“See that patient in Room Six? Half his neck is
missing. He has cancer of the larynx. That pain is something we cannot
conceive. If we had the delivery system, we would stick a patch on him
every four hours, which would relieve him of pain without causing pain.
How can I inflict him with an injection every four
hours? For years we have been battling to bring pain control drugs to
dying cancer patients. We have had numerous conversations with the
Minister of Health, Fuad Khan, apprising him of the situation. We have,
at his request, sent him lists of drugs we urgently need to control pain
in the dying among us, with no results.
“Our country does not match up the World Health
Organisation (WHO) standards for a humane society. Barbados is far ahead
of us. There is no shortage there. Even sub-Saharan Africa, which has
nowhere near our wealth, is virtually saturated with pain-relieving
drugs for the dying. “I have come to you because it can’t get worse.”
—Dr Jacqueline Pereira Sabga, the chairman and
medical director of Vitas House Hospice.
Seconds after I walked into a spotless, airy
building which made me think of a cheerful children’s library rather
than a hospice, Lilia Mootoo, the general manager, a briskly efficient
woman, asked: “You afraid of dead bodies?” I made a non-committal sound
as she walked me through a large hall with 12 cubicles and a doctors’
central station and ushered me to a bright dining room glowing with
afternoon light where we joined Dr Jaqueline Sabga, chairman and medical
director of Vitas House, and Pat Stollmeyer, the co-founder of Vitas and
retired registered nurse trained (in the UK) in pain management.
Of course I was afraid. Few people aren’t when
faced with the inevitability of our human fragility and mortality. I
addressed the three women—Lilia, Pat and Jaqueline—who have dedicated
their lives to the dying, and who fill in one another’s sentences
speaking volumes of their close teamwork. “What’s it like to watch
people die all the time?”
“We have helped 276 people make that transition
from life to death. We ask them, what do you fear the most about death?
They say they fear being in pain, not being able to breathe, dying
alone. And we say if we can guarantee you that you will not be alone,
that you will not be in pain and discomfort, does that take away the
fear? It does.
By keeping patients pain-free, we restore an
essential dignity to them, empower them to make decisions, allow them to
talk through their fears. All of them died with an extraordinary grace
which never fails to inspire us.”
From the corner of my eye I glimpsed two men
carrying out a body on a stretcher. There was nothing to indicate the
horror we associate with death, or cancer and its attendant emotions of
fear. Outside, the sun was hot. There was a view of the Savannah. There
was a bed of orange around an immortelle tree. “What did the patient die
of?” I asked.
“Lung cancer,” said Lilia. “He was a smoker and
drinker. He came the day before he died. “Some days it’s almost empty,
like now, and other weeks and months are hectic, with every cubicle
being occupied,” she added. The women tell me that the three other
cubicles are occupied by patients in various stages of advanced cancers
of the colon, thyroid and larynx. Two had been there for several months
and the third for a week. They were comfortable and their families
assured they will have virtually pain free deaths.
Unfortunately, Dr Sabga tells me, most patients
nationwide, due to the shortage of analgesic drugs, aren’t that lucky.
Many will die in pain, many “writhing and screaming.” Dr Sabga is in
turn saddened and enraged that so many of our ill people die without
pain relief, without humanity.
Dr Sabga: Ministry of Health refuses to level
She tells me that after an initial meeting with the
Minister of Health, Fuad Khan in August 2011, she (on the minister’s
request) shot him off a letter listing the shortage of drugs in the
country’s public and private pharmacies, including morphine elixir,
fentanyle patches, morphine immediate release, oxycodone, and
After that, nothing. “Despite repeated calls and
texts to the health minister, after repeated promises to visit the
hospice, after articles in the media, and radio and television
appearances appealing for analgesic drugs, the shortage continues. The
frustrating thing is, the Ministry of Health refuses to level with us.
The situation is under a shroud of fog. No one tells us why our requests
are going nowhere. We just keep getting put off.
“Many cancer patients would rather die than go
through the drudgery of a government system where they are told, ‘Come
back, we ran out.’ “The only way I may get some resolution now is if I
protest on the stairs of the Ministry of Health. “Where is the
conscience of the people in Government? Our plea is not just for drugs
for our hospice but for all private and public institutions treating
“A few years back, Pat and I went to see a patient
dying of head and neck cancer. He couldn’t swallow, had a feeding tube
in his mouth and had extensive mouth and tongue lesions. “I called the
FDA and they said they had no patch for his pain. They told me to give
him slow-release morphine rectally, although they weren’t sure it would
“I was shocked. I said, ‘Do you know the
indignity and added pain I will be giving this already suffering
gentleman, for a solution that may or may not work?’” A humane society
should not even be having this conversation, I thought, as I drove out
of the St James Medical Facility.