Providing Comfort: Initiating Palliative Care in Developing Countries

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SEATTLE — Palliative care—specialized medical care for those with a serious or terminal illness—is a common practice in most developed nations. Pain relief from debilitating illness, mental health care, counseling and hospice care are often accessible for patients and their families. However, for those living in developing nations, comfort medical care is rarely available. Palliative care in developing countries is gaining more attention, yet still faces additional hurdles in becoming a mainstream practice.

The Current State of Palliative Care in Developing Countries

Globally, diagnoses of cancer and other chronic diseases are growing, yet 80 percent of the world does not have access to sufficient pain management. Morphine, listed by the World Health Organization as an essential pain-relieving drug, costs very little to manufacture. However, more than 150 countries, including 5 million people with terminal cancer, still do not have access to this cheap and efficient pain management option.

Of the nearly 58 million people who die every year, 45 million die in developing countries. Factoring in chronic illness statistics, it is estimated that 60 percent of those who die in developing countries would benefit from proper palliative care. A large part of the issue in procuring pain-relieving medications such as morphine lies in the extremely restrictive policies of many developing nations.

For countries such as Egypt, India and Colombia, the attack on addiction and illicit use of morphine have become so great that it is affecting the ability for chronically ill patients to receive the drug. In 2008, morphine in India was so heavily restricted that only 4 percent of the 1 million people suffering from cancer were able to receive pain relief treatment.

The Impact of Opioid Addiction

There is a substantial divide between developed and developing countries when it comes to the relief of chronic illness pain. In the United States, narcotic pain-relievers are produced or imported at 31 times the amount needed. In contrast, China receives 16 percent of the needed amount of pain-relievers, Russia receives 8 percent, Haiti is at 1 percent and Nigeria receives 0.2 percent of its need.

Palliative care in developing countries faces multiple hurdles in the form of funding, social stigma around opioid pain-relievers and resources. Perhaps the most pressing issue to overcome is that of legislation and government investment in palliative care. Most developing countries do not have laws outlining palliative care as part of the health care system, resulting in expensive care if a patient can receive it at all.

Additionally, many western legislators oppose the use of opioid pain-relieving drugs in developing countries based on the fact that the United States is experiencing an opioid addiction epidemic. Meg O’Brien of Treat the Pain, an organization that works to improve access to pain medicines, commented on the anti-drug stance of western drug boards, telling the New York Times, “That has a chilling effect on developing countries. But it’s ridiculous — the U.S. also has an obesity epidemic, but no one is proposing that we withhold food aid from South Sudan.”

Solutions

Palliative care in developing countries has been an uphill battle for years, especially with the recent rise of opiophobia—the fear that the use of opioid medication will inherently lead to an addiction crisis. While palliative care is far from being a common practice in poorer nations, there are certain organizations and individuals working to make comfort medical care a reality.

The Worldwide Hospice Palliative Care Alliance (WHPCA) is an international NGO that focuses solely on global hospice and palliative care development. WHPCA aims to remove the stigma surrounding palliative care in order to create societies where no one living with or dying from a chronic illness must do so in pain. By partnering with multiple international programs, WHPCA is actively working to make palliative care for developing countries an integral part of the global health system.

Palliative care in Mongolia is getting more attention thanks to the efforts of Dr. Odontuya Davaasuren, who acts as the “mother of palliative care” in Mongolia. Through her advocacy, she was able to establish the Mongolian Palliative Care Society and the Palliative Care Resource Training Center in Mongolia. With these programs, Davaasuren implements new strategies for Mongolia’s palliative care policy and pain-relieving drug availability.

No one deserves to be in extreme pain from chronic illness just because they happen to live in a developing country. While millions currently live and die each year in preventable pain, the tide is slowly turning in favor of palliative care. With organizations such as Treat the Pain and WHPCA and individuals like Dr. Davaasuren advocating for the human right to pain relief and comfort care, palliative care in developing countries is getting the attention it needs to become truly mainstream.

– Holli Flanagan
Photo: Flickr

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