Armenia: dealing with the pain of cancer

“No one in this condition can bear such pain”

“Two years ago, my left hand became paralyzed due to a tumor. That’s when the awful pain began. It felt like my hand was on fire. It was hell… Now I feel it all the time, but it becomes really unbearable at night. It makes me literally scream. Two months ago, I was prescribed a bottle of Omnopon. At first it was enough to dull the pain for four hours, but now only for two. The pain comes without warning, and it makes me into an animal… No one in this condition can bear such pain.”

This is the story of Lyudmila, a 61-year old cancer patient from Armenia. Her story is presented in the new World Health Organization (WHO) report on palliative care (for the terminally ill) in the country.

• Life after cancer – a story from Armenia

What’s happening in Armenia

Instances of cancer are growing in Armenia. Around 8,000 people die from the disease annually. In some, it causes unimaginable pain.

But it is not tremendously difficult to ease their suffering. The normal solution to the pain is morphine – a painkiller that is both inexpensive and easy to manufacture and use.

Palliative care is also often provided by hospices.

Access to both of these, however, is often difficult for citizens of Armenia.

As a result, terminally ill patients are simply discharged from hospitals and sent home, adding psychological stress to their physical condition.

The main problems

After examining the state of affairs in Armenia, the WHO highlighted several main problems:

– Excessive regulations, impeding access to strong painkillers

– The widespread practice in the healthcare system of ignoring the needs of patients deemed terminal

– Lack of relevant knowledge among medical personnel

– Lack of palliative care facilities.

Necessary next steps

The WHO report contains specific recommendations for the Armenian government to help ease the suffering of patients:

– Work with manufacturers and importers to simplify procedures for registering opiate-based painkillers, primarily orally-ingested tablets. Use these drugs after their registration at all levels of the health care system.

– Give all clinical doctors (not only oncologists) the authority to prescribe opiates.

– Provide access to opiates to all terminal patients, not only those suffering from cancer.

– Remove bureaucratic hurdles from the prescription process, allowing doctors to make the decision themselves.

– Rescind the ability for law enforcement agencies to intervene in the process of prescribing opiates, except in cases where there is preexisting evidence of criminal activity.

– Immediately adopt a National Strategy and Action Plan for the creation of palliative care systems in the country.

– Introduce the basics of palliative care in training programs for doctors and nurses.

– Train medical personnel in the appropriate way to interact with terminal patients, especially when informing them about their diagnosis.

– Inform the public about the right to receive palliative care.

Only two hours without pain

For 61-year old Lyudmila, whose story was told above, she discovered a tumor in her breast in 2002. It was another five years before she sought medical care. In 2007, she was diagnosed with inoperable breast cancer that had metastasized to her armpit and left shoulder.

She began to experience extreme pain in 2010. Her Omnopon prescription provides only two hours of relief.

According to Lyudmila, the pain never goes away, but medication does reduce it to the point where she can talk with friends and family and do housework.