Page 330 Guide to Pain Management in Low-Resource Settings

318 M.R. Rajagopal

triangle need to be addressed if a pain relief program Th e following is an attempt to group these pro-
is to succeed. Personnel with the required training, grams according to the duration and type of training:
access to aff ordable essential drugs, and a supportive • Distance education programs that can deliver
administrative system are all needed. If one side of knowledge, but are generally inadequate to im-
these three components is lacking, the whole system part skills or attitude.
fails, naturally. • Short introductory courses of a few hours to one
or two days. Th ey off er some new knowledge and
What are the challenges are useful for sensitization of the participants to
regarding education? the new fi eld; but are seldom capable of changing
practice. Th ey do help in fi nding some “converts”
Educational needs of professionals must be considered who may want to study pain medicine more.
against a background in which generations of profes- • Foundation courses of 1–2 weeks that introduce
sionals in developing countries have had no exposure the subject in greater detail but usually are capa-
to modern pain management. Th e average doctor in a ble of attending only to the domain of knowledge.
developing country has not been trained to distinguish On the positive side, they may stimulate the par-
between nociceptive pain and neuropathic pain. Th e av- ticipant to seek more training and to build on the
erage nurse has never seen pain being measured in ac- foundation that has been laid.
tual practice. Th is means that education of professionals • Certifi cate courses of several weeks, which have
must include teaching of fundamentals. It is important both didactic and practical (clinical) components.
that such education be appropriate for the local socio- Th e participants gain enough here in all three do-
cultural realities. Not uncommonly, it so happens that mains of knowledge, skills, and attitude to start
professionals who are trained in excellent institutions practicing pain management, but they need con-
in developed countries try to start pain management fa- tinued mentoring.
cilities in their own developing countries and feel over- • Fellowship or diploma courses of 1–2 years,
whelmed by the scope of problems. Part of the diffi culty which prepare the participant to be an indepen-
could be an attempt to transplant the Western system in dent pain practitioner.
its entirety. Regional models of pain education that have It is important to remember that pain management
succeeded in Uganda and in India could be adapted to services cannot be really eff ective if they stand alone
individual countries. Th e organization or the individual isolated from the general medical and nursing com-
trying to set up a pain management program needs to munity. If they do, referral rates will be poor. Patients’
identify the most appropriate training program available compliance will also be poor because unless other pro-
to them in the region. Th e professionals involved in pa- fessionals understand what you do, patients may be
tient care should get such training as an essential fi rst discouraged from following your treatment. Hence, the
step. Ideally such training should include all three do- following scheme of action would be good for initial
mains of knowledge, skill, and attitude. practice:

Education Drug
Availability

Institutional
Policy