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

During the war, the rebel assault on the capital was called Operation No Living Thing. Child soldiers were hardened with mysterious drugs with names like gunpowder and brown-brown, along with glue and alcohol.

Esther Walker, a British nurse who sometimes works with Lewis, said she once gave a lecture on palliative care at the national medical school.

There were 28 students, and she asked them, "Who has seen someone die peacefully in Sierra Leone?"

"Not one had," she said.

In the poorest countries like this one, even babies suffer.

Momoh Sesay, 2, (no relation to Zainabu) is a pretty lucky little guy - for someone who tumbled into a cooking pot of boiling water.

He lost much of the skin on his thighs, and his belly is speckled with burns as if he had been sloshed with pink paint.

But he was fortunate enough to live close to Ola During Children's Hospital, the leading pediatric institution.

No doctor was in. There was not even any electricity. At night, nurses thread IV lines into babies' tiny limbs by candlelight. "And our eyes are not magnets," one of them, Josephine Maajenneh Sillah, complained.

But they knew Momoh would die of shock, and pumped in intravenous fluids and antibiotics.

If he had been born in New York, Momoh would have had skin grafts. Here, that is unthinkable.

Momoh was given saline washes, and his dead skin was scrubbed off with debridement, a painful procedure. In New York, he would have had morphine.

So probably would Abdulaziz Sankoh, 7, in another bed, who has sickle cell disease. He moans at night when twisted blood cells clump together and jam the arteries in his spindly legs, slowly killing his bone marrow.

As would Musa Shariff, an 8-month old boy whose scalp is so swollen by meningitis that his eyelids cannot close. Muctar Jalloh, the hospital director, said he would not prescribe morphine to babies or toddlers if he had it. Only in the case of third-degree burns, like Momoh's, did he say: "I would consider it - maybe."

That flies in the face of Western medicine, which allows careful use even in premature infants.

The strongest painkiller that Momoh, Abdulaziz and Musa can take, if their parents can afford US$1.65 per vial, is tramadol. It is impossible to know what morphine would cost if it were here, but it is sold in India at US$0.17 a pill by the same company that makes tramadol.

The nurses know the prices because they sell the drugs that are available. They have not been paid for three years, they say, so they support themselves in part by filling the prescriptions that the doctors write. Kind as they are - they do extend credit, and are sometimes moved to charity by the children - it is a business.

That is the other reason Jalloh said he would not order morphine. "I wouldn't want to leave my staff in charge of morphine," he said. "The potential for abuse is so high."

If morphine were to be imported to Sierra Leone, it would be overseen by two agencies: the National Pharmacy Board and the National Drugs Control Agency.

Kande Bangura, the rangy, sharp-eyed former police commander who runs the drug control agency, said the country had a serious drug-abuse problem, especially among former child soldiers.

Bangura said he had no objections to morphine, however, "as long as it's for medical use and is strictly controlled by the country's chief pharmacist."

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