What do Goa & Guatemala Have in Common?

The natural beauty of the land of course. But apart from that?

They share the pain and sorrow of man-made suffering in the face of disease.

Liliana DeLima, the executive director of IAHPC (www.hospicecare.com) writes about the “archaic restrictive laws” in Guatemala that prevented access to pain relief even in the face of a disease like advanced cancer. It almost reads like a horror story.

1. A representative of the National Competent Authority has to carry out visual inspections to ALL patients who are prescribed opioids. During this visit, the government representative verifies if the patients is really sick, verifies the amount prescribed, the amount dispensed and the amount taken by the patient to supposedly certify that no diversion has occured.
2. All physicians who prescribe need to submit monthly reports to the MOH with the names of the patients they prescribed opioids for, the diagnosis, the total amount in the month, the dates of prescription, the quantity and the formulation.
3. Patients who need opioids HAVE to travel to the capital to get their prescription stamped and approved by the NCA office – regardless of where in the country they are located. They have to travel each time with their prescription, get it stamped (confirmed as legal by the NCA) and then they can go to a pharmacy to buy it.

Fortunately, things have changed for the better in Guatemala very recently, and some of the restrictions have removed. But we have not done so well in Goa, the tiny beautiful coastal state in India.

In 1998, the Government of India asked all Indian states to simplify their narcotic regulations following a model structure. Goa is one of the 14 which did. But Goa effectively thwarted the purpose of the amendment by bringing in new barriers. The Goan with advanced cancer is forced to take every prescription to the Directorate and “apply” for a permit. He can buy the drug only when the permit is issued!

Good News from Vienna

The United Nations’ Commission on Narcotic Drugs (CND) met last week in Vienna.

Thanks to advocacy by several agencies, most noticeably Human Rights Watch, the commission has recognised that its role is not only to control narcotic drugs but also to ensure its availability for medical purposes.

Human Rights Watch conducted a side-event promoting the global need for opioids for pain relief which was attended by several organizations including PPSG and the Access to Control program of WHO and about 70 CND delegates from all over the world. HRW statements: Day 3: statement to the plenary & Day 4: supply reduction plenary

At the CND meeting, Mr Costa from UNODC highlighted [PDF] the need for improvement in opioid availability for pain relief.

The week long meeting passed a resolution “Promoting adequate availability of internationally controlled licit drugs for medical and scientific purposes while preventing their diversion and abuse.” [PDF]

We are sure it will be a powerful tool in our advocacy for pain relief.

News from the Opioid Availability Front

We have been blessed for a long time by strong support from the Department of Revenue and from the Narcotics Commissioner (and many other authorities) of the Government of India. The new desk calendar produced by the Narcotics Commissioner of India attracted international attention during the CND meeting at Vienna. It carries a slogan “Opium for Pain and Palliative Care”. Congratulations and thank you, Mrs Jagjit Pavadia!

So far in India, manufacturing of opiumand morphine from poppy has been the monopoly of the Government of India. In recent years, there has been a move to privatize this. We had a concern that this would steeply increase the cost of morphine. We now learn that the process of privatization has been delayed. The two firms which had initially come forward seem to have backed out. While the Government is still proceeding with the decision to privatize, it may take some considerable time to materialize.

Prestigious Award to Kathleen Foley

The Global Palliative care community rejoices the decision of the International Association for Study of Pain (IASP) that its John D. Loeser Distinguished Lecture Award goes to Dr Kathleen Foley. Dr Foley is an attending neurologist in the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center in New York City.

In IASP’s words,

the award recognizes work that gives new perspectives to understanding the experiences of pain and that opens the door to future reductions in suffering…

She is professor of Neurology, Neuroscience and Clinical Pharmacology at Weill Medical College of Cornell University, and holds the chair of the Society of the Memorial Sloan-Kettering Cancer Center in Pain Research. All that is how she is described in IASP’s newsletter. Let us provide our own six-word description of Kathy Foley:

She knows. She understands. She cares!

Congratulations, Kathy, and thank you for all that you are doing for this world.

Watch Dr Foley’s lecture “Pain and Palliative Care: What the Future Holds”

Annual Conference of IAPC at Lucknow

Mr Piyush Gupta of Cancer Aid Society, the organizing secretary of the next conference of the Indian Association of Palliative Care (IAPC) at Lucknow (U.P) on 11-13 February 2011 invites you to visit the conference website www.iapcon2011.com and to save money by availing the facility of early bird registration.

Last date Extended for Pallcare India Project

Pallium India has invited applications from cancer centers and Medical Colleges in North and North-East India for a project funded by Savitri Waney Trust, Farida &Yusuf Hamied Foundation and Bruce Davis Trust.

Please note that the last date for receipt of applications has been extended to 30 March 2010.

For details, see http://palliumindia.org/projects/pallcare

Leadership Development Initiative (LDI) at San Diego

San Diego Hospice and Open Society Institute together organized a Leadership Development Course for Palliative Care professionals from 15 different countries at San Diego, California.

Dr Priya Kulkarni from Cipla Hospice, one of the doctors who attended the course (the others from India were Dr Gayatri Palat and Dr Anil Paleri) writes about her experience.

We had the opportunity to learn from eminent teachers like Dr Frank Ferris, Dr Charles Von Gunten, Dr Kathy Foley, Dr Mary Callway, Dr Liliana De Lima and Dr Joe Harford.

A few of the things that I learnt from this course:

• Leadership may be by chance or by choice
• Identifying different personality types helps in dealing with team members as required.
• SWOT analysis (Strengths – Weaknesses-Opportunities – Threats) permits self analysis at depth.
• Developing a plan for individual development was thought provoking.
• Presentations related to Situation analysis from different countries and different individuals identified the similarities as well as country-specific problems.
• Presence of a Theatre and Drama person during the course helped us to make conscious efforts to learn presentation skills.

All the arrangements were excellent. It looked like a perfect team, all members performing in perfect synchronization with each other.

The Olbermann Videos

The ugly face of politics can distort any truth. In the recent American controversy which culminated at Blair House on the 25th of February 2010, palliative care services came to be called “death panels”!

You must watch Keith Olbermann’s “Countdown” at MSNBC where he describes his father’s experience in a hospital and proclaims that palliative care is indeed a “life panel”!

Please visit our blog and you will be able to watch the Keith Olbermann videos:

• An American Cry for Help
• Respecting Pain & Patient

Sadly, Mr Olbermann Sr passed away last weekend, read Keith’s tribute here…

Dignity and the Essence of Medicine

Olbermann’s description of his father’s experience brings to mind the following quote from Chochinov (BMJ.2007.335; 184-7):

“Treating a patient’s severe arthritis and not knowing their core identity as a musician; providing care to a woman with metastatic breast cancer and not knowing she is the sole carer for two young children; attempting to support a dying patient and not knowing he or she is devoutly religious — each of these scenarios is equivalent to attempting to operate in the dark.”

Conveying powerful messages about untreated pain and about end-of-life decisions. Very very powerful.

Of course it is all about USA.

So when you have finished watching it, please give yourself a minute to think about 80% of the world – the developing world.

What sort of torture goes on there?

Thank Heavens there are some clear headed people. Please see the touching video featuring Keith Olbermann on US TV, you cannot afford to miss it!

A Special Comment From My Father

I’m focusing on one thing in tonight’s Comment. The night my father asked me to stop his treatment. All Americans should be able to make medical decisions free of worry about cost…

This is not the central fact around which tomorrow’s health care summit at Blair House will, or should, revolve. But I’d like it on the record somewhere that I asked all those going there, including the President, to think more about people like my father – patients, in our hospitals, at this moment – and less about elections and political points and “crashing the party.” – Read the full transcript here…

Watch another Special Comment: “Respecting pain and patient”