2010; Volume 11, No 3, March



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Please welcome a new IAHPC Board Member Dr Scott Murray (Scotland)

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Regional Reports – India, Europe and Jordan

Palliative Care Book of the Month and Other Reviews


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Regional Reports

Opioid Accessibility in India by M.R.Rajagopal, MD

Ms. Hannah Gardner, a journalist with “The National” found it shocking to hear that people in pain in India did not have access to essential medications like morphine. This made her undertake a journey from Delhi, the capital of India, to Rohtak in the neighboring state of Haryana. She found that the Regional Cancer Center had frequent interruptions of the supply of morphine. This center is one of 28 designated centers in the whole country that should be providing comprehensive cancer care including palliative care. Her article ( http://www.thenational.ae/apps/pbcs.dll/article?AID=/20100208/FOREIGN/702079900/1140 ) points to the important barriers to pain relief in India, they are, stringent and complicated narcotic regulations (some states in India need as many as five licenses), and a lack of education of doctors regarding pain management.

Articles like this have a very important role in a country where change is slow to happen. Valuable work by David Joranson and his team at the Pain and Policy Studies Group in collaboration with Indian palliative care workers did achieve a great deal – as many as 14 of India’s 34 states and Union Territories now have simplified narcotic regulations. But, the fact remains that only a tiny minority of needy patients in the country have access to pain relief. Advocacy is very important. Donald McNeil’s article in New York Times in 2007 ( http://www.nytimes.com/2007/09/11/health/11pain.html?_r=1&ref=science&oref=slogin ), Diederik Lohman’s research leading to the report by Human Rights Watch in October 2009 ( http://www.hrw.org/en/reports/2009/10/28/unbearable-pain-0 ) and numerous other reports in the Indian press have all helped to garner support in favor of access to pain relief and palliative care. We are thankful to Hannah Gardner and to all the journalists for their support; but the sad fact remains that concrete action at the national level in India has yet to happen and greater advocacy continues to be necessary.

Dr. Rajagopal’s is an IAHPC Board member and his biography may be viewed at the following link http://www.hospicecare.com/Bio/mr_rajagopal.htm


Opioid Accessibility in Europe – A report

Formulary availability and regulatory barriers to accessibility of opioids for cancer pain in Europe: a report from the ESMO/EAPC Opioid Policy Initiative
N. I. Cherny, J. Baselga, F. de Conno & L. Radbruch

Annals of Oncology 21: 615–626, 2010

To read this report please go to URL: http://www.esmo.org/


From Jordan

A regional palliative care workshop conducted by WHO-EMRO

Jordan, from 10 th to 12 th of February

A palliative care workshop was conducted in Jordan. The workshop was an initiative of the world Health Organization - East M editerranean Regional office (WHO-EMRO), in collaboration with the palliative care committee in Jordan and King Hussein Cancer Center.

The participants were physicians, nurses, psychologists and social workers from Bahrain, Egypt, Jordan, Lebanon, Morocco, Oman, Palestine and Saudi Arabia.

The main speakers were regional experts in palliative care; Dr. Rafe Al-Shehry, Saudi Arabia; Prof.Sami Alsirafy, Egypt; Dr. Mustafa Beno, Jordan; and Dr. Mohammad Bushnaq, Jordan.

The sessions were conducted as an interactive workshop, and the goal was to increase awareness about the principles of palliative care and the concept and evolution of palliative care, pain management, non-pain symptom management, the role of interdisciplinary team members in palliative care, communication skills such as breaking bad news, and wound care.

There are many challenges to implement palliative care in the region, like a lack of awareness, a lack of education and training, and rules and regulation controlling opioid availability. This meeting was a unique opportunity for palliative care teams representing different countries in the region. There was also a session where each team talked about their experiences, challenges and plans for implementing palliative care.

It was agreed by all participants that it is important to create a network for collaboration and sharing experiences. It was suggested there is also a need to come up with regional guidelines for palliative care, and to establish a WHO-EMRO based regional training office for palliative care.

Mohammad Bushnaq, MD
Palliative and Hospice Care Consultant
Internal Medicine Consultant
King Hussein Cancer Center
Amman- Jordan

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