— Human Rights Watch says each year an estimated 70,000 Senegalese are in need of pain relief from prolonged illnesses and diseases such as cancer and HIV/AIDS, but that only a few hundred have access to basic medications such as morphine, and that government officials need to integrate palliative care measures into the country's health care system.
The 85-page report, "Abandoned in Agony: Cancer and the Struggle for Pain Treatment in Senegal,"
cites World Health Organization (WHO) statistics that indicate an estimated 80 percent of people worldwide have insufficient or no access to pain relief services.
While overly restrictive drug regulatory policies throughout parts of sub-Saharan African leave pain medications such as morphine largely inaccessible, the report indicates Senegal's current annual stock of morphine is enough to treat only 194 advanced cancer and HIV/AIDS patients.
"Palliative care in Senegal, and a lot of sub-Saharan countries in general, is very poorly developed because it’s not seen as a priority," says Angela Chung, a Social Justice Fellow for HRW’s Health and Human Rights Division and one of the report's lead researchers. "I think people might erroneously assume that cancer is something you get in a developed country, but it’s actually a huge problem in Africa and it’s increasing every year."
The report says only six sub-Saharan countries — South Africa, Kenya, Tanzania, Uganda, Rwanda and Swaziland — have made palliative care programs part of their national health plans, and an estimated 6,600 new cases of cancer are reported in Senegal annually.
According to Chung, access to palliative care services is extremely limited within Senegal’s capital and virtually non-existent at clinics throughout the country, forcing people who suffer from various diseases to travel up to 10 or 15 hours just for some pain relief.
Senegalese law restricts patients to one seven-day supply of morphine at a time, the report states, which means some patients make weekly trips to refill prescriptions in Dakar, where chronic morphine shortages often leave those prescriptions unfilled.
While inexpensive and easy to produce, morphine — an opiate extracted from poppy seeds — can be an important component of longer-term care and rehabilitation.
"Palliative care provides services, such as psychosocial support and pain and symptom relief, to help improve a patient’s quality of life," says Dr. Ahmadou Dem, a surgical oncologist at Dantec Hospital’s Joliot Curie Cancer Institute in Dakar. "Palliative care must be used as an accompaniment to medical treatment and should start from the very first visit. It is not only for people who are at the end of their life."
Marie Ka-Cisse, a representative of Senegal's Ministry of Health’s Department of Non-Communicable Diseases, says the government is aware of the problems surrounding palliative care, but that it currently lacks the resources to address them.
"When it comes to palliative care, the political will is there, [but] the government continues to try to support palliative care not only for cancer patients but for other diseases as well," she said. "The problem is the resources. There just is not enough money or manpower."
HRW says Senegal has recently taken some steps towards helping those in pain, but that there is a long way to go. The government, for example, has added oral morphine tablets to its list of essential medicines for the first time at the end of 2012, but, nearly a year later, has yet to start importing them.