The Gambia

The visit was only scheduled for two weeks later; the patient was therefore left in severe pain this whole time

One of our medical students spent some time at a small health service (with which we collaborate) providing medical care and ART for patients with HIV/Aids in The Gambia. She told us that she had accompanied the nurse to see a bedridden patient with HIV/AIDS and tuberculosis, who suffered from severe pain which was not alleviated with ibuprofen. The nurse wished to give him opioid treatment, but did not have these drugs with him on that particular day. He therefore just told the patient that he should ask for opioid medication when at the outpatient clinic of the service. That visit however was only scheduled two weeks later and the patient was therefore left in severe pain this whole time.

This patient suffered from HIV/Aids. An increasing number of services have been set up in recent years for this patient group providing ART and basic medical care. Patients with cancer find it much more difficult to access medical services. If you consider that this was probably the only service that would dispense opioid medications in the country, and that this was a nurse with some palliative care training, you can just imagine what other patients who do not have access to such services or trained nurses or physicians, have to suffer!

Lukas Radbruch, Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany; & Palliative Care Centre, Malteser Hospital Seliger Gerhard Bonn/Rhein-Sieg, Bonn, Germany.