Research to Develop Dying Without Pain

A leading North West academic is carrying out pioneering research to evaluate the prescribing of morphine by nurses in Uganda ? a study which may influence the care of the dying world-wide.

Professor Barbara Jack of Edge Hill University embarked on the project during a recent visit to the Hospice Africa Uganda project - a specialist home care programme, based in Makindye, Uganda - which cares for the terminally ill.

Hospice Africa is a UK registered charity founded by Dr Anne Merriman, originally from Liverpool, in 1993 as a 'model? hospice which provides training programmes for health professionals and volunteers.

Professor Jack, who has undertaken extensive palliative care research said:

"Pain in advanced cancer and aids can be effectively controlled, but in many developing countries access to pain relief for the dying is practically non-existent. In Uganda there are only 18 doctors to treat around 100,000 people, this means that one doctor may have to prescribe for around 200 patients in pain. This situation has resulted in unnecessary suffering and distress and led to a pioneering nurse prescribing programme which I am currently evaluating."

In 2004 Hospice Africa Uganda developed a nine-month course to train nurses in prescribing morphine, so that more dying patients can experience pain relief.

"The research has shown that nurses prescribing morphine to the dying has a very positive impact on patients and their families," added Professor Jack. "Although initially some of the nurses had concerns at the responsibilities around prescribing morphine, they soon saw the benefits they could bring to patients who otherwise would suffer severe pain. This programme is vital to Ugandan people as many more now experience a peaceful end to life - an impact that not only benefits patients and their families, but also the clinical teams who previously had to witness intense unnecessary suffering."

Innovations such as the programme at Hospice Africa Uganda show how palliative care can be effectively transferred out of the western world to help to provide a peaceful death without pain.

Dr Anne Merriman the founder of Hospice Africa says that patients? lives have been transformed since the nurse prescribing programme began:

"We?ve seen patients who have been ostracised from the family because they had no peace from the screams of the patient in pain. People have placed family members in an out-house so that they can sleep at night. Things have really moved on now and 24 hours after visiting the hospice or receiving a home visit, pain is controlled. People just can?t believe the difference, nor can they believe the fact that medical people are prepared to go into their home to see them." A paper based on the findings of Professor Jack will be submitted for publication in January 2007.