Published on: April 30, 2014

What would a nurse do if a patient is in pain in a cancer hospital in India?
Usually nothing.

If the pain is agonizing?
“…I’ll call the doctor. If he is available, I will say that patient is feeling very restless, he needs some morphine, I will suggest it: “He may need some morphine, sir. He is feeling restless, he is shouting.” If doctor says, “no, no, no not morphine, you give tramadol injection,” or anything like that, I will give”.

And even if the doctors consent to give morphine? Would it be available? At least after obtaining all necessary licenses?

“So, again it’s paperwork. Again, going to the Director,“sir, the transport permit is ready, we need to procure the drug, please kindly make the advanced payment.”Director signs one letter and from the in-charge of the department we get one letter to make the necessary arrangements for advance payment and again that copy should go to the purchase section, from there the purchase section to the billing department, again from the billing department, to the accountant and then accountant settles the money, after doing his own format, he will have some work to do, to arrange for payment with the Director…But again if you depend for this dispatch thing from the hospital, they say very silly reasons saying that we don’t have envelope covers, or we don’t have revenue stamps or some stamps to attach, so today this dispatch guy didn’t come, so this person did not come, who will go and post it and come? So again it takes another 3, 4 days or 1 week delay … And then finally, they send the drug. So because it’s a big parcel it takes minimum 1 week to 10 days to reach us…finally our stock is ready in the pharmacy. And even though our stock is ready in the Pharmacy, we can’t just like that open the stock and use it. Again there’s a process. We have to call the Drug Inspector who has come and make the report initially and submit it to the Director of Drug Controller, he should come, we should call him, he will not be available on the phone, he will not take the calls, and we should call him repeatedly, one week, minimum 3 to 4 days we have to call him. Once it took 15 days also, we have stock in the hospital and we are unable to open the stock and use it.”

And that is not all. The nightmare is unending. Read the paper by Virginia LeBaron and colleagues in The Oncologist 2014;19:1–8.

The recent amendment of the NDPS act will change some things. Only some things. It is going to be a long and hard struggle to change mindsets. Thank you Virginia and colleagues for doing this work in India and to help focus attention on this issue.