Listen: A Place Where The Opioid Problem Is Upside Down
"This message comes from NPR sponsor xfinity. Some things are slow like a snail races. Other things are fast like Xfinity X. by get get fast speeds even when everyone is online working to make WIFI simple easy awesome more at xfinity dot com restrictions apply all right here in the United States too much access to opioids has led to rampant addiction and overdose but we're going to hear from a part of the world facing the exact opposite problem a lack of powerful pain medications in the Gambia in West Africa. Doctors want greater access to opioids. They say they can help speed a patient's recovery. NPR's Jason Bovine traveled there recently as part of our ongoing look at treating pain and and the story does contain some uncomfortable medical details. It's mid morning at the Gambia's only teaching hospital orthopedic Surgeon Cabot Marina is talking with several nurses about two operations that they're about to start. I just bring it into the United States. It's not going to be perfect. MARINA IS A fit thirty seven year old. He's pulling on scrubs. He and his staff are looking up an X. Rays of leg bones and a light box on the wall. A curtain divides the operating room into on the left is a fourteen year old. He fractured his knee in a soccer game in a collision goalie. His parents say he almost scored on the right is a twenty nine year old man. He was in a nasty car crash a week earlier and Tibia is now protruding coming from his Shin Doctrine says operations like these pain is unavoidable hammers and saws and Gills and things like that so so afterwards old patients expected how some pain but in the Gambia managing that pain can be difficult. I the Gambia is one of the poorest countries in the world. Many medications including painkillers are in short supply and even if Moreno can get powerful opioids for his patients nurses on the general wards aren't trained to administer or monitor them. Dr Moreno spent the last thirteen years working in the United Kingdom. He says one of the striking things about returning. Home is the contrast pain management everyone I I end up. I have to leave the world when they were doing dressings because I couldn't handle the screams but you get used to it which is not great but it's what you have to do. In order to survive in the environment lived in the operating room. Dr Moreno does have access to anesthesia for the two surgeries on this day. Each patient will get a spinal block. It makes their legs. Go numb highly effective. You've at one point the fourteen year old asks. What's my leg doing up there as a nurse moves them around on the bed patient on the right is getting a steel pin driven vertically from mm-hmm is need to almost as ankle to stabilize his broken? Tibia in the UK. Both these patients would be completely asleep under general anesthesia but not here. That's partly because this country of two million people doesn't have any anesthesiologists. The only ones working in the Gambia are doctors on loan from China or Cuba so ninety eight percent of Anaesthesia Services Don byas Mahmoud El Moussa borrow heads the College of Nursing at the American International University West Africa in the Gambian capital bright across the country all had facilities well rations stick. Please where what you find the semester these specially trained nurses. I can do many of the procedures that full anesthesiologist would but there aren't many of them and they tend to work mainly in surgical operating rooms they aren't present and labor in delivery wards leaving most women here to give birth with no pain medication at all back at the surgical ward doctrine just finished resetting setting the bones and the teenagers knee he twisted the leg back into place drilled three hole through the top of the knee and secured the joint with wires sitting have to open the skin off but it still we'll be painful think you saw how. I had to bend it back into place the start and he will be sore afterwards. If I have been doing this operation in England the boy would have gotten a local anesthetic around the joint ease the pain as he wakes up but again not here the pain meds that are readily available in the Gambia are generic versions of pilot and advil an aspirin. The only narcotic clinicians sometimes dispense is a synthetic opioid called tram at all. It's considered less powerful and less addictive than opioids like oxycodone or morphine. Meanwhile the operation on the other table is continuing north comedic surgeon from China is literally hammering Rod until the twenty nine year olds leg first couple of attempts didn't go so well. I may have to back out the Pan A. and try again but doctrine is confident. It will all work. He says these pins are highly effective before they made up and walking and they usually went home. even the next day broken leg one day walking out onto the streets of London the next but only because their pain was well controlled with opioids doctrine doesn't predict such a tranquil post surgical recovery for this guy. The patient is clearly uncomfortable gripping the table as the hammering continues and he still under under the spinal anesthetic off in about six hours time then there's usually some screaming on the words and and it just takes some getting used to the patient and stuff as well in the absence of a strong pain medication. It'll be several days. Maybe a week before this man can put any weight on his leg. These patients are also likely elite experience flare ups of what Dr McCall's breakthrough pain in the UK Moreno with treat this with oral morphine but morphine isn't available on the wards here for the fourteen year old who just had knee surgery his recovery starts on a trip on a Gurney to the pediatric ward. The Children's Ward is actually sleep in another building across the street from the main hospital. There are no rails on the Gurney and he slides around as the orderly pushes him through the potholed streets. Finally he arrives at the crowded kids ward. His legs are still numb from the anesthetic during surgery his father Hassan Manual. Camara says they know his recovery will take time where they were. Just try to support him as much as possible. Kamara worries about his son being in pain but he recognizes that he just had surgery. He doesn't expect his son to be comfortable. Dr Moreno wishes he had stronger pain meds for his patients. This teen will be hurting for the the next few days but despite that Renna says this operation was a success is now he's going to straight Meghan into suffer the rest they may not have access a strong opioids but Dr Moreno and the other caregivers here have confidence that their patients will heal and eventually the pain will go away Jason Bobi. NPR N._p._R. News the Gambia."