A world of pain
For most people in the developed world, painkillers for disease or for recovery from surgery are just a prescription away. Not so for people in much of the rest of the world. They live, quite literally, in a world of pain. Bob Simon of "60 Minutes" teamed up with students from the University of British Columbia's International Reporting Program to see first-hand how one country is trying to ease the pain:
In a small village in southern Uganda, outside a town called Mbarara, sits the house of Josephine Nimaya. An infection has disfigured her feet, and the pain would be excruciating, if it wasn't for the red liquid the nurses just delivered to her.
It's the same stuff that's delivered through IV pumps in every American hospital - morphine.
But here it's taken by mouth, and it comes in recycled water bottles.
Morphine is also what has helped Patrick Sabwe, who used to be a fisherman but is now confined to his shack because he has AIDS and the painful Karposi's sarcoma rash that often accompanies the infection.
Hellen Birungi, a healthcare worker, has been taking care of Patrick for months. "He couldn't sit, the legs were so swollen," she explained. She brings him morphine.
Before the morphine, Patrick wasn't able to walk - he had to be brought in a wheelchair. "So after, like, two weeks of morphine he started walking," said Birungi.
That may sound unremarkable, but in Uganda and many other countries it's nothing short of a miracle.
The fact is, 80 percent of the world's population lives in countries with little or no access to morphine. That's roughly 5 billion people making do with just 5 percent of the global supply.
Compare that with a handful of wealthy nations, including the U.S.: With just 5 percent of the world population, they consume 95 percent of the morphine.
Which means, for millions, scenes of screaming agony by patients are all too common.
Human Rights Watch, an international organization widely known for fighting torture, among other things, has recently taken up the issue of global pain.
Diederik Lohman, a senior researcher with Human Rights Watch, said he has spoken with patients who have told him they commit suicide because the pain was simply unbearable.
"It's quite a leap, from campaigning about torture to campaigning about a drug like morphine, isn't it?" asked Simon.
"When we started working on this, I was actually struck by the parallels you see in the testimony you get from your traditional torture victim and someone who has cancer pain that is not relieved," Lohman said. "And so what you see is that your typical torture victim will sign a confession and the torture ends. The patient with pain doesn't have that option."
Surprisingly, Lohman says, the shortage isn't about money. Morphine is easy to produce and it's cheap - just pennies a dose.
The problem is where it comes from - the same kind of poppy fields that produce morphine's illicit cousin, heroin.
"Many countries have become so zealous in trying to limit access to controlled substances that their regulations have started interfering with availability for legitimate medical purposes," Lohman said. "You could call them collateral damage of the war on drugs."
"So people are suffering terribly because of bureaucracy?" asked Simon.
"Essentially, yes."
Anne Merriman is working to cut through the bureaucracy, and get morphine to the people who need it. "It's a God-given answer for pain, but we've abused it, so it's scarce for people in pain," she said.
Merriman is a doctor and former nun from Liverpool who came to Uganda as a medical missionary two decades ago, and said she simply wouldn't stand for what she saw.
"I saw these patients were in terrible diseases, terrible cancers and the strongest they have was codeine, and you could only have that if you could afford it," Dr. Merriman said.
She campaigned for laws making access to morphine a basic right. But there was still the challenge of how to get prescriptions for this controlled narcotic written in a country with very few doctors.
"The laws were so rigid that access to morphine was impossible," said Dr. Jack Jagwe, a longtime Ugandan health ministry official, who worked with Dr. Merriman to come up with a creative solution around the doctor shortage: Convincing the government to amend the law, allowing nurses to be able to prescribe morphine.
"That was a big thing - the first country to get that allowed," Dr. Merriman said.
Now, specialized nurses in Uganda are trained on how to diagnose which patients need morphine and how to administer the drug.
Hellen Birungi is one of close to a hundred nurses and clinicians who have been trained so far. She makes half-a-dozen visits a day to patients in their homes, which often are hidden deep inside slums.
Jackline Sonya, who has cancer, said through a translator that her pain is limited now that she has morphine; yesterday she managed to clean the house and wash some clothes.
Perhaps the most stark medical transformation is evident at the country's only hospital burn unit.
Not a peep. Not a single cry of pain.
"The reality is, without morphine, there is a limit to how much you can really support somebody who is in severe physical pain,' said Dr. Mhoira Leng, the first head of palliative care at Mulago Hospital. She introduced Simon to some of the patients, such as Richard Sebandeke, who just days before was badly burned in a house fire.
"In many ways, what we are doing is we are bringing hope and we are bringing relief, and we're bringing a very human sense of compassion and care," said Dr. Leng.
Compassion and care are being handed out along with the morphine.
Nurse Betty Bifabusa heard about a sick man who was homeless, sleeping in the bush, abandoned by his family. Betty gave him morphine, but she also collected money to build the man a mud hut.
It turned out the patient, Kasaija Karabe, had advanced cancer.
"So currently he is taking 2 mils every four hours and then 4 mils at night," said Bifabusa.
When she's not around, the only one left to administer the medicine is the man's young son, Fred.
The night after the students met Kisaja and his son Fred, the father died.
The women of the village came out to wrap the body and prepare it for a traditional burial.
Thanks to morphine, Fred didn't have to see his father suffer in his final moments, a small victory in the war on pain.
Dieterik Lohman of Human Rights Watch hopes this is just one of many victories yet to come.
"A government that is willing to make rational changes to its drug regulations, to its health policies, can actually make a tremendous amount of progress in providing pain treatment," Lohman said. "Someone who's dying of cancer should not have to unnecessarily suffer from severe pain. We all agree on that."
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