Pain control in a patient with myeloma in Zimbabwe.

The treatment of pain control in hospitals in developing countries must take into account the knowledge of the local health care workers, the traditional means of curing illness and treating pain, limited resources, and the general cultural values of that society. The authors discuss the treatment history of a patient with myeloma in a hospital in Harare, the capital of Zimbabwe. Although the patient understood and promised to comply with a long-term treatment plan of radio- and chemotherapy aimed at alleviating pain, for periods of time he defaulted and returned home to be treated by traditional healers. In this way, ancestral spirits were appeased. Traditional treatment by scarification did alleviate pain. Although the hospital does not accept such alternative methods of pain control, patients are allowed to leave the hospital to receive native treatment after completing initial courses of therapy and receiving the date of the next treatment course. The authors also discuss the difficulties of giving medication for pain control in Zimbabwe: Health care workers may have misconceptions about addiction, and patient may be too stoical.