Global leaders provide concrete examples of the bureaucratic challenges. Mary Callaway (USA), Dr MR Rajagopal (India), Liliana de Lima (Colombia), Dr Stephen Connor (USA), Dr Kathleen Foley (USA), Dr Eva Rossina Duarte Juarez (Guatemala), Dr Natalya Dinat (South Africa) and Dr Meg O’Brien (USA) provide notable quotes:

“I think the one wedge issue that we’ve had in palliative care over the last several years is pain,” explains Mary Callaway (USA). “Nobody’s going to argue that people should suffer in pain. So nobody’s going to argue against it but there’s not enough action – that’s where the gap is. How do we get people in positions of authority to respond to that?”

Dr MR Rajagopal (India) identifies complex regulations as one of the main barriers and gives the example of the Narcotic Drugs and Psychotropic Substances Act of India, which runs to around 1,400 pages.

“In their effort to implement the [United Nations] Single Convention on Narcotic Drugs some countries have misinterpreted the Single Convention and adopted regulations and laws that are overly restrictive and actually hinder access to the medical and scientific needs,” explains Liliana de Lima (Colombia).

Dr Stephen Conner (USA) continues, “It’s really difficult to change these laws and regulations in some of these countries you really have to get every ministry within the government to agree to do it and typically the law enforcement and justice ministries are the most difficult.”

“Because of the abuse of prescription drugs the cancer patient has become an extraordinary victim in this,” states Dr Kathleen Foley (USA), “With heightened controls placed on access to those medicines for patients who are in terrible pain.”

“Most Latin American countries have similar problems,” reflects Dr Eva Rossina Duarte Juarez (Guatemala), “So they were very concerned about control and diversion but they didn’t realize the importance of having those medicines available for pain relief.”

“I don’t think these are bad people, “states Mary Callaway, “They just don’t know. And then, it’s not only that they don’t know but they don’t know what to do.”

Dr Natalya Dinat (South Africa) continues, “I think where the challenge lies in where there are competing priorities and who’s to say what’s more important – childhood immunization for example or maternal health care or pain relief – they’re all equally important. We don’t want to be placed in an either/ or situation.”

“I think it’s about saying as human beings that we should not be able to stand by and watch people suffer when we have the tools to relieve that suffering,” concludes Dr Meg O’Brien (USA).