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In Africa the HIV epidemic laid bare the huge need for palliative care and pain control. Families and health workers were faced with looking after the sick in homes and hospitals that were ill prepared and ill equipped to manage chronic symptoms, especially pain. Most clinicians and nurses had little experience or training in palliative care or the use of analgesia. Oral morphine was seldom available, intramuscular pethidine pro re nata (prn) was used, mainly post operatively, and many children suffered silently and stoically. Health workers were demoralised by the inability to relieve suffering.
Local individuals, to their credit, were determined to change this unsatisfactory situation. They provided care and symptom control for these people and most importantly lobbied at every level—internationally, regionally and nationally—for better, stronger analgesics, especially to make oral morphine available.1 To provide adequate analgesia appropriate drugs have to be available, affordable, accessible and properly and rationally used. There needs to be a reliable and easy way to measure the severity of pain so that requirements and efficacy can be adequately assessed.
Opioid availability is covered by the protocols for the Single Convention on Narcotic Drugs of 1961 and 1972.2 These protocols focus on preventing misuse, but at the expense of medical access. In 2005 the United Nations Economic and Social Council (resolution 2005/25) and the World Health Assembly (resolution WHA 58.22) called on countries and international bodies such as WHO and the International Narcotics Control Board, to remove barriers to the medical use of such analgesics.3 These barriers not only raise legal and policy issues, but also present educational obstacles affecting policy-makers, clinicians, patients and the community at all levels. African countries are among the lowest users of …