Fazal Dad is in his mid-80s, speaks only Urdu and has never been to hospital before. Arriving in the urology ward of Birmingham's University Hospital three days ago in severe discomfort from a bladder complaint, he would normally have had to rely on an interpreter to describe his symptoms to medical staff before receiving pain relief.
With fear and anxiety known to heighten pain perception, it would be no surprise if the combination of being taken ill and finding himself in an alien environment, plus the language difficulties, compounded his distress. Yet, as an English-speaking relative explains, his experience proved far less traumatic - thanks to a new approach being pioneered at the hospital.
It is a non-verbal code which allows people from any culture to indicate how much pain they are in. Designed to overcome language barriers common in areas such as Birmingham, with its large ethnic population, those who have used the pain assessment chart in its introductory month claim it is simple, fast and effective.
First, the patient chooses a number from nought to three which represents their pain level, and marks the problem area on a diagram. Then they select one of four facial expressions which best reflects their mood.
Available in English and five Asian languages, the chart is kept at the patient's bedside. "It is particularly useful for clinical procedures where the patient remains awake, such as keyhole surgery, and for wound dressing and ward rounds," says the hospital's pain management nurse, Debby Bright.
Drawings and numbers have long been used to measure pain, but this is believed to be the UK's first ethnically sensitive approach. Developed under the Nexus Project, a department of health-funded study to improve services for ethnic groups, the chart was compiled after consultation with community leaders, who agreed its trademark symbol: a wincing patient with their head in their hands.
While not designed to replace the traditional hospital interpreter, says Bright, it could ease the burden on an overstretched translation service, and also help to prevent errors of interpretation.
"Patients can be misunderstood. Words in some languages can mean different things - for instance, sore does not always mean painful in some cultures. And translators cannot be at someone's bedside continuously."
Regardless of their ethnic background, the patient is the only person who can assess and understand their pain, she says. "This hands control back to them. We have patients being seen by a variety of people, and everyone moves around the building. It makes sense to have the same assessment tool throughout to ensure consistency of treatment."
Senior nurse Louise Hall, who researched the chart, believes it will help medical staff to understand cultural differences. "It's vital we don't make assumptions based on ignorance," she says.
Several groups, including the local Afro-Caribbean and Chinese communities, were consulted, though Hall's brief was to provide for those who visit the hospital most. "We hope this is just the start," she says. "Other NHS trusts are already showing an interest."
Dr Veronica Thomas, a clinical psychologist at London's St Thomas's Hospital, says: "We are so proud of our multi-cultural Britain, but we are not serving its patients well in handling their pain. The more this measure is used, the more validated it is."
Asked - via interpreter - how he is feeling, Fazal Dad points to the smiling face on his Urdu chart. Earlier he was at number two: in moderate pain. Now he has none. When you're suffering, he says, it's hard enough to collect your thoughts, let alone describe symptoms to someone who doesn't speak your language. "The pictures make it easy, they show what's needed."
