Opium war

Why cancer patients are cheering a recent change in the narcotics law

More than a million cancer and Aids patients will get easier access to medicinal morphine.

As members of Parliament stormed through the country's least-productive session this winter, people suffering from cancer had their eyes on the status of a bill to amend the Narcotic Drugs and Psychotropic Substances Act. As its name suggests, the act regulates the production, possession and trade of narcotics.

To their great relief, the Narcotic Drugs and Psychotropic Substances Act Amendment Bill was passed by the Rajya Sabha on February 21, the last day of the session, making it easier for millions of patients with cancer, Aids and other chronic illnesses to avail of medicinal morphine for pain management.

Before the Act was amended, the availability of morphine and other opium-derived medical drugs was severely restricted in most states. Numerous licenses were required to manufacture, sell, purchase or store the products. Now, nearly 20 years after palliative care sector began campaigning for the right of patients to pain-relieving drugs, the amendment to the act will simplify the regulations for issuing these licenses.

“The Act was introduced in 1985 with the aim of policing misuse of narcotic drugs, not for regulating its medical use, but the restrictive law led to a huge decline in the demand for medicinal opioids,” said Dr. Nagesh Simha, president of the Indian Association of Palliative Care, one of the non-profit organisations that pushed for the amendment.

In 1998, recognising the disservice that tight regulations did to patients in advanced stages of chronic illnesses, the central government advised all states and union territories to introduce a single-window licensing system for morphine and similar drugs. The Drug Controller of each state was to be responsible for regulating the quota of morphine to be allotted to recognised medical institutions.

However, only 16 states chose to ease their regulations. Often, this made inter-state transport of opioids even more complicated.

“Today, there is a limited number of hospitals that provide morphine pills and it is particularly difficult to avail of them outside metro cities,” said Vandana Gupta, founder of the non-profit V-Care Foundation that provides support to cancer patients.

As a result, in a country where more than one million people are in the advanced stages of very painful cancers – and more than 1.5 million suffer from chronic ailments that causes severe pain – only one per cent of patients actually get access to affordable medicines like morphine.

“My estimate is that India needs around 36,000 kilograms of morphine to cater to the required need,” said Dr. MR Rajagopal, chairman of Pallium India, a charitable trust for palliative care. “But at the moment we are only able to use around 200 kilos.” Ironically, India is one of the largest cultivators of poppy in the world, but most of the opium derived from it is exported.

It is in response to these skewed statistics that palliative care activists filed a public interest litigation in the Supreme Court in 2008 and began to push the central government to amend the law. While the case is still being heard, the legislation has finally come through.

“The amendment essentially introduces uniform regulation across states and scraps the long list of licenses required to obtain and store morphine sulphate by drug makers and hospitals,” said Dr. Priyadarshini Kulkarni, medical director of the Cipla Palliative Care and Training Centre in Pune. “This is a huge step in our efforts to bring dignity and quality to the lives of suffering patients.”

The amendment is not likely to lead to a sudden spurt in the demand for morphine, but Simha believes the demand will rise gradually, and that the Indian poppy industry is more than equipped to cater to this need. However, activists emphasise that availability alone cannot address the needs of patients in pain.

“Since many hospitals have not been stocking morphine for so many years, many doctors have never used or prescribed the drug and are afraid of it,” said Rajagopal. “So education in pain management and palliative care will be a must to train doctors on the use of morphine.”

 
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“My body instantly craves chai and samosa”

German expats talk about adapting to India, and the surprising similarities between the two cultures.

The cultural similarities between Germany and India are well known, especially with regards to the language. Linguists believe that Sanskrit and German share the same Indo-Germanic heritage of languages. A quick comparison indeed holds up theory - ratha in Sanskrit (chariot) is rad in German, aksha (axle) in Sanskrit is achse in German and so on. Germans have long held a fascination for Indology and Sanskrit. While Max Müller is still admired for his translation of ancient Indian scriptures, other German intellectuals such as Goethe, Herder and Schlegel were deeply influenced by Kalidasa. His poetry is said to have informed Goethe’s plays, and inspired Schlegel to eventually introduce formal Indology in Germany. Beyond the arts and academia, Indian influences even found their way into German fast food! Indians would recognise the famous German curry powder as a modification of the Indian masala mix. It’s most popular application is the currywurst - fried sausage covered in curried ketchup.

It is no wonder then that German travellers in India find a quite a lot in common between the two cultures, even today. Some, especially those who’ve settled here, even confess to Indian culture growing on them with time. Isabelle, like most travellers, first came to India to explore the country’s rich heritage. She returned the following year as an exchange student, and a couple of years later found herself working for an Indian consultancy firm. When asked what prompted her to stay on, Isabelle said, “I love the market dynamics here, working here is so much fun. Anywhere else would seem boring compared to India.” Having cofounded a company, she eventually realised her entrepreneurial dream here and now resides in Goa with her husband.

Isabelle says there are several aspects of life in India that remind her of home. “How we interact with our everyday life is similar in both Germany and India. Separate house slippers to wear at home, the celebration of food and festivals, the importance of friendship…” She feels Germany and India share the same spirit especially in terms of festivities. “We love food and we love celebrating food. There is an entire countdown to Christmas. Every day there is some dinner or get-together,” much like how Indians excitedly countdown to Navratri or Diwali. Franziska, who was born in India to German parents, adds that both the countries exhibit the same kind of passion for their favourite sport. “In India, they support cricket like anything while in Germany it would be football.”

Having lived in India for almost a decade, Isabelle has also noticed some broad similarities in the way children are brought up in the two countries. “We have a saying in South Germany ‘Schaffe Schaffe Hausle baue’ that loosely translates to ‘work, work, work and build a house’. I found that parents here have a similar outlook…to teach their children to work hard. They feel that they’ve fulfilled their duty only once the children have moved out or gotten married. Also, my mother never let me leave the house without a big breakfast. It’s the same here.” The importance given to the care of the family is one similarity that came up again and again in conversations with all German expats.

While most people wouldn’t draw parallels between German and Indian discipline (or lack thereof), Germans married to Indians have found a way to bridge the gap. Take for example, Ilka, who thinks that the famed differences of discipline between the two cultures actually works to her marital advantage. She sees the difference as Germans being highly planning-oriented; while Indians are more flexible in their approach. Ilka and her husband balance each other out in several ways. She says, like most Germans, she too tends to get stressed when her plans don’t work out, but her husband calms her down.

Consequently, Ilka feels India is “so full of life. The social life here is more happening; people smile at you, bond over food and are much more relaxed.” Isabelle, too, can attest to Indians’ friendliness. When asked about an Indian characteristic that makes her feel most at home, she quickly answers “humour.” “Whether it’s a taxi driver or someone I’m meeting professionally, I’ve learnt that it’s easy to lighten the mood here by just cracking a few jokes. Indians love to laugh,” she adds.

Indeed, these Germans-who-never-left as just diehard Indophiles are more Indian than you’d guess at first, having even developed some classic Indian skills with time. Ilka assures us that her husband can’t bargain as well as she does, and that she can even drape a saree on her own.

Isabelle, meanwhile, feels some amount of Indianness has seeped into her because “whenever its raining, my body instantly craves chai and samosa”.

Like the long-settled German expats in India, the German airline, Lufthansa, too has incorporated some quintessential aspects of Indian culture in its service. Recognising the centuries-old cultural affinity between the two countries, Lufthansa now provides a rich experience of Indian hospitality to all flyers on board its flights to and from India. You can expect a greeting of Namaste by an all-Indian crew, Indian food, and popular Indian in-flight entertainment options. And as the video shows, India’s culture and hospitality have been internalized by Lufthansa to the extent that they are More Indian Than You Think. To experience Lufthansa’s hospitality on your next trip abroad, click here.

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This article was produced by the Scroll marketing team on behalf of Lufthansa as part of their More Indian Than You Think initiative and not by the Scroll editorial team.