Cancer patients suffering due to lack of access to oral morphine

-Beacon Foundation head

President of Beacon Foundation Patrick de Groot has said that the organisation’s inability to access oral morphine through the Ministry of Public Health has resulted in many of its cancer patients suffering in pain.

de Groot, who was speaking at a recent public forum and later confirmed his comments to Stabroek News, explained that while the foundation has been accessing the morphine injection, it is difficult for its three nurses to travel to all the patients to administer the injection. He pointed out that the injection has to be administered by a registered nurse or doctor but in case of the oral morphine this is not required. He also pointed out that they have patients in Corentyne, Corriverton, Parika, Linden and in Region Four and that visits can only be made once or twice a month.

For almost 34 years the Beacon Foundation has been delivering relief and support to terminally ill cancer patients around Guyana with its domiciliary hospice care.

Both the oral form and the injection are accessed free of cost through the Ministry of Public Health but there has been no access to the oral medication. de Groot said there has been no explanation for the situation and he was expected to raise the issue with Public Health Minister Volda Lawrence when he meets with her.

Stabroek News made contact with Chief Medical Officer Shamdeo Persaud, who while not addressing the issue of the reported shortage of the oral morphine was at pains to state that both the oral and vaccine forms of the medication must be administered in the same manner.

He said that the Narcotic Drugs and Psychotropic Substances (Control) Act states that both forms of the medication must be administered by a doctor or registered nurse. He stressed that the drug cannot be administered in an “unprofessional manner.”

According to Persaud, the ministry assists Beacon by supplying medication based on its needs and “… it is provided free of charge from Ministry of Public Health and we expect that they comply [with] all of the requirements under the Act.”

However, a local medical source, who preferred not be named, when contacted told this newspaper that once the patient is prescribed the medication it can be taken at home, without the presence of either a nurse or doctor. The doctor pointed out that there will be strict guidelines on how the medication should be taken. The only concern, according to the doctor, is that someone, a family member or even a neighbour, will assume the responsibility for assisting the patient. “You know, when people are in so much pain they can become very frustrated and might want to overdose so it is important that a family member or a neighbour to have the drugs under control and only give the patient as prescribed,” the doctor said.

Various online sources, including the United Kingdom’s National Health Services, have all indicated that oral morphine can be taken at home without a nurse or a doctor once it is prescribed and there are guidelines.

Asked specifically if there has been a shortage of oral morphine, Persaud responded: “I can’t say yes or no, I can check with my facilities… Whatever request comes, I will sign off, and ask the pharmacies to provide same.”

‘Angry and helpless’ Nurse Bibi Salim, one of the nurses who visit the many patients the Foundation works with, yesterday said that not accessing the oral morphine has made her “really angry and really helpless.” She said they have had no access to the oral morphine since July, 2018.

“I have seen them [the patients], I have held their hands, felt their pain,” she said before adding that they are unable to make visits often to the patients and many of them depend on the morphine to ease the excruciating pain they feel in their last days.

She gave the example of one patient who was forced to travel to the Foundation from Diamond and when she arrived she was in so much pain she had to meet her downstairs to give the injection. “She later came back and said ‘Nurse, thank you’ with a smile and she was doing so much better…this is what keeps us going,” Salim said.

For her, it is “absolutely important” that the Foundation get access to the medication because of the fact that the three nurses and one driver cannot visit patients’ homes often enough to administer the injection.

“It is not humanly possible for us to be at the East Bank and East Coast at the same time,” the nurse said.

She said in the interim they have asked the patients to visit their nearest health facility but many times the facilities don’t have what the patient needs or there are times when they don’t want to help.

“Health workers can sometimes have the attitude that they are dying anyway and do not give the help needed. Who are you to say that to people? We are all dying anyway. People just need you to put a little life in them,” the nurse stressed.

She said that 90% of the time people just want to know you care.

Nurse Salim also pointed out that should the foundation receive permission to bring in some of the oral medication into country there are organizations and persons who are willing to assist with the cost, “but it is a long story, a lot of writing, and we can’t just be in the office writing when people need help.”

Stabroek News had reported earlier that the Foundation’s roster of patients is based on referrals made by doctors at private medical institutions as well as the Georgetown Public Hospital (GPH). For the caregivers at Beacon, support means bonding with the patients, and knowing and catering to their welfare needs. This includes providing hampers as well as educating and sensitising the family to the needs of their relatives, and also educating them on the effects of certain lifestyle choices and on preventative measures, including regular testing.