Although many patients in Uganda with Cancer, Tuberculosis (TB) or HIV endure unbearable pain, some of them cannot access orally administered morphine.
According to the World Health Organization (WHO) pain treatment guidelines, HIV, TB and Cancer patients experience severe pain requiring treatment with opioid analgesics, the most commonly used opioid is morphine.
Dr. Emmanuel Luyirika, Executive Director – African Palliative Care Association, explains that analgesics are drugs used to manage extreme pain in treatment of terminally ill patients or in medical procedures.
Morphine also comes from a class of drugs that can cause addiction and therefore its use therefore many medical practitioners are cautious about prescribing them. However Dr. Luyirika says that if the drug is administered for the correct purposes the chances of getting addicted are limited.
Dr. Luyirika says that medical studies show that when administered orally or through injections, the drug obstructs the perception of pain, but it doesn’t treat the cause of pain, which could be diseases like Cancer, or AIDS
Morphine falls under the class of drugs originally derived from the opium of the Poppy plant. Dr. Luyirika explains that opioid attach to proteins called opioid receptors, found in the spinal cord, brain and digestive tract.
This process inhibits the signals sent to the brain that let you know pain is being felt. In effect, they do not take away the source of the pain itself; rather they prevent the perception of pain.
However the drug is widely found in community based care, or in referral hospitals, it is rare for Health Centre’s three and four to stock morphine, yet some patients with severe pain make their initial contact with these facilities.
A visit to Naguru Hospital revealed that the hospital does not administer Morphine, neither is the drug stocked. Principal Nursing Officer (PNO) Sr.Vanice Katusiime says this is not an oversight, since when patients are diagnosed with a terminal condition; they are transferred to referral hospitals.
On whether health care givers have skills on pain management to care for patients with severe pain before they are transferred, Katusiime says that it is mandatory for all the nursing and medical staff to have knowledge on palliative care.
In Uganda, Morphine is produced and packaged by Hospice Africa – Uganda, a local NGO. It imports the opium in powder form from Scotland, processes it into liquid and packages. The drug is then taken to National Medical Stores (NMS) and the church-funded Joint Medical Stores.