Painful Inequities — Palliative Care in Developing Countries
N Engl J Med 2012; 366:199-201 January 19, 2012
Excerpts:
In many countries, physicians learn only about opiates' side effects, not their potential benefits, said Dr. M.R. Rajagopal, a palliative care physician in India. “Modern principles of pain relief and palliative care still aren't taught to medical students in 80% of the world,” he said, noting that many physicians in India finish training without ever seeing a morphine tablet.
Rajagopal recalled treating a patient with nasopharyngeal cancer whose pain was eventually controlled with morphine. The patient was also undergoing radiation therapy, and when his primary care doctor saw his morphine prescription, he tore it up, saying, “Never let me catch you with that again. That will destroy you.” Like many physicians, he feared opioid addiction and refused to believe that radiation alone was inadequate to treat the pain.
In Kerala, India, the opportunities for treating pain were similarly restricted until a few years ago. Physicians had to secure five licenses from different government bodies before they could prescribe a milligram of morphine. Often, one license expired before another was obtained, and the physician would have to start the process again without having administered a dose. In response to the efforts of Rajagopal, the palliative care physician, Kerala's rules have changed, but in most Indian states prohibitive hurdles remain (see Table).
For the full text, please visit http://www.nejm.org/doi/full/10.1056/NEJMp1113622
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