The training programmes offered by Nairobi Hospice are aimed at alleviating the continuing resistance to the use of morphine in Kenya amongst some doctors and nurses. The difficulties in accessing morphine are being addressed by the national hospice association. Brigid Sirengo comments:

it’s very difficult to get some of the senior doctors to change their minds to prescribe morphine, particularly if the patient is experiencing a lot of pain and needs higher doses of morphine. They are very, very apprehensive about that: they are quite reluctant. But with the training we hope that things will change.²⁴

Nairobi Hospice

Important networking with the Ministry of Health was undertaken when the hospice was established to ensure a supply of morphine for patients. The hospice imports morphine powder from the UK for reconstitution as liquid morphine for hospice distribution within Kenya. Injectable morphine is also available. Other drugs prescribed by Nairobi Hospice are guided by the WHO analgesic ladder. Strong analgesics, other painkillers and adjuvants include ibuprofen, di-hydrocodeine, paracetamol, aspirin and laxatives. Amitriptyline and diazepam are used for depression and anxiety. Antibiotics, mystatin and antifungal drugs, are prescribed as necessary, especially for people living with HIV. Antiretroviral treatments (ARVs) are not prescribed. There is no palliative care formulary to date. Most drug costs for all Kenyan hospices are covered by a Dutch donor: Nairobi Hospice - Holland.

Meru Hospice

The WHO analgesic ladder is used as a guideline for pain control although most of the patients are late referrals and consequently are introduced to morphine immediately. The use of generic drugs reduces costs. Most of the patients cannot afford to pay for morphine and Meru Hospice provides liquid morphine free of charge.

Eldoret Hospice

Morphine syrup is generally used for pain control. In 2004 12 litres of morphine was used:

However, sometimes our patients have to make do with dihydrocodeine tablets. When the powder is out of stock as it happened sometimes last year, the other alternative we would use is morphine sulphate tablets.²⁵

Coast Hospice.

Coast Hospice gets drug donations from the same Dutch organization as Nairobi Hospice.

Nyeri Hospice.

An average of 1kg of morphine powder is used annually.²⁶ The following morphine policy is in place as a guideline to nursing staff.

The International Narcotics Control Board²⁷ has published the following figures for the consumption of narcotic drugs in Kenya: codeine 28 kg; morphine 2 kg; dihydrocodeine 6kg; pethidine 49kg .

For the years 2000-2002, the average defined daily dose consumption of morphine for statistical purposes (S-DDD)²⁸ in Kenya was 1. This compares with other African countries as follows: Swaziland 1; Egypt 2; Uganda 4; Zimbabwe 13; Namibia 73; South Africa 103. Twenty nine countries reported no morphine consumption during 2000-2002 (Table 2).

Table 2 Average daily consumption of defined daily doses (for statistical purposes) of morphine per million inhabitants, 2000-2002: countries of Africa

Source: International Narcotics Control Board Narcotic Drugs: Estimated World Requirements for 2004. Statistics for 2002. New York: United Nations, 2004.