A Nurse in the House

As a documentary filmmaker exploring the issue of untreated pain and palliative care delivery globally, I discovered the extraordinary difference health workers make to patients facing end-of-life issues. The quality of care a patient receives at this critical time can have a profound impact on both patients and their families. When I learned that nurses in Uganda were able to prescribe oral morphine in the homes of patients, thereby relieving pain and returning quality of life to many who were too sick to travel, I had to find out more. 

“Many developing countries still have a real problem about the use, importation, and manufacture of morphine,” explained Eugene Murray, former CEO of the Irish Hospice Foundation. “The second thing is having appropriate ways to distribute it. In Uganda, they dilute powdered morphine into water which is colored with a dye to indicate the three different strengths and is distributed by nurses in a community using recycled water bottles. That may seem very crude but in terms of pain control that is absolutely transformational.”

In Uganda, both doctors and nurses (who have completed a nine-month clinical palliative care course at Hospice Africa Uganda) can prescribe oral morphine. Nurses are able to travel to patients who are often too sick to move, and prescribe and administer pain relief in their homes. Through a series of simple hand gestures the nurses can rate the patient’s level of pain and prescribe the correct dosage. The effect for the patients is dramatic—they are able to eat, sleep, bathe, dress, and be with their families again. In short, they regain quality of life. Martha Rabwoni, administrator at Hospice Africa (Uganda) reflects, “The pain, if it is not treated, the patient is in total chaos—they cannot think, they cannot do anything, they concentrate all their mind on the pain. The relatives in that home…no one sleeps.”

Rose Kilwanuka, national coordinator at the Palliative Care Association of Uganda, explained that there are currently 120 nurses in Uganda who are now able to prescribe morphine for patients in both metropolitan and regional districts. However, I learned that in many other countries like South Africa, only doctors are able to prescribe, so even if there is morphine available, there is often no one available to prescribe it. For many people living in rural areas, or poor township areas, their first point of contact is with a nurse clinician.

Now that I have finished the documentary LIFE Before Death and 50 short films themed around pain control and end-of-life issues I realize the journey I went on in making this film was nothing short of transformative. To see health workers in action, the level of compassion, and the depth of care they show in their work everyday is extraordinary. It has been one of the most rewarding projects I have ever worked on and I hope it builds awareness of the amazing work being done by palliative care workers around the globe and demonstrates why everyone deserves access to these essential services!

Sue Collins is a documentary film producer at Moonshine Movies in Melbourne, Australia. She is passionate about using film as a tool to ignite social change.

Related items:

• Creating Partnerships in Support of Health Workers in Uganda

• Update on the MDGs: Where Are the Health Workers?

• Health Workers’ Role in Health Service Integration

Photo 1 courtesy of Sue Collins. Photo 2 by Carol Bales (Mary Philomena Okello, palliative care nurse in Lira, Uganda).