Last night in Limbe

Today was my last day of work at St. Joseph Mission Hospital in Nguludi.  So much to do and so little time. In the other hand a single person can have a significant impact over a short stay. My main task before coming was to implement an electronic inventory system for their pharmacy. This was what the hospital had identified as a need. After my briefing session on arrival, I discovered that the initial thought of inviting a pharmacist had germinated from a need with their palliative care unit and their difficulty in securing morphine supplies. I was not sure how I would go about that since morphine is provided at a deep discount to hospitals (12.5 % of the cost) by the government and supplied from the national provider are limited.  The physician of the hospital, the clinicians at the palliative care unit, the staff at the pharmacy department all identified the need for acquiring more morphine but had limited expectations as far as potential success in acquiring supplies. In Malawi the strong analgesic of choice is morphine with the liquid form being the most readily available. Here at St.Joseph Mission Hospital it is the only form available. When asking one of the clinicians at the palliative care unit how they managed patients over night, I was told that “We double the dose before going to bed.” Not very effective to last the night, I would suspect. “And if we run out of morphine, we use acetaminophen or ibuprofen, sometimes we have acetaminophen with codeine but not always”. So everywhere I went, the Phamaceutical Supplier in Limbe (which happened to be just across my hotel), the Malanje Mission Hospital, the Malanje District Hospital, I asked about how to get morphine. In Limbe, I have learned that you can get morphine but only one supplier in the country has stocks. Since the government supplies morphine at a deep discount their is no incentive or market for the private suppliers. But their was one potential source that could import morphine from outside the country albeit at a much higher price, but there was some hope. With sufficient finances i could get morphine, even long-acting morphine. At Mulanje Mission Hospital, a sister hospital of St. Joseph’s, they have a significant donor and they had a whole 4 liters of liquid morphine just sitting on the shelf. So the possibility was there but the chance of being successful was slim in the long-term due to financial constraints. I was a bit discouraged and started to feel the same desperation as the people at St. Joseph’s. This was until 2 days ago. At lunchtime, a met a pharmacist from France who was working with the organization Medecins Sans Frontieres. Start to talk to him, what he was doing. He told me about his work and most what he did revolved around the provision of antiretroviral agents and that they were moving away from lopinavir/ritonavir based regimens to atazanavir/ritonavir and that they were doing some training about that next month. In passing I inquire about possible source of supply for morphine. To my surprise, they also provide free morphine as HIV is not their only target area but also cancer and palliative care. Not only they can provide liquid morphine but also long-acting morphine, and tramadol which is one of the only other strong analgesic available. The only request that he had was for the hospital to supply him with estimated quantities that they would need and they would supply them for free, and over the long term. In addition, he said that they usually had good quantities in stock. A goal that sounded improbable to reached was accomplished. A basic need to provide palliative care patients access to medications to relief their suffering.


3 thoughts on “Last night in Limbe

  1. Doing great to a people in need.Please keep up the struggle for the profession of pharmacy and humanity.

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