Teaching pediatric pain management in Zambia and Cyprus

Dr. Stefan Friedrichsdorf, director of Pain and Palliative Care and Integrative Medicine at Children’s, is on a two-week trip overseas to train caregivers about pediatric pain management.

This week, he’s in Zambia, Africa, for the  1st Annual Pediatric Palliative Care Symposium. He will teach more than 150 professionals at an event sponsored by the CDC/Atlanta and the US President’s Emergency AIDS Fund.

Next week, he’ll be in Cyprus for “Advanced Pain Medicine & Palliative Care for Children: Workshop for Professionals in Pediatric Hematology / Oncology,” where he’ll teach the Middle East Cancer Consortium about pediatric pain management, teaching Israelis and Arabs in the same room, united by a desire to help children in pain.

Here are his first reports from his trip:

Monday, Nov. 21
Arrived in Lusaka, capital city of Zambia in Africa on Sunday night. Following a peaceful transition of power (the last coup attempt was eight years ago) last month, a newly elected government is in charge here.  The old president admitted defeat in a recent election and stepped aside without any power struggle — pretty unheard of in this part of the world.

The First Annual Pediatric Palliative Care Symposium opened in Lusaka,  Zambia.  There are more than 150 participants (mostly physicians and nurses, but also social workers, chaplains, health ministry administrators, psychologists).  The energy in the room is palpable.

Morphine only became widely available in Zambia about a year ago.  When I asked in my keynote about opioid myths, the answers were exactly like we hear in the U.S.:

  • Fear of addiction (Fact: children don’t become addicted when treated for acute pain)
  • Fear of respiratory depression (Fact: carefully administered morphine does not cause respiratory depression)
  • Fear of starting too early (Fact: when a child is in severe pain morphine must be started immediately – there are always enough treatment options later in the disease cause or at end of life)

Tuesday, Nov. 22
The second day of the conference was opened with traditional Zambian drummers, singers and dancer (joined by participants in the audience!).

Palliative Care means to live as long as possible as well as possible.

There are 6.8 million children younger than 18 years in Zambia. In Western Countries the prevalence of a life-limiting condition (cancer, genetic aberrations, neurodegenerative diseases, muscular dystrophy etc.) is 12 out of 10,000 so we would expect 8,100 affected children in Zambia in need of palliative care. Unfortunately, there are an additional 120,000 children in the country with HIV/AIDS … 120,000 children younger than 14 years! This is a true catastrophe … especially since only first and second line antiretrovirals are available. 1.3 million children under 17 here are orphans (690,000 due to AIDS). See the full statistics.

I visited the Pediatric Wing at Our Lady’s Hospice in Lusaka: six beds in a 300-square-foot room. I chatted with a 15-year-old boy with Class IV HIV on 2nd line antiretrovirals and palliative cancer-directed therapy who is in the terminal phase of life. He likes watching soccer and told me Manchester United is his favorite team. He has a difficult social situation (one-room house, six siblings), so he has spent a lot of time in the Pediatric Hospice House. He has now presented with a large open Karposi sarcoma on his leg extending into the abdomen. He receives pain and symptom control (on schedule plus as needed morphine) by the amazing team from Tiny Tim and Friends led by Tim Meade, MD from the Twin Cities (named after his little adopted son).  Dr. Meade is my host here.

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