Efforts to scale up pain relief around Kenya have in the recent past been championed by Treat the Pain, a program of the American Cancer society which has been working closely with Kenya Hospices and Palliative Care Association. The ministry of Health is now procuring and supplying morphine powder to institutions through the Kenya Medical Supplies Authority (KEMSA). Morphine is used to treat moderate to severe pain in adults and pediatric patients. A project recently started in Kenya is the Pain Free Hospital Initiative (PFHI).
The PFHI is a one‐year hospital‐wide quality improvement initiative to integrate pain treatment into service delivery by providing education for patients and staff, raising motivation and awareness, documenting pain levels, improving medicine supply, and communicating impact. Health care workers get lectures on different aspects of pain in four sessions tailored to suit their need and developed by Treat the Pain program. The Initiative has five main components:-
i. Motivate – surveys are done on knowledge before and after the initiative
ii. Supply – ensure that hospitals have essential pain medicines
iii. Equip – regular training sessions are conducted to improve clinicians knowledge on pain management
iv. Measure – patient pain scores and opioid consumption are monitored over the period of the project
v. Communicate – results of the intervention will be shared to motivate other hospitals implement this initiative
At the end of the four sessions, participants receive certificates of participation as evidence of attendance of the sessions. Some of the topics include; classification of pain, assessment, pharmacological and non pharmacological management and pain management in special groups. The sessions focus on physical pain management.
Kenyatta National Hospital (KNH), the country’s largest teaching and referral hospital in Kenya, is the first hospital in the country to run the project. The sessions are done as per departments coordinated by a staff champion, Dorcas Kabugo through the KNH Pain and Palliative Care unit. By September 2015, all departments at the hospitals will have been reached by the project.
The sessions are carried out one hour each week for four consecutive weeks.
Participants also receive resources such as training manuals, “Beating Pain” book by African Palliative Care Association (APCA) and various promotional materials including pain bracelet, pain buttons, and stickers. KEHPCA has developed pain management posters for adults and children to help healthcare workers remember appropriate pain assessment and medicines used. There are also posters to help encourage patients report their pain to clinicians.
“No more pethidine” said one of the participants from Accident and Emergency department. “I now know that it is not in the WHO essential medicines list.”
“Doctors should attend these sessions too since they do prescription of opioids” said a nurse.
“Pain is real and I will not fear morphine if my patient is in severe pain” was a take home message by a participant in the department of medicine.
At the moment, 98 healthcare workers have attended all the four sessions from four departments in the hospital and the project hopes to reach more.