In 2009, Dr O'Brien Kyololo took his sick firstborn son to hospital for treatment. What should have been a routine procedure quickly became an unforgettable moment.
Nurses repeatedly attempted to insert a cannula into the baby's arm while the child cried in distress. Eventually, the baby's mother could not bear it any longer and walked out of the clinic carrying him.
“The baby had cried and cried until it could not cry anymore," Dr Kyololo recalls. “And I began asking myself, how come we, health care providers, are more focused on completing procedures without considering the trauma we are causing to the baby and, by extension, the mother?"
That experience stayed with him and later shaped the direction of his work at the Aga Khan University's School of Nursing and Midwifery, East Africa (SONAM, EA), where his research focuses on improving how health care providers perceive and manage pain in babies and children.
He later joined a study focused on developing a paediatric pain curriculum for anaesthesia fellows across Sub-Saharan Africa (SSA), serving as an expert panel member. The work addresses a gap that continues to affect everyday clinical care across the region.
Dr Kyololo notes that pain in children in SSA is often under-prioritised and untreated.
“We were not trained to appreciate pain as a symptom that must be managed. A child comes in with vomiting and pain; the clinician focuses on the vomiting. Pain becomes secondary."
According to Dr Kyololo, the problem is not only linked to limited training or clinical practice norms. Cultural beliefs among communities and healthcare providers also shape how pain is perceived.
“In many cultures, showing pain is frowned upon. Children are encouraged not to cry, and boys are told to be strong. Those beliefs also influence healthcare providers because they come from the same communities."
He explains that many people wrongly assume a quiet baby is comfortable.
“That quiet baby may have stopped crying because they have exhausted all the energy they had. The discomfort is still there."
The curriculum developed through the study was specifically designed for the Sub-Saharan African context. While similar programmes exist in Europe and North America, Dr Kyololo says local health systems face different realities, including limited resources and different training models.
“Our training is different; we rely a lot on observation, listening, and touch. Therefore, we needed a curriculum that fits our context."
Alongside general knowledge about paediatric pain, the curriculum promotes practical and low-cost approaches that can ease a child's distress during procedures. These include breastfeeding, swaddling, skin-to-skin contact, and the calming presence of a mother.
“Just the smell of the mother brings comfort; babies feel safe when they are close to their mothers."
Medications such as paracetamol and ibuprofen can also help manage pain in babies and children, while stronger medicines, including morphine and tramadol, may be used in severe cases. However, the research emphasises combining medical treatment with approaches that remain practical within local settings.
Still, Dr Kyololo says training alone is not enough.
“Healthcare providers may have the knowledge, but they also need the right tools, resources, and institutional support to translate what is learned into practice."
To help close this gap, Dr Kyololo and his team are undertaking two additional research projects exploring cultural considerations in pain assessment and how healthcare workers can better apply pain management training in daily clinical practice.
For Dr Kyololo, the message remains simple but urgent:
“Babies feel pain, and we must do better."
