Jo Eland: A Remembrance, by Neil Schechter, MD, President and CEO of ChildKind International
Although many readers of this post may not be familiar with the name Jo Eland, the lives of literally millions of children have been changed for the better because of her. Joanne Eland, PhD, RN, FAAN, FNAP, who died September 25 after a long illness, was a young faculty member in the early 1970s who noticed what was obvious but somehow ignored – that pain in children was treated differently than pain in adults. While supervising students in 1971 on a pediatric oncology ward, she observed how little was done for the pain associated with these diseases. In a later reflection on this experience, she wrote:
Watching so many children die in unrelieved pain caused me to begin reading everything I could about pain and soon found there was virtually nothing written about pediatric pain. The memories of so many children dying in unrelieved pain left a lasting impression that has never left me. (Reproduced with kind permission of Jo Eland)1
That impression led to a life of advocacy and action regarding children’s pain. Her master’s thesis offered the first published comparison of the disparity between the treatment of adults and children. Of the 25 post-operative 4 -8 year old children whose charts she reviewed, only 12 received any analgesics at all. Those 12 received a total of 24 doses, half opioid, half non-steroidal. She compared them to a group of 18 post-operative adults who received 372 opioid doses and 299 non-opioid analgesics. In a frequently cited chapter in a textbook on pain management nursing in 1977, she reported this information and offered a laundry list of fallacious explanations for this phenomenon which she called “myths” about children’s pain which she felt persisted because of the limitations of the existing research. It is fair to say that her recognition of this problem provided the impetus for many investigators to further document the existence of this problem and to identify the devastating consequences physically and psychologically of untreated pain.
Jo then became a fierce advocate for the treatment of children’s pain. Throughout the 1980s and 90s, she lectured to often hostile medical audiences who did not like being told that their practice patterns were antiquated, especially by a nurse. But she persisted and bolstered by the work of KJS Anand and a host of other investigators, her message gained resonance. Due to her visibility in the field, a woman from Italy, Lucia Benini, who had lost her child, Livia, to leukemia, contacted Jo and offered to help fund a conference under the auspices of the WHO to develop guidelines to address cancer and acute pain in children. Those guidelines were published in 1998 and have had significant impact on practice worldwide. Jo subsequently developed a relationship with Jill Lawson, a mother whose infant had died following unanesthetized surgery (which was the standard of care) for patent ductus in 1985. When Ms. Lawson recognized that this had occurred, she became an outspoken advocate for pain control in children. The Jeffrey Lawson Award was subsequently established by the American Pain Society to recognize advocacy in the treatment of pediatric pain and Jo Eland was its first clinician recipient.
Jo had stated that “Nurses own pain” and went on to mentor and inspire hundreds of nurses and infuse in them an interest and passion for pediatric pain. She continued her relationship with her Italian colleagues and by bringing her students and colleagues to Italy and training armies of Italian nurses, she had a dramatic impact on the way pain was treated there. In 2009, she established a similar relationship with nursing and physician colleagues in India and developed a pain curriculum now required for all nursing students.
Fortunately, Jo’s contribution and leadership was appreciated in her lifetime by professional colleagues and she was given numerous national and international awards in recognition of her impact on the care of children in pain. Children’s Hospice International awarded her the Robert A. Milch Award for Palliative Pain and Symptom Management. She received the Audrey Hepburn Award for her international work with children’s pain and the Jean Guyvean Award from the American Society of Pain Management Nurses, an organization of which she was past president.
Jo Eland was not only an extraordinary clinician but on a personal level, she was open and generous and had an unexpectedly rollicking sense of humor which emerged when she lectured and is frequently mentioned in her uniformly excellent on-line ratings as a professor. She was also a loyal friend who displayed a genuine interest in people and truly loved her canine friends. She brought a love of technology to her work, was an early adapter, and had a passion and genuine talent for photography in which her eye for beauty is evident – take a look at some of her work online when you are in the middle of a difficult day.
So Jo Eland is gone but her life serves as a model of a life well lived and an example of how, in an often frustrating and challenging world, kindness, competence, and persistence can create ripples that beget a tidal wave of change.
- Unruh AM, McGrath PJ. History of Pain in Children. In McGrath PJ, Stevens BJ, Walker SM, Zempsky WT. Oxford Textbook of Pediatric Pain, 2013, p 7.