The call came from the capital city of a North Indian state

2009 December 22
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The caller was in some distress; he was a doctor who had just finished our six weeks training in palliative care at Trivandrum and returned to his regional cancer center.

He would be starting a palliative care service soon as part of a Pallium India-PPSG-USCPRC project – in a state which till now had no effective palliative care facility.

But in the meantime, he was confronted with this situation – a five year old boy with a rhabdomyosarcoma in an upper limb, in excruciating pain. The child also had severe lymphoedema and extensive blisters and some abscesses. The child was receiving an NSAID, but it had not helped much. What could the doctor do?

No, they do not have oral morphine yet. No, they do not have injectable morphine either. Nor even injectable pethidine. They do have injectable fentanyl, though.

God, why is it that hospitals in our poor country have only the most expensive medications? Even if it were affordable, how would this child get pain relief round the clock with such a short-acting drug? Would someone study this international phenomenon which affects the 80% of the globe that forms the developing world? Fentanyl and morphine are controlled by the same narcotic regulations; but you cannot get hold of morphine!

Dear doctor, we sense your patient‟s pain and your distress. We will work with you and fight with you till you have access to morphine.

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