Pain Control in the African Context: the Ugandan introduction of affordable morphine to relieve suffering at the end of life

Sub-Saharan Africa faces a very high burden of incurable terminal disease. During 2007 there were 22.5 million people living with HIV infection; 1.7 million adults and children became infected with HIV; and 1.6 million died of AIDS (UNAIDS). The burden of cancer is just beginning to be understood and receive attention with clinical research and policy. The burden of other non-malignant diseases is unknown, although heart failure is recognized as a leading cause of death in Southern Africa. Palliative care can relieve the suffering of patients and families affected by these diseases and a strong body of evidence has demonstrated this [1]. The pain, symptoms, insight and anxiety associated with HIV can also be controlled under palliative care [2]. For this reason, policy and legal frameworks have sought to remove this unnecessary suffering and to promote cheap and effective palliative care as both a public health issue and as a human right [3]. Medical ethics requires that we "do no harm". Leaving my patient in pain in the era when pain relief and symptom control is affordable, is breaking our ethical code.Since the modern palliative care speciality was developed and grew in the 1960's across Western Europe, Australia and North America it has (to a greater or lesser degree) become integrated into the health system. The palliative care needs of a range of patients and families can be met (although still only a proportion of those who could benefit actually get access). Therefore it is difficult to imagine, and impossible to justify, a country where there is no medicine for severe pain. This, however, is the case for many countries in Africa today. While there are centres of excellence providing care, education and advocacy, they are few and far between [4,5]. To reach the poorest and those suffering in an appropriate and ethical manner, a public health policy needs to be accepted and delivered in every country.WHO defines palliative care as follows [6]:"Palliative care