Thursday, September 20, 2007

September 20, 2007 - The Politics of Pain

Recently I ran across a news article that was a real eye-opener for me. (Donald G. McNeil, Jr., “Drugs Banned, Many of World’s Poor Suffer in Pain,” New York Times, September 10, 2007.) We’ve all become overwhelmed with statistics about how widespread poverty is in our world, and how inequitably wealth is distributed. I don’t mean to be cavalier about it, but it’s a simple fact: you can only read so many accounts of millions of refugees living under canvas in displaced-persons camps before your eyes glaze over with the sheer enormity of it all.

A week and a half ago, the New York Times ran a feature story that coalesced this universe of statistics into a single point: the story of one poor cancer patient who’s living in pain. More than the story, it’s a photo of her that speaks the proverbial thousand words. It depicts her pursing her lips and wrinkling her forehead, as she endures unspeakable agony.

Let me share a few insights from the article that made an impression on me.

The woman’s name is Zainabu Sesay, and she lives in the tiny nation of Sierra Leone, in West Africa. She’s got breast cancer – a case so advanced that it displays symptoms rarely seen in Western hospitals. Even the poorest of the poor, in America, would not be permitted to go so long without treatment. Her tumor, says the Times article, has broken through the skin of her breast, and looks “like a putrid head of cauliflower weeping small amounts of blood at its edges.” It's long past being curable, or even operable.

Sierra Leone is not a good place to be a cancer patient. There’s not a single CT scanner in the entire country. Only one private hospital offers chemotherapy treatments. Sharecroppers like Zainabu and her husband couldn’t dream of affording even one chemo treatment (as though one treatment could make a difference, anyway). For most people in this benighted land, a cancer diagnosis of any kind is a death sentence.

A kindly nurse is attending to her. All he can do is change her dressing, sprinkle antibiotic powder on the skin infection and give her Tylenol and tramadol – a medication related to codeine, that’s only 10 percent as effective as morphine. That, and offer her some encouraging words.

The lack of curative treatment is bad enough, but Zainabu also suffers unremitting pain, because morphine-based pain-killers are all but unknown in her country. In part, this is a decision of her country’s government. Fearing the impact of drug abuse on a country already devastated by years of civil war, they have enacted a total import ban on all opiates. Yet, the shortage also has to do with simple economics. Morphine is a relatively cheap medication, but in an economy like Sierra Leone’s, it would still be beyond the reach of nearly everyone’s ability to pay.

Sierra Leone is not alone. Here are some telling statistics: “Six countries – the United States, Canada, France, Germany, Britain and Australia – consume 79 percent of the world’s morphine, according to a 2005 estimate. The poor and middle-income countries where 80 percent of the world’s people live consumed only about 6 percent.”

Do the math: 80 percent of the world’s people get just 6 percent of the world’s narcotics. That means a whole lot of cancer patients are living with levels of pain unimaginable to anyone in our culture.

I think back to my minor surgeries, and how worried I felt about pain of a few seconds’ duration, that might break through the “twilight sedation” I had been given. Compare that to Zainabu Sesay’s unceasing agony – well, there’s no comparison. None whatsoever.

The hospice nurse speaks to her in the local pidgin dialect, a hybrid of English and tribal languages left behind by the English colonists who formed this nation as a place to settle repatriated slaves. He suggests that Zainabu let a neighbor plait her hair for her - just to make her feel better - but she declines.

“It’s necessary for to cope,” he says. “For to strive for be happy.”

“I ‘fraid for my life,” she says.

“Are you ‘fraid for die?”

“No, I not ‘fraid. I ready.”

“So what is your relationship to God? You good with God?”

“I pray me one.”

Prayer is about all she’s got. Effective medicine is an impossible dream.

1 comment:

hannah said...

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