Dr Chetty embraces the chance to ease SA’s pain burden

“It’s been a steep learning curve and I’ve probably only been exposed to the tip of the iceberg so far, but I’m amazed at what is achieved by encouraging research in a busy clinical environment,” says Dr Sean Chetty on his first few months at Massachusetts General Hospital (MGH) in Boston.

Being gifted with the chance to impact the critical shortage of pain management skills in South Africa was totally unexpected for Dr Chetty, who arguably has the most clinical and research expertise in pain medicine locally. He reckons there are probably only five to 10 people in South Africa with the expertise to properly manage chronic pain.

Embracing opportunity through the MGH Fellowship Award

“My boss at the time asked me to represent our department at a local Discovery presentation to increase awareness of the Foundation Fellowship Awards. I was on call, but it sounded interesting. Walking back, I bumped into Dr Brian Allwood (a colleague at Tygerberg Hospital who won the MGH Fellowship Award in 2017). He was enthusiastic about his learnings there and urged me to apply. I said maybe, but it felt kind of tongue-in-cheek,” recalls Sean.

Paging through the Discovery Foundation booklet that weekend, his intent solidified. He put an application together and contacted MGH to locate a mentor – who called him a few weeks later to clarify certain things in his application. “It was a very casual, friendly chat – I was telling her why I like pain management, she said thanks, and that was that. The next thing I got a call to say I had it!”

‘There’s a silent epidemic of pain in SA’

It’s a strange anomaly that in a country with a huge burden of disease, nobody can legitimately call themselves a pain specialist. While pain management is recognised as a field of study by the Colleges of Medicine, the Health Professions Council of South Africa has yet to register it. To Dr Chetty, that’s “an abomination.” Bureaucratic

He feels that patients are cared for up to a point. As a specialist in Critical Care, he enjoyed looking after his patients post-operatively – but once they were recuperating in a ward, he never saw them again. “There’s a silent epidemic of pain in SA,” he asserts. “I think more thought needs to be given the patient’s quality of life. The problem is so big and affects every area of medicine.”

‘Sometimes patients just need someone to talk to’

Trained at the Wits University Chronic Pain Unit and head of the Clinical Department of Anaesthesiology and Critical Care at Stellenbosch University, Dr Chetty is passionate about promoting the bio psycho-social model of pain care.

“Rather than just a procedure and giving meds, we need to probe other aspects of the patient’s life that impact on their pain. What coping skills can we pass on; and how does their core musculature contribute to pain management? It’s also very much about rehabilitation and psychological management.”

“Amazingly, sometimes patients just need someone to talk to. With pain, stoicism does not make you stronger. Whether acute, traumatic or chronic pain, we need to educate our healthcare professionals to recognise and treat patients appropriately. Most pain can be managed at GP level,” he contends.

Learning from front-runners – to return and lead

Dr Chetty will spend at least a year at the trailblazing MGH Centre for Translational Pain Research. His Fellowship will involve pre-clinical research, especially around modulating neuropathic pain (pharmacological and interventional management); translational pain research and clinical observation of interventional pain procedures; and work in a pain laboratory (not available in South Africa).

He sees his role upon his return as holistically improving patients’ quality of life through teaching, research, prevention, care and advocacy. “The entire clinical work environment here is driven towards research and it’s something I definitely want to replicate back home,” he enthuses. “I hope to export appropriate systems to my South African work environment – and hopefully to the SA health system as wel!”

Read more about how Discovery Fellows are bringing cutting-edge medicine to SA shores.