A guest column from the American Society of Anesthesiologists, exclusive to KevinMD.com.
Approximately 30 percent of the world’s population reports living with some form of pain, ranging from headaches to joint pain to cancer-related pain. Unfortunately, pain medicine expertise and the medications and non-drug therapies available to relieve pain are not as widespread as the populations seeking care. Furthermore, many are economically and socially disadvantaged, compounded by the impact of health care disparities due to gender, race, religion, education, identity, etc.
I have had the great privilege of going on several mission trips. It has been one of the greatest joys of my life. These trips have taken me to three African countries, Haiti, Honduras, Trinidad and Tobago, Barbados, and Guyana, and each trip has impacted my life in its own unique way. However, trips with a medical focus have tugged at my heartstrings the most.
In September 2017, I traveled with a medical care team to a remote village in Zimbabwe. The plan for our mission trip was multi-fold – to provide medical care to the people in the village as well as to determine the needs of the school we used as the base for our clinic. Getting to our location was an adventure in itself. The team landed in South Africa and after a short rest, we began our journey to Zimbabwe, which was scheduled to take nine hours but ended up being 16 hours and included a border crossing in the middle of the night. After finally arriving in Zimbabwe, we bought the few things we would need for our remote location and set off. When we arrived at our location, it was a culture shock for the team. There was no electricity, running water and indoor plumbing. Not to be deterred, our team focused on the work ahead and set up our clinic.
Over the next two days, we had about 300 visits to the clinic, many of whom were women and children. About halfway through my first day of clinic, I noticed a recurring theme. Many of the women had the same diagnosis: severe hypertension, with some having systolic pressures higher than 200; arthritis with associated pain in the knees, hips, cervical and lumbar spine; and myofascial pain, with such significant muscle spasms it was surprising to me that our patients were still fully functional. To put everything in context, women in this village spent a significant part of their day carrying heavy loads (like water) on their heads, while often carrying a baby or two. Demand for simple drugs such as acetaminophen and ibuprofen was high, with many patients returning for repeat visits and reporting different symptoms to receive medication.
I wanted to do more as a board certified anesthesiologist and pain medicine specialist. I wanted to function like at home. If I had the resources, I could provide many of the joint blocks or nerve blocks that we give our patients at home. However, I had to come to the heartbreaking realization that giving a single injection would do exactly what I wanted – relieve the immediate pain – but what would happen when the pain returned? The chances of these patients receiving ongoing follow-up and treatment were nil. Our only option was to give them painkillers with instructions written by our translator and weigh the risks of giving NSAIDs in the setting of severe compensated hypertension (patients were completely asymptomatic at determination of blood pressure > 200 /100).
As a pain medicine provider, we practice in a place that provides us with the resources and equipment to properly care for our patients. September is Pain Awareness Month, when I am reminded of how grateful I am for the opportunity to give back to places where resources are inaccessible or equally accessible to those living with pain. Giving is one of the most meaningful things we can do, and one way to do that is to get involved in a volunteer medical mission. While technology, equipment, and some medications may not be accessible, you can have a significant impact on the life of someone suffering from chronic pain, such as data, such as acetaminophen and NSAIDs.
Educating and equipping the next generation of physician leaders in low- and middle-income countries with the right skills and tools is equally important. For example, programs such as the American Society of Anesthesiologists Charitable Foundation Global Scholars Program provide the opportunity for physicians in the US to support the education, clinical experience, and professional development of physicians from other areas of the world. These programs ultimately help physicians learn the skills necessary to provide patients with the effective and consistent treatments they so desperately deserve. In October, ASA will host 15 global scholars from Ethiopia, Cambodia, Nigeria, Indonesia, Tanzania, Uganda, and Rwanda to New Orleans to participate in continuing medical education courses as well as join observers in New Orleans University Medical Hospital, Ochsner Health System and Tulane Medical Center before returning to their home countries.
Donna-Ann Thomas is an anesthesiologist.
Image credit: Shutterstock.com
