Email this article 
Hide
Show all
Original Research
Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania
Submitted: 11 May 2013 | Published: 14 November 2014
About the author(s)
Kristopher Hartwig, Evangelical Lutheran Church in Tanzania, Tanzania, United Republic ofMervyn Dean, Consultig Palliatie Care Physician, Tanzania, United Republic of
Kari Hartwig, College of Health Sciences, Walden University, United States
Paul Z. Mmbando, Evangelical Lutheran Church in Tanzania, Tanzania, United Republic of
Abduraoof Sayed, Department of Community Health, University of Cape Town, South Africa
Elma de Vries, Division of Family Medicine, University of Cape Town,, South Africa
Abstract
Background: In Tanzania, a country of 42 million, access to oral morphine is rare.
Aim: To demonstrate the effectiveness of palliative care teams in reducing patients’ pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.
Setting: One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.
Method: A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years’ palliative care experience and no access to strong opioids.
Results: Patients and their family caregivers identifid statistically signifiant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when ‘bad cases’ arose who would likely benefi only from oral morphine.
Conclusion: People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.
Keywords
Metrics
Total abstract views: 9160Total article views: 13045
Crossref Citations
1. Strategies used to establish palliative care in rural low- and middle-income countries: an integrative review
Atsede Aregay, Margaret O’Connor, Jill Stow, Nicola Ayers, Susan Lee
Health Policy and Planning vol: 35 issue: 8 first page: 1110 year: 2020
doi: 10.1093/heapol/czaa051
2. Impact of palliative care consult service in inpatient hospital setting: a systematic literature review
Elene Janberidze, Kristýna Poláková, Lucie Bankovská Motlová, Martin Loučka
BMJ Supportive & Palliative Care vol: 11 issue: 4 first page: 351 year: 2021
doi: 10.1136/bmjspcare-2020-002291
3. Community-based palliative care needs and barriers to access among cancer patients in rural north India: a Participatory action research
Mayank Gupta, Ankita Kankaria, Liya E. Joshy, Sandeep Singh, Bhajan Lal, Subhash Choudhary, Sapna Marcus, Anju Grewal, Lajya Devi Goyal, Rakesh Kakkar
BMC Palliative Care vol: 23 issue: 1 year: 2024
doi: 10.1186/s12904-024-01572-7
4. What is the value of palliative care provision in low-resource settings?
R Eleanor Anderson, Liz Grant
BMJ Global Health vol: 2 issue: 1 first page: e000139 year: 2017
doi: 10.1136/bmjgh-2016-000139
5. Qualitative Analysis of Palliative Care for Pediatric Patients With Cancer at Bugando Medical Center: An Evaluation of Barriers to Providing End-of-Life Care in a Resource-Limited Setting
B. Emily Esmaili, Kearsley A. Stewart, Nestory A. Masalu, Kristin M. Schroeder
Journal of Global Oncology issue: 4 first page: 1 year: 2018
doi: 10.1200/JGO.17.00047
6. Nurses’ experiences of providing nonpharmacological pain management in palliative care: A qualitative study
Wisdom Muleya Munkombwe, Kerstin Petersson, Carina Elgán
Journal of Clinical Nursing vol: 29 issue: 9-10 first page: 1643 year: 2020
doi: 10.1111/jocn.15232
7. Community health workers in palliative care provision in low-income and middle-income countries: a systematic scoping review of the literature
MacKenzie Clark MacRae, Owais Fazal, James O'Donovan
BMJ Global Health vol: 5 issue: 5 first page: e002368 year: 2020
doi: 10.1136/bmjgh-2020-002368
8. Fardeau des maladies chroniques en Afrique subsaharienne : plaidoyer pour une mise en place des soins palliatifs et d’accompagnement en fin de vie en République démocratique du Congo
J.M. Lofandjola, E. Kiswaya Sumaili, J. Petermans
Ethics, Medicine and Public Health vol: 3 issue: 3 first page: 374 year: 2017
doi: 10.1016/j.jemep.2017.06.003
9. Palliative care in Africa: a scoping review from 2005–16
John Y Rhee, Eduardo Garralda, Carlos Torrado, Santiago Blanco, Ibone Ayala, Eve Namisango, Emmanuel Luyirika, Liliana de Lima, Richard A Powell, Carlos Centeno
The Lancet Oncology vol: 18 issue: 9 first page: e522 year: 2017
doi: 10.1016/S1470-2045(17)30420-5
10. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas
Marie Bakitas, Kristen Allen Watts, Emily Malone, J. Nicholas Dionne-Odom, Susan McCammon, Richard Taylor, Rodney Tucker, Ronit Elk
Journal of Clinical Oncology vol: 38 issue: 9 first page: 963 year: 2020
doi: 10.1200/JCO.18.02432
11. “We never speak about death.” Healthcare professionals' views on palliative care for inpatients in Tanzania: A qualitative study
E. Grace Lewis, Lloyd L. Oates, Jane Rogathi, Ashanti Duinmaijer, Aisa Shayo, Simon Megiroo, Barthlomew Bakari, Felicity Dewhurst, Richard W. Walker, Matt Dewhurst, Sarah Urasa
Palliative and Supportive Care vol: 16 issue: 5 first page: 566 year: 2018
doi: 10.1017/S1478951517000748
12. Addressing Barriers in Palliative Care for Rural and Underserved Communities
Matthias Weiss, Susan Sabo-Wagner, Julia Frydman, C.S. Pramesh
American Society of Clinical Oncology Educational Book vol: 45 issue: 3 year: 2025
doi: 10.1200/EDBK-25-472842
13. mPalliative Care Link: Examination of a Mobile Solution to Palliative Care Coordination Among Tanzanian Patients With Cancer
Mamsau Ngoma, Beatrice Mushi, Robert S. Morse, Twalib Ngoma, Habiba Mahuna, Kaley Lambden, Erin Quinn, Sarah B. Sagan, Yun Xian Ho, F. Lee Lucas, Joshua Mmari, Susan Miesfeldt
JCO Global Oncology issue: 7 first page: 1306 year: 2021
doi: 10.1200/GO.21.00122
14. Barriers to accessing internationally controlled essential medicines in sub-saharan Africa: A scoping review
Gaby I Ooms, Janneke van Oirschot, Denise de Kant, Hendrika A van den Ham, Aukje K Mantel-Teeuwisse, Tim Reed
International Journal of Drug Policy vol: 118 first page: 104078 year: 2023
doi: 10.1016/j.drugpo.2023.104078