Morphine's Reputation As A Dangerous Drug Is Being Challenged By Uganda : Goats and Soda Uganda is challenging morphine's reputation as an archaic, dangerous drug — and inspiring other African countries to do the same.
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A Sip Of Morphine: Uganda's Old-School Solution To A Shortage Of Painkillers

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A Sip Of Morphine: Uganda's Old-School Solution To A Shortage Of Painkillers

A Sip Of Morphine: Uganda's Old-School Solution To A Shortage Of Painkillers

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DAVID GREENE, HOST:

Across Africa, patients experiencing extreme pain often don't get access to adequate medication. One country, Uganda, has found this creative solution. NPR's Nurith Aizenman explains.

NURITH AIZENMAN, BYLINE: Dr. Chimwemwe Kabaghe is in an SUV, bumping along a rutted road in Uganda's capital, Kampala. Kabaghe is visiting from the nearby nation of Malawi. And she explains that she's made this trip because of an encounter she once had with a hospital patient who was dying.

CHIMWEMWE KABAGHE: This lady was constantly crying.

AIZENMAN: Her body was riddled with painful tumors.

KABAGHE: She wasn't eating. She wasn't sleeping. She was just constantly crying in pain.

AIZENMAN: In Malawi's hospitals, this kind of suffering is par for the course. As in many African countries, doctors there generally don't have options beyond painkillers like ibuprofen. The woman's screams weren't even getting her much sympathy - just stressing the staff out.

KABAGHE: Everyone in the ward was angry with her.

AIZENMAN: Then, by chance, a colleague of Dr. Kabaghe's suggested a low-tech but potent solution - liquid morphine. It's essentially a mixture of powdered morphine and water that's recently been legalized for prescription in Malawi.

KABAGHE: And I was like, is that safe? Is that OK?

AIZENMAN: Morphine has a reputation.

KABAGHE: This is a very dangerous drug because it comes from opium. So maybe it's like there's something that addictive about it or maybe it kill the patient.

AIZENMAN: But after Kabaghe did some research, she was reassured that those risks were low, so she gave the woman the morphine.

KABAGHE: It worked almost immediately. Like, within, like, 10 minutes, she quieted down. You could see her face, that her face is more peaceful. And I think she was able to then die peacefully.

AIZENMAN: And this led Kabaghe to a life-changing conclusion - the shortage of painkillers in Africa had made health workers like her lose sight of the value of just making sure their patients are comfortable.

KABAGHE: I saw how it was really, really beneficial for people to not be in pain.

AIZENMAN: Which is what's brought Kapadia here to Uganda. She's shadowing a Ugandan nurse who's delivering liquid morphine to patients who are too sick to come into a clinic.

JOSEPHINE NABITAKA: So this is the home.

AIZENMAN: Their first stop is at the house of an 81-year-old woman with advanced colorectal cancer. They find her curled up in bed, a mosquito net hanging over her.

NABITAKA: (Non-English language spoken).

UNIDENTIFIED PERSON: (Non-English language spoken).

AIZENMAN: The nurse, Josephine Nabitaka, speaks to the woman softly, asking her if the morphine is still working.

NABITAKA: (Non-English language spoken).

AIZENMAN: Then, Nabitaka takes a look at the card where doses are being logged.

NABITAKA: OK. Whenever we come to the home, before we leave, we have to check on their balance of the medication.

AIZENMAN: Nabitaka is with Hospice Africa, a nonprofit that has helped Uganda's government set up a whole system for manufacturing liquid morphine, then providing the bottles to patients for free so they can drink it at home.

NABITAKA: It's two - this is 2.5.

KABAGHE: Yeah.

AIZENMAN: Dr. Chimwemwe Kabaghe has come to see them in action. She's one of a stream of visitors from more than a dozen African countries who've made pilgrimages like this to learn from Uganda. Dr. Emmanuel Luyirika heads the African Palliative Care Association, a nonprofit that's trying to get more countries to adopt Uganda's model.

EMMANUEL LUYIRIKA: They come here. They see what Uganda does.

AIZENMAN: And he says a handful have taken inspiration. Malawi is one of several countries that have now legalized the importation of liquid morphine. Botswana, Rwanda and Swaziland are even covering the cost for patients. But overall, says Luyirika, when it comes to actually getting morphine to patients, progress has been glacial.

LUYIRIKA: We have countries in Africa where the amount of morphine that they import meets almost zero of their need.

AIZENMAN: In Uganda, only about 11% of patients who need liquid morphine are getting it.

LUYIRIKA: And people think that Uganda is doing well.

AIZENMAN: Luyirika says the biggest problem is there's not enough funding for everything from buying the drug to training medical staff on how to use it.

LUYIRIKA: Even where you have access to liquid morphine, you need personnel who will be able to go to the home of the patient.

AIZENMAN: Compared to health programs that save lives, he says, efforts to reduce patients' pain are just a much lower priority for African governments and for international donors, which is maddening to Luyirika because pain management through liquid morphine is cheap - $2.50 for a week's supply.

LUYIRIKA: We don't need a lot of money.

(SOUNDBITE OF ENGINE REVVING)

AIZENMAN: Back in the car, Dr. Chimwemwe Kabaghe, the doctor from Malawi, says she recently took a post as her government's main contact on pain management for the terminally ill, what's called palliative care.

KABAGHE: So I'm trying to be the one who will make the Ministry of Health sort of, like, take initiative.

AIZENMAN: But she says her main challenge will be to get more of her fellow health workers to recognize the importance of focusing on their patients' pain. Otherwise, her own experience has shown her that even when you're told liquid morphine is an option...

KABAGHE: You're just like, hmm, no. Maybe not. Maybe let's just stick to the things that we know.

AIZENMAN: There has to be a mindset change, she says, and not just in Malawi, across Africa. Nurith Aizenman, NPR News.

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