Thoughts on the seed of the poppy

I had my first opportunity yesterday to meet with "the registrars", the family physician residents in training at the government district hospital 5 miles down the road. It was supposed to happen two days prior, but Jan had called me that morning to say don't come; all the registrars had been suspended without pay by Moi University, and told to go to Nairobi and camp out at the Ministry of Health until the Ministry promised to pay the university the tuition that was owed to it, going back over a year. As they say they say here, "TIA" (this is Africa...)

My assignment with the registrars was to introduce the topic of palliative care and hospice. In my trips back to Kenya over the years, I had begun to feel very strongly that this was sorely needed here. People can die horrible deaths, with inadequate pain control and no attention to their psychological needs. This is especially true with cancer patients, but can also happen with AIDS, heart disease, and really any chronic incurable disease.

In the meantime, I had been able to make contact with the Kenya Hospice and Palliative Care Association (through their contact with Hospice of Lancaster County); their major purpose is to assist communities in starting their own hospice programs.

The session with the registrars went well, had two hours to explain the rationale of what we do in hospice, i.e., when a disease is incurable and progressing toward a predictable outcome, the attention turns to quality of life and relief of symptoms. All this made intuitive sense, and they were easily able to come up with examples from their own recent experience of patients who would benefit.

The sticking point was the use of morphine and other strong opioids for the relief of pain. There is a great fear of morphine here among physicians; it is hard to know what it is based on, since few have any experience at all. It is not easy to get (and in fact the first task of a new hospice here is always to secure the supply of morphine), but it is possible. I think I was able to allay many of their fears and speak from experience how necessary it is to the function of hospice. (In the U.S., morphine would be just one of several alternatives available; but those alternatives are absolutely unavailable here, hence the importance of morphine).

Sometimes, in advocating for this, I find myself thinking almost theologically. We each have in the cells of our brain finely-tuned opiate receptors, which allow the brain to turn down pain signals. It just so happens that a certain compound purified from the seed of the poppy plant, originally growing in central Asia, exactly fits those opiate receptors, and with this compound we are able to greatly ease the pain of suffering patients. What a wonderful example of the bounty and mystery of God's creation! And also a tribute to human ingenuity, which was able to discover all this.

Creation is good; but creation is also fallen. Human ingenuity has also learned how to make use of the seed of the opium poppy for unhealthy and destructive purposes, and this has led directly to the fear of doctors here.

Creation is good, creation is fallen, and creation can be redeemed. Could it be that the proper use of morphine is part of that redemption?