Tens of thousands lack pain medication in Senegal (Update)

by Krista Larson

Tens of thousands of people in Senegal struggling with advanced cancer and other illnesses are left with only basic headache medicines to treat their pain because the country does not have enough morphine in stock, according to a report released Thursday.

Only about 1 kilogram (2.2 pounds) of the powerful opioid drug is available each year in the West African country—enough for less than 200 people, Human Rights Watch found. As a result, those already confronting the pain of death are now spending their final months often unable to even sleep or eat because of their agony.

Fatoumata Seck, a 33-year-old woman from Mali battling advanced cervical cancer, described her pain without morphine as "infernal." She told Human Rights Watch it was "by far the worst pain" she'd ever felt in her life, even after having delivered six babies.

Morphine's use has long been strictly regulated because of the potential for addiction and overdose. Advocates, though, say as a result people in the final stages of cancer are needlessly dying in excruciating pain.

As in many countries in West Africa, Senegalese families struggle to pay not only the costs of medical care but also for travel expenses to hospitals and clinics in the capital. Many patients are diagnosed in the advanced stages of cancer because early screening is not available or out of reach financially.

"Unless palliative care becomes available near their homes, these people will continue to die in horrific circumstances when they fall ill with cancer or other chronic illnesses," the report said.

Senegal's National Pharmacy says it has added oral morphine tablets to its 2012 essential medicines list and plans to begin importing more of it later this year.

Government regulations, though, still require patients to get the drug from only a limited number of regional and national hospitals. Restrictions on prescriptions also mean families must refill morphine weekly.

And even when family members do make the journey, sometimes they find the drug is not in stock. Only a handful of places have oral morphine at all, and the report found the "complication authorization and important process creates many opportunities for delays."

Alboury Seck told HRW during one morphine shortage he sent a relative abroad in hopes he could bring back some of the drug. He rationed his remaining pills but nothing else could keep the pain from advanced prostate cancer at bay.

"I tried to bear the pain for two to three days, and when I could not handle it, I would take one pill," he said. "I went to all the pharmacies and they do not sell it. I tried to use Tylenol, Motrin, it is the only thing I have with me. Two, three, four times a day, but it is not enough. Only the morphine works."

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