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Cold Hands Don’t Need Narcotics

Grandma B’s Hands. Photo by John Carroll.

The USA is the land of plenty. And that includes narcotics. We have plenty of narcotics.

Over two million Americans are estimated to be dependent on opioids, and more than 95 million of us used prescription painkillers during 2015—more than tobacco. (New York Times)

Drug overdose deaths in 2016 most likely exceeded 59,000 and is now the leading cause of death among Americans under 50.

We are in an escalating public health crisis called opioid addiction. And this crisis has been made more deadly by illicitly manufactured fentanyl and similar drugs.

***

I am friends with a Haitian-American family in the States who contacted me several months ago about 78-year-old Grandma B (name changed). They told me that they are related to Grandma B by marriage and that she is suffering from end stage liver cancer in Port-au-Prince.  And they wanted to know if I could prescribe something for pain for Grandma B.

Two years ago a police chief in a city near Peoria donated narcotics to Haitian Hearts so we could use them in Haiti. Several months ago I brought down some of the donated fentanyl patches for Grandma B. I met with her son who picked up the patches after hearing an explanation from me on how to use them. Grandma B obtained immediate relief with this narcotic being absorbed through her skin.

Grandma B continued to decline during May, June, and July. I called her son yesterday and I told him that I would bring more fentanyl patches for his mother. And so this morning I traveled 45 minutes on a motorcycle and met with Grandma B’s son at a predetermined location and climbed into his car.

He was just coming from church and he told me in a very matter of fact fashion that Grandma B died while he was in church this morning. But he hadn’t been home and had not seen her.

We quickly arrived at their home and went to the front door. The son’s wife met us at the door with tears in her eyes. She graciously invited me in and led me to Grandma B’s bedroom. Two young women were sitting next to her bed. Grandma B was lying peacefully on her left side with her eyes closed and without respirations.

I felt her hands which were surprisingly cold and stiff….rigor mortis had already set in. She had no fentanyl patch on her skin and the patches that I brought her today would not help her now. I was too late.

We sat around Grandma B in plastic chairs and talked. Church members slowly strolled in and stood at the foot of her bed. It appeared to me that Grandma B was the matriarch of a fairly well off middle-class Haitian family. The son told me that his mother started complaining of pain in the upper right abdomen last October. They were able to obtain a CAT scan of her abdomen in February. I studied the CAT scan which showed an obvious large mass in her liver.

Grandma B had only been to church once since January. And most recently she had not been eating or drinking much and was more obtunded. This morning before church she slowly sipped three tablespoons of water. And that was it.

Haiti is only 99 minutes by air from Miami.  After 35 years of working here, I have never seen one successful prescription for narcotic filled for anyone in Haiti.

Haitians have pain. And even though we think Haitians have a “high tolerance for pain”, they really don’t. I would say they have a “high acceptance of pain” because they have no choice. Most people are forced to grin and bear it in Haiti because complaining doesn’t help.

Narcotics are used for all types of pain. Broken bones, post-surgical pain, vehicular trauma, burns, cancer pain, and for shortness of breath as people suffer from respiratory failure at the end of life. Palliative care physicians and hospice physicians all over the “developed world” depend on narcotics to lessen suffering every day.

But not in Haiti.

While we overdose and die on illicit narcotics in the States in epidemic proportion, suffering Haitians die here without any narcotics.

Haiti’s basic health care is deficient. Pain control in Haiti is almost nonexistent. Untreated cancer is ubiquitous in Haiti and to allow these cancer patients to suffer and die every day without adequate pain control is another “crime against humanity”.

(The photo above are the hands of newly deceased Grandma B. Her family agreed with the publication of this photo and the contents of this post.)

More articles by:

John A. Carroll, M.D. is a physician working in Port-au-Prince.

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