Alleviating the access abyss in palliative care and pain relief-an imperative of universal health coverage.

In agonising, crippling pain from lung cancer, Mr S came to the palliative care service in Calicut, Kerala, from an adjoining district a couple of hours away by bus. His body language revealed the depth of the suffering.

We put Mr S on morphine, among other things. A couple of hours later, he surveyed himself with disbelief. He had neither hoped nor conceived of the possibility that this kind of relief was possible.

Mr S returned the next month. Yet, common tragedy befell patient and caregivers in the form of a stock-out of morphine.

Mr S told us with outward calm, “I shall come again next Wednesday. I will bring a piece of rope with me. If the tablets are still not here, I am going to hang myself from that tree”. He pointed to the window. I believed he meant what he said.

Stock-outs are no longer a problem for palliative care in Kerala, but throughout most of the rest of India, and indeed our world, we find near total lack of access to morphine to alleviate pain and suffering.