Case study - An NGO using qualitative and quantitative records to improve treatment

Dr Ahmed was puzzled. He was listening to someone at a meeting who was talking about pain and HIV/AIDS. The speaker said that people living with HIV/AIDS often have pain but it tends to be undiagnosed, untreated or ignored by health workers.

During the break, Dr Ahmed talked to others, including a doctor from a cancer hospital which had started to treat some HIV/AIDS patients as well. This doctor confirmed that the speaker might be right, at least in his limited experience; some of his HIV/AIDS patients had seemed just depressed or sad, but when he gave them analgesia they became brighter and more able to communicate.

Back at his clinic, Dr Ahmed wondered if he, too, had failed to understand about his HIV/AIDS patients' pain. He provided support to a number of community nurses, so he called a meeting with them. They decided to ask their HIV/AIDS patients more carefully about pain to get an idea of what was needed - a qualitative approach. They also kept some simple records, using a list of painkillers and recording the quantities of each drug they handed out and how many patients received them.

This simple mix of qualitative and quantitative research revealed that, although many people living with HIV/AIDS said they had pain, many thought they just had to tolerate it and did not ask for any pain relief. But it also revealed that some people had pain that was too severe for the mild painkillers that the nurses were able to provide. Even codeine, for moderate pain, was not offered because the regulations prohibited nurses from issuing it. Morphine was definitely not allowed except within specialist hospitals.

Dr Ahmed talked to other HIV/AIDS physicians and together they negotiated with the authorities and showed them the information that he and his nurses had gathered from patients. After more research, the regulations were changed to allow community nurses to provide codeine, with careful supervision by the doctor and recording of use in a special register.

The doctors and nurses also advocated that specially licensed community doctors be allowed to prescribe and provide morphine as tablets or syrup for patients with severe pain. Eventually, government officials and specialist doctors were convinced enough to allow a pilot analgesia project for a limited period.

Once again, gathering qualitative and quantitative information confirmed that there was a real need for morphine, that the right amounts of drugs were being used, and that none were being abused or diverted to illicit use by addicts. New laws were drawn up about the medical use of morphine and a training programme was developed to improve doctors' and nurses' understanding of pain control, based on WHO recommendations.