RACHEAL NINSIIMA
Norah
Nanziri’s days have fallen short of pain. As she lies on a crowded mattress at
her home in Makindye, she is at ease telling the story of her life from illness
to recovery. The 40-year-old is currently undergoing palliative care for
advanced rectal cancer.
“Before
I started receiving this kind of treatment, I had a lot of pain passing out
waste and sometimes, I passed out only blood and pus,” Nanziri narrates,
“In
fact, I used to hold onto walls for hours when I was easing myself.”
After
rounds to Nsambya and Mulago hospitals yielded no relief, Nanziri finally
settled for Hospice Clinic in Makindye where she was given free chemotherapy
and Morphine, a drug for controlling severe pain. She even underwent spiritual
and psychological rejuvenation through prayers and counselling.
Today,
Nanziri can sit upright and easily excretes notwithstanding the pain she lived
with for a year.
The
World Health Organization defines palliative care as an approach that improves
the quality of a patient’s life facing problems associated with life
threatening illnesses through early identification and treatment of physical,
psychosocial and spiritual pain. It’s usually availed to cancer and HIV/AIDS
patients. Such treatment, while not curative, prolongs life for a considerable
period of time and restores the quality of life.
However,
access to life saving medicines like Morphine for palliative care patients like
Nanziri, is now threatened by anti counterfeiting laws. This was revealed last
week during the launch of ‘The Development of Palliative Care in Uganda’ report
in Kampala.
“This
is increasingly happening through the enactment of legislation in East Africa
ostensibly to fight counterfeits but is in actual sense tightening enforcement
of intellectual property rights as a step towards banning generic drugs,” Binaifer
Nowrojee, the director of the Open Society Initiative for East Africa (OSIEA)
said.
Kenya
enacted such a law in 2008 and the East African community is considering a
regional law that will supersede national laws on anti counterfeiting.
Nowrojee
added that the problem of poor quality medicines will not be contained by enlarging
the application of intellectual property rights in order to ban generic
medicines. Rather, regulatory services need to be strengthened to oversee the
quality, safety and efficacy of medicines on the market.
Palliative care in Uganda
With
an increase in of HIV (130,000 new infections annually) and cancer in Uganda, the
need for palliative care is on the rise.
“No
human right affects us as much as health and caring for people with lifelong
illnesses is a universal challenge. We all need comfort, dignity and freedom
from debilitating physical pain and this is what palliative care ensures,” Nowrojee
says.
The
need for palliative care is intensified by the fact that the health care system
is underfunded with government expenditure providing $1.67(about Shs 5,000) per
person annually and yet the ministry needs at least $4 (about Shs10, 000)
According
to Rose Kiwanuka, the country director for the Palliative Care Association of
Uganda (PCAU), there is a wide gap between health care services in rural and
urban areas and hence the need to extend coverage for palliative care.
Among
the factors slowing down palliative care service provision in Uganda are:
inadequate trained health professionals, lack of clear understanding and
targets for palliative care, inadequate awareness, support and training institutions.
“Palliative
care development requires policies covering the training of health workers,
ensuring that they are legally allowed to prescribe opioids including morphine
and integration of the care into the country’s mainstream clinical services,”
Dr Jacinto Amandua the commissioner of Clinical services in the Ministry of
Health says.
History
Management
of severe pain and symptoms among cancer and HIV/AIDS patients started in 1993
when Dr Anne Merriman, on a feasibility study for a model hospice, introduced palliative
care services.
In
the same year, government imported oral Morphine and services were first
delivered at Nsambya Hospital. Expansion of these services beyond Kampala
started in 1998 with the establishment of Mobile Hospice Mbarara (MHM) and
Little Hospice Hoima (LHH).
Today,
palliative care is spread in over 61 districts and at least one health facility
in each region provides the service.
Despite
the absence of a stand-alone palliative care policy, palliative care is
recognized as an essential clinical service with strategies for expansion in
the 2010 Health Sector Strategic investment Plan (HSSIP).
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