29 May 2014

Unreported World: Africa’s drugs scandal

In 2014 people shouldn’t die in pain. Access to palliative drugs ought to be a basic human right.

Morphine was isolated by scientists more than 200 years ago and has been sold by medical drug companies since 1827. It is relatively cheap, very safe when used under medical supervision and stops excruciating pain dead.

And yet according to the World Health Organisation around 80 per cent of the world’s morphine supply is consumed by six rich countries.

This was a story that just hadn’t occurred to me. It was the passion of director Danny Bogado that made all of us on Unreported World sit up. A documentary about people dying in pain? “Who’s going to watch that?”, we wondered.

But of all the films I’ve made in recent years this was a true eye opener, and one I hope you are as gripped by as I was. It was also the first time in 26 years that I have lost my composure during an interview.

If that makes me sound like a strangely heartless creature I’m not. It is just that I’ve always been able to maintain a professional distance from the most upsetting situations so that I can report on them calmly.

But children, with cancer, running out of painkillers? Even I couldn’t cope with the thought of that. Especially once I had met Abdurahmane.

senegal1(See full Senegal gallery, below)

The iPhone has become the universal bonding tool of children the world over. Abdurahmane seized on mine with ease.

At just four years old the games generally played by my seven and nine-year-olds were a bit tricky at first. But he managed them quickly. Once I’d prised it from his hands, thinking how cross my wife gets about our own kids playing with screens for too long, we played football – which didn’t go down brilliantly in the ward.

But Abdurahmane doesn’t have many people to play with, and no dad around, so he seized the chance at an interested playmate.

He had been suggested to us by the team at Dakar’s Aristide Le Dantec Hospital, where we were filming in Senegal’s only children’s cancer unit.

“He’s a real character, and demands his morphine when he needs it himself,” explained the specialist, “But he’s going home today so you’d better find him quick.”

Sure enough Abdurahmane was a lovely little boy; clearly bright, playful and affectionate in equal measure.

Read more: The African cancer patients dying in unnecessary pain

He and his mother Bambi told us about the last few months of treatment and how they were looking forward to going home. There had been shortages of morphine even here in this specialist centre while they had been there. It sounded horrendous, but now all was well. He was most excited about going home to play with his siblings and cousins.

Catch-22

The shortages happen because Senegal doesn’t order enough morphine in the first place. As an internationally controlled drug every country worldwide has to estimate how much morphine it needs, and submit the required paperwork.

But Senegal is caught in a bizarre and bureaucratic catch-22. Most doctors in most hospitals have never prescribed morphine because they know there isn’t any in the pharmacy. Because they don’t prescribe it the central authorities don’t order it. So the pharmacy stays empty of morphine and the vicious circle continues.

Patients have never heard of morphine and don’t question the doctors anyway. They are grateful for the paracetamol that is the bog standard prescription. If they are lucky they will get tramadol, the next level of painkiller up the tree.

But morphine is generally only prescribed in a few places in the capital. Senegal only orders enough morphine every year for a couple of hundred patients – the same amount it has ordered for years on end.

With no patients’ demand or medical rebellion it just carries on that way, and people live with pain. Until a report by Human Rights Watch drawing attention to the scandal the politicians in Senegal were largely unaware of the problem.

Even though they are now, there doesn’t seem to be the political will to solve the problem quickly. The health minister wouldn’t talk to me about it. Our requests were interview were rejected.

When I tried to “doorstep” her about it she was furious and demanded whether I would dare treat a British health secretary like this. “Er, yes” was the reply. I should have told her to Google me.

‘Overwhelmed’ and ‘angry’

On our journey around Senegal we concentrated on two other cases. Matar was a young man with advanced liver cancer. Aminata had non-Hodgkins Lymphoma. Both were in horrific amounts of pain, both had to suffer without morphine. Neither had heard of it, and nor had their families.

The doctors looked heartbroken when I asked them about it. They knew perfectly well morphine would have stopped the pain, but there wasn’t any in the pharmacies so they didn’t prescribe it.

Cancer kills nearly one-in-three people in Britain but surely in Africa, many people think, it must be infectious diseases that remain the problem.

Malaria, Aids, TB, diarrhoea are the things we associate with poor countries, and that is where the big charities, development organisations and philanthropists concentrate their firepower.

But in Senegal more people are now dying of cancer than many of these things put together. Development and education has brought down many of the infectious diseases, and as people live longer cancer is emerging in more and more people.

It will be one of the great growing health challenges for the whole developing world and they simply aren’t equipped for it. It isn’t expensive to solve. That makes it all the more infuriating that it hasn’t been.

We filmed this report in late March. Since then Abdurahmane is back in hospital. For now, he has a supply of morphine. But it is fragile and could run out almost at any time.

The psychologist on the unit told me that all people, and children especially, tend to regard pain as an indicator of their pathology. So when they feel terrible pain they think they are going to die.

For a terrifying moment I thought of the children in the unit and I thought of my own children. At that point I felt overwhelmed. Today I feel more angry about it.

Unreported World is on Channel 4 on Friday 30 May at 7.30pm or on 4OD

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