A new report by Human Rights Watch (HRW) has criticized the state of palliative care in Kenya for not doing more to prevent HIV-positive children and children with cancer from experiencing preventable pain.
Despite impressive gains in per capita income, Kenya’s rates of childhood illness and child mortality are already high – and increasing. Over the past twenty years, the country’s child mortality rate went from 105 to 128 deaths per 1,000 live births. Children infected with HIV – even those with access to anti-retroviral drugs and adequate food – experience uncomfortable and traumatic pain. For these children especially, palliative care is essential.
The report, entitled “Needless Pain,” was released today and is available on the organization’s website.
Palliative care refers to the long-term treatment and pain relief of patients with chronic or progressive illnesses when a cure is not possible. Morphine is generally used for pain relief; oral doses are the World Health Organization’s drug of choice for such purposes. It is inexpensive and easily administered.
Yet, claims the report, it remains widely inaccessible to most Kenyans in need. At present, the Kenya Medical Supplies Agency (KMSA) doesn’t include oral morphine in its essential medicines procurement programme. This can make it financially tricky for hospitals to stock it.
There are also strict narcotics regulations in place to prevent drug trafficking in morphine powder. The lack of a clear legal framework on what is and is not legal (in combination with insufficient understanding of existing laws by health care workers) further adds to hospitals’ hesitancy to procure morphine.
The report quoted one doctor working in the field of paediatric cancers practicing in Nairobi: “People have no problems with relieving pain in adults with morphine, but when it comes to children, there is always some reservation. Putting a child on morphine is always a big issue,” he said, adding that “morphine is underutilized.”
Part of this reservation lies in public perceptions concerning the drug. In Kenya, morphine is used only to treat the terminally ill. Giving morphine to a child, then, would be seen as being tantamount to giving up on the child’s life, telling anxious parents to wait for his or her impending death.
HRW recommends the reduction of tax barriers, a better legal framework and the scaling up of palliative care programs in order to improve sick kids’ access to morphine.