jorder1010
Bluelighter
- Joined
- Nov 13, 2004
- Messages
- 885
Although the rainy season is coming on fast, Zainabu Sesay is in no shape to help her husband. Ditches must be dug to protect their cassava and peanuts, and their mud hut's palm roof is sliding off.
But Sesay is sick. She has breast cancer in a form that Western doctors rarely see anymore - the tumor has burst through her skin, looking like a putrid head of cauliflower weeping small amounts of blood at its edges.
"It bone! It booonnnne lie de fi-yuh!" she says of the pain - it burns like fire - in Krio, the English-African blend spoken in this country where British colonizers resettled freed slaves.
No one has told her directly yet, but there is no hope - the cancer is also in her lymph glands and ribs.
Like millions of others in the world's poorest countries, she is fated to die in pain. She cannot get the drug she needs, one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source - the opium poppy. She cannot get morphine.
That is not merely because of her poverty, or that of Sierra Leone. Narcotics incite fear: Doctors fear addicting patients, law-enforcement officials fear drug crime, and members of the government elite who can afford medicine for themselves are indifferent to the sufferings of the poor.
The World Health Organization estimates that 4.8 million people a year with moderate to severe cancer pain receive no appropriate treatment. Nor do another 1.4 million with late-stage AIDS. For other causes of lingering pain - burns, car accidents, gunshots, diabetic nerve damage, sickle-cell disease and so on - it issues no estimates but believes that millions go untreated.
Figures gathered by the International Narcotics Control Board, a United Nations agency, make it clear: Citizens of rich nations suffer less. Six countries - the United States, Canada, France, Germany, the United Kingdom and Australia - consumed 79 percent of the world's morphine according to a 2005 estimate. The poor and middle-income countries where 80 percent of the world's people live consumed only about 6 percent.
Some countries imported virtually none. "Even if the president gets cancer pain, he will get no analgesia," said Willem Scholten, a WHO official who studies the issue.
In 2004, consumption of morphine per person in the United States was about 17,000 times that in Sierra Leone.
At pain conferences, doctors from Africa describe patients whose pain is so bad that they have chosen other remedies: hanging themselves or throwing themselves in front of trucks.
Westerners tend to assume that most people in tropical countries die of malaria, AIDS, worm diseases and unpronounceable ills. But as vaccines, antibiotics and AIDS drugs become more common, more and more are surviving past measles, infections, birth complications and other sources of a quick death. They grow old enough to die slowly of cancer.
About half the six million cancer deaths in the world last year were in poor countries, and most diagnoses were made late, when death was inevitable. But first, there was agony. About 80 percent of all cancer victims suffer severe pain, the WHO estimates, as do half of those dying of AIDS.
Morphine's raw ingredient, opium, is not in short supply. Poppies are grown for heroin, of course, in Afghanistan and elsewhere. But vast fields for morphine and codeine are also grown in India, Turkey, France, Australia and other countries.
Nor is it expensive, even by third world standards. One hospice in Uganda, for example, mixes its own liquid morphine so cheaply that a three-week supply costs less than a loaf of bread.
Nonetheless, it is still routinely denied.
"It's the intense fear of addiction, which is often misunderstood," said David Joranson, director of the Pain Policy Study Group at the University of Wisconsin's medical school, who has worked to change drugs laws around the world. "Pain relief hasn't been given as much attention as the war on drugs has."
Third world doctors, he explained, often have beliefs about narcotics that prevailed in Western medical schools decades ago - that they are inevitably addictive, carry high risks of killing patients and must be used sparingly, even if patients suffer.
Pain experts argue that it is cruel to deny them to the dying and that patients who recover from pain can usually be weaned off. Withdrawal symptoms are inevitable, they say - as they are if a diabetic stops insulin. But benefits outweigh the risks.
In Sesay's case, Alfred Lewis, a nurse from Shepherd's Hospice, is doing what he can to ease her last days.
When he first saw her, her tumor was wrapped with clay and leaves prescribed by a local healer. The smell of her rotting skin shamed her.
She had seen a doctor at one of many low-cost "Indian clinics" who pulled at the breast with forceps so hard that she screamed, misdiagnosed her tumor as an infected boil, and gave her an injection in her buttocks that abscessed, adding to her misery.
Nothing can be done about the tumor, Lewis explained quietly. "All the bleeders are open," he said. "Her risk now is hemorrhage. Only a knife-crazy surgeon would attend to her."
Earlier diagnosis would probably not have changed her fate. Sierra Leone has no CAT scanners, and only one private hospital offers chemotherapy drug treatment. The Sesays are sharecroppers; they have no money.
So Lewis was making a daily 10-mile trip from Freetown, the capital, to change her dressing, sprinkle on antibiotics and talk to her. He asks a neighbor to plait her hair for her, so she will look pretty. Sesay says she can't be bothered.
"It's necessary for to cope," he says. "For to strive for be happy."
"I 'fraid for my life," she says.
"Are you 'fraid for die?"
"No, I not 'fraid. I ready."
"So what is your relationship to God? You good with God?"
"I pray me one."
He asks her, half-jokingly, whether she still has sex with her husband. No, she says. Since the illness, he stays in his room and she stays in hers. She, too, is joking. In their hut, there is only the one.
Life has become hard, she adds, and her husband is getting too old for farm labor. She, too, is getting old, she says - she is somewhere in her 40s. "We are really being punish."
For her pain, Lewis gives her generic Tylenol and tramadol, a relative of codeine that is only 10 percent as potent as morphine. It is all he can offer.
"I would consider putting her on morphine now," Lewis says. "If we had morphine,"
Fear of morphine dooms third world poor to die painfully
International Herald Tribune
September 9, 2007
But Sesay is sick. She has breast cancer in a form that Western doctors rarely see anymore - the tumor has burst through her skin, looking like a putrid head of cauliflower weeping small amounts of blood at its edges.
"It bone! It booonnnne lie de fi-yuh!" she says of the pain - it burns like fire - in Krio, the English-African blend spoken in this country where British colonizers resettled freed slaves.
No one has told her directly yet, but there is no hope - the cancer is also in her lymph glands and ribs.
Like millions of others in the world's poorest countries, she is fated to die in pain. She cannot get the drug she needs, one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source - the opium poppy. She cannot get morphine.
That is not merely because of her poverty, or that of Sierra Leone. Narcotics incite fear: Doctors fear addicting patients, law-enforcement officials fear drug crime, and members of the government elite who can afford medicine for themselves are indifferent to the sufferings of the poor.
The World Health Organization estimates that 4.8 million people a year with moderate to severe cancer pain receive no appropriate treatment. Nor do another 1.4 million with late-stage AIDS. For other causes of lingering pain - burns, car accidents, gunshots, diabetic nerve damage, sickle-cell disease and so on - it issues no estimates but believes that millions go untreated.
Figures gathered by the International Narcotics Control Board, a United Nations agency, make it clear: Citizens of rich nations suffer less. Six countries - the United States, Canada, France, Germany, the United Kingdom and Australia - consumed 79 percent of the world's morphine according to a 2005 estimate. The poor and middle-income countries where 80 percent of the world's people live consumed only about 6 percent.
Some countries imported virtually none. "Even if the president gets cancer pain, he will get no analgesia," said Willem Scholten, a WHO official who studies the issue.
In 2004, consumption of morphine per person in the United States was about 17,000 times that in Sierra Leone.
At pain conferences, doctors from Africa describe patients whose pain is so bad that they have chosen other remedies: hanging themselves or throwing themselves in front of trucks.
Westerners tend to assume that most people in tropical countries die of malaria, AIDS, worm diseases and unpronounceable ills. But as vaccines, antibiotics and AIDS drugs become more common, more and more are surviving past measles, infections, birth complications and other sources of a quick death. They grow old enough to die slowly of cancer.
About half the six million cancer deaths in the world last year were in poor countries, and most diagnoses were made late, when death was inevitable. But first, there was agony. About 80 percent of all cancer victims suffer severe pain, the WHO estimates, as do half of those dying of AIDS.
Morphine's raw ingredient, opium, is not in short supply. Poppies are grown for heroin, of course, in Afghanistan and elsewhere. But vast fields for morphine and codeine are also grown in India, Turkey, France, Australia and other countries.
Nor is it expensive, even by third world standards. One hospice in Uganda, for example, mixes its own liquid morphine so cheaply that a three-week supply costs less than a loaf of bread.
Nonetheless, it is still routinely denied.
"It's the intense fear of addiction, which is often misunderstood," said David Joranson, director of the Pain Policy Study Group at the University of Wisconsin's medical school, who has worked to change drugs laws around the world. "Pain relief hasn't been given as much attention as the war on drugs has."
Third world doctors, he explained, often have beliefs about narcotics that prevailed in Western medical schools decades ago - that they are inevitably addictive, carry high risks of killing patients and must be used sparingly, even if patients suffer.
Pain experts argue that it is cruel to deny them to the dying and that patients who recover from pain can usually be weaned off. Withdrawal symptoms are inevitable, they say - as they are if a diabetic stops insulin. But benefits outweigh the risks.
In Sesay's case, Alfred Lewis, a nurse from Shepherd's Hospice, is doing what he can to ease her last days.
When he first saw her, her tumor was wrapped with clay and leaves prescribed by a local healer. The smell of her rotting skin shamed her.
She had seen a doctor at one of many low-cost "Indian clinics" who pulled at the breast with forceps so hard that she screamed, misdiagnosed her tumor as an infected boil, and gave her an injection in her buttocks that abscessed, adding to her misery.
Nothing can be done about the tumor, Lewis explained quietly. "All the bleeders are open," he said. "Her risk now is hemorrhage. Only a knife-crazy surgeon would attend to her."
Earlier diagnosis would probably not have changed her fate. Sierra Leone has no CAT scanners, and only one private hospital offers chemotherapy drug treatment. The Sesays are sharecroppers; they have no money.
So Lewis was making a daily 10-mile trip from Freetown, the capital, to change her dressing, sprinkle on antibiotics and talk to her. He asks a neighbor to plait her hair for her, so she will look pretty. Sesay says she can't be bothered.
"It's necessary for to cope," he says. "For to strive for be happy."
"I 'fraid for my life," she says.
"Are you 'fraid for die?"
"No, I not 'fraid. I ready."
"So what is your relationship to God? You good with God?"
"I pray me one."
He asks her, half-jokingly, whether she still has sex with her husband. No, she says. Since the illness, he stays in his room and she stays in hers. She, too, is joking. In their hut, there is only the one.
Life has become hard, she adds, and her husband is getting too old for farm labor. She, too, is getting old, she says - she is somewhere in her 40s. "We are really being punish."
For her pain, Lewis gives her generic Tylenol and tramadol, a relative of codeine that is only 10 percent as potent as morphine. It is all he can offer.
"I would consider putting her on morphine now," Lewis says. "If we had morphine,"
Fear of morphine dooms third world poor to die painfully
International Herald Tribune
September 9, 2007
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