Imagine a world where however bad the pain, the strongest pain killer is just paracetamol.
When Hospice Africa started in Kampala, Uganda, in September 1993 this was the reality for Bashir, aged 8. Bashir had cancer and had just had his arm amputated. and was in dreadful pain. He was one the first to be helped through our partner, Hospice Africa Uganda, so that his last days were spent pain free, at home with his family.
In the early days the morphine could only be prescribed by a doctor, but Uganda has a shortage of doctors. Indeed, many Ugandans, especially the poor or those in rural areas, never see a health professional. To overcome this problem, HAU through Dr. Jack Jagwe, a former adviser to the Ugandan Health Ministry, lobbied the Ugandan Government to amended its rigid narcotics laws, allowing nurses trained by HAU to prescribe morphine to cancer patients without having a doctor present, which proves essential in delivering morphine to patients in rural areas who are unable to trek long distances to city clinics.
HAU, produced its own morphine formulation in the pharmacy at Makindye. Initially it was made up into colour coded strengths easy for the patients to recognise. Oral morphine solution is highly effective in the fight against pain. It is non-addictive, cheap simple to prepare and easily understood by the patient and their carers. Costs per-patient for pain-control are now estimated to be about $1 per week. That experience, though still a work in progress, should be a model for other resource-challenged countries. Now HAU prepares morphine for all of Uganda in a modern environment. Gradually the “Merriman formula” has spread and oral morphine is slowly becoming available in other African countries.