The Heartbreak And Joy Of Missions-Based Pain Medicine: A Pain Physician’s Perspective

A guest column by 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 widely distributed as the populations that require care. Additionally, 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 enormous privilege of going on several mission trips. It has been one of the great 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, the trips with a medical focus have pulled on my heartstrings the most.

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In September 2017, I traveled with a medical care team to a remote village in Zimbabwe. The plan for our mission trip was multifold – to provide medical care to the people in the village as well as determine the needs for the school we were using as the base for our clinic. Getting to our location was an adventure in itself. The team landed in South Africa, and after a brief rest, we began our drive to Zimbabwe, which was planned for nine hours, but ended up taking 16 hours and included a border crossing in the middle of the night. Once we finally made it to Zimbabwe, we shopped for the few essentials we would need for our remote location and headed out. When we arrived at our location, it was a culture shock for the team. There was no electricity, no running water, and no 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 clinic visits, many of which were women and children. About halfway through my first day of clinic, I noticed a recurring theme. Many of the women shared the same diagnosis: severe hypertension, with some having systolic pressure higher than 200; arthritis with related 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 place everything in context, the women in this village spent a significant portion of their day carrying heavy loads (such as water) on their heads while often carrying an infant or two. The demand for simple drugs like acetaminophen and ibuprofen was high, with many patients returning for repeat visits and reporting different symptoms in order to obtain medication.

I wanted to do more as a board-certified anesthesiologist and pain medicine specialist. I wanted to function as I did at home. If only I had the resources, I could provide many of the joint blocks or nerve blocks we give to our patients at home. However, I had to come to the heartbreaking realization that providing a single injection would do exactly what I wanted it to – relieve the immediate pain — but what would happen when the pain returned? The chances of these patients receiving follow-up and continued treatment were nil. Our only option was to give them pain medications with instructions written by our translator and weigh the risks of providing NSAIDs in the setting of severe compensated hypertension (patients were completely asymptomatic in the setting of blood pressure > 200/100).

As pain medicine providers, we practice in a country that affords us the resources and equipment to appropriately take care of our patients. September is Pain Awareness Month when I’m reminded of how thankful I am for the opportunity to give back to countries where resources are inaccessible or equally accessible to those living in pain. Giving back 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 certain medications may not be accessible, you can still make a significant impact in the life of someone suffering from chronic pain, such as with basic anatomically-guided injections and over-the-counter pain relievers we often take for granted, such as acetaminophen and NSAIDs.

Educating and equipping the next generation of physician leaders in low- and middle-lower income countries with the proper skills and tools is equally important. For example, programs like the American Society of Anesthesiologists Charitable Foundation’s Global Scholars Program provide the opportunity for physicians in the U.S. 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 needed to provide patients with the effective and continued treatments they so willingly deserve. In October, ASA will host 15 global scholars from Ethiopia, Cambodia, Niger, Indonesia, Tanzania, Uganda, and Rwanda in New Orleans for them to participate in continuing medical education courses as well as join observerships at University Medical Hospital New Orleans, Ochsner Health System, and Tulane Medical Center before they return to their home countries.

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