For additional information on advocacy please read the following publications:


80% of opioid consumption occurs in 6% of the world’s population!

A key issue which prevents pain management in cancer patients is the lack of availability of oral morphine and other strong analgesics. Oral morphine is cheap and effective. It is on the list of essential medicines, published by the WHO in 1986 and revised several times since. The IAHPC list of essential drugs in palliative care includes morphine and other strong opioid analgesics.

Pallium India have led an important initiative called the Morphine Manifesto which draws attention to this issue and calls for affordable access to immediate release oral morphine.

Sign the manifesto by clicking on the link on the top of the page or visiting the following website where the call for actions are spelt out:

http://palliumindia.org/about/tips/ [Accessed 16.4.2012 2012].


Moonshine Movies have produced a feature film called Life Before Death along with a series of YouTube videos to draw attention to the international crisis of poor pain relief and lack of palliative care.

This film was internationally launched on World Cancer Day, February 2012 with many viewings held across Australia around that time. A special viewing was held in Canberra hosted by Palliative Care Australia and attended by members of parliament in departments of health and foreign affairs.


Just US$20 can stop the pain of a patient facing severe debilitating pain for a whole month. A pain-free month can change the entire experience of patients and families facing life-limiting illnesses or diseases that threaten their quality of life.

The tragedy of untreated pain is particularly acute in India, however significant progress is being made thanks to hundreds of grassroots programs that urgently need your support.

Visit www.palliumindia.org and find out how just US$20 can provide a month’s pain relief to patients.

To support this cause, the Lien Foundation in Singapore will provide US$100,000 to Pallium India. Half of the funds would go to buying pain relief medicine for the poor and the other half to train doctors and nurses in pain treatment.

The Life Before Death DVD can be purchased here: http://lifebeforedeath.com/movie/buy-the-movie.shtml


PPSG INTERNATIONAL PUBLICATIONS 2008. The Single Convention on Narcotic Drugs-Implementation in Seven Countries. A MONOGRAPH PREPARED FOR:International Pain Policy Fellowship Training Madison, Wisconsin, USA, University of Wisconsin Pain & Policy Studies Group.

WHO & HAI 2011. WHO/HAI Project on Medicine Prices and Availability Review Series on Pharmaceutical Pricing Policies and Interventions. Working Paper 3:The Regulation of Mark-ups in the Pharmaceutical Supply Chain. Review Series on Pharmaceutical Pricing Policies and Interventions.

WORLD HEALTH ORGANISATION 2011. Ensuring balance in national policies on controlled substances: Guidance for availability and accessibility of controlled medicines, Geneva, WHO Press, World Health Organization.

Project Focus

As some of you may be aware, in early 2016 the Asia Pacific Hospice Palliative Care Network (APHN) held four ‘APHN Dialogs’, in which clinicians across the Asia Pacific region could link in through Skype to attend a webinar. The following webinars took place:

- A discussion of palliative care service development in the Asia Pacific region, presented by Odette Spruyt
- Pain control in palliative care by Yoshiyuki Kizawa from Kobe, Japan
- Management of the cancer wound by Edward Poon from Singapore
- Bereavement care by Jun-Hua Lee from Taiwan

These sessions were well received and provided a valuable opportunity for clinicians in different countries to learn from an expert in that field and also to share their own professional experiences. Unfortunately, not all countries in the region have reliable internet coverage or sufficient bandwidth so some attendees were unable to join the meetings. In response to this, in recent months APLI has been looking at a new educational initiative in partnership with APHN.

Project Focus aims to set up online discussion groups between palliative care clinicians in specific countries in the Asia Pacific region and APLI mentors. Some nascent palliative care centres struggle with isolation, limited practitioner experience and variable institutional support. In effect, Project Focus would work towards similar objectives to Project Hamrahi: to improve the capacity for best practice patient care in the local setting and to reduce the isolation of palliative care providers in emergent services.

APLI is therefore calling for expressions of interest for mentors to volunteer their services to help support our regional partners. Project Focus would particularly suit clinicians who might otherwise find it difficult to travel overseas for mentoring work, as the contact will be online using a small group discussion format on the ‘Slack’ communication platform. APHN has already identified local clinicians in two separate services in remote and regional Indonesia who would like to be partnered with APLI mentors. In addition to this, there has also been some interest from doctors in Vietnam, Brunei and Nepal whose learning needs were unable to be supported by the APHN Dialogs.

Although the exact process will be flexible, it is proposed that education would begin with case presentations from the local APHN clinicians. These would then serve as a springboard for the APLI mentors to explain current evidence based practice recommendations. The subsequent discussion would then take into account local factors such as medication availability, local resources, staffing and other factors such that a viable and culturally appropriate management plan can be formulated.

I hope that you will share our excitement for this initiative. Project Hamrahi has demonstrated the value of teams of mentors made up of both doctors and nurses working together with local Indian clinicians over a sustained period of time. Project Focus has the potential to broaden the scope of such partnerships to other countries and so I invite you to contact me via chairman@apli.net.au with a short biography and reflection on why you would wish to work as a mentor.

- Anil Tandon


Your donations to APLI help in the following ways:

assist with training of doctors and nurses in palliative care practice in developing nations

support nurses to travel and teach as part of Project Hamrahi

help with purchase of critical site resources such as essential equipment and supplies,  medicines and educational materials