Ira Math­ur

"See that pa­tient in Room Six? Half his neck is miss­ing. He has can­cer of the lar­ynx. That pain is some­thing we can­not con­ceive. If we had the de­liv­ery sys­tem, we would stick a patch on him every four hours, which would re­lieve him of pain with­out caus­ing pain.

How can I in­flict him with an in­jec­tion every four hours? For years we have been bat­tling to bring pain con­trol drugs to dy­ing can­cer pa­tients. We have had nu­mer­ous con­ver­sa­tions with the Min­is­ter of Health, Fuad Khan, ap­pris­ing him of the sit­u­a­tion. We have, at his re­quest, sent him lists of drugs we ur­gent­ly need to con­trol pain in the dy­ing among us, with no re­sults.

"Our coun­try does not match up the World Health Or­gan­i­sa­tion (WHO) stan­dards for a hu­mane so­ci­ety. Bar­ba­dos is far ahead of us. There is no short­age there. Even sub-Sa­ha­ran Africa, which has nowhere near our wealth, is vir­tu­al­ly sat­u­rat­ed with pain-re­liev­ing drugs for the dy­ing. "I have come to you be­cause it can't get worse."

-Dr Jacque­line Pereira Sab­ga, the chair­man and med­ical di­rec­tor of Vi­tas House Hos­pice.

Sec­onds af­ter I walked in­to a spot­less, airy build­ing which made me think of a cheer­ful chil­dren's li­brary rather than a hos­pice, Lil­ia Mootoo, the gen­er­al man­ag­er, a briskly ef­fi­cient woman, asked: "You afraid of dead bod­ies?" I made a non-com­mit­tal sound as she walked me through a large hall with 12 cu­bi­cles and a doc­tors' cen­tral sta­tion and ush­ered me to a bright din­ing room glow­ing with af­ter­noon light where we joined Dr Jaque­line Sab­ga, chair­man and med­ical di­rec­tor of Vi­tas House, and Pat Stollmey­er, the co-founder of Vi­tas and re­tired reg­is­tered nurse trained (in the UK) in pain man­age­ment.

Of course I was afraid. Few peo­ple aren't when faced with the in­evitabil­i­ty of our hu­man fragili­ty and mor­tal­i­ty. I ad­dressed the three women-Lil­ia, Pat and Jaque­line-who have ded­i­cat­ed their lives to the dy­ing, and who fill in one an­oth­er's sen­tences speak­ing vol­umes of their close team­work. "What's it like to watch peo­ple die all the time?"

"We have helped 276 peo­ple make that tran­si­tion from life to death. We ask them, what do you fear the most about death? They say they fear be­ing in pain, not be­ing able to breathe, dy­ing alone. And we say if we can guar­an­tee you that you will not be alone, that you will not be in pain and dis­com­fort, does that take away the fear? It does.

By keep­ing pa­tients pain-free, we re­store an es­sen­tial dig­ni­ty to them, em­pow­er them to make de­ci­sions, al­low them to talk through their fears. All of them died with an ex­tra­or­di­nary grace which nev­er fails to in­spire us."

From the cor­ner of my eye I glimpsed two men car­ry­ing out a body on a stretch­er. There was noth­ing to in­di­cate the hor­ror we as­so­ciate with death, or can­cer and its at­ten­dant emo­tions of fear. Out­side, the sun was hot. There was a view of the Sa­van­nah. There was a bed of or­ange around an im­mortelle tree. "What did the pa­tient die of?" I asked.

"Lung can­cer," said Lil­ia. "He was a smok­er and drinker. He came the day be­fore he died. "Some days it's al­most emp­ty, like now, and oth­er weeks and months are hec­tic, with every cu­bi­cle be­ing oc­cu­pied," she added. The women tell me that the three oth­er cu­bi­cles are oc­cu­pied by pa­tients in var­i­ous stages of ad­vanced can­cers of the colon, thy­roid and lar­ynx. Two had been there for sev­er­al months and the third for a week. They were com­fort­able and their fam­i­lies as­sured they will have vir­tu­al­ly pain free deaths.

Un­for­tu­nate­ly, Dr Sab­ga tells me, most pa­tients na­tion­wide, due to the short­age of anal­gesic drugs, aren't that lucky. Many will die in pain, many "writhing and scream­ing." Dr Sab­ga is in turn sad­dened and en­raged that so many of our ill peo­ple die with­out pain re­lief, with­out hu­man­i­ty.

Dr Sab­ga: Min­istry of Health re­fus­es to lev­el with us

She tells me that af­ter an ini­tial meet­ing with the Min­is­ter of Health, Fuad Khan in Au­gust 2011, she (on the min­is­ter's re­quest) shot him off a let­ter list­ing the short­age of drugs in the coun­try's pub­lic and pri­vate phar­ma­cies, in­clud­ing mor­phine elixir, fen­tanyle patch­es, mor­phine im­me­di­ate re­lease, oxy­codone, and buprenor­phrine.

Af­ter that, noth­ing. "De­spite re­peat­ed calls and texts to the health min­is­ter, af­ter re­peat­ed promis­es to vis­it the hos­pice, af­ter ar­ti­cles in the me­dia, and ra­dio and tele­vi­sion ap­pear­ances ap­peal­ing for anal­gesic drugs, the short­age con­tin­ues. The frus­trat­ing thing is, the Min­istry of Health re­fus­es to lev­el with us. The sit­u­a­tion is un­der a shroud of fog. No one tells us why our re­quests are go­ing nowhere. We just keep get­ting put off.

"Many can­cer pa­tients would rather die than go through the drudgery of a gov­ern­ment sys­tem where they are told, 'Come back, we ran out.' "The on­ly way I may get some res­o­lu­tion now is if I protest on the stairs of the Min­istry of Health. "Where is the con­science of the peo­ple in Gov­ern­ment? Our plea is not just for drugs for our hos­pice but for all pri­vate and pub­lic in­sti­tu­tions treat­ing dy­ing pa­tients.

"A few years back, Pat and I went to see a pa­tient dy­ing of head and neck can­cer. He couldn't swal­low, had a feed­ing tube in his mouth and had ex­ten­sive mouth and tongue le­sions. "I called the FDA and they said they had no patch for his pain. They told me to give him slow-re­lease mor­phine rec­tal­ly, al­though they weren't sure it would work.

"I was shocked. I said, 'Do you know the in­dig­ni­ty and added pain I will be giv­ing this al­ready suf­fer­ing gen­tle­man, for a so­lu­tion that may or may not work?'" A hu­mane so­ci­ety should not even be hav­ing this con­ver­sa­tion, I thought, as I drove out of the St James Med­ical Fa­cil­i­ty.

To be con­tin­ued next week.