Painful Inequities: Palliative Care in Developing Countries, a NEJM article
What kind of world do we we live in? Purely due to misapprehensions, ignorance and callousness, we force people into a living hell!
Artur, a man in pain from advanced cancer is denied pain relieving medicines and now lives with a bottle of liquor and a gun beneath his pillow!
When Artur, a former KGB agent in Ukraine, developed prostate cancer that metastasized to his bones, his pain grew so intense that he moved hours away from his family so they would not witness his suffering.
“I don’t want them to see me cry,” he said.
Lacking access to the opioid regimens that we in the United States depend on to treat the pain accompanying end-stage prostate cancer, Artur turned to what he had available: a bottle of liquor and a gun beneath his pillow.
The article in New England Journal of Medicine (N Engl J Med 2012; 366:199-201) by Dr Daniela Lamas MD and Lisa Rosenbaum MD lucidly brings out the “painful equities” pertaining to palliative care in developing countries.
It brings out some positives and negatives in the Indian scene too – the complicated narcotics control system in the country as well as its recent simplification in some states.
The article quotes Meg O’Brien, who directs the Global Access to Pain Relief Initiative (GAPRI),
“There isn’t a single government that couldn’t procure morphine if they wanted it,”
The article concludes with the statement,
“With the recent United Nations conference on noncommunicable disease, the world has opened its eyes to the growing burden of cancer.
Closing the gap in cancer care will depend on marshaling limited resources toward disease-specific approaches to treatment and prevention.
Pain, of course, has no pink ribbon and no celebrity survivor. But layering pain treatment onto any evolving health care system, no matter the disease, is as reachable a goal as any.”
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