Dr Allen Finley is a consultant anaesthesiologist in Halifax, Canada. Since the late 1980s, he has made it his mission to promote paediatric pain management across the globe. Training in Toronto, Canada, there was no specific avenue for specialising in paediatric pain management but in 1989, an encounter with a paediatric patient changed everything.
Getting started
In Autumn 1989, Dr Finley was scheduled to give anaesthesia to a 4 year old with a neuroblastoma. The patient seemed to be in pain but there was no strategy in place to manage this. Dr Finley suggested a plan for the patient and visited the patient for 3 more days until eventually he took over this case. With properly managed pain, the patient’s quality of life massively improved. The patient became happy and smiling, enjoyed drawing and at Christmas, the patient was able to go home for a short time with an ambulatory pump before passing away. Dr Finley describes his experience; “It was a real privilege following the family’s journey”
After this experience, he was consulted by different departments about paediatric pain management. What started as one case, gained momentum and he expanded out from oncology when other departments were contacting him too. Eventually this took him to Boston, which was the first established paediatric pain service in North America. Dr Finley then sent up his own service in Canada — this is the longest running paediatric pain program in Canada.
Going global
In the early 1990s, a visiting professor from Florida came to Dr Finley’s hospital in Canada. This professor talked about Operation Smile and in 1992, he made his first trip to Vietnam. This was a life changing experience for him. He describes: “Never in Canada did a 10 year old grab my hand and pull me to the operating theatre because they were so desperate for their surgery.“
This was the start of a number of trips to Asia and Africa with Operation Smile. Eventually he came back to Thailand with a research grant that was from Canada to do research in an LMIC.
ChildKind
Dr Finley is a founding member of ChildKind, an NGO, which aims to improve the quality of paediatric pain care globally. Based on the Baby Friendly model from the WHO and UNICEF, ChildKind will work with sites to develop standardized protocols and policies for managing paediatric pain, advise on best working practices using the latest research, share an extensive resource library on pain management and then certify institutions once they reach standards of excellence in paediatric pain management. They hope to reach out to hospitals around the world. At the moment, they are volunteer-led, and the certification site visit is done by members of their team. Currently they have certified hospitals in North America and Singapore only, although in Singapore the KK women’s and children’s hospital was accredited virtually due to the Covid 19 pandemic. They take a flexible approach to helping each institution build a personalised framework by taking into account patient profiles, resources available and infrastructure present. Dr Finley describes the plan as “customisable” and this enables ChildKind to bring each hospital to the highest standard it can achieve. Dr Finley says “It is generally not expensive but [there] needs to be willingness, the people, and the commitment” and he says “We support techniques for pain management that are appropriate to the setting, for example, if you treat paediatric cancer you need a protocol for that, but every hospital needs a protocol for needle pokes… reducing needle pain has an amazing impact on children and we provide ideas that fit with limited resources”.
InterSurgeon and ChildKind
InterSurgeon and Dr Finley met at the G4 alliance conference in Geneva last month – ChildKind is a member of G4 alliance. After a great introduction and discussion, Dr Finley decided to place an offer on InterSurgeon on behalf of ChildKind. He very quickly received a response from a member in the Burns community. This is the magic of InterSurgeon and as it grows, we hope that Dr Finley will get many more responders to his offer through InterSurgeon. This does not need to be limited to clinician members who may have a leadership role in their own facility but organisation members too who are enacting change on a regional and national level through advocacy and policy change. One of the strategies Dr Finley was kind enough to share with us is using an ecologically valid paediatric pain score which was developed with children to properly help them rate their own pain. This is a long way from computer generated smiley faces and focusses more on real expressions of discomfort called the Face Pain Scale Revised (FPS-R, available free-of-charge for clinical and research use at https://www.iasp-pain.org/resources/faces-pain-scale-revised/). This simple change can have a huge impact on children around the world being able to accurately describe their pain even if they are non-verbal.
The future
As ChildKind starts to accredit more and more institutions globally, they hope to collaborate with existing institutions to be regional or national site visitors. This may be particularly important if there are language barriers. At the moment, they are mainly able to work in English with some French and Spanish speaking capability. This will also reduce time to travel and cost of travelling, making reaching accreditation much more accessible to smaller institutions from LMICs.
Finally…
We asked Dr Finley why take his passion for paediatric pain management and ChildKind into the global surgery SOTA space? He said: “When we started ChildKind, it was always going to be global. The world needs this support.”
Please look at Dr Finley’s request on our offer and request page by clicking here.
Or you can login and contact Dr Finley directly on his profile by clicking here.
