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How a nurse in Gambia does it: goats and soda: NPR



27-year-old Nabia Drammeh, a nurse, talks to Maram Ceesay and her granddaughter Awa at the Minor Health Center outside Banjul, Gambia. Awa's mother died during childbirth and left Maram to take care of her. The 2-year-old is being treated for pneumonia.

Samantha Reinders for NPR


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Samantha Reinders for NPR

Nabia Drammeh, 27, a nurse, talks to Maram Ceesay and her granddaughter Awa at the Minor Health Center outside Banjul, Gambia. Awa's mother died during childbirth and left Maram to take care of her. The 2-year-old is being treated for pneumonia.

Samantha Reinders for NPR

Nadia Drammeh grew up in Gambia, West Africa, always knowing she wanted to become a nurse. "My aunt was a nurse," she says. "Before I went to the clinic and saw how she works, I said to her:" I really want to become a nurse in the future! "So I loved this job since I was a kid." [19659008] The 27-year-old graduated from the nursing school in 2012 and has been a nurse ever since.

She works now only in the Brufuter health clinic outside the Gambian capital Banjul.

It is a modest government hospital housed in a cluster of one-story cement buildings.

"The cases we see here are mostly malaria cases, pneumonia, ear problems," she says.

Drammeh and her colleagues at the clinic also treat many urinary tract infections. They sew cuts from small car accidents. They deal with sick children and fractures due to accidents in agriculture. A constant among most cases, says Drammeh, is the pain.

"Eighty to ninety percent of the patients who come here are already in pain," she says. Patients come with back pain, muscle pain, abdominal pain.

It's what drives people to their clinic. Often, most of their patients often want to speak first.

"Most cases that come here have physical or mental pain."

One might think that Drammeh wants to pour out potent opiate-based medicines that have been shown to cause incredible pain reduction. But she does not do it. And not only because she has no opioids.

"Taking care of the pain is not just about drugs," says Drammeh with a hint of indignation. "Drugs are the last when it comes to breastfeeding."

Gambia is one of the poorest countries in the world. Even doctors from the main teaching hospital in Banjul, the capital, do not have regular access to opioids or other strong analgesics. The leading painkillers in Gambia are acetaminophen and ibuprofen, generic versions of Tylenol and Advil.

But Drammeh says this lack of analgesics is not a problem. Your goal as a nurse is not to eradicate this pain. The pain is a clue that helps her to find the real underlying problem.

Instead of drugs, Drammeh uses her "nursing skills" to relieve a patient's pain.

"First, we have to take the patient well," she says. "Show the person that he or she is welcome [at the clinic]."

And then she lets her know that there is a solution to her pain. A burning urinary tract infection – there are medicines for it. A headache? could be a sign of malaria and a dose of malaria pills will do the trick.

"You need to use your nursing skills to calm the patient," she says. "Show the patient that life is ahead."

If you only persuade a patient that her specific health problem can be treated, the pain goes away, she tells Baby at the maternity ward at the Brufut Minor Health Center outside of Banjul, Gambia. Midwives at the clinic say they do not deliver painkillers during childbirth because they believe they are "not needed" most of the time.

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But first, according to Drammeh, one has to connect with the patient and gain his trust.

"Tell the patient that this is normal, that we have many patients who come here with this problem or even more serious cases than this problem," she says. "But they were treated and went home."

What she does not do is hurry to relieve the patient's pain with drugs.

And it's not just her.

Even in the maternity ward of this clinic, midwife Rohey Jallow says she does not provide pharmaceutical pain relief to pregnant women during labor.

"That's not necessary," says Jallow. "Most of the time it is not needed here."

Like Drammeh, she also sees her role in comforting the patient and letting the woman know that birth pain is normal and that she will survive it.

It calms the mothers that the baby will come eventually. "Pain is part of it," she tells the women at work. "If there is no pain, the baby will not come." At many medical facilities in the US, doctors first try to treat the pain. Jallow and Drammeh do not work that way. Drammeh explains how a woman came in earlier in the day and complained of back pain. The patient seemed uncomfortable talking in the open courtyard.

"I saw in her that she could not express herself there," says Drammeh. "So I told her, if you want, I can take you home privately so I know what the problem really is." They slipped into an empty section of the station.

It turned out that the woman with back pain also had hemorrhoids and was blocked for weeks. Drammeh told the woman that she needed to deal with the constipation immediately. She advised her to include more fruits in her diet and gave her laxatives and some hemorrhoid cream.

"I made her understand that these are the medications that can take care of you."

By using her nursing skills to address the underlying problem, the woman's back pain will disappear. "It works, it's very effective," she explains. "So that's the best way to deal with pain."


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