Tuesday, April 7, 2015

Living Through The Pain

Each and every one of us has had an experience dealing with pain. From cutting a finger to falling off a trampoline as a child, or in more serious cases such as getting in a car accident. Pain is very subjective to the person experiencing it. Myself, as a nurse, I cannot truly evaluate how much someone might be in pain because every individual displays pain differently and pain thresholds vary from person to person. However, we all can agree that being in pain hurts. No matter if it's emotional, physical, psychological or spiritual, pain hurts. Therefore pain is an experience that requires an intervention in order to create relief. 
During my surgical rotation in Lewanika General Hospital I observed many people in pain with very little interventions being done. The World Health Organization revealed that pain is the second most common reason for people to seek out medical attention. The lack of interventions may be due to the lack of resources, the lack of knowledge, fear of addiction and dependence or due to a majority of africans stoic appearance when experiencing pain. 
The idea of Stoicism is prevalent here in Mongu. Stoicism is a term that describes an individual in pain or hardship without a display of feelings and without complaint. A majority of Zambians have this idea that men and woman should be strong and should "take the pain". Patients may not want to appear weak or may believe the pain they are enduring is "God's will" (Alvarado, A. 2008). This was very obvious during my experience on the surgical unit and in the theatre room this week. Procedures usually done with an anesthetic and/or analgesic such as patients having ankles pulled to reset broken bones, tracheotomies put into, or sores cut into were given little to no analgesic given. When a patient in pain would catch my eye they would appear flat and dissociative as if they are not allowed to feel pain or display their vulnerability. This raised great concern for me taking into account my mother went through excruciating uncontrollable pain that was not addressed properly this fall. I felt the need to advocate and hold the hands of the patient who could not speak for themselves just as I would do with a family member. What shocked me the most was the patients that were crying, yelling or begging the physician to stop were being shamed by the rest of the ward. It was like a vicious circle of shaming. There was a feeling of unconcern from bystanders who were indifferent about my feeling of empathy. It was as if a normal reaction to pain was unreasonable or comical. 
Lack of access to essential medicines such as morphine for treatment violates a persons human right to proper health care. According to the World Health Organization states four  countries, canada, US, Australia, and the U.K account for 68% of her worlds opioid consumption. This leaves over 5.5 billion people (83%of the world’s population) with little or no access to pain relief medications. They estimate that therefore each year a staggering 5.5 million terminally ill cancer patients and one million patients in the end stage of HIV/AIDS are denied pain relief. Patients here (and some at home) are unaware that they may be doing more harm then good to their health by enduring chronic pain. Speaking to a nurse on the surgical ward she explained, “If a patient is in pain, we just give them paracetamol. This is routine." Paracetamol is equivalent to Tylenol at home but occasionally  Tylenol just isn't sufficient. Due to opioids being a narcotic they have such a bad stigma attached.Not only patients themselves at Lewanika General hospital have a fear of opioids but a majority of health care providers as well. Most health care providers in Canada know the truth about opioids, however, some may unintentionally stereotype patients when only seeing a few cases of addiction and dependence which in return deters them from providing adequate pain. This may due to the lack of knowledge of how addiction/dependence occurs or a lack of comfortability of a potent analgesic due to the lack of product. Patients rarely become addicted. Doctors concerned about abuse can prescribe limited amounts, so that the patient will return often for monitoring. There is no such thing as too much pain medication for a patient in pain. Morphine has no upper limit as long as a patient can tolerate any side effects caused by the medicine. This why it is important for health care providers to educate patients on the truth behind opioids, which may not be easy when health care providers themselves are scared of addiction or are not provided adequate education.

Trisha Rempel 

Alvarado, Anthony J., "Cultural Diversity: Pain Beliefs and Treatment among Mexican-Americans, African-Americans, Chinese- Americans and Japanese-Americans" (2008). Senior Honors Theses. Paper 127.

1 comment:

  1. Excellent capture of your awesome experience Trisha! Enjoy,