Tuesday, September 11, 2007
India's poor are denied a painless death - International Herald Tribune
It was a neighbor screaming in pain 35 years ago that set M.R. Rajagopal on the path to his nickname: India's "father of palliative care."
"He was dying of cancer, with lots of tumors on his face and scalp," Rajagopal said. "His family asked if I could help, and I couldn't. I was just a medical student."
Today, the same neighbor with the same cancer would almost certainly die the same way - unless he lived in the tiny state of Kerala, where Rajagopal runs his Pallium India clinic here in the capital. Although opium was one of the chief exports of British India and the country still produces more for the legal morphine industry than any other country, few Indians benefit. They end up like millions of the world's poor: spending their last days writhing in agony, wishing death would hurry.
...
Elsewhere, the state laws enforcing the Narcotic Drugs and Psychotropic Substances Act, passed in 1985 to curb drug trafficking, are complex and harsh. The book outlining them is 1,642 pages, and even minor infractions can mean 10-year sentences. Legal morphine use in India plummeted 97 percent after 1985, reaching a low of 40 pounds in 1997. It has since crept up.
...
Rajagopal's manner is soothing; he sits on beds, holds hands and even strokes patients as he questions them.
"For a senior doctor in India, that's just unheard of," Leng said. "They usually keep a formal distance."
Talking unravels fears. Chandraprabha, 40, who like many people here uses only one name, avoided her hourly pills because she could not bear to look at a clock. it reminded her she was dying and her children would go to a stepmother she detested.
Abdulaziz, 62, said that what upset him more than death was that he felt too unclean to pray.
"My body is not pure," Abdulaziz said. "Also, because of the bandage, it's difficult to bathe."
He had sung the call to prayer at his mosque for 20 years, but had to stop in January when mouth cancer left him able only to mutter. Then the aggressive tumor ate through his face, making a beefy crater. as if a firecracker tucked in his cheek had gone off. Then, worse: A fly got under his bandage, and maggots began emerging, leading his imam to "excuse" him from attendance.
That was something Rajagopal's team could help with, cleaning out the ghastly invaders. And the six five-milligram morphine pills Abdulaziz takes daily have taken away what he called "a catching pain, like a fishhook in my face."
...
As a young anesthesiologist, he helped a professor with a cheek tumor by injecting alcohol to kill the nerve. It worked - but the professor hanged himself two nights later."I learned from his cousin that the fact that I had treated him for his pain alone was what told him his condition was incurable," Rajagopal said, still feeling guilty about it. "None of us had ever asked him what he knew about his disease, or how he felt. If only we had, maybe his children could have had their father for a couple of years more." ...
It was a neighbor screaming in pain 35 years ago that set M.R. Rajagopal on the path to his nickname: India's "father of palliative care."
"He was dying of cancer, with lots of tumors on his face and scalp," Rajagopal said. "His family asked if I could help, and I couldn't. I was just a medical student."
Today, the same neighbor with the same cancer would almost certainly die the same way - unless he lived in the tiny state of Kerala, where Rajagopal runs his Pallium India clinic here in the capital. Although opium was one of the chief exports of British India and the country still produces more for the legal morphine industry than any other country, few Indians benefit. They end up like millions of the world's poor: spending their last days writhing in agony, wishing death would hurry.
...
Elsewhere, the state laws enforcing the Narcotic Drugs and Psychotropic Substances Act, passed in 1985 to curb drug trafficking, are complex and harsh. The book outlining them is 1,642 pages, and even minor infractions can mean 10-year sentences. Legal morphine use in India plummeted 97 percent after 1985, reaching a low of 40 pounds in 1997. It has since crept up.
...
Rajagopal's manner is soothing; he sits on beds, holds hands and even strokes patients as he questions them.
"For a senior doctor in India, that's just unheard of," Leng said. "They usually keep a formal distance."
Talking unravels fears. Chandraprabha, 40, who like many people here uses only one name, avoided her hourly pills because she could not bear to look at a clock. it reminded her she was dying and her children would go to a stepmother she detested.
Abdulaziz, 62, said that what upset him more than death was that he felt too unclean to pray.
"My body is not pure," Abdulaziz said. "Also, because of the bandage, it's difficult to bathe."
He had sung the call to prayer at his mosque for 20 years, but had to stop in January when mouth cancer left him able only to mutter. Then the aggressive tumor ate through his face, making a beefy crater. as if a firecracker tucked in his cheek had gone off. Then, worse: A fly got under his bandage, and maggots began emerging, leading his imam to "excuse" him from attendance.
That was something Rajagopal's team could help with, cleaning out the ghastly invaders. And the six five-milligram morphine pills Abdulaziz takes daily have taken away what he called "a catching pain, like a fishhook in my face."
...
As a young anesthesiologist, he helped a professor with a cheek tumor by injecting alcohol to kill the nerve. It worked - but the professor hanged himself two nights later."I learned from his cousin that the fact that I had treated him for his pain alone was what told him his condition was incurable," Rajagopal said, still feeling guilty about it. "None of us had ever asked him what he knew about his disease, or how he felt. If only we had, maybe his children could have had their father for a couple of years more." ...
Labels: compassionate people, suffering
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