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Report: Kenya Failing to Prevent Needless Pain in Children

  • Michael Onyiego

The Kenya government's failure to invest in palliative care - alleviation of symptoms - has left thousands of children suffering from acute and chronic pain that is treatable.

That's according to a new report by New York-based Human Rights Watch, which asserts that many of those with chronic pain are suffering largely because the Kenyan government has not integrated care that helps alleviate symptoms into its public-health services.

Palliative care is provided to patients suffering with terminal and life-threatening illnesses, such as HIV/AIDS, cancer and sickle cell anemia. Palliative care helps patients manage pain and also provides support for the emotional, psychological and social effects of the diseases.

According to the report's author, Juliane Kippenberg, one of the groups in greatest need of access to palliative care is children.

"Kenya is afflicted by childhood disease. Over 12 percent of Kenyan children die before their fifth birthday. There are around 150,000 children in Kenya living with HIV and many of them suffer pain - even some of those on anti-retroviral drugs. Cancer is on the rise in Kenya. Children also suffer from sickle cell disease, tuberculosis and other painful diseases. Palliative care should go hand in hand with curative treatment. In some cases it can even help curative treatment succeed, for example by enabling a child on anti-retroviral drugs to adhere to the medication," said Kippenberg.

One of the most basic ways to manage this pain is morphine. The World Health Organization has designated oral morphine as an essential medicine for basic health care. Kenya has given oral morphine a similar designation, but the report found it was rarely, if ever, purchased by the government. It is largely unavailable in all but seven of Kenya's more than 250 public hospitals.

Of the nearly 250,000 Kenyans taking anti-retroviral medication, there only is enough morphine to treat about 1,500.

Part of the problem is the perception in Kenya's medical community. According to Kippenberg, Kenyan doctors tend to view morphine as dangerous, rather than essential. As a result, they rarely prescribe it or even request supplies for health-care facilities.

But the national coordinator for the Kenya Hospices and Palliative Care Association, Zipporah Ali, says pain medication and palliative care can actually make medical treatments more effective.

"Palliative care and pain medication actually prolongs life for people with terminal illnesses," said Ali. "If you actually control a patient's pain you improve their quality of life; you might even actually prolong their life. Palliative care and pain medication go hand in hand with curative treatment."

Though hospice care has been available in Kenya since 1990, there are only about 30 facilities in the country and none specialize in the treatment of children, which often prevents a proper diagnosis of a child's pain.

Human Rights Watch is calling for the Kenyan government to make oral morphine available in all public hospitals and to provide health-care professionals with proper training on palliative care for children.

According to Ali, the Kenya Hospice and Palliative Care Association is working with the government to integrate palliative care into the national health system. Ali said the government was planning to unveil palliative care units in 10 government hospitals by the end of this year.