Sometimes the progress that I make at BSMMU is so slow that I almost don't feel like you're moving forward. Today I looked back and realized how far we've come.
I was updating a friend in Canada about how things are going on the ward. She was asking about how I was doing with getting access to morphine to patients who really need it.
You'll recall that when I first started working at BSMMU, there was no morphine available on the ward. In fact the only way to get morphine was to send the patient's father or mother all the way to Dhanmondhi to Gonoshotu Hospital where it was possible to purchase G-Morphine tablets, a considerable distance from BSMMU. As you can imagine, this took hours or several days! If the parents didn't get there before 2pm, then the pharmacy would be closed and they'd have to return the next day. If a child developed pain in the night, then there wasn't anything that we could do to help them until the next morning.
Not only this, but the type of morphine which was available was G-Morphine which is a long acting form of morphine, it lasts 12 hours instead of the usual 4 hours. This may seem like it would be beneficial, but it makes it very difficult to adjust the patient's dose quickly as you can only give one dose every 12 hours. Thirdly, the pills only came in one strength, which was too large for most kids, so we'd be trying to cut the pills in half or quarter, which wasn't easy. There wasn't a liquid form available, so it was difficult to give the medication to small kids.
Now, the situation is much improved; morphine is available on the children's cancer ward at BSMMU. The department purchases it directly from the drug manufacturer and then we provide it to patients free of cost! Now I can give morphine to my patients within 5 minutes! This makes a big difference for getting kids adequate pain control when they have cancer.
Secondly, the rapid formulation of morphine is now available. This is the type that lasts 4 hours, making it much more useful as I am able to safely increase the dose more rapidly in situations where a child has a lot of pain.
Overall these 2 changes: having morphine available from the medicine dispensary on the cancer ward and having the "regular" form of morphine have made a huge difference in ensuring that children who are in pain get the relief that they need.
Of course, this doesn't solve the problem for all the other children's cancer wards in Bangladesh, but it's a step towards our goal of ensuring safe and effective pain control is part of the care of all children with cancer in Bangladesh.