It’s such a sunny bright day morning when I had social service on Sunday, 26th November 2017. A few days before, one of my best, Eva, invited me to join social service that’s been held by SAI BABA Yogyakarta foundation. This foundation is related, correct me if I’m wrong, to humanism foundation. My friend, Ayu, said that the members are some Hindu’s people –especially Indian, especially med stud. Funny thing is, the ‘founder’ of this a Chinese Buddha woman. She had a upstair place to pray that been used by Hindu’s people –in the past most of Indian med stud-
This is my very first social service for me, as a doctor. I had participated in some social services before, but as a ‘blood-pressure-girl’. My jobdesc was measuring people’s blood pressure. And for this time, I’m the doctor. I’ve trusted to help people by hearing their health problem and giving some advice. I’m soooo nervous. I asked about the most health problem in that place, the medicine, etc. I made some recipes full of the dose and the indication. I really want to help people and didn’t want to give carelessly advice.
There were 4 doctors, all of them are my classmate and the participant of this social service almost 150 people. Most of the patient had the same problem. Pain, and mostly on their head, back, and knees.
So, let’s talk about pain.
What is pain ?
Pain is uncomfortable sensory and emotional experience because of the damaged or potentially damaged tissue or described in terms of such damage. Pain is related to both psychic and psychological. It’s also related to how brain interprets the damage. It could be also the real damage or not. Because pain is related to the psychological, someone can feel the pain, although there is no real problem in their health that can cause pain. Another example, if two people have the same damage tissue, they can have the different level of pain.
There are simple measurements of pain’s severity. One of them called VAS (Visual Analog Scale). The measurement is so simple. We can ask patient about the pain, from 0 to 10. 0 is described as none pain and 10 is described as so much pain that they’ve ever had. It’s very subjective. Some people can easily exaggerate their pain. To confirm the pain, we can ask about how the pain affects their daily life. Is it make them couldn’t do anything or not ?
Then, how to deal with it ?
I will talk about the medicines. WHO had the ‘step ladder’ analgetics treatment. First, this treatment was used to people with cancer, but then it can be used to all types of pain. As far as I know, this treatment is still used (because my teacher taught this when I’m on my lecture, 2014).
Based on the severity of the pain, the recommended treatment :
- For mild pain (1–3/10 on a numerical analogue scale), start at step 1
- For moderate pain (4–6/10), start at step 2
- For severe pain (7–10/10), start at step 3
In the daily life, from my experience, many patient feel better with NSAIDs, for example, ketorolac, mefenamic acid, or natrium diclofenac. But, from the experience, I learned something else.
When I had public health rotation, there were not many stocks of NSAID medicine, then the patients were given vitamin. It was out of my sight, but as far as I know, they feel better with it. Another experience, when I was studying in Bali, there was a patient that had chronic pain in his lower back. When he entered the examining room, he was looked healthy and very excited to tell us about his vacation. But when the doctor asked, ‘what’s your problem ?’ suddenly his face changed and he touched his back, and asked, ‘ah ya, I have low back pain’ after a long happy conversation about the waterfall he’s visited. I thought that for a second he forgot about the pain, but when he remembered it, he will feel the pain again. Maybe this is the real experience about pain that related to psychological. When I had neurology rotation, there was a patient whose felt chronic pain. She had given strong analgetic but she didn’t feel better. The neurologist advice her to go to a psychologist to get psychological therapy.
Yeah, I learned about how to communicate with patient. Because pain, or other health problems are related to the psychological. It’s important to be a good communicator, how to make patient trust to us, how to persuade them, not only give the medicine.
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