Abandoned in Agony: Cancer and the Struggle for Pain Treatment in Senegal

Oct 1, 2013
The 85-page report found that 70,000 Senegalese each year need what is known as palliative care to control symptoms related to chronic, life-threatening diseases. Morphine is an essential and inexpensive medication for treatment of severe pain, but Senegal only imports about one kilogram of morphine each year -- enough to treat about 200 cancer patients. Human Rights Watch also found that morphine is unavailable outside of Dakar, Senegal's capital. Frequent shortages limit access to the medication in the capital as well.
  • The most recent records indicate that Senegal uses an annual amount of morphine that is only sufficient to treat only about 194 patients suffering from pain due to advanced cancer. (Foley 2012)
  • As of 2013, Senegal's population is 14.1 million, and approximately 70,000 Senegalese need palliative care. (WHO 2007)
  • For 2013, Senegal estimated it would need 1,180 grams of morphine (INCB 2013), which would be 0.084 mg per capita -- 71 times less than the global average of 5.96 mg per capita (INCB 2008).
  • Relatively little reliable data is available on non-communicable diseases and chronic illness. The HIV/AIDS rate in Senegal is 0.7%, and there are 53,000 Senegalese living with the disease; each year, 1,600 Senegalese die from AIDS (UNAIDS 2012). WHO estimates that NCDs account for 30% of all deaths in the country in 2008. Of the NCD deaths in 2011, 45.1%, nearly half, were people under age 60 (WHO 2008).
  • Based on records and estimates from UNAIDS and WHO, cancer kills more than three times the number of Senegalese as HIV/AIDS does, and also kills more Senegalese than HIV/AIDS, malaria, and tuberculosis combined. (Ba and Coulbary, 2009)
  • With 46.7% of the population living at the poverty line, and 34% of living on less than $1.25 dollars per day, many people will not pay for a doctor until symptoms become severe; at that point cancer is often already advanced.
  • According to patients and health care workers, traditional medicine is significantly cheaper, with fees said to be around 200 CFA (less than 50 cents), and often more accessible. However, there is no licensing or regulatory system for traditional medicine, and patients risk paying for fake cures, or for harmful substances. (Fortier 2011)
  • The lack of a universal health coverage system means that patients are not protected from the financial ruin that often comes with chronic illnesses. Indeed, almost every patient we interviewed for this report spoke of financial problems, often resulting in an inability to afford potentially life-saving medications.
  • With only a few hospitals in Dakar offering any form of palliative care services, most patients who develop severe pain suffer without relief. The situation is particularly dire for patients from rural areas, where 70% of Senegal's population lives.
  • In the course of conducting research for this report, Human Rights Watch visited three of Senegal's 13 regions outside of Dakar. In each of these regions, we found that there were no palliative care services; some health care workers had no knowledge of what "palliative care" was, and there was no morphine, not even in hospitals. Sometimes, NGOs would donate limited packets of oral morphine, but it is not regularly stocked.
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