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REPORT: Thousands Face Unnecessary End Of Life Suffering In Guatemala

I thought I was going to die, not from the cancer, but from the pain.

Marianna Hernandez, 58-year-old woman with liver and abdominal cancer, Guatemala City, December 2014


Thousands of seriously ill patients in Guatemala are needlessly suffering from severe pain and anxiety because they cannot find or afford appropriate pain medications, according to a troubling new Human Rights Watch report.

According to the 62-page report, “‘Punishing the Patient’: Ensuring Access to Pain Treatment in Guatemala,” the Central American country’s drug control regulations make it almost impossible for dying patients to get strong painkillers, including morphine.

“Many patients in Guatemala face unbearable suffering at the end of life, but it doesn’t have to be that way,” said Diederik Lohman, acting health director at Human Rights Watch, in a news release.

“With a few simple, inexpensive steps, the government can drastically improve the plight of these patients.”

Human Rights Watch, an American-founded international non-governmental organization, estimates at least 5,000 Guatemalans with cancer and HIV/AIDS live and die in pain each year. Many must make multiple trips to doctors because of the dearth of medicine.

Human Rights Watch interviewed 79 people —including 37 people with cancer or their relatives, and 38 health care workers – for the report.

Gabriel Morales said he faced a journey of more than seven hours every 10 to 15 days on public buses for painkillers for abdominal cancer in the country’s capitol. He said:

‘I would wake up at 1 a.m., walk about half a kilometer, and catch the 2:30 a.m. bus. I would get to the boundary of Guatemala City around 8 a.m., where I would take a second bus to the center of the city.’

Human Rights Watch is calling for the government of Guatemala reform its drug control regulations, work to ensure immediate-release oral morphine becomes available in every departmento, and develop a mandatory undergraduate curriculum in palliative care and mandatory clinical training in palliative care for doctors of certain postgraduate programs.

Palliative medicine is provided to the terminally and seriously ill to help treat symptoms and side-effects of disease and aggressive treatments. The goal of palliative care is not cure, but symptom management.

The World Health Organization considers morphine critical for moderate to severe pain. However, Guatemala’s efforts at combating drug abuse have made such medications difficult to obtain.

“Overly restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate pain relief and palliative care,” according to WHO.