CHENNAI: Brindha Raghunathan lay still on the frail wooden cot in her house here. She could not move her arms and legs. Her eyes full of tears were devoid of expression, fixed on an empty spot on the ceiling. A few days before, she had twisted her ankle and fell twice in just a few hours, the second fall severely injured her head and back. Her organs were failing one after the other. Brindha, terminally ill from cardiac complications, couldn’t walk straight after her brain’s functions slowed, and she couldn’t control her limbs anymore.
“My back hurts badly, turn my body around please. I fell down,” she said without emoting. More tears rolled out of her eyes. A few hours of silence later, she involuntarily chewed for a while again and said, “My back hurts. Are you hitting me? Don’t! Turn my body please!”
Neither Brindha, nor her family was aware that they could make her death less painful. She bore traumatic episodes of pain she couldn’t fully express, threw up a dozen times and succumbed to death the next day. She is among the 96 per cent of people from low and middle income countries who are either unaware or did not have access to palliative health care that offers morphine as an alternative to excruciating pain.
Purview of the rich
Globally, 61 million people suffer serious physical and psychological suffering and pain each year. Of this, 83 per cent live in low-and-middle-income countries where access to low-cost, off-patent morphine is rare or completely unavailable, even though the cost should be pennies for a tablet, according to a recent study by the Lancet Commission on Global Access to Palliative Care and Pain Relief.
Morphines are drugs that bind to the opioid receptors on the surfaces of nerve cells in the brain and spinal cord. This triggers a chain of chemical signals within the cell, making its membrane less excitable. This means that pain-sensing nerve cells become electrically ‘sluggish’ and don’t fire so many impulses.
Between 1985 and 1997, morphine consumption decreased by 97 per cent globally, reaching a low of 18 kg in 1997. India’s per capita consumption of morphine ranked 113th of 131 countries. During the same period, global consumption increased by 437 per cent.