'Ripple Effect'
Location
Dr. Zipporah Ali is the National Coordinator for Kenya Hospices and Palliative Care Association (KEHPCA). She has been involved in palliative care for over 18 years as a health care provider as well as an advocate. She has completed the International Pain Policy Fellowship and is also on the International Leadership Development Program with the Institute for Palliative Medicine at San Diego Hospice. She serves on several boards, including the International Association for Hospice and Palliative Care (IAHPC)Board of Directors.
“This pain is present every day, unyielding, oppressive, still there. Why doesn’t it take a day off?” Sue Falkner Wood, Life with Chronic Pain
While there have been recent developments in access to pain relief in Kenya, our average morphine consumption is still way below what is recommended for the treatment of pain. This is not because there are a lack of patients in pain, but mostly because clinicians do not regard pain as a symptom that needs to be treated. After all, as Kenyans, we must endure pain because our ‘culture’ dictates so. This is more of an ‘attitude’ problem than a ‘cultural’ one. Cancer pain and other debilitating pains do not know or respect ‘culture.’ It is time we changed this belief and our attitude towards patient’s pains. When we deny a patient pain medication, what exactly is going on in our minds? Would we deny a loved one freedom from pain? Would we want to be denied freedom from pain?
In 1968 a pioneer in pain management named Margo McCaffery, defined pain as "[…] what the person says it is and exists whenever he or she says it does" (McCaffery, 1968). This definition of pain brings a totally different voice to the understanding of pain (Ferrell 2005). Betty Ferrell further demonstrates that pain is a personal and individual experience, where the patient is the expert…the expert we need to listen to and learn from in our daily practice. McCaffery’s definition laid down a simple foundation of respect for people in pain. Yet, we fail to show this respect when we do not teach clinicians about pain management and when we do not put in place systems to ensure access to appropriate pain medication for those who need it. Not only are we failing ourselves, but we are also failing all of mankind.
Physical pain can destroy the will to live and impact the course of disease. Pain is often cited as a reason for the perceived need for physician assisted suicide – a further testament to the need to expand access to pain relief. Pain not only physically and emotionally destroys the patient, it has a lasting impact on the patient’s loved ones. Family and friends do not want to see their loved one suffer. What they wish for them is good quality of life and an absence of physical, emotional and spiritual pain. It is everyone’s right. Let us not deny our patients’ their rights because of our inadequacy, ignorance and unnecessarily prohibitive regulations. We must recognize pain as a deeply human experience and not just as a neurologic phenomenon –this is a critical step toward a social recognition of its urgency (Ferrell 2005).
Kenya Hospices and Palliative Care Association (KEHPCA) has taken up the challenge to educate clinicians on the importance of impeccable assessment and treatment of pain. It is a challenge that will take time to overcome, but the good news is that there is now more morphine in Kenya and demand and consumption has improved significantly. We would like to thank the hospices and palliative care providers across the country who are working together to make a difference.
When the time comes death should simply become a discrete but dignified exit of a peaceful person from a helpful society, without pain or suffering and ultimately without fear (Aries, 1977).
References:
Jacox A, Carr DB, Payne R, et al. March 1994. Management of Cancer Pain. Clinical Practice Guideline No. 9. AHCPR Publication No. 94-0592. Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Public Health Service, Rockville, Maryland. Janjan
Falkner S W: Life with Chronic Pain: A How-to Guide. http://www.everydayhealth.com/blog/life-with-chronic-pain/
Ferrell, B. Ethical Perspectives on Pain and Suffering: The Effect of Unrelieved Pain and Suffering : http://www.medscape.com/viewarticle/512438_4
McCaffery, M. (1968) Nursing Practice Theories Related to Cognition, Bodily Pain, and Man-Environment Interactions. Los Angeles: University of California at LA Students Store.
Philippe Ariès: The Hour of Our Death. Oxford Paperbacks.
