Nigeria needs morphine. According to the Global Access to Pain Relief Initiative (GAPRI), only 1 kg of the pain medicine has been imported since 2007, an amount that covers approximately 216 people in a nation of 155 million. Doctors instead rely on weaker analgesics like Tramadol, which may not be adequate for the severely ill.

In March, Nigeria signed an agreement with GAPRI (an offshoot of the Switzerland-based Union for International Cancer Control) to import 26 kg of morphine. The order is expected to arrive in April in the capital city of Lagos. "[It's] a stopgap to re-establish a stock of narcotics in the country," explains Tunji Odelola, who is leading the Nigeria-GAPRI collaboration at the Federal Ministry of Health.

While the partnership is a boon for Nigerian medicine, this story is nothing new. It extends back to the 1980s, when Nigeria grappled with drug trafficking issues. "There was military rule at that time," explains Dr. Simbo Amanor-Baodu. "They knew nothing about pain management; they just put a blanket ban on narcotics coming into the country." As an anesthetist and member of Nigeria's national opioid availability committee, Amanor-Baodu has witnessed for decades the problems plaguing palliative care. She also helped found the Society for the Study of Pain, Nigeria (SSPN).

SSPN was launched in 1998, aimed at rehabilitating what Amanor-Baodu calls a "lack of understanding [from] the people in control." By 2001, she says, the Federal Ministry of Health finally purchased morphine and other opioids lobbied for by anesthetists. But the drugs never reached Nigeria's cancer and HIV/AIDS patients, nor did they make their way into its hospital emergency and operating rooms. "They sat on the shelf," saysAmanor-Baodu, "simply because medical professionals had forgotten how to prescribe opioids."

Odelola agrees. "Issues of narcotics control and availability over the years have led to low prescription rates," he says of the hesitation about morphine over the last decade. "[Healthcare professionals] have inadequate knowledge about the complex features of pain. We are working on an enlightenment campaign to advise practitioners of the availability and relatively low risk of [opioid] abuse, if properly managed, for chronically ill patients."

GAPRI's assistance will include training programs looking at the risks of severe pain and co-morbidity in patients, which both Odelola and Amanor-Baodu say is misunderstood by many healthcare providers. "We have patients who have life threatening illnesses [whose] doctors give supportive care without defining what those cares are supposed to be," explains Amanor-Baodu.

Whether these patients will have better, direct access to the new morphine is unclear. GAPRI is working with hospitals, hospices and palliative care centers across the country to streamline approvals so that drug orders may be picked up promptly, says Odelola. But the stockpile is housed in only one location, the Federal Medical Stores facility in Lagos. Amanor-Baodu feels this centralization is problematic.

"The pharmacists are the ones who actually told us we need to decentralize," she explains. Trips to Lagos from remote parts of Nigeria can take days, even by air. Before traveling, she says, "[the patient] has to put his papers together and present them to the Ministry of Health of the state in which he is a resident and the chief pharmacy of that state has to approve his papers, because without that information he cannot buy more opioids. It's [only] then that he starts going down to Lagos." More bureaucracy waits in the capital. By the time the patient has his drugs in hand, "he can end up getting TB [tuberculosis] or more. It is unfair."

Amanor-Baodu would like to see Nigeria's palliative care problems solved with funding and technical assistance from GAPRI. "The nation has embraced it, the nation is running with it. We have some money, even if it's from outside," she laughs. "But it's money that can be expended for the benefit of humanity."

Tech Bytes

➲ China's State Oceanic Administration has made data from one of its satellites available for public use. The oceanic surveying satellite Haiyang-2 monitors maritime conditions and extreme weather patterns and was launched in August 2011. It is expected that the new open data will be of use to those interested in oceanic research and disaster prevention.

➲ Plans are underway to build a new international astronomical observatory in Tibet, China. While the exact location is still unknown, Chinese Academy of Sciences astronomer Yao Yongqiang says it may be built in the autonomous region's Ngari Prefecture, where altitude reaches 5,100 meters and clouds are sparse. Research would focus on star formations, gamma-ray bursts and other astronomical phenomena.