Published on: August 26, 2011

Short Film 15 of 50 in the LIFE Before Death documentary series about the global crisis in untreated pain and the dramatic life changing affect palliative care services can deliver to patients and their families around the world.

In “Nurse in the House” we learn about the innovative health policies in Uganda allowing nurses to prescribe oral morphine in the homes of patients.

“Sometimes we visit patients in their homes because when the patient has to move it makes the pain worse,” explains Martha Rabwoni (Uganda). “The pain if is not treated, the patient is in total chaos — they cannot think, they cannot do anything, they concentrate all their mind on the pain — they cannot eat, they cannot dress, they cannot bathe, they cannot move. The relatives in that home — nobody sleeps.”

We see Hospice Nurse Charlotte Komunda treating late stage cancer patient Beatrice in her home in Kampala, Uganda.

“Many developing countries still have a real problem about the use, importation and manufacture of morphine,” explains Eugene Murray (Ireland). “The second thing is having appropriate ways to distribute it. In Uganda, they dilute powdered morphine into water which is which is colored with a dye to indicate the three different strengths and is distributed by nurses in a community using recycled water bottles. That may seem very crude but in terms of pain control that is absolutely transformational.”

“We need morphine because most of the drugs don’t control the pain in cancer patients so morphine is very important,” states Nurse Charlotte Komunda.

In Beatrice’s house we observe Nurse Charlotte utilizing the simple but effective gesture-based communication tools that are used in many parts of Sub-Saharan Africa to rate a patient’s level of pain.

“Uganda is at an advantage because doctors are allowed to prescribe [morphine] and nurses who have done their 9 month palliative care course can prescribe morphine,” explains Dr Faith Mwangi-Powell (Uganda). “But in other countries only doctors are able to prescribe. So sometimes you find that morphine is available but there’s no one to prescribe it.”

“For many people living in rural areas, or poor township areas, their first point of contact is with a nurse clinician,” continues Dr Natalya Dinat (South Africa).

“Currently we have over 120 nurses who have had specialist training in palliative care and are now able to prescribe it for the patients in the districts,” concludes Rose Kilwanuka (Uganda). “So at least as a country, we’ve increased our number of prescribers.”

Featuring Martha Rabwoni (Uganda), Charlotte Komunda (Uganda), Eugene Murray (Ireland), Dr Faith Mwangi-Powell (Uganda), Dr Natalya Dinat (South Africa), Rose Kilwanuka (Uganda), Beatrice (Uganda).

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If you’ve missed previous episodes, catch up on the LIFE Before Death website…