When you have to treat that pain with morphine

Many health practitioners have told patients that morphine is a no go. To date, this drug is highly regulated in many countries because of the danger of misuse and addiction.
However, oral liquid morphine, according to Emmanuel Luyirika, the African Palliative Care Association executive director, is a safer bet for patients feeling uncontrollable pain resulting from cancer or HIV.

Morphine, a highly regulated drug, is the world’s strongest painkiller that controls moderate to severe pain.
According to the World Health Organisation (WHO), oral morphine has side effects on a patient and presents very little or no interruption with other drugs.
“Both adults and child patients in severe pain can take morphine drug at intervals of four hours as prescribed by a trained clinical officer, doctors or nurses depending on the weight and condition of the patient,” says Luyirika.

Who needs morphine?
According to WHO and World Hospice Palliative Care Alliance, both adult and child patients with chronic and life- threatening illnesses such as cancer, liver cirrhosis, diabetes mellitus, HIV/Aids, kidney failure, parkinson’s disease, drug resistant TB and meningitis, need morphine because of the extreme pain that such patients go through.
However, at no time can a patient be prescribed the drug without an assessment by qualified or specialised medical personnel.

Morphine, according to Ludoviko Zirimenya, the Hospice Africa Uganda executive director, is a free drug that is illegally sold by some people.
The drug, especially oral liquid morphine, Zirimenya says, is illegally sold for as high as Shs500,000 “but this is illegal and can lead to prosecution”.
It is only found in gazzeted health facilities that are recognised by government.
In the early 90s Uganda pioneered the use of morphine as a drug that reduces pain among patients with life-threatening illnesses.

The drug is mostly accessed through referral health centres, district hospitals, general hospitals and health centre IVs.
Private clinics and pharmacies, according to Zirimenya, are outlawed from stocking oral liquid morphine due to the fear that the drug will be misused.

The link between morphine and palliative care
Morphine and palliative care are like twins as the two are the best alternatives for a patient in their last days.
Palliative care touches the soul of the patient, family and those around the patients. It allows the patient to die with dignity and minimal suffering.

According to WHO, palliative care improves the quality of a patient’s life through prevention and treatment of pain and other complications that are beyond physical but might be economic, psychological, social or spiritual.
Immaculate Owomugisha, a lawyer with Uganda Network on Law, Ethics and HIV/AIDS (Uganet), says: “… everyone has a right to die with dignity and with less pain. People with chronic and life-threatening illnesses need to live a good life right from the time of diagnosis up to their deathbed.”
When someone falls ill, she says, the entire family is affected, this is where palliative care comes in to help and wash away the spiritual, social and psychological pain.

Families are torn by sickness, especially chronic illness, and the challenges such as succession and inheritance of property requires a professional to sail the family through the situation.

Palliative care is applicable early in the course of an illness, together with other therapies that are intended to prolong a patient’s life such as chemotherapy, radio therapy or antiretroviral treatment.
Globally, more than 400 million people need palliative care and 80 per cent of these live in developing countries.

WHO estimates that 1 per cent of each country’s population at least needs palliative care.
In Uganda, although there are palliative care units in all regional referral hospitals, out of the 10 people that need palliative care, only one gets it according to Jacinto Amandua, the commissioner clinical services at the Ministry of Health.

Amandua says palliative care is one of the basic essential clinical services that government highlighted in the Health Sector Strategic plan for 2011-15.
The plan sought to provide pain-free management medication in the form of oral liquid morphine, among others.

Why few patients get palliative care
Few patients, according to experts, get palliative care because of poor health management behaviour.
Most times, experts say, patients that have chronic illness are deep in remote areas where access to health facilities is hard.

Such patients are usually left to die with the belief that they will be near to their burial grounds. They indeed die with no necessary treatment and care, even when there is a probability of living a little longer.But beyond this is the ignorance of some medical personnel on the availability of palliative care services.

As of April 2015, there were 203 health facilities that provide some form of palliative care in Uganda. These, at least majority of them are supported by government but there are also other free standing palliative care programmes or hospices scattered throughout the country which provide different models of palliative care, including home care, road side clinics, outreach palliative care programmes, community services, as well as facility based daycare.
Ministry of Health together with Palliative Care Association of Uganda has accredited a number of facilities to provide palliative care services.

Palliative care services in Uganda are offered free of charge and Hospice Africa Uganda estimates that the government spends Shs86,000 every week on a patient for the home-based care model.

However, the lack of a policy to support provision of palliative care services, inadequate funding, low knowledge and awareness of palliative care among policymakers and delayed diagnosis and treatment, remain big challenges of the provision of effective palliative care.

Myths about palliative care

According to Zirimenya, palliative care is not only given to people who are waiting to die or those who are terminally ill. It can be given to the elderly who are sometimes susceptible to extreme pain. Such people are allowed to spend time more preciously other than dying in extreme pain.

They can be discharged from hospital because government and some non-government organisations have made it possible to extend the service into patient’s homes since many patients will in such conditions prefer to spend their time at home and family members.

Palliative care goes beyond the patient to include family members and those taking care of the patient. It mainly seeks to relieve the patients and their families of the stress that comes worth illness, especially if it is terminal.
It prepares the family for any eventuality as well as allowing the patient to have a dignified end to life.

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