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More than 25 million people dying in agony without morphine every year

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Concern over illicit use and addiction is putting morphine out of reach for millions of patients globally who need it for pain relief.

More than 25 million people, including 2.5 million children, die in agony every year around the world, for want of morphine or other palliative care, according to a major investigation.

Poor people cannot get pain relief in many countries of the world because their needs are overlooked or the authorities are so worried about the potential illicit use of addictive opioids that they will not allow their importation.

“Staring into this access abyss, one sees the depth of extreme suffering in the cruel face of poverty and inequity,” says a special report from a commission set up by the Lancet medical journal.

In Haiti, for instance, says the report, there are no nursing homes or hospices for the dying and most have to suffer without pain relief at home.

“Patients in pain from trauma or malignancy are treated with medications like ibuprofen and acetaminophen,” says testimony from Antonia P Eyssallenne of the University of Miami School of Medicine. “Moreover, nurses are uncomfortable giving high doses of narcotics even if ordered to do so for fear of being “responsible” for the patient’s death, even if the patient is terminal.

“Death in Haiti is cruel, raw, and devastatingly premature. There is often no explanation, no sympathy, and no peace, especially for the poor.”

A doctor in Kerala, India, which has a palliative care service, told of the arrival of a man in agony from lung cancer. “We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible,” said Dr M R Rajagopal.

But when he returned, morphine stocks were out. “Mr S told us with outward calm, ‘I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree’. He pointed to the window. I believed he meant what he said.”

The commission’s three-year inquiry found that nearly half of all deaths globally – 25.5 million a year – involve serious suffering for want of pain relief and palliative care. A further 35.5 million people live with chronic pain and distress. Of the 61 million total, 5.3 million are children. More than 80% of the suffering takes place in low and middle-income countries.

Jim Yong Kim, president of the World Bank, said things had to change. “Failure of health systems in poor countries is a major reason that patients need palliative care in the first place. More than 90% of these child deaths are from avoidable causes. We can and will change both these dire situations.”

Morphine is hard to obtain in some countries and virtually unobtainable in others. Mexico meets 36% of its need, China meets 16%, India 4% and Nigeria 0.2%. In some of the world’s poorest countries, such as Haiti, Afghanistan and many countries in Africa, oral morphine in palliative care is virtually non-existent.

Oral and injectable morphine is out of patent, but costs vary widely and it is cheaper in affluent countries like the USA than in poor countries. A second issue is “opiophobia” – the fear that allowing the drugs to be used in hospitals will lead to addiction and crime in the community.

“The world suffers a deplorable pain crisis: little to no access to morphine for tens of millions of adults and children in poor countries who live and die in horrendous and preventable pain,” says Professor Felicia Knaul, co-chair of the commission from the University of Miami, calling it “one of the world’s most striking injustices”.

Knaul says she only realised that many people suffered without pain relief when she was working to improve access to cancer treatment in low-income countries. “I was shocked. I had no idea. When people were showing me the data I thought it can’t be in this world,” she told the Guardian.

She had also experienced the need for morphine herself after a mastectomy for breast cancer. “When I woke up I couldn’t breathe because the pain was so bad. If they hadn’t arrived with the morphine I don’t know how I would have got through it.” And as a young girl in Mexico, she had to watch her father suffer as he died without pain relief.

“I don’t think that we have cared enough about poor people who have pain,” she said. “It doesn’t make them live any longer. It doesn’t make them more productive. It is simply the human right of not suffering any more pain and we don’t care about that for people who are poor.”

The commission recommends that all countries put in place a relatively inexpensive package of effective palliative care for end of life conditions that cause suffering, including HIV, cancers, heart disease, injuries and dementia.

One of their most emphatic recommendations, says Knaul, “is that immediate-release, off-patent, morphine that can cost just pennies should be made available in both oral and injectable formulations for any patient with medical need. The disparity and access abyss between the haves and have-nots is a medical, public health and moral injustice that can be effectively addressed by the commission’s recommendations.”

Guardian

Health and Safety

LASG Unveils 24-hour Customer Service Centre To Enhance Traffic Management

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LASG Unveils 24-hour Customer Service Centre To Enhance Traffic Management

In a significant move to enhance the operations of the Lagos State Traffic Management Authority (LASTMA), the Lagos State Government has launched a 24-hour Customer Service Center, equipped with a dedicated Toll-Free Hot Lines, a Walk-In Complaint Centre, a Website, a Whistleblower App, and a new Department of Statistics, Research, and Data. 

According to the Special Adviser to the Governor on Transportation, Sola Giwa, the centre is at the LASTMA headquarters.

Speaking at the inauguration, the Special Adviser to the Governor on Transportation, Giwa officially opened the Customer Service Center and announced the dedicated lines as 0800-00-527862 or 0800-00-LASTMA.

Explaining the initiative, Hon. Sola Giwa said Motorists can contact the Call Center via the toll-free hotlines to report incidents, request assistance, or seek information on road conditions, including updates on the activities of LASTMA personnel. 

He said the centre will also enable drivers get real-time updates on road conditions and traffic advisories, enabling them to plan their routes more effectively, avoid congestion and reduce travel time.

Highlighting the features of the customer support centres, the Special Adviser further explained that the whistleblower app is designed to involve everyone in the state’s traffic management. 

“When you see something, say something,” he added. The app is available for download on the Android Play Store”, Sola Giwa said, stressing that the whistleblower app will allow Motorists and other road users to report dangerous driving and other reckless behaviours on the road, enabling LASTMA to take immediate action and uphold traffic regulations. 

He said the public can also earn points for every valid incident they report and get rewarded for their actions.

Hon. Giwa also mentioned that a walk-in complaint centre and a live interactive website (lastma.org) are available for citizens to engage with traffic management personnel, urging everyone to embrace the initiative.

Discussing the new Department of Statistics, Research, and Data, he explained that the department aims to provide a comprehensive breakdown and analysis of vehicles on Lagos roads. 

This includes real-time data on the number of vehicles impounded, categorized by private and commercial vehicles, and details on accidents and other traffic offences.

In the demonstration on statistics and data carried out between January and June 2024, the Special Adviser debunked the belief that the agency concentrates more on private vehicles disclosing that 5, 547 commercial vehicles were impounded for traffic infringement as against 3, 823 private vehicles. 

In his address, the Commissioner for Transportation Mr Oluwaseun Osiyemi emphasized that the customer support centres aim to improve communication between the public and LASTMA, streamline traffic operations, and significantly enhance the overall driving experience in Lagos State. 

He noted that with these new centres, Traffic Management Officers are now just a phone call away, at no cost to the public.

The General Manager of LASTMA, Mr. Olalekan Bakare Oki, confirmed that officers managing the newly launched Call Center have been thoroughly trained by the government, noting that the agency will use multiple languages, including English, Pidgin, and Yoruba, to ensure convenient communication for all members of the public.

 

He reiterated the agency’s commitment to prioritizing public feedback, stating that input from citizens will aid in efficient traffic management across the state.

The event was also attended by the Permanent Secretary of the Lagos Ministry of Transportation Mr. Olawale Musa, Directors in the ministry and LASTMA Personnel.

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Health and Safety

Waterloo: NAF Kills Several Terrorists In Aerial Bombardment In Borno

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Waterloo: NAF Kills Several Terrorists In Aerial Bombardment In Borno

The Nigerian Air Force (NAF) says the Air Component of Operation Hadin Kai, has eliminated several terrorists in an aerial bombardment in their hideouts in Borno.

This is contained in a statement by the Director, Public Relations and Information, NAF, AVM Edward Gabkwet, on Thursday in Abuja.

Gabkwet said that the hideouts located near Degbewa and Chinene in the Mandara mountains in the state were known terrorists’ hideouts.

He said the air strikes became expedient after several days of aerial surveillance which revealed a consistent gathering of a large number of terrorists in the area.

According to him, the location is also suspected to be a site for manufacturing Improvised Explosive Devices and a storage area.

”The terrorists were also observed to be loitering within the vicinity, clearly oblivious of what was to befall them, and probably confident that their location was safe and secured from any form of military bombardments.

”The air strikes were thus authorised with the aircraft bombarding the locations in several passes until the majority of the terrorists were eliminated.

”Others observed fleeing the location were taken out using canons,” he said.

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Health and Safety

Sumal: 1 Dies, 12 Arrested In Ibadan Palliative Protest – Police

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ABUJA: Police Arrest 1 Prankster, 5 Kidnappers

… Affirms protest hijacked by criminal elements who forced their way into the factory

The Police Command in Oyo State says one person died and 12 suspects were arrested in a violent protest by workers of Sumal Food Company, Ibadan, over palliatives on Monday.

The command’s Public Relations Officer, SP Adewale Osifeso, confirmed this in a statement issued on Tuesday in Ibadan.

Osifeso said the protest broke out in the factory located at Oluyole Industrial Estate, Ibadan around 4 p.m. on Monday.

He said that the workers staged the protest to challenge what they called non-distribution of the palliatives allegedly given by the Federal Government to all private companies across the country.

Osifeso said that it was sad that the protest was hijacked by criminal elements who forced their way into the factory, thus destroying vehicles and other property worth millions of naira.

“One person died and 12 suspects were arrested in connection with the violent protest,’’ he said.

The spokesman, however, said that normalcy had returned to the area where the company is located, following the deployment of police operatives to maintain peace.

He also said that the Commissioner of Police in the state, Ayodele Sonubi, had ordered the transfer of the matter to the homicide unit of the Criminal Investigations Department for further investigation.

“Preliminary investigation revealed that the protest was premised on false information created and peddled by some workers over the disbursement of palliatives to privately-owned companies,’’ he said.

Osifeso said that the command would give further information on the matter as soon investigation was concluded.

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