Two weeks ago during the middle of editing a documentary, i received a desperate phone call from an ex-domestic help of ours. She was in Dhaka in a hospital with a relative, and the doctors would not explain to her what was going on despite the patient being in acute discomfort. No suprise there for me. I am very well conversant with the patronising and patriarchal attitudes of healthcare professionals in the country. She asked me to speak to the doctor in charge via her mobile. Accent and status are all important in dealing with the medical fraternity. The news was bad, and brought back personal memories. He had swollen glands underneath his arms and all down his spine. The doctor graciously explained what he had refused to do moments earlier to R. Its probably TB or lymphoma he said and that they would carry out tests and would know in about three days. He also suspected signs of organ failure. I was sufficiently unhappy with the proceedings to request R to remove her relative to another “better” hospital. Anyway, the upshot of it was that it was indeed cancer and very late on. The tumours were impacting on organs and they did not expect him to live long.

In the new hospital we enquired about pain relief. Now came the staggering and mind boggling responses. Firstly, there was surprise that we were contemplating this from the medics. Secondly, they had no regimen in place ( “We will need to have a board meeting” ) and thirdly when I made the patient’s relatives aware of the costs ( well within the budget they had indicated to me they had brought to Dhaka), they sheepishly told me “What is the point if he is going to die?”

This all brought home the point made to me by my friend Natalya, a palliative health care medic in South Africa, that access to pain relief should be a human right. It can’t be left to the individual calculus and the advocacy or otherwise of his “loved ones” or the medical establishment where the patient finds himself in. Dr Nezamuddin Ahmed of the Bangabandhu Sheikh Mujib Medical University wrote this ( on World Hospice and Palliative Care Day, October 6th 2007):

Prevailing health care approach in Bangladesh is cure-oriented in accordance with the global trend. As a result, patients having been diagnosed as suffering from an incurable disease do not get knowledge-based appropriate attention from health care providers. Concept of palliative medicine…… is not known amongst the medical community. Official palliative care services and educational programmes do not exist here.