“Pain is whatever a patient says it is. It exists wherever and whenever a patient says it does”. In an assessment of pain video clip, Dr. John Campbell quotes these famous words said by McCaffery in 1968 about pain management. “The patient is the only judge of their pain and they have to be believed”, Dr. Campbell adds.
The reason why the Kenya Hospices and Palliative Care Association (KEHPCA) team weathered a chilly morning in Limuru, Kiambu County on 14th March was that freedom from pain and distressing symptoms is a basic right. For the same reason of mitigating pain, 52 medical personnel mobilized by Dr. Mary the hospital’s medical consultant, gathered at 8:30 am in the Nazareth hospital’s boardroom for their weekly Continuous Medical Education.
In an interactive PowerPoint presentation, Dr. Muinga the Coordinator for Access to Pain Relief and Palliative Care together with David Musyoki also from KEHPCA talked about types of pain, measuring and evaluation of pain in adults and children, treating pain with and without medication. Referencing Dr. Campbell’s video clip on assessment of pain by, Dr. Muinga said that 99% of patients are undertreated. This is because as opposed to the familiar assumption that patients exaggerate on pain, the truth is that a majority underreport pain. Patients need to be given the opportunity to elaborate on their pain and above all, they have to be believed.
Outside the session Purity, a student at Nazareth Hospital Medical College expressed that it is not easy to listen to someone expounding on their pain. “It comes with an uncomfortable feeling and it is like some pain is being transferred to the listener”, she said. She recommended that despite this disturbing feeling medics should help patients point out the real level of their pain.
Rose Masindet, a pastoral counselor at the hospital said that when patients experience pain, they connect it to so many things like family issues, work, tradition, personal history, religion and relationships among others. An elderly patient told the counselor that there is something wrong he did in his childhood and that was why he was being tormented by endless pain. “Helping patients disconnect from unrealistic and superstitious causes of pain cancels out their despair and makes them respond better to treatment”, she added.
Nazareth Hospital has a promising palliative care unit that includes an inpatient section of four beds in the male ward and four others in the female ward. On the day of training, the female section had two occupied beds while the male one was fully occupied. Nelson a middle-aged man lay on one of the beds. Though his face was bright and his body relaxed, he is paraplegic secondary to cancer. He receives palliative home care from his relatives but had been brought to the hospital recently because he had developed persistent vomiting. “The vomiting has subdued and I do not have any pains. I am looking forward to going home to be with my family”, with a contented look on his face Nelson tells the KEHPCA team.