Pain Control in the African Context: the Ugandan introduction of affordable morphine to relieve suffering at the end of life

Richard Harding,Anne Merriman

doi:10.1186/1747-5341-5-10

Abstract

Dr Anne Merriman is the founder of Hospice Africa and Hospice Africa Uganda. She is presently Director of Policy and International Programmes. Here she tells the story of how HAU was founded. Dr Richard Harding is an academic researcher working on palliative care in Sub-Saharan Africa. This paper described Dr Merriman's experience in pioneering palliative care provision. In particular it examines the steps to achieving wider availability of opioids for pain management for those with far advanced disease. Hospice Africa Uganda has been a model facility in achieving high quality clinical care embedded in a strategy of advocacy and education, using a multifaceted approach that has addressed logistical, policy and legislative barriers. Until 1990 control of severe pain in Sub-Saharan Africa was non-existent except in Zimbabwe and S Africa. Oral affordable morphine was brought to Kenya through Nairobi Hospice that year, and to Uganda through Hospice Africa Uganda in 1993. This paper offers an example of a highly effective and cost efficient model of care that has transformed the ability to humanely manage the problems of those with terminal illness, and to offer a culturally appropriate "good death". Thus it is now possible to complete the ethical circle of care in resource poor circumstances.

Highlights

Terminal disease: the need for palliative care Sub-Saharan Africa faces a very high burden of incurable terminal disease
During 2007 there were 22.5 million people living with HIV infection; 1.7 million adults and children became infected with HIV; and 1.6 million died of AIDS (UNAIDS)
More than 16,000 patients and families have since received such care from Hospice Africa Uganda- and many more receive high quality palliative care from doctors, nurses, and other health professionals trained by HAU initially

Summary

Background

Terminal disease: the need for palliative care Sub-Saharan Africa faces a very high burden of incurable terminal disease. In particular without the availability of morphine to control his pain, this boy would have had no opportunity for a pain free and peaceful end to his life His family would have suffered alongside him. More than 16,000 patients and families have since received such care from Hospice Africa Uganda- and many more receive high quality palliative care from doctors, nurses, and other health professionals trained by HAU initially. Less than a quarter of African countries have affordable oral morphine available To address this problem, a combination of advocacy, education and training is required to ensure and maintain good analgesia for those in need. HAU has shown how commencing from very little, with the support of Government and networking organisations, pain control opens the door to providing holistic care to the patient and family. There is physical harm to the patient, suffering for the patient and family

Conclusion

Findings

Additional material