AILSA CHANG, HOST:
In the U.S., health care workers are rethinking how to prescribe pain medications in the midst of the opioid crisis. But in some other parts of the world, doctors and nurses don't have those concerns because they hardly have any powerful pain medications at all. NPR's Jason Beaubien reports on how nurses in the Gambia try to address pain with tools other than drugs.
NABIA DRAMMEH: It's very good. (Laughter).
JASON BEAUBIEN, BYLINE: At the Brufut health clinic just outside the Gambian capital, Nabia Drammeh says she fell in love with nursing when she was a little girl. One of her favorite aunts was a nurse, and whenever she could, Drammeh would visit her at work.
DRAMMEH: I used to go to the clinic, and I see the way she works. So I told her, I really want to be a nurse. I loved this job since when I was a child.
BEAUBIEN: She graduated from nursing school in 2012 and has been a nurse ever since. Drammeh works in a modest government clinic. It's housed in a cluster of single-story cement buildings in a rural part of the Gambia.
DRAMMEH: And some of the cases we see here are mostly malaria cases, pneumonia cases, ear problems.
BEAUBIEN: Urinary tract infections, cuts and fractures from minor car crashes and farming accidents. And every day, Drammeh and her colleagues hear a lot about pain.
DRAMMEH: Eighty to 90% of patient that come here already have pain.
BEAUBIEN: Patients arrive with back pain, muscle pain, stomach pain.
DRAMMEH: So let's say most of the cases that come here are in pain, either physically, psychologically. They are in pain.
BEAUBIEN: In her view, pain is at the center of what she does. It's what drives people to her clinic. Pain is what most of her patients talk about first. The Gambia is one of the poorest countries in the world. Even at the top teaching hospital in the capital, doctors don't have regular access to opioids. The country often has shortages of various medicines. But Drammeh says this is not a problem. Her goal as a nurse isn't to exterminate that pain. The pain is a clue to help find the real problem.
DRAMMEH: When taking care of the pain, you don't only deal with drugs. Drugs is last when it comes to nursing.
BEAUBIEN: Instead of drugs, she uses what she calls her nursing skills.
DRAMMEH: You need to use your nursing skills, showing the patient that there's life ahead.
BEAUBIEN: Just convincing a patient that their particular problem can be treated will cause their pain to go down, she says. And to do that, you have to connect with the patient and win their trust.
DRAMMEH: First of all, we have to receive the patient well, show the person that he or she is welcome.
BEAUBIEN: And again, let them know that a solution exists. A burning urinary tract infection - we've got medicine for that. Pounding headache - malaria pills might just do the trick.
DRAMMEH: Most patient that come here with that problem or even more serious cases than that problem - they were treated, and they've gone home. You understand?
BEAUBIEN: What she doesn't do is rush to quell the patient's pain with drugs. And it's not just her.
(SOUNDBITE OF BABY CRYING)
BEAUBIEN: Even at the maternity ward at this clinic, midwife Rohey Jallow says they don't give pregnant women any pharmaceutical pain relief during labor.
And why don't you use it - because it's not available, or because it's not needed?
ROHEY JALLOW: It's not needed. Most of the time, it's not needed here.
BEAUBIEN: Like Drammeh, she also sees her role as comforting the patient, letting the woman know that pain is normal in childbirth and that she will get through it.
JALLOW: Telling them that the baby - it will come. Pain is part of it. So when there is no pain, the baby will not come.
BEAUBIEN: In many medical settings in the United States, clinicians start by trying to treat the pain. Drammeh doesn't work that way. She explains how a woman had to come in just a bit earlier. The patient was complaining about lower back pain and seemed uncomfortable to be talking in the open courtyard.
DRAMMEH: So I saw it in her that she could not express herself there. So I told her, if you want me to take you privately, I can take you privately so I could know what the problem really is.
BEAUBIEN: Drammeh took her to a quiet corner of the ward. It turns out the woman with back pain also had hemorrhoids and had been constipated for weeks. Drammeh told the woman that she must deal with the constipation immediately. She advised her to add more fruit to her diet and gave her laxatives and some hemorrhoid cream.
DRAMMEH: But I made her understand that these are the medicine that can take care of you.
BEAUBIEN: Address the underlying problem, she says, and the back pain will go away.
DRAMMEH: Yes, it works. It is very effective. You understand. So that is the best way of managing pain. In fact, as a nurse, this is what I can say.
BEAUBIEN: Drammeh thinks that even if she did have access to powerful opioid painkillers, she'd only use them in extreme situations. For the vast majority of her patients, pain can be controlled, she says, with the power of nursing skills.
Jason Beaubien, NPR News, the Gambia.
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