Original Research

Where there is no morphine: The challenge and hope of palliative care delivery in Tanzania

Kristopher Hartwig, Mervyn Dean, Kari Hartwig, Paul Z. Mmbando, Abduraoof Sayed, Elma de Vries
African Journal of Primary Health Care & Family Medicine | Vol 6, No 1 | a549 | DOI: https://doi.org/10.4102/phcfm.v6i1.549 | © 2014 Kristopher Hartwig, Mervyn Dean, Kari Hartwig, Paul Z. Mmbando, Abduraoof Sayed, Elma de Vries | This work is licensed under CC Attribution 4.0
Submitted: 11 May 2013 | Published: 14 November 2014

About the author(s)

Kristopher Hartwig, Evangelical Lutheran Church in Tanzania, Tanzania, United Republic of
Mervyn 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


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.


Rural Palliative Care Morphine


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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