Back in 2010, I went to see this lovely woman seated here, Dina. At the time she was living with her brother in Kigali, close to a local hospital. She was poor, from a rural village, and dying with Gastric cancer. Like like so many people, she presented for care at a late stage in her illness, and once it was realized there was no hope for cure... She was sent home with only Acetaminophen. At that time, there was no formal home care program in Kigali, except for the small fledgling effort of my friend "nurse Grace." It was with Grace, and Dr. Dan that we went to see Dina.
We found Dina lying listless in the back room, moaning softly. Well cared for and loved by her brother, but profoundly suffering. Her beautiful sprit imprisoned by pain.
We asked Dina what she was hoping for...And I'll never forget her words...She said in Kinyarwanda, "If this medicine can help just a little, maybe I can sit up and sing to God, and maybe...maybe I can return to my village to see my children one last time."
We gave her only a teaspoon (about 5mg) of a morphine we had managed to purchase at a local hospital where we miraculously obtained the only tablets available - just a small number of 10mg tablets. Of course we purchased as many as we could, then crushed and dissolved them in a water solution, as we had heard her swallow was worsening.
Well, 20 minutes after the morphine, Dina's countenance lifted, she smiled a little, and then whispered softly in Grace's ear. At that point, slowly and deliberately Dina sat up and sang, as if her spirit had been somehow liberated.
"Imana Iman' irabize ~ Imana Iman' irabize" God will provide (what man can not)"
The bitter irony is that we human beings do know how to effectively and safely control cancer pain. Yet as Ronald Piana so poignantly articulates in his NY Times article cited here,
"Untreated cancer pain is a human disaster not unlike famine;
its victims are starving for relief."
At Hospice WIthout Borders, We're doing our best to change that, and as you can read in our prior posts, after 4 years of sustained effort, the Rwandan Ministry of health is now manufacturing morphine solution for people like Dina, whose spirits are starving for relief. Please read Mr. Piana's inspiring article, and join us in our effort insure that every human being has equal access to pain control. No one should be "Dying Without Morphine!"
This is one of the very first bottles of oral morphine we produced in Rwanda on November 13th, 2014. When all the calculations were done, we determined it costs about 15 cents in USD per day to achieve pain relief for a patient suffering with severe pain related to progressive incurable cancer and or HIV/AIDS.
15 cents! In many of the villages where we work in Rwanda, 15 cents is not trivial. It equals about 100 Rwandan Francs, and this is about the cost of taxi bus fare across town in Kigali. Yet 15 cents is affordable for most people; moreover, the Ministry of Health lists Morphine as an "essential medicine," indispensable to the relief of moderate to severe pain (see the WHO definition and list of Essential Medicines). That means all Rwandese citizens should be able to access to opioid analgesics when clinically indicated. For us at HWB, increasing the availability and accessibility of oral morphine in countries like Rwanda is important, because 15 cents is doable, and thus even a small organization like ours can make a difference on the ground, in the lives of individual human beings. And of course word gets around: Once people begin to experience first hand the benefit of pain control - the people themselves begin to demand access, and the pain gap begins to close! Visit our friends at Treat the Pain, to learn more!
~ Buhoro buhoro ni rwo rugendo ~ together we take the journey~
For the benefit of those we meet along the path, we must work in solidarity!
Many of our patients are widowed genocide survivors with HIV: HIV and often concomitant cancer. These are strong resilient women living under difficult circumstances; women who must work often low wage day jobs simply to survive day to day, and more often than not, this means working in pain.
Of course, most of our palliative care patients lost family members to the 1994 genocide, and many more since then to illness. These people often now find themselves alone, sick themselves,
suffering, and destitute.
Please support our effort to insure that all people have access to pain control, and please remember what I share here: On average, a pain free day with oral morphine costs only 15 cents, and that can mean the difference between being able to get out and work and being trapped in pain and poverty.
Global State of Pain Relief.pdf
Adobe Acrobat Document [1.8 MB]
Turi Kumwe ~ We are Together!
Hospice without borders is pleased to announce that our colleagues from Rwanda will be traveling to Kampala later this month to work with Hospice Africa Uganda (HAU), and further expand their expertise in the production and distribution of oral morphine solution for palliative care and hospice patients in Rwanda living with moderate to severe pain.
Vedaste Habyalimana, lead Quality Control Pharmacist for the republic of Rwanda, is shown here at left touring Jean Claude Tayari and David Slack through the testing unit at the Labophar production facility.
Most important to their upcoming trip, Vedaste and Richard Gatera, the chief production pharmacist at Labophar, will be making visits to the homes of hospice patients. In those homes, on the ground, they will see firsthand the power of oral morphine to improve the quality of life for those people suffering with incurable illness and crippling pain. At HWB, we are grateful for the opportunity to work in solidarity with leaders such as Vedaste and Richard, who are committed to improving access to opioid analgesics for all the people in Rwanda living with incurable illness and severe pain. Turi Kumwe!