This in not an official U.S. Department of State (DOS) blog and the views and information presented are my own and do not represent the Fulbright Program or the DOS.

Dr. Eddie Mwebesa, the Clinical Director, Sammi, Dr. Merriman, Jenna

In the USA we definitely take it for granted that if we have severe pain we can just go to a doctor or the hospital and get strong opioid (narcotic) painkillers like Morphine (Brands like Roxanol, MS Contin, etc.) or Oxycodone (Brands like Percocet or Oxycontin, etc.).  Not so easy in Uganda.  In general, there are very few analgesics available through the government health system. They have Tylenol (acetaminophen), which they call Panadol, diclofenac (a Non-Steroidal anti-inflammatory like Motrin or Aleve (ibuprofen or naproxen, respectively)), and tramadol (Ultram).  The tramadol, an opioid analgesic albeit much less potent than Morphine, is the strongest drug that is fairly readily available.  It wasn’t until Dr. Anne Merriman started Hospice Africa Uganda in 1993 and making Morphine, that patients with severe pain began to realize some relief. But as she and her team have ratcheted up the production of morphine to being the only supplier of oral Morphine solution in all of Uganda, still only about 10% of the needs of the people of Uganda are met. And these are mostly patients that are dying of Cancer or advanced HIV/AIDs.  Patients with fractures or accidents or after having normal surgeries most likely only receive Tramadol at best.  If a patient has money to buy their own drugs or the clinic is a private one, Demerol (meperidine) is sometimes available through non-governmental sources. Below is a series of photos that will show you the process for making the Morphine oral solution. The day we were there the product made was the 10mg/ml concentration.  After production is complete, including the labeling of the bottles, it is sent to the National Medical Stores (NMS) for distribution all over the country.  NMS is the government purchasing and storage facility.  The government pays for the morphine so that all patients can access it for free from those who are “certified” to prescribe it.  Dr. Merriman also has developed a wide variety of educational courses from 1 week long to 1 year long to help healthcare professionals learn more about palliative care and the appropriate use of Morphine.  Nurses and Clinical Officers (like physician’s assistants in the USA) who complete the 1-year diploma course in Palliative Care are able to prescribe Morphine. This helps to bridge the gap so that more patients in need can gain access to this quality-of-life-improving drug since there are way too few physicians in Uganda to meet all the needs.   (I’m having some trouble getting all of the image captions to show so the ones you can’t see are as follows:  Putting the morphine powder in a small container to dissolve it thoroughly. The dye is also added to this phase of the process; putting the dyed morphine solution into the large container to formulate the correct strength. Notice the “pink” solution?; filling the bottles and adhering a label is the last step in the process.)

KarenBeth is holding the red dye that will be added to the solution so all will know it is the 10mg/ml strength

The process is followed carefully step-by-step and each is signed off by the Chemist.

The scale is calibrated to make sure the morphine weight will be accurate.

The morphine is weighed. A Pharmacist has to come to the Hospice center on days when the Morphine is prepared to double check and observe the process.

Adding the batch of concentrated morphine with the dye added (see it looks pink) to the full container to make the correct dilution.