SPOTLIGHT IN-DEPTH: How and why pain management for children continually falls short in South Africa

council, 30% of the South African population are children and adolescents, but only 7 % of the pain clinics in the country are dedicated to children. The council provided comments toIn the public sector, they say the Western Cape is the only province with a paediatric pain clinic, while KwaZulu-Natal and Limpopo each have one adult pain clinic which occasionally treats children. Gauteng, the Eastern Cape, and the Free State only have adult pain clinics.

They added: There is a desperate need to increase the capacity for access to appropriate pain management in all the provinces. South Africa needs to focus on creating multidisciplinary teams that can develop low-cost pain treatment strategies with non-pharmacological therapies, such as physical therapy and psychological support.According to Meiring, professionals will often say “the system is overburdened; we don’t have enough time” to assess and manage children’s pain.

Meiring explains it is also due to supply and demand. If clinicians aren’t prescribing enough then pharmacists aren’t preparing enough. Morphine ordering is done based on consumption because the drug needs to be monitored to prevent it from getting into the wrong hands. “We find in busy settings this often doesn’t happen because it means that someone has to properly assess the pain in between doses or listen to the parent’s report,” says Meiring.

“Really difficult pain will sometimes require intravenous infusions of several scheduled drugs that need to be monitored closely for side effects. Ideally, this should be done in high care settings with nurses able to watch closely. Often with bed pressure availability, this is not possible.

“Apart from the control of pain and other distressing symptoms, there is a huge need to provide more psychosocial support and spiritual care to families of chronically ill children. These children have extensive needs, which often means someone in the house has to give up work or school to care for them. It cuts deeply into family finances and affects the whole family, including the siblings.

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