Sun, Sep 16, 2007 - Page 17 News List

Lacking drugs, world's poor die in agony

Though opium is cheap and could be made readily available, millions of the world's poor are dying in excruciating pain

By DONALD G. McNEIL Jr.  /  NY Times News Service , WATERLOO, SIERRA LEONE

Zainabu Sesay winces as she tries to rest outside her home in Waterloo, Sierra Leone, after hospice workers came to change the dressing on the tumor in her breast. Like millions of others in the world's poorest countries, she is destined to die in pain.

Photo: NY Times News Service

Although the rainy season was coming on fast, Zainabu Sesay was in no shape to help her husband. Ditches had to be dug to protect their cassava and peanuts, and their mud hut's palm roof was sliding off.

But Sesay was sick. She had breast cancer in a form that Western doctors rarely see anymore - the tumor had burst through her skin, looking like a putrid head of cauliflower weeping small amounts of blood at its edges.

"It bone! It booonnnne lie de fi-yuh!" she said of the pain - it burns like fire - in Krio, the blended language spoken in this country where British colonizers resettled freed slaves.

No one had directly told her yet, but there was no hope - the cancer was also in her lymph glands and ribs.

Like millions of others in the world's poorest countries, she is destined to die in pain. She cannot get the drug she needs - one that is cheap, effective, perfectly legal for medical uses under treaties signed by virtually every country, made in large quantities, and has been around since Hippocrates praised its source, the opium poppy. She cannot get morphine.

That is not merely because of her poverty, or that of Sierra Leone. Narcotics incite fear: doctors fear addicting patients and law enforcement officials fear drug crime. Often, the government elite who can afford medicine for themselves are indifferent to the sufferings of the poor.

The World Health Organization estimates that 4.8 million people a year with moderate to severe cancer pain receive no appropriate treatment. Nor do another 1.4 million with late-stage AIDS. For other causes of lingering pain - burns, car accidents, gunshots, diabetic nerve damage, sickle-cell disease and so on - it issues no estimates but believes that millions go untreated.

Figures gathered by the International Narcotics Control Board, a UN agency, make it clear: citizens of rich nations suffer less. Six countries - the US, Canada, France, Germany, Britain, and Australia - consume 79 percent of the world's morphine, according to a 2005 estimate. The poor and middle-income countries where 80 percent of the world's people live consumed only about 6 percent.

Some countries imported virtually none. "Even if the president gets cancer pain, he will get no analgesia," said Willem Scholten, a World Health Organization official who studies the issue.

In 2004, consumption of morphine per person in the US was about 17,000 times that in Sierra Leone.

At pain conferences, doctors from Africa describe patients whose pain is so bad that they have chosen other remedies: hanging themselves or throwing themselves in front of trucks.

Westerners tend to assume that most people in tropical countries die of malaria, AIDS, worm diseases, and unpronounceable ills. But as vaccines, antibiotics and AIDS drugs become more common, more and more are surviving past measles, infections, birth complications and other sources of a quick death. They grow old enough to die slowly of cancer.

About half of the 6 million cancer deaths in the world last year were in poor countries, and most diagnoses were made late, when death was inevitable. But first, there was agony. About 80 percent of all cancer victims suffer severe pain, the WHO estimates, as do half of those dying of AIDS.

Morphine's raw ingredient - opium - is not in short supply. Poppies are grown for heroin, of course, in Afghanistan and elsewhere. But vast fields for morphine and codeine are also grown in India, Turkey, France, Australia, and other countries.

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