Guljahan Fazilovna Pirnazarova, Head of Family Nursing Education Department at the Kyrgyz State Medical Institute in Bishkek, describes a recent patient situation that relates to a longer article published in the March/April issue of the European Journal of Palliative Care.
Today, a woman came to me and asked for help.
Her daughter is 35 years old, divorced with two sons aged 17 and 11. Two years ago, a small tumour appeared on her right tibia. She lives in a small town where a surgeon removed the tumour; but very soon, new tumours grew in larger sizes. After that, the patient came to the capital (Bishkek) and was seen by an oncologist who diagnosed her with stage 4 cancer with metastasis. She was admitted to a hospital where she received several courses of chemotherapy.
Her condition has deteriorated, she has fallen into depression, and her parents and children are very worried. The patient does not want to believe that she has cancer in the final stages. She wants to be cured. When she was discharged from hospital she decided to seek the assistance of healers and ‘traditional medicine’ men. These healers charge exorbitant amounts of money for prescribing herbs and unknown solutions. This young woman received a three-week supply of an herbal tincture for 18,000 SOM (US$350).
Her mother told me that she really wants to help her daughter and has agreed to buy her any medication or herbal infusion. The daughter has severe pain for which her mother gives Ketonal (acetaminophen). When I asked her, “Why don’t you give opioids to your daughter?” She said she knows that her daughter will die, but the daughter believes that ‘only the dying’ receive morphine….
How I can help this weeping, traumatised mother who will lose her child?
Here are the problems we face in our country:
- Information about the role of pain medication needs to be clarified among citizens and professionals alike.
- There are many bureaucratic barriers to obtaining opioids. (If you live in the village, you have to go into town to find a doctor who will prescribe only a limited number of vials of medication. Then the patient must find a pharmacy to buy these medications. Even then, only injectable drugs are available; there are no oral forms of opioids.)
- There is no support for the patient and family members at a time when they have difficulties, depression and are in a state of shock.
- There are no specialists trained in providing palliative care.
- There are limited hospice and palliative care beds.
- When patients and family members do not receive help from medical professionals, they go to the scams and the charlatans who exhaust the dying patient and family of their small savings.
But changes are under way in Kyrgyzstan as dedicated clinicians strive to provide comfort for the dying. Governmental and non-governmental groups are working to open the doors to improved training for professionals, opioid access, models of care, and increased awareness of the need for palliative care. The barriers still exist, but hopefully comfort for the dying will be a reality in the near future.
To read a copy of the full article…
This blog post relates to a longer article, Access to palliative care and pain medication in Kyrgyzstan by Guljahan Pirnazarova and Jane Schlickau, published in the March/April 2014 issue of the European Journal of Palliative Care (vol. 21.2). If you already have a web-based subscription to the European Journal of Palliative Care you will be able to download this issue, plus all articles in the journal archive. You can also browse the archive and download articles by taking a 10-minute or 30-minute subscription. Members of the EAPC receive discounted subscription rates to the journal – click here to subscribe online.