LETTER OF THE DAY - The sickler's painful dilemma

The Editor, Sir:

Sickle-cell disease affects 10 per cent of the Jamaican population. This disease causes many complications, including very severe painful crises. For severe painful crises, doctors commonly prescribe pethidine or morphine - yet nurses and pharmacists in the public health-care system continually erect obstacles and often refuse to serve these medications to the patients.

Late last year, while I was a patient on the ward at one of the two major Kingston hospitals, the main nurse on night duty refused to give me the prescribed pethidine injection, stating that it was addictive and that which had caused Michael Jackson's demise. I was thus offered Panadol (which any sickle-cell patient will agree is useless to us), and left to suffer in obvious severe pain for over nine hours.

When my doctor came to assess me in the morning, she was distraught and forced not only to double the dose that the nurse was supposed to give but intravenously apply the pethidine and extend my hospitalisation as my painful crisis had got alarmingly severe. This is just one of many examples of the unwillingness among nurses in public hospitals to give the prescribed morphine or pethidine in prescribed doses with prescribed frequency to admitted sickle-cell patients in severe painful crises.

Throughout Portland, Kingston, St Andrew and St Mary, as far as I have experienced and been told, pethidine and morphine are only made 'readily' available to patients at the pharmacies of two major Kingston hospitals and one private Kingston pharmacy. At one of the hospital pharmacies unless their hospital is the one prescribing the drug or the patient has a registration number at their hospital, they refuse to fill the prescription. When their criteria are met, only half the amount that the doctor prescribes (usually to last two weeks) is supplied (i.e. one week).

Waste of time

At times, they have refused to supply a prescription for the remaining portion - often treating us with the air one tend to treat an addict. Thus, when the quota that they have chosen to supply is finished and the pains are either unresolved or we experience another painful crisis, they are not only forced to repeat the hassle of seeing a doctor, then journeying to the pharmacy but to also waste time allowing already severe pain to get worse, simply because the pharmacy refuses to supply the amount that the doctor saw it necessary to prescribe.

I understand that there is the possibility and existence of persons who obtain these drugs illegally or legally for illegitimate purposes; but why should legitimate patients be punished in their stead? I am appealing to the Ministry of Health and pharmacies to put in place a system where we can have adequate access to needed painkillers in medically required quota without the extra unwarranted pain and stress - and without being treated as painkiller addicts begging another fix - our lives are already very very painful. We may be a minority but we are a contributing minority.

I am, etc.,

SICKLE-CELL PATIENT

St Mary