title: Where there is no morphine: the challenge and hope of palliative care delivery in Tanzania.
abstract: BACKGROUND
  In Tanzania, a country of 42 million, access to oral morphine is rare.
  
  
  OBJECTIVE
  To demonstrate the effectiveness of palliative care teams in reducing patients' pain and in increasing other positive life qualities in the absence of morphine; and to document the psychological burden experienced by their clinical providers, trained in morphine delivery, as they observed their patients suffering and in extreme pain.
  
  
  METHODS
  One hundred and forty-fie cancer patients were included from 13 rural hospitals spread across Tanzania.
  
  
  METHODS
  A mixed method study beginning with a retrospective quantitative analysis of cancer patients who were administered the APCA African POS tool four times. Bivariate analyses of the scores at time one and four were compared across the domains. The qualitative arm included an analysis of interviews with six nurses, each with more than fie years' palliative care experience and no access to strong opioids.
  
  
  RESULTS
  Patients and their family caregivers identifid statistically signifiant (p < 0.001) improvements in all of the domains. Thematic analysis of nurse interviews described the patient and family benefis from palliative care but also their great distress when 'bad cases' arose who would likely benefi only from oral morphine.
  
  
  CONCLUSIONS
  People living with chronic cancer-related pain who receive palliative care experience profound physical, spiritual and emotional benefis even without oral morphine. These results demonstrate the need for continued advocacy to increase the availability of oral morphine in these settings in addition to palliative care services.
authors.affiliation: Evangelical Lutheran Church in Tanzania. kristopher.hartwig@gmail.com.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Hartwig
authors.forename: Mervyn
authors.initials: M
authors.lastname: Dean
authors.forename: Kari
authors.initials: K
authors.lastname: Hartwig
authors.forename: Paul Z
authors.initials: PZ
authors.lastname: Mmbando
authors.forename: Abduraoof
authors.initials: A
authors.lastname: Sayed
authors.forename: Elma
authors.initials: E
authors.lastname: de Vries
mesh_terms: D000701:Analgesics, Opioid / Q000600:supply & distribution; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000600:supply & distribution; D009369:Neoplasms / Q000451:nursing*; D059408:Pain Management; D010147:Pain Measurement; D010166:Palliative Care; D011788:Quality of Life; D012189:Retrospective Studies; D013636:Tanzania
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine