In Africa the HIV epidemic laid bare the huge need for palliative care and pain control. Families and health workers were faced with looking after the sick in homes and hospitals that were ill prepared and ill equipped to manage chronic symptoms, especially pain. Most clinicians and nurses had little experience or training in palliative care or the use of analgesia. Oral morphine was seldom available, intramuscular pethidine pro re nata (prn) was used, mainly post opera-tively, and many children suffered silently and stoically. Health workers were demoralised by the inability to relieve suffering.
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