Africans endure a high burden of pain and suffering from HIV/AIDS and cancer, yet receive a meager amount of the world's pain medication. This tragedy occurs needlessly, given that inexpensive, effective and easily administered interventions are available. WHO has a 'three-step analgesic ladder' framework for managing cancer pain. This widely adopted clinical practice guideline is an integral part of palliative care programs and has also been applied to non-cancer pain. However, untreated pain is a major public health problem due to the discordance between scientific evidence and public policy. Historically, the International Narcotics Board has taken an unbalanced prohibitionist approach to international drug control that has emphasized suppressing controlled substances over making them available for medical and scientific purposes. The procurement process for controlled pain medications in most African countries is a morass of restrictions that make it exceedingly difficult for patients to obtain these drugs. Often, these restrictions arise in part from a misunderstanding of addiction and dependence on opiates. The result has been widespread 'opiophobia' among African policy makers and physicians. A host of factors have misaligned the analgesic pharmaceutical supply chain. Taken together, access to medically necessary controlled substance in sub-Saharan Africa is suboptimal.
The Ebola Virus Disease (EVD) outbreak in WestA total of 60 residents participated in the survey. Of these, 11 (18.3%) were psychiatry residents, 5 (8.3%) each were preventive and occupational medicine residents, while 13 (21.7%) and 26 (43.4%) were family and internal medicine residents, respectively. Compared to other specialties, resident physicians in occupational medicine had higher knowledge of the first step in the management of Ebola virus (EBOV) (p=0.042). On whether use of personal protective equipment (PPE) was required for individuals driving or riding in a vehicle carrying human remains of EBOV patients, only 10 respondents (16.7%) answered correctly, with preventive medicine residents performing significantly better than other physicians (p<0.0001). In conclusion, this study identified that resident physicians have a low level of knowledge regarding the presentation, prevention and management of EVD, including handling post-mortem remains. This study highlights the importance of educational interventions to improve knowledge on EVD prevention and management.
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