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."  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.
Samantha Reinders for NPR