'India's health care system abandons many to severe pain'

Imagine being pricked with needles. Imagine a burning raw chilli on your tongue. Imagine a very bad headache and multiply the pain a thousand times over.

Imagine this pain in your head. In your legs. In your genitals.

This is what millions of Indians, who are suffering from cancer and other major ailments, go through every day. Many try to commit suicide. But some survive.

"You know how painful it is to have a headache. Now imagine the pain that is a thousand times more than that and having to suffer that day in and day out. That is what about a million Indians suffer everyday," Dr Diederik Lohman, senior health and human rights researcher with the Human Rights Watch, says.

Lohman has just authored a report on severe pain in India and how palliative care (the field specialising in making life comfortable for those suffering from life threatening diseases) can give them immense relief.

Thousands of patients in India unnecessarily experience excruciating pain, the report said, adding that restrictive drug regulations, lack of training for health care workers, and poorly integrated care result in needless suffering for patients.

The report, titled 'Unbearable pain: India's obligations to ensure palliative care' reveals that India's major cancer hospitals do not provide patients with morphine, though 70 per cent of patients are incurable and likely to require pain treatment and palliative care.

Similarly, health centers offering services to people living with HIV do not have morphine or doctors trained to prescribe it.
"India's health care system abandons so many patients to severe pain. They are left to suffer; many told me that their pain was so bad they would prefer to die," says Lohman.

Severe pain is a common symptom among cancer patients, particularly during the last stages of the disease. It is estimated that more than one million advanced cancer patients in India experience severe pain in any given year. In addition, many other patients, including those with HIV, TB, or other infections or illnesses, may face acute or chronic severe pain.

Lohman and other specialists in the field say India's restrictive drug regulations were to blame.

"Many Indian states have excessively strict narcotics regulations that make it very difficult for hospitals and pharmacies to get morphine," Dr M R Rajagopal, of Pallium India, said.

But in 1998, the central government recommended that states adopt modified regulations. "Now, the problem is not the regulations. It is the fact that more than half of our states and union territories do not follow them and even those who follow them do not have any morphine," he says.

"India is one of the world's largest legal producers of opium, the raw material for morphine. But almost all of it is exported while hundreds of thousands -- if not millions -- of Indians suffer needlessly," Lohman said.

The report focuses specifically on the availability of pain treatment for cancer patients. It says that, based on official morphine consumption reports, fewer than four per cent of patients with advanced cancer have access to appropriate pain treatment. The report also says that increased government funding for cancer has not emphasised palliative care.

"The Indian government deserves credit for investing in regional cancer centers and increasing funds for cancer control," Lohman said. "But without specific efforts to ensure that all cancer hospitals can treat pain and offer palliative care, these funds will do little to relieve the suffering for patients with advanced, incurable cancer."

Ignorance too, to a large extent, plays a role. "Generations of doctors have qualified and grown up without ever seeing morphine. And even doctors think palliative care is terminal care -- that is, it is something administered to people who are about to die," Dr Rajagopal said.

Harmala Gupta, of CanSupport, a cancer support organisation says, "I am a cancer survivor myself. But when I was undergoing treatment, the attitude of the doctors was: 'come on! We are treating you. The least you can do is suffer the pain while you get cured'".

Ironically, India is among the world's largest producer of opium for clinical needs. And opium is the raw material for morphine.

"I know doctors in Uttar Pradesh and Madhya Pradesh, where opium is produced, who tell their patients to go to the black market and procure opium. They even guide the patients on how to spot the correct seeds, since only at a particular stage of growth the opium can act as a pain reliever," Dr Rajagopal said.