美国国家公共电台 NPR A Place Where The Opioid Problem Is Upside Down

A Place Where The Opioid Problem Is Upside Down

RACHEL MARTIN, HOST:

All right. Here in the United States, too much access to opioids has led to rampant¹ addiction² and overdose. But we're going to hear now from a part of the world facing the exact opposite problem - a lack of powerful pain medications. In the Gambia in West Africa, doctors want greater access to opioids. They say they can help speed a patient's recovery. NPR's Jason Beaubien traveled there recently as part of our ongoing³ look at treating pain. And a note - this story does contain some uncomfortable medical details.

JASON BEAUBIEN, BYLINE⁴: It's mid-morning at the Gambia's only teaching hospital. Orthopedic surgeon Kebba Marenah is talking with several nurses about two operations that they're about to start.

KEBBA MARENAH: You can just put a wire just to bring it in to the right place. It's not going to be perfect.

BEAUBIEN: Marenah is a fit 37-year-old. He's pulling on scrubs. He and his staff are looking up at X-rays of leg bones on a lightbox on the wall. A curtain divides the operating room in two. On the left is a 14-year-old. He fractured his knee in a soccer game in a collision with a goalie. His parents say he almost scored. On the right is a 29-year-old man. He was in a nasty car crash a week earlier, and his tibia is now protruding⁵ from his shin. Dr. Marenah says, in operations like these, pain is unavoidable.

MARENAH: If you've ever seen an orthopedic surgeon, we are always holding hammers and saws and drills and things like that. So afterwards, all the patients are expected to have some amount of pain.

BEAUBIEN: But in the Gambia, managing that pain can be difficult. First, the Gambia is one of the poorest countries in the world. Many medications, including painkillers⁸, are in short supply. And even if Marenah can get powerful opioids for his patients, nurses on the general wards⁷ aren't trained to administer or monitor them. Dr. Marenah spent the last 13 years working in the United Kingdom. He says one of the striking things about returning home is the contrast in pain management.

MARENAH: I remember when I first turned up, I’d have to leave the ward⁶ when they were doing dressings⁹ because I couldn’t handle the screams. But you get used to it, which is not great, but it’s what you have to do to survive in the environment.

BEAUBIEN: In the operating room, Dr. Marenah does have access to anesthesia. For the two surgeries on this day, each patient will get a spinal¹⁰ block. It makes their legs go numb¹¹. It's highly effective. At one point, the 14-year-old asks - what's my leg doing up there? - as a nurse moves him around on the bed. The patient on the right is getting a steel pin driven vertically¹² from his knee to almost his ankle to stabilize¹³ his broken tibia. In the U.K., both these patients would be completely asleep under general anesthesia - but not here. That's partly because this country of 2 million people doesn't have any anesthesiologists. The only ones working in the Gambia are doctors on loan from China or Cuba.

MOMODOU MOUSA BARO: So 98% of anesthesia services are done by nurses.

BEAUBIEN: Momodou Mousa Baro heads the College of Nursing at the American International University West Africa in the Gambian capital.

BARO: Right across the country in all health facilities where operations take place, what you find there are nurse anesthetists.

BEAUBIEN: These specially¹⁴ trained nurses can do many of the procedures that a full anesthesiologist would. But there aren't many of them, and they tend to work mainly in surgical¹⁵ operating rooms. They aren't present in labor¹⁶ and delivery wards, leaving most women here to give birth with no pain medication at all.

MARENAH: We're finished now. Do you want to see?

BEAUBIEN: Back at the surgical ward, Dr. Marenah just finished resetting¹⁷ the bones in the teenager's knee. He twisted the leg back into place, drilled three holes through the top of the knee and secured the joint¹⁸ with wires.

MARENAH: So we didn't have to really open the skin at all. But it still will be painful because, I think, you saw how I had to bend it back into place at the start. So he will be sore afterwards.

BEAUBIEN: If Marenah had been doing this operation in England, the boy would have gotten a local anesthetic¹⁹ around the joint to ease the pain as he wakes up - but, again, not here. The pain meds that are readily available in the Gambia are generic²⁰ versions of Tylenol and Advil and aspirin²¹. The only narcotic²² that clinicians sometimes dispense²³ is a synthetic²⁴ opioid called Tramadol. It's considered less powerful and less addictive²⁵ than opioids like oxycodone or morphine.

Meanwhile, the operation on the other table is continuing. An orthopedic surgeon from China is literally²⁶ hammering a rod into the 29-year-old's leg. The first couple of attempts didn't go so well, and they had to back out the pin and try again. But Dr. Marenah is confident it will all work. He says these pins are highly effective.

MARENAH: So when we did these in the U.K., the following day they're up and walking. And they usually went home even the next day.

BEAUBIEN: Broken leg one day, walking out onto the streets of London the next but only because their pain was well controlled with opioids. Dr. Marenah doesn't predict such a tranquil²⁷ post-surgical recovery for this guy. The patient is clearly uncomfortable. He's gripping the table as the hammering continues. And he's still under the spinal anesthetic.

MARENAH: When that wears off in about six hours' time, then there's usually some screaming on the wards. And it just takes some getting used to for the patient and the staff as well.

BEAUBIEN: In the absence of a strong pain medication, it'll be several days - maybe a week - before this man can put any weight on his leg. These patients are also likely to experience flare²⁸ ups of what Dr. Marenah calls breakthrough pain. In the U.K., Marenah would treat this with oral morphine, but morphine isn't available on the wards here.

For the 14-year-old who just had knee surgery, his recovery starts on a trip on a gurney to the pediatric ward. The children's ward is actually in another building across the street from the main hospital. There are no rails on the gurney and he slides around as the orderly pushes him through the potholed street.

UNIDENTIFIED PERSON: (Shouting in foreign language).

BEAUBIEN: Finally, he arrives at the crowded kids' ward. His legs are still numb from the anesthetic during surgery. His father, Hassan Emmanuel Kamara (ph) says they know his recovery will take time.

HASSAN EMMANUEL KAMARA: We're a family. We just try to support him as much as possible.

BEAUBIEN: Kamara worries about his son being in pain, but he recognizes that he just had surgery. He doesn't expect his son to be comfortable. Dr. Marenah wishes he had stronger pain meds for his patients. This teen will be hurting for the next few days. But despite that, Marenah says, this operation was a success.

MARENAH: At least now he's got a straight leg and he's not going to suffer for the rest of his life.

BEAUBIEN: They may not have access to strong opioids, but Dr. Marenah and the other caregivers here have confidence that their patients will heal. And eventually, the pain will go away. Jason Beaubien, NPR News, the Gambia.

(SOUNDBITE OF FOUR TET'S "YOU ARE LOVED")

1 rampant   

adj.(植物)蔓生的；狂暴的，无约束的

参考例句：

• Sickness was rampant in the area.该地区疾病蔓延。
• You cannot allow children to rampant through the museum.你不能任由小孩子在博物馆里乱跑。

2 addiction   

n.上瘾入迷，嗜好

参考例句：

• He stole money from his parents to feed his addiction.他从父母那儿偷钱以满足自己的嗜好。
• Areas of drug dealing are hellholes of addiction,poverty and murder.贩卖毒品的地区往往是吸毒上瘾、贫困和发生谋杀的地方。

3 ongoing   

adj.进行中的，前进的

参考例句：

• The problem is ongoing.这个问题尚未解决。
• The issues raised in the report relate directly to Age Concern's ongoing work in this area.报告中提出的问题与“关心老人”组织在这方面正在做的工作有直接的关系。

4 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

5 protruding   

v.（使某物）伸出，（使某物）突出( protrude的现在分词 )；凸

参考例句：

• He hung his coat on a nail protruding from the wall. 他把上衣挂在凸出墙面的一根钉子上。
• There is a protruding shelf over a fireplace. 壁炉上方有个突出的架子。 来自辞典例句

6 ward   

n.守卫，监护，病房，行政区，由监护人或法院保护的人（尤指儿童）；vt.守护，躲开

参考例句：

• The hospital has a medical ward and a surgical ward.这家医院有内科病房和外科病房。
• During the evening picnic,I'll carry a torch to ward off the bugs.傍晚野餐时，我要点根火把，抵挡蚊虫。

7 wards   

区( ward的名词复数 )； 病房； 受监护的未成年者； 被人照顾或控制的状态

参考例句：

• This hospital has 20 medical [surgical] wards. 这所医院有 20 个内科[外科]病房。
• It was a big constituency divided into three wards. 这是一个大选区，下设三个分区。

8 painkillers   

n.止痛药( painkiller的名词复数 )

参考例句：

• The doctor gave him some painkillers to ease the pain. 医生给了他一些止疼片以减缓疼痛。 来自辞典例句
• The primary painkillers - opiates, like OxyContin - are widely feared, misunderstood and underused. 人们对主要的镇痛药——如鸦片剂奥施康定——存在广泛的恐惧、误解，因此没有充分利用。 来自时文部分

9 dressings   

n.敷料剂；穿衣( dressing的名词复数 )；穿戴；（拌制色拉的）调料；（保护伤口的）敷料

参考例句：

• He always made sure that any cuts were protected by sterile dressings. 他总是坚持要用无菌纱布包扎伤口。 来自辞典例句
• I waked the orderly and he poured mineral water on the dressings. 我喊醒勤务，他在我的绷带上倒了些矿质水。 来自辞典例句

10 spinal   

adj.针的，尖刺的，尖刺状突起的；adj.脊骨的，脊髓的

参考例句：

• After three days in Japan,the spinal column becomes extraordinarily flexible.在日本三天，就已经使脊椎骨变得富有弹性了。
• Your spinal column is made up of 24 movable vertebrae.你的脊柱由24个活动的脊椎骨构成。

11 numb   

adj.麻木的，失去感觉的；v.使麻木

参考例句：

• His fingers were numb with cold.他的手冻得发麻。
• Numb with cold,we urged the weary horses forward.我们冻得发僵，催着疲惫的马继续往前走。

12 vertically   

adv.垂直地

参考例句：

• Line the pages for the graph both horizontally and vertically.在这几页上同时画上横线和竖线，以便制作图表。
• The human brain is divided vertically down the middle into two hemispheres.人脑从中央垂直地分为两半球。

13 stabilize   

vt.（使）稳定，使稳固，使稳定平衡；vi.稳定

参考例句：

• They are eager to stabilize currencies.他们急于稳定货币。
• His blood pressure tended to stabilize.他的血压趋向稳定。

14 specially   

adv.特定地；特殊地；明确地

参考例句：

• They are specially packaged so that they stack easily.它们经过特别包装以便于堆放。
• The machine was designed specially for demolishing old buildings.这种机器是专为拆毁旧楼房而设计的。

15 surgical   

adj.外科的，外科医生的，手术上的

参考例句：

• He performs the surgical operations at the Red Cross Hospital.他在红十字会医院做外科手术。
• All surgical instruments must be sterilised before use.所有的外科手术器械在使用之前，必须消毒。

16 labor   

n.劳动，努力，工作，劳工；分娩；vi.劳动，努力，苦干；vt.详细分析；麻烦

参考例句：

• We are never late in satisfying him for his labor.我们从不延误付给他劳动报酬。
• He was completely spent after two weeks of hard labor.艰苦劳动两周后，他已经疲惫不堪了。

17 resetting   

v.重新安放或安置( reset的现在分词 )；重拨（测量仪器指针）；为（考试、测试等）出一套新题；重新安置，将…恢复原位

参考例句：

• Range represents the maximum strain which can be recorded without resetting or replacing the strain gage. 量程表示无需重调或重装应变计就能记录到的最大应变。 来自辞典例句
• Adding weight to the puddle jumper by resetting its inertial dampeners. 通过调节飞船的惯性装置来增加重量。 来自电影对白

18 joint   

adj.联合的，共同的；n.关节，接合处；v.连接，贴合

参考例句：

• I had a bad fall,which put my shoulder out of joint.我重重地摔了一跤，肩膀脫臼了。
• We wrote a letter in joint names.我们联名写了封信。

19 anesthetic   

n.麻醉剂，麻药；adj.麻醉的，失去知觉的

参考例句：

• He was given a general anesthetic.他被全身麻醉。
• He was still under the influence of the anesthetic.他仍处在麻醉状态。

20 generic   

adj.一般的，普通的，共有的

参考例句：

• I usually buy generic clothes instead of name brands.我通常买普通的衣服，不买名牌。
• The generic woman appears to have an extraordinary faculty for swallowing the individual.一般妇女在婚后似乎有特别突出的抑制个性的能力。

21 aspirin   

n.阿司匹林

参考例句：

• The aspirin seems to quiet the headache.阿司匹林似乎使头痛减轻了。
• She went into a chemist's and bought some aspirin.她进了一家药店，买了些阿司匹林。

22 narcotic   

n.麻醉药，镇静剂；adj.麻醉的，催眠的

参考例句：

• Opium is classed under the head of narcotic.鸦片是归入麻醉剂一类的东西。
• No medical worker is allowed to prescribe any narcotic drug for herself.医务人员不得为自己开处方使用麻醉药品。

23 dispense   

vt.分配，分发；配(药)，发(药)；实施

参考例句：

• Let us dispense the food.咱们来分发这食物。
• The charity has been given a large sum of money to dispense as it sees fit.这个慈善机构获得一大笔钱，可自行适当分配。

24 synthetic   

adj.合成的，人工的；综合的；n.人工制品

参考例句：

• We felt the salesman's synthetic friendliness.我们感觉到那位销售员的虚情假意。
• It's a synthetic diamond.这是人造钻石。

25 addictive   

adj.(吸毒等)使成瘾的，成为习惯的

参考例句：

• The problem with video game is that they're addictive.电子游戏机的问题在于它们会使人上瘾。
• Cigarettes are highly addictive.香烟很容易使人上瘾。

26 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

27 tranquil   

adj. 安静的, 宁静的, 稳定的, 不变的

参考例句：

• The boy disturbed the tranquil surface of the pond with a stick. 那男孩用棍子打破了平静的池面。
• The tranquil beauty of the village scenery is unique. 这乡村景色的宁静是绝无仅有的。

28 flare   

v.闪耀，闪烁；n.潮红；突发

参考例句：

• The match gave a flare.火柴发出闪光。
• You need not flare up merely because I mentioned your work.你大可不必因为我提到你的工作就动怒。