Chronic Pain

Laura, I’m sure you will be able to connect (somewhat) with this one.

“Hello, good afternoon.” I said to the patient as he walked in the clinic.

“Good afternoon, sir.” He replied

“What can I do for you today?”

“I need pain tablets (medication).” He replied.

“Um…ok, well I don’t give out tablets and that’s not really how this works. You tell me what is wrong then we talk with Medex and decide the treatment. So what’s wrong?”

“My knee is paining me, sir.”

“How long has it been paining you?”

“I don’t know. Let me think…like 10 years.” He calmly stated. “Can I get pain tablets now?”

WHAT? At first I thought he said 10 days. But no.

I’ve been working now for over 7 months in our village’s health center and I have seen a slew of injuries and illnesses; from a man almost cutting his Achilles with a large jungle knife, to a 7 week old baby that weighed less than 4 pounds (praise God, it survived), to a baseball sized abscess, snakebites, broken limbs, oh how the list could just keep going on and on. Most things we see however are just your common illnesses, (well, common for a developing nation) such as diarrhea, high fevers, malaria, high blood pressure and general pain.

Each illness may seem different from each other, i.e. diarrhea and high BP, but really nearly everything I see in the health center, outside of random accidents, all have three things in common.

1.) They are nearly all preventable. If people stopped eating oil, they would lower their BP. If they used their mosquito nets, they wouldn’t get malaria. If they stopped drinking water next to their poop, they wouldn’t get diarrhea. In the developed world we have effectively prevented most of these illnesses with proper education.

2.) How far people need to travel with their illness. There are no cars. No mass transit. If your feet won’t work people will carry you, but you must be close to death. That leaves your feet. I’ve seen a guy walk 3 hours with a malaria induced fever. Or the guy who came in with a broken arm he sustained mining, about a 2 hour walk away. Poor health drives you into desperation to get treatment.

3.) How long people live with illnesses. We don’t have any x-ray machines. No surgeons. No defibulators. No rapid blood work labs. Trust me this is bare bones and even then the people trained to work in these barebones centers, are great people, who lack proper knowledge and diagnostic practices. I’ve seen my Medex (community doctor) misdiagnose a common cold as Tuberculosis. Or throw highly liver intensive malaria drugs at someone who just had a fever. It’s not that people aren’t smart they just don’t know any different. The lack of supplies and the lack of training drives people to wait until the illness or the pain is unbearable to receive treatment. We in the west know that this just perpetuates the problem and can actually make an issue untreatable.

People in the village therefore learn to live with the health care system they have been given, which often requires them to live the majority of their lives with broken down bodies. They have just accepted that their system is the system they must live with. Even if they have been living with chronic pain and illnesses for 20 years.