Drugs Banned, Many of World’s Poor Suffer in Pain

This article sheds light on the abysmal state not only of pain management but of the entire health system in places like Sierra Leone. When I was there last Fall, I was surprised to find that the country had not had an electricity for >40 years. Even the hospitals I visited depend on generators. However, most of the hospitals I visited either did not have functioning generators or could not afford the petrol required to run them. I visied the "ICU" in Kissey Hospital in Freetown, where there was a single patient being fanned by his relative. He had a high fever and was delirious. He had no I.V. nor monitors hooked up. The nurses said there were no bags of saline etc.. for the I.V. The monitors hadn't worked in years. Anyway, the generators weren't working. I asked the nurse what then made this and "ICU?" She repllied, there are two nurses per patient.....


Like millions of others in the world’s poorest countries, she is destined to die in pain. She cannot get the drug she needs — one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source, the opium poppy. She cannot get morphine.

That is not merely because of her poverty, or that of Sierra Leone. Narcotics incite fear: doctors fear addicting patients, and law enforcement officials fear drug crime. Often, the government elite who can afford medicine for themselves are indifferent to the sufferings of the poor.
(..)
At pain conferences, doctors from Africa describe patients whose pain is so bad that they have chosen other remedies: hanging themselves or throwing themselves in front of trucks.

Westerners tend to assume that most people in tropical countries die of malaria, AIDS, worm diseases and unpronounceable ills. But as vaccines, antibiotics and AIDS drugs become more common, more and more are surviving past measles, infections, birth complications and other sources of a quick death. They grow old enough to die slowly of cancer.

About half the six million cancer deaths in the world last year were in poor countries, and most diagnoses were made late, when death was inevitable. But first, there was agony.
(..)
When he first saw her, her tumor was wrapped with clay and leaves prescribed by a local healer. The smell of her rotting skin made her feel ashamed.

She had seen a doctor at one of many low-cost “Indian clinics” who pulled at the breast with forceps so hard that she screamed, misdiagnosed her tumor as an infected boil, and gave her an injection in her buttocks that abscessed, adding to her misery.

Nothing can be done about the tumor, Mr. Lewis explained quietly. “All the bleeders are open,” he said. “Her risk now is hemorrhage. Only a knife-crazy surgeon would attend to her.”

Earlier diagnosis would probably not have changed her fate. Sierra Leone has no CAT scanners, and only one private hospital offers chemotherapy drug treatment. The Sesays are sharecroppers; they have no money.