Helping dying patients in Jamaica

Cancer services in Jamaica are improving

Millions of people around the world die in agony because they do not have access to pain relief.

Most of them live in some of the world's poorest countries, where traditionally there hasn't been any money to help and their needs have been ignored.

In one country at least, the situation is starting to improve.

Dr Dingle Spence was recently appointed as a consultant in both oncology and palliative medicine at the Hope Institute in Kingston, Jamaica.

She is the country's first doctor specialising in helping patients who are terminally-ill.

Dr Spence worked in the UK for many years before returning to the country of her birth.

Outdated practices

She has discovered that much work is needed to bring healthcare on the island up to western standards.

"Sadly, in Jamaica the management of cancer and end stage cancer is probably where the UK was about 30 years ago.

People die in hospital but with uncontrollable pain. Dr Dingle Spence

"There is not many resources put into the treatment of cancer initially and there is virtually no resources put into the treatment of people whose cancer is not treatable," she says.

"A majority of people die in hospital but with uncontrollable pain."

One of the problems has been that doctors are reluctant to prescribe morphine to patients.

"Morphine has been around for a very long time. There is a lot of myths about morphine," she says.

Some doctors are concerned that patients will become addicted to the drug or that it can increase the risks of severe breathing problems.

"If prescribed properly the risks are virtually non-existent," she says.

"It is well known that one can control about 90% of cancer pain with relatively simple measures."

Dr Spence has already transformed the treatment of terminally ill patients at the Hope Institute.

Doctors and nurses now follow international guidelines on helping to reduce patients' pain.

"It is really about being able to educate those involved in the treatment of cancer patients," she says.

Dying at home

The strategy has proved successful.

"Now patients are often pain free and are able to go home which is wonderful."

Dr Spence now has her eyes set on changing practices in hospitals across the island.

"I think if we can do that in Jamaica in hospitals island-wide, I think we would have made an enormous step."

Dr Spence is also trying to address the other needs of patients with terminal illnesses.

"It's not just about their physical quality of life, it's about their emotional, spiritual, psychological and social quality of life and that of their family as well," she says.

This story is featured in the radio programme Health Matters on the BBC World Service.

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