Providing paediatric palliative care in Kenya

Abstract

According to a Human Rights Watch report released on Sept 9, Kenyan children with diseases such as cancer, HIV/AIDS, and sickle-cell anaemia are unable to get palliative care and pain treatment, and subsequently are living and dying in uncontrollable agony. The report: Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya documents failures by the government, the health-care system, and health donors.Both WHO and Kenya consider morphine an essential medicine. WHO reccomends the drug to treat moderate-to-severe pain. It is cheap, safe, and effective, yet the report states that the Kenyan Government does not procure morphine for public health facilities because it maintains there is little demand for it. Of the country's 250 public hospitals only seven stocked morphine. Furthermore, medicines to treat neuropathic pain common in patients living with AIDS and cancer are also largely unavailable. The report also criticises health donors for overlooking pain treatment and palliative care in their programmes.Kenyan health-care professionals are rarely trained to treat pain and are unaware of the benefits of morphine. Fears of addiction, belief that the drug is dangerous in children, misconceptions about palliative care with importance placed on curative care, and absence of psychosocial support and services at hospitals and at home have resulted in a dismal lack of attention to children with life-limiting illnesses. Sadly, the situation is much the same in other parts of Africa.The Kenyan Government should immediately improve access to oral morphine, in line with their own essential drugs list, and draw up a policy and plan of action on how to scale up palliative care. WHO's long overdue treatment guidelines on chronic pain for children should be completed and made widely available to countries with poor pain management.Clearly, legal obligations to ensure the child's right to the highest attainable standard of health are being broken in Kenya. With the African Palliative Care Association conference, taking place Sept 15–17 in Windhoek, Namibia, the report should help focus attention on ending some of the needless suffering of children in the continent. According to a Human Rights Watch report released on Sept 9, Kenyan children with diseases such as cancer, HIV/AIDS, and sickle-cell anaemia are unable to get palliative care and pain treatment, and subsequently are living and dying in uncontrollable agony. The report: Needless Pain: Government Failure to Provide Palliative Care for Children in Kenya documents failures by the government, the health-care system, and health donors. Both WHO and Kenya consider morphine an essential medicine. WHO reccomends the drug to treat moderate-to-severe pain. It is cheap, safe, and effective, yet the report states that the Kenyan Government does not procure morphine for public health facilities because it maintains there is little demand for it. Of the country's 250 public hospitals only seven stocked morphine. Furthermore, medicines to treat neuropathic pain common in patients living with AIDS and cancer are also largely unavailable. The report also criticises health donors for overlooking pain treatment and palliative care in their programmes. Kenyan health-care professionals are rarely trained to treat pain and are unaware of the benefits of morphine. Fears of addiction, belief that the drug is dangerous in children, misconceptions about palliative care with importance placed on curative care, and absence of psychosocial support and services at hospitals and at home have resulted in a dismal lack of attention to children with life-limiting illnesses. Sadly, the situation is much the same in other parts of Africa. The Kenyan Government should immediately improve access to oral morphine, in line with their own essential drugs list, and draw up a policy and plan of action on how to scale up palliative care. WHO's long overdue treatment guidelines on chronic pain for children should be completed and made widely available to countries with poor pain management. Clearly, legal obligations to ensure the child's right to the highest attainable standard of health are being broken in Kenya. With the African Palliative Care Association conference, taking place Sept 15–17 in Windhoek, Namibia, the report should help focus attention on ending some of the needless suffering of children in the continent. Ending inequities in access to effective pain relief?The undertreatment of pain caused by cancer and other conditions is a global health tragedy. WHO estimates that 5 billion people live in countries with low or no access to opioid analgesics.1 Each year, tens of millions of patients suffer without adequate treatment, including 5·5 million patients with terminal cancer.1 The fact that this appalling situation needs to be remedied was recognised at the annual meeting of the UN Commission on Narcotic Drugs, in March, 2010. Full-Text PDF