Stop ’Russian Roulette’ for patients and physicians

Categories: Opinion.

In Moscow, on 7 February 2014, Admiral Vyacheslav Apanasenko shot himself with a pistol. The Admiral left a suicide note that clearly indicated his reasons. He wrote: “I do not want to blame anyone but the Ministry of Health and the Government. I am ready to suffer, but seeing the suffering of my relatives is unbearable”.

Barriers to accessing pain medication

The Admiral suffered from end-stage pancreatic cancer. Irina Apanasenko, the Admiral’s widow, said her husband had suffered from pain every single day after a surgical procedure. However, the Admiral believed that he must endure his pain. When the pain became intolerable, he approached the physician at the local polyclinic, where Tramadol was prescribed for him, but did not help.

After much persuasion, a physician prescribed Duragesik that had a little effect. Later, a hospice physician visited the Admiral at his home and recommended adding morphine. But the Admiral could only get a prescription for morphine at the local polyclinic. Mrs Apanasenko spent many hours at the polyclinic going from one doctor to another gathering the necessary signatures and a special form to get the prescription for the opioid analgesic and its correct dosage.  Finally, the exhausted woman went to the 7th floor to the medical director for her signature and for the official stamp of the polyclinic, but the medical director was not in her office. Meanwhile, the polyclinic closed and any hope to receive the needed morphine was lost for the day.

Where does responsibility lie?

The Russian Society of Officers-Submariners noted in their obituary that Admiral did not die from the disease, but rather that he was executed by the national health care system. They stated: “Not sea depths, nor radiation of nuclear submarines, nor the bureaucracy of the Ministry of Defense was able to destroy him, but overwhelming formalities created by the Russian Ministry of Health led the Admiral to commit suicide.”  

The Admiral’s suicide had a ripple effect – many people began to accuse officials from the Ministry of Health (MoH) and the Federal Service of Drug Control (FSDC) of creating an intolerable obstruction in the treatment of pain. Many asked the same question: “If an Admiral cannot receive proper pain treatment in Moscow, what can we assume is happening to ordinary people in small cities and villages?”

The FSDC has denied these claims, stating on their website: “We consistently pursue a policy of humanization of regulations for prescriptions of opioids for patients with severe pain,” and that they had sent a proposal one year ago to the MoH, containing recommendations on how to simplify access to painkillers.

However, real life suggests that despite these professed efforts to streamline access, patients and their families still find it almost impossible to access adequate pain relief.

Doctor’s ordeal continues

Alongside Admiral Apanasenko’s high-profile case, Dr Alevtina Khorinyak is for the second time to appear before a Russian court for writing two Tramadol prescriptions in 2009 to relieve the intolerable pain of a terminally ill cancer patient, Victor Sechin. Anastasia Sechin, Victor’s mother, says that her son had severe pain and that he could not sleep for days. Victor’s mother feared nights the most, when Victor even lost consciousness from his pain. Anastasia cannot forget the kindness of the two ladies, Alevtina and a close friend of the family, who helped her son and did not let Victor die in pain.

The Sechin family, Dr Alevtina Khorinyak, and her helper are parishioners of the Evangelical Christian Baptists. Victor had suffered from spinal myopathy since childhood and was bedridden. However, he graduated secondary school with honors through home schooling. He read a lot, thought deeply about life and never complained. All these people met at the church and had helped Victor for over 20 years.

However, according to the authorities, all of these people are members of a criminal community and pose a threat to society.

Starting the conversation

After Admiral Apanasenko’s death, Russians are finally starting to discuss the problem of pain relief. More and more people understand that adequate pain management and the manner in which society treats sick people are issues associated with social norms and moral values. Unfortunately, these values have not yet been reflected in the current Russian health care system.

Russian roulette for the suffering people in pain and their physicians should be stopped.

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