Acute pain relief: Why Hospice only handles HIV/AIDS, cancer patients
Jun 20, 2011
JANE Nansakusa was admitted to Mulago Hospital with a heart problem. She was bedridden for over a month but nothing could be done to cure her ailment. Due to inadequacy of beds at the hospital, she was discharged and given medication to take along.
By Joyce Nyakato
JANE Nansakusa was admitted to Mulago Hospital with a heart problem. She was bedridden for over a month but nothing could be done to cure her ailment. Due to inadequacy of beds at the hospital, she was discharged and given medication to take along.
Shortly after, Nansakusa started experiencing excruciating pain, and fortunately, she received pain management intervention from Hospice. However, this was short-lived because heart ailments are outside the operation of Hospice’s mandate.
Hospice was formed in Africa in 1993 to help in palliative (pain reduction) care among cancer patients. In developed countries, cancer is among the leading causes of deaths, and with the advent of HIV/AIDS, it is increasing rapidly.
The World Health Organisation defines palliative care as an approach that improves the quality of the life of patients and their families facing the problem associated with life-threatening illnesses through the prevention and relief of suffering.
It incorporates the treatment of pain and other problems, physical, psychosocial and spiritual.
Palliative care is, therefore, appropriate for any patient with an incurable, progressive and life-threatening illness, and should be provided from the point of diagnosis until the end of life, and should also provide bereavement support for family members, if required.
However, according to Dr. Jennifer Ssengooba, the clinical director of Hospice Uganda, their mandate lies within cancer patients and people living with HIV/AIDS.†We treat few patients to maintain a model from which our students can learn the whole concept of palliative care,†she says.
She explains that they can reach out to a few compared to the country’s need, but they offer nationwide training in management of pain for all diseases.
The cornerstone of palliative care is the relief of pain and other distressing symptoms.
However, palliative care cannot be said to be present if pain control is the only intervention available. She reasons that cancer patients are high priority on the list because the fact that one has cancer alone can be disheartening.
Few patients seek medical care and they do so when it is in its late stages, with severe consequences of pain and gross disfigurement. That is when they come in to control the pain and symptoms during critical illness and at the end of life. Simply put, it allows the patient die with dignity and painlessly. The commonest pain killer used is morphine.
What is morphine?
Morphine is a natural drug that can be extracted from opium. Morphine is in a group of drugs called narcotic pain relievers. It is used to treat moderate to severe pain, and works by dulling the pain perception centre in the brain. With the help of the Ministry of Health, oral affordable morphine was brought into Uganda in September 1993.
According to, Fredrick Sekyana, the public relations officer of National Drug Authority, morphine is a classified drug and a lot of care and stringency should be followed when dealing with it.
To combat shortage of morphine in the country, this year Hospice was given the mandate to manufacture liquid morphine which will be used countrywide for pain relief.
Uganda has started diluting the oral morphine but still, the National Drug Authority has to overlook the importation of the concentrates.
Research reveals that patients in Africa prefer to die in their homes than in institutions. As a result, some of them, especially cancer patients awaiting death, are attended to in their homes. For pain relief to be used continuously in a home, morphine should be administered orally.
Dr. Joseph Masaba, a surgeon at Mulago Hospital, adds that oral morphine is less in hospitals and more in the palliative care centres like Mild May, The AIDS Support Organisation and HOSPICE.
Usually when patients are in pain and suffering from terminal illnesses like cancer and HIV/AIDS, they are referred to these centres for assistance. These centres request for a transfer from the doctor that has been treating the patient.
Who administers morphine?
Doctors and pharmacists, given their nature of training, can prescribe a narcotic for pain management.
Nurses, however, have to study a nine months diploma in palliative care to be granted authority to prescribe the class ‘A’ drug.
Makerere University awards certificates in specialist palliative care offered by Hospice Africa. The Government gave them the training mandate.
Under these strict guidelines, fears of the drug being diverted from healthcare into the hands of recreational users are baseless. “We don’t get any addiction problems with our patients because we measure what is enough for them,†Sengooba says.
The patient and family are trained to give morphine at regular intervals so that the pain does not return. They are instructed to give an extra dose for breakthrough pain and the number of extra doses used is calculated to adjust the daily dose at the next visit of the team.
Patients and families are also advised on how to use the drug and to keep it out of the reach of children.
JANE Nansakusa was admitted to Mulago Hospital with a heart problem. She was bedridden for over a month but nothing could be done to cure her ailment. Due to inadequacy of beds at the hospital, she was discharged and given medication to take along.
Shortly after, Nansakusa started experiencing excruciating pain, and fortunately, she received pain management intervention from Hospice. However, this was short-lived because heart ailments are outside the operation of Hospice’s mandate.
Hospice was formed in Africa in 1993 to help in palliative (pain reduction) care among cancer patients. In developed countries, cancer is among the leading causes of deaths, and with the advent of HIV/AIDS, it is increasing rapidly.
The World Health Organisation defines palliative care as an approach that improves the quality of the life of patients and their families facing the problem associated with life-threatening illnesses through the prevention and relief of suffering.
It incorporates the treatment of pain and other problems, physical, psychosocial and spiritual.
Palliative care is, therefore, appropriate for any patient with an incurable, progressive and life-threatening illness, and should be provided from the point of diagnosis until the end of life, and should also provide bereavement support for family members, if required.
However, according to Dr. Jennifer Ssengooba, the clinical director of Hospice Uganda, their mandate lies within cancer patients and people living with HIV/AIDS.†We treat few patients to maintain a model from which our students can learn the whole concept of palliative care,†she says.
She explains that they can reach out to a few compared to the country’s need, but they offer nationwide training in management of pain for all diseases.
The cornerstone of palliative care is the relief of pain and other distressing symptoms.
However, palliative care cannot be said to be present if pain control is the only intervention available. She reasons that cancer patients are high priority on the list because the fact that one has cancer alone can be disheartening.
Few patients seek medical care and they do so when it is in its late stages, with severe consequences of pain and gross disfigurement. That is when they come in to control the pain and symptoms during critical illness and at the end of life. Simply put, it allows the patient die with dignity and painlessly. The commonest pain killer used is morphine.
What is morphine?
Morphine is a natural drug that can be extracted from opium. Morphine is in a group of drugs called narcotic pain relievers. It is used to treat moderate to severe pain, and works by dulling the pain perception centre in the brain. With the help of the Ministry of Health, oral affordable morphine was brought into Uganda in September 1993.
According to, Fredrick Sekyana, the public relations officer of National Drug Authority, morphine is a classified drug and a lot of care and stringency should be followed when dealing with it.
To combat shortage of morphine in the country, this year Hospice was given the mandate to manufacture liquid morphine which will be used countrywide for pain relief.
Uganda has started diluting the oral morphine but still, the National Drug Authority has to overlook the importation of the concentrates.
Research reveals that patients in Africa prefer to die in their homes than in institutions. As a result, some of them, especially cancer patients awaiting death, are attended to in their homes. For pain relief to be used continuously in a home, morphine should be administered orally.
Dr. Joseph Masaba, a surgeon at Mulago Hospital, adds that oral morphine is less in hospitals and more in the palliative care centres like Mild May, The AIDS Support Organisation and HOSPICE.
Usually when patients are in pain and suffering from terminal illnesses like cancer and HIV/AIDS, they are referred to these centres for assistance. These centres request for a transfer from the doctor that has been treating the patient.
Who administers morphine?
Doctors and pharmacists, given their nature of training, can prescribe a narcotic for pain management.
Nurses, however, have to study a nine months diploma in palliative care to be granted authority to prescribe the class ‘A’ drug.
Makerere University awards certificates in specialist palliative care offered by Hospice Africa. The Government gave them the training mandate.
Under these strict guidelines, fears of the drug being diverted from healthcare into the hands of recreational users are baseless. “We don’t get any addiction problems with our patients because we measure what is enough for them,†Sengooba says.
The patient and family are trained to give morphine at regular intervals so that the pain does not return. They are instructed to give an extra dose for breakthrough pain and the number of extra doses used is calculated to adjust the daily dose at the next visit of the team.
Patients and families are also advised on how to use the drug and to keep it out of the reach of children.