The Healer's Touch

Here in Ethiopia, I often find myself wondering to what extent pain is a cultural construct. The medical staff at our clinic regularly suture wounds and perform painful procedures with little to no anesthesia or pain medication. Women in labor are often reprimanded for being “uncooperative” if they struggle with the pain of childbirth. Patients are expected to accept a certain level of pain without complaint or resistance.

Sometimes this expectation is a reasonable result of limited access to narcotics and other pain remedies. But, at times, the cultural expectations around pain are downright shocking to us westerners. And this, my friends, sets us up for my medical story of the day…

On a recent visit to a nearby hospital, I decided to observe a straightforward hernia repair surgery. In the US this surgery is usually performed under general anesthesia. The patient feels and remembers nothing of the procedure. In Ethiopia, this surgery is performed under local anesthesia with lidocaine. In this instance, the surgeon was operating in presumably sterile conditions, with sterile gowns, gloves, drapes, instruments, etc. A crowd of nursing students were gathered around to observe. The patient, a 50 year old man, received a couple shots of lidocaine at the site of the hernia repair. But as soon as the surgeon began to cut, the patient yelled out in pain and distress. It was clear that the anesthesia was not sufficient, and the procedure was going to be excruciatingly painful. Yet, instead of administering more lidocaine, the surgeon sternly reprimanded the patient for his outburst and instructed the nursing students to hold down the man’s arms and legs. The surgery continued. Again, unable to contain himself, the patient yelled out and squirmed. This time the surgeon lifted a bloody glove and swiftly smacked the patient across his face. The patient, stunned, reprimanded, and apologetic, held himself still and the surgeon completed the procedure.

I can imagine a number of questions and exclamations are whirling through your head right now. Let me add another one to the list… how “sterile” do you think the surgeon’s glove was after that smack to the face??