“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
“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
“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
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.