BUSHEKELI – It was something, the silence. Nothing but the puff of her breath and the scuff of her slip-on shoes as Madeleine Mukantagara walked through the fields to her first patient of the day. Piercing cries once echoed down the hill to the road below. What she carried in her bag had calmed them.
For 15 years, her patient Vestine Uwizeyimana had been in unrelenting pain as disease wore away her spine. She could no longer walk and could barely turn over in bed. Her life narrowed to a small, dark room with a dirt-floor in rural Rwanda, prayer beads hanging on the wall by her side.
A year ago, relief came in the form of liquid morphine, locally produced as part of Rwanda’s groundbreaking effort to address one of the world’s great inequities: As thousands die from addiction in rich countries awash with prescription painkillers, millions of people writhe in agony in the poorest nations with no access to opioids at all.
Companies don’t make money selling cheap, generic morphine to the poor and dying, and most people in sub-Saharan Africa cannot afford the expensive formulations like oxycodone and fentanyl, prescribed so abundantly in richer nations that thousands became addicted to them.
Rwanda’s answer: plastic bottles of morphine, produced for pennies and delivered to homes across the country by community health workers like Mukantagara. It is proof, advocates say, that the opioid trade doesn’t have to be guided by how much money can be made.
“Without this medicine I think I would die,” said Uwizeyimana, 22.
___ This story was produced with support from the Pulitzer Center on Crisis Reporting. ___
When Mukantagara arrived, she smiled.