Palliative care activist addresses UNGASS plenary

Categories: Policy.

I want to share my late brother’s story, a common one in low and middle income countries. In 1991 my brother, Harun, was diagnosed with Leukemia at age 31. His last two weeks were horrific. His three children remember: “Baba was always in pain.”

As a young physician, I felt helpless to relieve his pain.

Injectable pethidine was the only strong opioid then available in Kenya. But his doctor refused to use this.

Our beloved Harun lingered in excruciating pain. I held his hand as he died, but was haunted long after by anger and guilt.

Why was my brother, like millions of others, denied access to adequate pain relief?

Because, the substances needed to treat his pain – recognised as essential medicines by the World Health Organization – are also subject to control under the UN Commission for Narcotic Drugs.

Morphine, for example, is the gold standard for the treatment of severe pain, and is included in the WHO List of Essential Medicines.

Under the universal right to health, essential medicines must always be accessible, available, and affordable.

Yet, the International Narcotics Control Board estimates more than 75% of the world population has no access to pain medications.

Efforts to create a ‘Drug-Free World’ have resulted in profound imbalance in policy and significant harms, leaving many millions in pain and with substance-use disorders, without the medicines they need.

As representatives of civil society, we call for a different approach.

The African Union Common Position recognises that the world drug problem requires an “integrated approach to drug supply; demand reduction and harm reduction strategies, as well as ensuring the availability of controlled substances for medical and scientific use.”

It calls for: “greater support to ensure the provision of opiates and other essential and controlled medicines for palliative care and pain relief.”

Governments, drug-law enforcement and health sectors must collaborate to ensure this vision: Re-allocate resources for palliative care and drug dependence. Pursue alternative solutions for minor offences.

Kenya has come a long way since my brother’s painful death. Kenya’s National Patients’ Rights Charter now recognises palliative care and pain relief as a human right.

Kenya’s Ministry of Health purchased 50 kilograms of morphine for distribution to hospice and public and mission hospitals, although this is just 10% of what is needed.

Yet the vast majority of countries in the world, including Kenya, still face barriers, including: healthcare providers’ lack of knowledge and skills; attitudes; punitive laws; lack of public awareness, and poverty.

Knowing their disease may not be treated; patients suffer psychological and physical pain, which violates the essence of their humanity.

We must not wait until we ourselves, or dear relatives like my late brother are stricken.

We, in this building this week, have the will, compassion and expertise to ensure progress towards universal access to pain relief.

We all have a duty to end unnecessary suffering, and we should start today.