My Pain Obsession

(by Greg)

It is hard for me to watch people suffering in physical pain.  That is not to say that it is easy for others.  But as an anesthesiologist, part of our work is to control pain, before, during and after surgery.  There are even “pain specialists” now in the US and other countries, anesthesiologists who go on to do further sub-speciality training in pain management.  Unfortunately, in most hospitals in low and middle income countries, pain, and especially post-op pain, is often ignored.  Most patients with fractured legs or perforated intestines, receive Tylenol, and nothing more.

There are a multitude of barriers to providing people with effective pain control at Kibuye.  For one thing, our patients rarely complain of pain.  Africans in general are extremely stoic.  On top of this, our physicians are swamped with patients, and so pain evaluation and treatment takes a back seat to things like fluids and oxygen and antibiotics.  And I understand all this.  But last fall, I decided that perhaps the Lord was calling ME to try to tackle this problem.  And so I started with the advice of Atul Gawande, in his book Better, who suggests that one of the steps in becoming a “better” physician is to mesure something … anything.  I found two eager medical students who were willing to spend an hour every day for two months, measuring pain scores and vital signs on all of our post-operative patients.  I was grateful to have found a facial pain scale that had been translated into Kinyarwanda, and so could be easily understood by our patients who speak Kirundi.

At the end of this 2 month period, I began to do pain rounds everyday with my students, implementing the World Health Organization 3 level pain scale to guide our treatment,  and we continued collecting data.  This data will now provide the material for the theses presentations of 4 of our medical students.  But, what brings me the most joy is that we have been able to prove that providing adequate pain control is possible even in a rural African hospital.

Now I am not one to celebrate victories, much to my shame.  And while this all sounds good, on a daily basis I am much more prone to melancholy, frustration that more cannot be done, worry that when I leave for home assignment all of this will come to a halt and wishing I could find a way to put a sustainable system in place to continue this project, which admittedly has become a bit of an obsession for me.

Despite my negative attitude, one evening while at dinner, Jesh sent me a photo.  It was of one of the medical students rotating on his surgery service. She was using her phone to show the above mentioned pain scale to a patient.  Now this was a student who was not involved in this pain project and who had not yet rotated on my service.  But she had heard from others about what we were doing and she took it upon herself to find a copy of this pain scale and start evaluating the pain level of her patients.  I am so grateful to Jesh for taking the time to send me this photo, because it was a reminder that God is often doing things that I am completely unaware of.  I am completely insufficient for this work.  But His grace is made perfect in my weakness, and He is continuing to bring transformation, beyond what we are capable of, for His glory and for His love of people who are suffering.  Please pray that this work will continue, even in my absence, and pray for our patients.  Please pray for me to have opportunities to share this work with others.  I would love for other hospitals around Burundi and around Africa to invest in this work.  But I am confident that God will continue this work, with or without me.