2017; Volume 18, No 11, November

Featured Article

Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter. This month our Guest Writer is Professor Rosa Buitrago from the Republic of Panama.

Rosa Buitrago is Professor of Pharmacology and Pharmaceutical Care in Cancer Pain Management and is currently Dean of the School of Pharmacy, University of Panama. She has trained hundreds of healthcare providers in the field of pharmacology and pharmacotherapy of pain management and palliative care. Her other areas of expertise include policy-making to improve access to opioids and pain management in Latin America, and curriculum planning in pharmacology, pharmacotherapy of pain, palliative care and quality of medicine.

Living without pain depends on you – it depends on everyone

In October 2006, I had an extraordinary opportunity: The Pain & Policies Study Group (PPSG) of the University of Wisconsin chose eight people, including me, to develop a fellowship aimed to improve access to opioids. This cohort comprised people from across the world including: Argentina, Colombia, Nigeria, Serbia, Sierra Leone, Uganda, Vietnam and Panama. Over two years, we received specialized training from a multidisciplinary group of high-level experts. In the case of Panama it was extended for three more years.

After training, each fellow had to make a diagnosis of the barriers that prevented access to opioids in their countries and propose and implement an action plan to improve the situation. In Panama, it was necessary to change the rules and provide education on pain management. At that time, the overall per capita morphine mean was 5.8 mg and Panama´s was 0.51. This is one of the indicators that reflect how close each country is to having the medicine considered by the World Health Organization (WHO) as essential for pain relief.

Opioid estimates workshop organized by Dr. Nisla Camaño, Caja de Seguro Social, Panamá.

Since then, there have been several important changes in the laws that regulate this matter in Panama, and a National Palliative Care Program has been implemented, increasing palliative care provision to almost all cities in Panama. Education programs in Pain Management and Palliative Care are offered to all health professionals, especially in continuing and postgraduate education. The School of Pharmacy of the University of Panama has reinforced links, leading to important collaborative initiatives, with professional associations, the Ministry of Health, and with international organizations including: WHO, The United Nations Office on Drugs and Crime (UNODC), International Association for Hospice and Palliative Care (IAHPC), Latin American Association for Palliative Care (ALCP), Livestrong Foundation, Open Society Foundations, Human Rights Watch and the PPSG. Moreover, Panama has taken an important step by actively participating in the recent decisions taken at UN General Assembly Special Session on Drugs (UNGASS) 2016, which recommend that every country should prioritize access to controlled medicines for pain relief, while maintaining a balance with control measures.

However, eleven years later, the global mean of morphine is 5.42 mg per capita, and that of Panama still remains well below this – a reality shared by 82 percent of countries in the world. A reality that implies that when patients suffer from severe to moderate pain they will not receive the medicine they need – or will receive it inconsistently.

I would like to propose to every doctor, pharmacist or nurse who reads the IAHPC Newsletter that we work together to become the necessary agent of change. Barriers are common to all countries: laws that are too strict; outdated, confusing terminology; inappropriate or insufficient training in pain management; lack of knowledge of methods of calculation of opioids estimates, among others. Let us work collaboratively with all these organizations, ask for support, and choose at least one area in which each one works to achieve fair access to pain relief.

‘Living without pain depends on you, it depends on everyone’: the slogan for the walk organized in celebration of World Hospice and Palliative Care Day by pharmacology students, School of Pharmacy, University of Panamá.

As examples of key actions, here are some recent events that took place in Panama on World Hospice and Palliative Care Day:

... They have already started to play their part!

Let's all play an active role, don’t let another eleven years pass without achieving the desired goal, there is no time to lose …

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