Stephen R Connor, PhD, International Palliative Care Consultant
I am writing from Bishkek in Kyrgyzstan where we have just celebrated World Hospice and Palliative Care Day. At the time of writing I had just finished appearing on a live morning talk show, Zamana, to tell the public about palliative care. We had six callers from around the country asking for help with problems ranging from Hepatitis B to incurable cancer. Many other public events are planned. We will shortly have a press conference so our local experts can talk about palliative care. More than 4,000 people die of cancer in Kyrgyzstan each year and very little help is available. An additional 16,000 with progressive non-malignant diseases also need help.
Only injectable morphine and tramadol are available for pain relief and it is a huge bureaucratic headache for oncologists to prescribe and they are the only ones allowed to. Opiophobia is widespread. In Kyrgyzstan, a major trans-shipment point for drugs from Afghanistan, heroin is the same price as having a couple of beers ($2) and cancer patients are sometimes forced to buy illegal drugs for pain relief because ‘licit’ morphine is so hard to obtain.
Fledgling efforts to establish palliative care at the Osh and Bishkek cancer centers have been under way for several years but more training and resources are needed. In spite of these and other problems much progress has been made thanks to the Soros Open Society Foundations’ International Palliative Care Initiative. Some of the accomplishments include:
- A national needs assessment has been done
- A national strategy has been approved by the government
- Several training courses have been held and key clinicians sent for training to Romania and Mongolia
- In January the Kyrgyz State Medical Institute will initiate a series of courses delivering basic training in palliative care to post graduate physicians and nurses
- Clinical protocols have been drafted and work on standards is beginning,
- Two pilot projects will start in December, one at the national oncology center in Bishkek and one at the regional oncology center in Osh
- Oral morphine is on the verge of being registered and should be available by the end of the year for palliative care patients. The Health Insurance Fund will cover the cost of oral morphine for patients.
Much more work is needed to establish and grow palliative care in this and other former soviet republics but some momentum is beginning. Most of these countries are in the midst of major healthcare reforms anyway so all aspects of healthcare have to be re-examined, creating an opportunity for the introduction of palliative care, as a necessary part of the healthcare continuum.