Palliative care toolkit developed for staff in developing countries

BMJ 2008; 336 doi: (Published 24 April 2008) Cite this as: BMJ 2008;336:913
  1. Rebecca Coombes
  1. 1London

Two doctors and colleagues from the United Kingdom have this week launched a toolkit for healthcare professionals in poor countries that advises on palliative care. The authors were struck that many countries struggle to provide even the most rudimentary control of symptoms and social support for patients with incurable conditions, chiefly AIDS and cancer.

Vicky Lavy, a doctor at Helen and Douglas House Hospice, Oxford, and an author of the toolkit, said that one of the biggest problems in providing palliative care in many poor countries is the lack of morphine.

In her 10 years’ experience in Malawi, Dr Lavy said that the only painkillers in reliable supply were paracetamol, aspirin, and “perhaps a non-steroidal on a good day. But even ibuprofen is not widely available. Codeine is very expensive.”

Ironically, she said, powdered oral morphine was “dirt cheap” to buy from manufacturers, but many African governments were resistant to free supply because of fears of drug misuse.

The situation in Malawi improved after doctors met with the health minister and convinced him of the need to relax …

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