Friday, September 15, 2006

Pain in Haiti

Several years ago, while working in a good sized mission hospital in the province in Haiti, I realized how poorly patients were treated that were suffering severe pain. We had many post op patients, severely burned patients, cancer patients, and trauma patients that were shot, had machette wounds, and were involved in automobile accidents. We treated them all very inadequately for their pain. Even children that were having their skin debrided and dressings changed each morning for their burn wounds, were not pretreated with pain medication or with medication to sedate them. Their screams could be heard all over the hospital.

When I would walk through the post op ward or the orthopedic ward in the mornings with my bottle of oxycontin, many hands would flash forward in the supine position, as these patients pleaded for this strong narcotic.

Haitians do not have a "stronger pain tolerance" than do other people. We like to think of it that way, but it is not true. What is true, is that Haitians are "more use to pain" than most cultures. They feel some sort of pain each day. Pain is universal.

The hospital referred to above, had several vials of Demerol in the pharmacy and that was it. This hospital was the only hospital on call 24-7 for over 2 million people. The pain medication we prescribed the most was Talwin. It doesn't work near as well as morphine or Demerol.

Some cultures encourage patients to suffer needlessly in silence, and this allows caregivers like me to turn my head a little easier and ignore their suffering as well.

Achieving balance in natural opiods (morphine) control policy is very important for the local minister of health. We were not getting more narcotics at the hosptial where I worked because he would not allow it. And when doctors and nurses in the developed or developing world have burdensome prescription filling requirements, we are discouraged from writing these very important prescriptions. And we shouldn't worry that our 45 year old Haitian with metastatic cervical carcinoma, that could have been prevented in the first place, is going to become an addict. She needs narcotics to ease her way out of Haiti and into Heaven.

WHO predicts that over the next 20 years, the number of cases of people diagnosed with cancer will double to 20 million cases/year worldwide. Pain care will be very important, especially in the developing world. When we don't prevent or diagnose in a timely fashion someone's cancer, the least we could do is prevent some of their pain at the end of their lives.

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