Health Minister & Palliative Drugs
“We wish Government would look into the care of the dying. Pain is the biggest symptom for people dying with cancer. We get slow release tablets and liquid morphine but we urgently need morphine and fast release fentanyl patches lasting for three days.
“For those that cannot swallow, it relieves them of pain. Patients have gone through enough without injections and intravenous drips which ties them to the bed. The family cannot hug them, or lie next to them. It’s absurd and inhumane to cause pain to relieve pain.
“The patch is ideal. We got some once but the Government never gave permission to bring them back in. The country regularly runs out. There is a nationwide shortage of palliative care drugs (including morphine elixir, fintanyl patches, morphine immediate release patches, oxycodone and buprenorphrine) which is regarded as inhumane by World Health Organisation standards.
“We are getting patients from state hospitals coming to us at Vitas House hospice for pain and symptom control which is shameful and speaks volumes about our health care. They come in for preventable cancers but due to lack of public education and clogged public health facilities many die due to ignorance of early detection, bad eating habits and lack of exercise.
A 52-year-old woman just died here of colon cancer—if it was picked up earlier, or if she was educated about the disease she would be alive.”
Dr Jaqueline Sabga, chairman and medical director of Vitas House, and Pat Stollmeyer, retired registered nurse and co-founder of Vitas.
Last week I reported based on an interview at Vitas House, a 12-bed hospice run by Dr Jaquline Sabga and her colleagues, that there was a massive shortage of drugs used to treat pain in cancer patients. Dr Sabga was outraged, on behalf of the terminally ill, at the ostensible lack of action by the Minister of Health on the issue given that these drugs are readily available everywhere—from Barbados to the far reaches of sub-Saharan Africa.
This week, I asked the health minister, Dr Fuad Khan, to respond to Dr Sabga’s charge that he has dragged his feet on the issue of drugs for the dying. Dr Khan said: “To say I have not responded is not fair. Before my being here nothing was happening. Being a surgeon, I understand the importance of medication.
“I spoke to Dr Sabga in August and got a list of drugs from her. Since then I have been tearing my hair out working with the Food and Drug Administration to get the required drugs to Trinidad. They say the 1960s legislation is restrictive in the types of drugs and quantities they can bring in. They have to apply to WHO for more.
“A public-service drug advisory committee decides these things and there is always a great delay in the sitting of the committee. Sometimes they take up to two years to read documents. They don’t meet for months at a time. I informed the PS and the DMO of the situation.
“It’s a public-service systemic error rather than lack of effort on my part. I am working like hell to bring in the drugs.” I asked Dr Khan what he was doing to untangle the systemic issues, from updating legislation to the archaic FDA rules. “Legislation is a lengthy and time-consuming process. Amendments need to be taken to Cabinet, drafted, and finally taken to Parliament.
“I told the FDA two weeks ago not only to look at the intent of the legislation, which was drafted in the 60s, but the spirit of it. I am saying to them the patches already went through rigorous testing in developed countries before being approved and to bring them in. I am trying to create policy pending the change in the legislation.”
A civilised society is judged by the way we treat our most vulnerable, and the women at Vitas House understand that. Pat Stollmeyer and Dr Sabga tell me that caring for the dying actually brings unexpected grace to us all. “Palliative care embraces much more than dying time. Once conventional medicine has failed them, we transition patients into dying. No one dies alone, fearful or in pain.”
What does caring for the dying teach you, I asked Pat, the only trained registered nurse in palliative health care in this country. “It teaches you how to live. Dying people, freed of pain, give us the gift of wisdom. They are all given grace. Nobody dies with fear. It’s a tremendous honour to watch someone stop breathing. There is something about the moment of death that reinforces how valuable life is. “It creates a lasting imprint on everyone around them and makes us more humane and loving towards one another.”
Vitas House is the brainchild of Dr George Laquis, who, along with Pat, and Hannah Janoura, founded this hospice three years ago for cancer patients with a prognosis of six months or less. With the help of Dr Sabga and the GM, Lilia Mootoo, what began as an abandoned warehouse behind the St James Medical Complex was transformed (through private donations and fund-raisers) into the oasis of grace it is for the dying today.