi Sarcoma is common with 165 000 people currently in need of palliative care. Merriman shared the story of a 24-year-old dying man who had to travel to hospital every day on the back of his 13-year-old son’s bicycle ‘ simply to get pain medication.
If Merriman is the mother of palliative care in Africa, Ugandan doctor Jagwe is described as the father. He said it was ‘miserable and pathetic’ that only 23 of 154 countries were above the global average when it came to access to pain medication.
Dr Liz Gwyther presented statistics which showed that while the global mean in terms of morphine access was 5,9 ‘ the African average was 0,45.
‘We know more, but fewer people are getting pain control,’ she said.
Gwyther said 70% of the more than 10-million cancer patients diagnosed annually suffered pain. Between 60 and 100% of the more than 33-million people living with HIV experienced pain.
African countries that had introduced palliative care with access to morphine possible include Zimbabwe, South Africa, Kenya, Uganda, Tanzania, Malawi, Nigeria and Cameroon – 32 African countries have almost no access at all to oral morphine.
Merriman identified the main barriers to access as the low priority afforded to pain management in health care systems, greatly exaggerated fear of addiction, severe ‘morphinephobia’, inadequate knowledge about morphine and overly restrictive laws governing the use of narcotics.