Pain

#motherteresa, #palliativecare and me!


Netti MTIt is not often one can say that you have meet a formally canonized saint. But today is the day. 34 years ago as a fifth year medical student at the University of Adelaide I was planning to head off to do an elective at St Christopher’s Hospice in London.

My mother, a hospice nurse at Mary Potter Hospice, had spent a few month’s at St Christopher’s, and had brought back the concept of oral morphine to Mary Potter. Yes, the first dose of oral morphine in Adelaide was administered during my medical career!  Not the result of a pharmaceutical company but the finding of a a group of nun’s working in London in the 1920’s and 30’s. Cicely Saunders had documented and published the finding that the regular administration of oral morphine to patients with advanced cancer resulted in much better pain relief. A convoluted path did not get me to St Christopher’s until some 20 years later. Calcutta beckoned.

The work of Mother Teresa was getting significant press around the world, due to Malcolm Muggeridge’s 1971 book, Something Beautiful for God. My father, a physician, met her when she visited Australia in 1982, and mentioned he had some medical students interested in working with her. She gave him the details, I wrote and in November of that year, took off to spend 3 months in Calcutta, at the Home for the Dying.

A life changing experience in many ways! But let me stick to Palliative care.

Nirmal Hriday is located next to the Kali temple on the south side of Calcutta and the poor and sick were brought there; often to die, but primarily to be cared for by the nun’s and many volunteers from both India and beyond. I was supervised by two young physician who each visited the home twice/week. We used medicines that had been donated to the Missionaries of Charity, including at times codeine based products which we administered IM to patients with pain associated with advanced cancer. The nuns often gave IV fluids in the belief that patients should not die thirsty (an approach still debated in palliative care to this day).

Were we providing Palliative care of excellence? Remember this was 1982. Bal Mount had only just coined the term! The WHO’s Cancer Pain guidelines not yet written! Morphine was not commonly used for cancer pain relief in Wisconsin at that time! India had some access to opioids but the restrictive rules that severely limited their medical use were not yet written and applied!

No it was not palliative care of excellence but is was care for those who could not receive care elsewhere. There are many things I could criticize in the care provided but today I celebrate Mother Teresa, for her bold move to care for the poorest of the poor and to thank her for the opportunity to meet and work with her, her nuns and the international volunteers.

My experience in Calcutta set me along a path of addressing global access to pain relief for cancer patients and others who are approaching the end of life, a journey I continue to this day in improve access to the 80% of the world’s population who lack access to these essential medicines.

jim

 

About Pain policy & palliative care

Improving global pain relief by achieving balanced access to opioids worldwide

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