Paper short abstract:

Morphine has a special role in Tanzanian palliative cancer care. Prescribing and dispensing morphine is at first a way to ease pain, but additionally an act of care where there is no resource for psychosocial and spiritual support. It substitutes and complements palliative care practices.

Paper long abstract:

Through rapid demographic transition NCDs have recently received attention in Sub-Saharan Africa. Among those cancer stands out with the highest mortality and fastest deterioration. For many patients curative treatment is no possible and pain management and palliation becomes first and only priority. But holistic palliative care seems a luxury as most patients are dying anyway and financial and human resources are needed elsewhere.

My PhD research took place in Tanzania's only specialized cancer hospital between 2012 and 2015. It is intended to show how and in what extent professional and private care is provided. Tanzania is one of few African countries where liquid morphine is available. Especially cancer patients benefit from the legalisation and availability to cope with their pain.

During the course of my research I observed a strong shift in morphine usage: from being restricted and exclusively handled by the palliative care team, to widely available on other wards and prescribed to most patients. In the meantime, there is a bottle of morphine on every patients' beside table. Additionally, a limited number of highly technological dispensing machines facilitated easy and exact use for a few dozens of patients.

Beside relieving patients from pain, administering morphine seems as a way to deal with high numbers of patients and their needs for treatment and attention where staff and treatment options are scarce. As medical professionals avoid extensive and emotional conversations and information disclosure remains fragmentary, prescribing and dispensing morphine is substituting and complementing palliative care practices.