Dying a painless death SLUG: India palliative care REPORTER: Gayatri Parameswaran DATE: INTRO; Thousands of patients in India

experience unnecessary pain because access to morphine is restricted. Morphine, which comes from opium, is one of the most effective painkillers. India grows opium poppies, and produces opium for the international pharmaceutical market. But terminally ill patients in more than half the country are not getting it. The strict government regulations were created out of fears of illicit drug use and addiction. But in recent years Kerala in the south of the country has become to the fist state to relax the rules and has started using morphine for patients who are dying. Despite having less than three per cent of the country's population, it hosts 2/3rds of the country's palliative care centres. Gayatri Parameswaran travelled to find out more. TEXT SFX 1: Hospital room ambient 34-year old Raj Mohan is in his ward at the palliative care unit in a hospital in Trivandrum, Kerala. His left leg was amputated a couple of months ago. From the operation, doctors found out that he also suffers from cancer. Raj Mohan clip 1 [Male/ Tamil, 00:35]: “I am ill. I have nodules all over my body. The doctor called it cancer nodules. I have nodules on my head and my buttocks as well. Apart from that, I have fever. I can't eat.” Rajmohan had to travel about 100 kilometers from his village to this hospital. He lives in neighbouring Tamil Nadu state, where he couldn't find any doctor who would prescribe him morphine -- the only drug which will ease his pain at this stage.

02:30]: “Any doctor could prescribe it but you can’t buy it from anywhere because the pharmacists stopped stocking it. rigorous imprisonment. a pioneer of palliative care in India. we have a generation of doctors who have not seen a tablet of morphine. the attitude of the professionals and the healthcare industry as a whole are the major negative factors.” With complicated license procedures. 01:20]: “The lack of awareness.” Based on a proposal made by Indian Association of Palliative Care. When I say the healthcare industry.then there are so many licenses necessary. And. the judge will have no option but to give him rigorous imprisonment for ten years. So. But until now only less than half of the country’s states and union territories have simplified narcotics regulations which allow doctors to prescribe morphine.In 2009. Yes. inappropriate intensive care or inappropriate chemotherapy. Which means that if a pharmacist makes an error in his calculations and is found in possession of three grams of morphine. But Dr MR Rajagopal. Human Rights Watch found that many major hospitals in India do not provide cancer patients with morphine. I suppose one could make a profit out of it. it doesn’t suit the system as a whole.” This results in more patients dying with terminal illness in pain. Under laws created in the 1980s morphine is strictly regulated in the country out of fears of drug abuse. Dr Rajagopal clip 1 [Male/English. if you are found in unlawful possession of more than two grams. Dr Rajagopal clip 2: “The regulations also had a secondary ripple effect. today. which would carry a much better profit margin... In most states in India – each state has its own narcotic regulations – in most states you need anywhere from three to four different licenses to be able to use it. doctors and other professionals became more and more unfamiliar with the drug. in 1998 the Indian government ordered all states to simplify their narcotics law. pharmacists to stock it and patients to access it with ease. the morphine consumption came down. . Dr Rajagopal explains why. Dr Rajagopal clip 3 [Male/English. what I mean is – palliative care doesn’t necessarily mean adequate profit for the industry because most of palliative care is a low cost thing. you would be liable for a minimum imprisonment. So the pharmacists stopped stocking it. By those regulations. says the laws have affectively stopped people from getting access to morphine. but not as much as you could make out of. Because hospitals stopped using it. say. of ten years. So much so.

I used to go to the pharmacist and buy painkillers. Then the doctor in my village called up this hospital and they asked me to come here and promised they would help. I said I don’t have any money to pay for the treatment. They agreed and I came here. . a privilege to be where I am. Kerala now has 140 palliative care units and now provides two-thirds of India’s palliative services. Kerala. for Asia Calling. Dr Rajagopal and his NGO Pallium India have been busy spreading awareness about the medical use of morphine to ordinary people as well as health professionals and providing it free of cost to the needy. Rajmohan clip 2 [Male/Tamil. Dr Rajagopal clip 4 [Male/English. It would give me relief for a few minutes but then I would suffer again. Out of making such a huge difference to people’s lives. 00:45]: “One huge sense of personal privilege. I don’t experience any pain.For the last twenty years. The satisfaction that comes out of it. And this was really a powerful reward for all the difficulties that were there. But since yesterday. I don’t have a penny left. So I begged them for a favor.” This is Gayatri Parameswaran in Trivandrum. We got this very great kick. Before this. a high. Rajmohan is happy because for the first time after the operation. That’s a great reward. 01:00]: “I used to be in a lot of pain all over my body for the last three months. Dr Rajagopal is really proud about his work.” SFX2: Ambient walking to patient’s room Back to the hospital in Kerala. from seeing people so visibly relieved. I used to lie wailing in pain. Somebody coming begging to be killed and in an hour sitting up and having a cup of tea. I’ve spent all my money treating this disease. he is pain-free.

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