Imagine a world where the strongest pain-killer is paracetamol. Million face this reality. 

This was Bashir’s reality. A young Ugandan boy, Bashir, was in dreadful pain after having his entire left shoulder removed due to his losing struggle to cancer.  However, he was one of the first helped by Hospice Africa Uganda and spent his final days at home, pain-free, surrounded by his family and friends.  

Oral liquid morphine
Oral liquid morphine is essential medication for the management of severe pain in life threatening illnesses in low economy countries. It is made with four ingredients: morphine powder, water, a preservative and dye to differentiate the strengths. It is cheap, simple to manufacture and easy for patients to take in their homes. Costs per-patient for pain-control are now estimated to be about $1 per week.

Manufacturing
Hospice Africa Uganda first began reconstituting the powdered morphine into oral morphine through the ‘kitchen sink method’. So simple to make, it was literally first made in a kitchen sink. The oral morphine was diluted into recycled plastic water bottles and color coded to identify strength level (weakest-green; medium- pink; strongest – blue).

In 2003, Uganda changed a statute so nurses and clinical officers trained in palliative care would be recognized as a registered prescriber of oral morphine. Later that year, the Ministry of Health undertook to pay for oral morphine for all in need in Uganda. HAU solidified the contract with the Ugandan government and became the sole manufacture of morphine for the Country of Uganda in 2011. The kitchen sink method was still being employed, until 2015 when the American Cancer Society donated more sophisticated liquid morphine production equipment.  

BBC features HAU’s oral morphine production (video and article). Link

Brief History
The formula was first reconstituted in Singapore at Dr. Merriman’s request for a simple solution of pure oral morphine, for the cancer patients dying in pain at home. The work and advances in Singapore opened the door to affordable pain control and holistic care in Africa. The ‘Merriman formula’ came over to Africa with Dr. Merriman when she accepted a job as Medical Director of Nairobi Hospice in 1990. It came to Uganda in 1993, when the Ugandan political leadership, spearheaded by Minister of Health Dr. James Makumbi, allowed the first importation of morphine powder. HAU initially manufactured oral morphine for its own clinical services and in 2011 became the sole manufacture of oral morphine for the Country of Uganda.