Physical Health Taiwan Project #12976

Give burn survivors access to rehabilitation

by Sunshine Social Welfare Foundation

Give burn survivors access to rehabilitation

Project Report | Jan 13, 2014
A burn therapist finds support with her peers

By Marie-Claude Pelchat | Project Leader

Buvi during her training at Sunshine Foundation

Helping burn rehabilitation specialists in India 1

In April 2013, Sunshine Foundation launched its newest capacity building cooperation project in India. Over a three-year period, Sunshine Foundation will provide technical support to International Foundation for Crime Prevention and Victim Care (PCVC), a Chennai-based NGO working in the field of victim care and prevention of gender violence, for the establishment of a Recovery and Healing Center for women burn survivors. Following a site visit carried out at the newly established Recovery and Healing Center in April 2013, the Sunshine team developed a specialized training program to help build the burn rehabilitation capacities of PCVC staff.

Sunshine had the immense pleasure of welcoming to Taiwan two PCVC staff for training from November 16 to December 14, 2013. The trainees were Buvi, a physical therapist and Joy, a social worker. For both of them, it was the first time to go abroad for professional training. For Sunshine staff, it was the first time to receive international trainees. The experience has been rewarding for everyone.

Buvi – The little therapist with big responsibilities

With the opening of the Recovery and Healing Center, PCVC began offering physical rehabilitation to women burn survivors. For the organization, this is a whole new, unfamiliar field of work but fortunately, they were able to soon find a therapist. Buvi joined PCVC early in 2013 after graduation and is currently the only therapist at the Center. Little in stature but full of energy and motivation, she immediately had to shoulder the big responsibility of setting up physical rehabilitation services, such as planning equipment, material and work schedule, as well as evaluating and designing rehabilitation programs for every client of the Center.

Burn rehabilitation is a specialty within the broader field of rehab but back in university, Buvi didn’t get too much exposure to burns, and finding relevant textbooks on this topic has proven quite difficult. As the only therapist at the Center, she understood her responsibility and was committed to her work, but where would she find answers to her questions and how would she know if what she was doing was right?

“I was like a rough stone, but now I feel like you have shaped me and sculpted me”

When the Sunshine team met Buvi back in April 2013, the two therapists from Sunshine Foundation accompanied Buvi over the course of a week, working with clients together and discussing cases, giving recommendations on interventions or on tools used, etc. From this observation, specific training goals were outlined to establish her knowledge and technical skills regarding: scar formation and scar management, reconstructive surgery and post-surgery rehabilitation, splinting, evaluation burn clients, and based on this evaluation, design, implementation and modification of a rehabilitation plan. Furthermore, the training aimed to help Buvi understand the role and responsibility of the therapist in an organization and within the burn team. Training was carried out over one month, through theoretical courses, book reading, site visits and clinical practice and observation.

Used to working mostly alone, Buvi was suddenly thrust into the busy environment of the Sunshine Rehabilitation Center, surrounded by a team of therapists under the supervision of Karen Fong-Yi HSIAO. She wasn’t deterred by the fast pace of training, but eagerly absorbed all the knowledge that she could, “shadowing” Karen, asking questions and constantly seeking clarifications about her work. Based on her extensive experience in burn rehab, Karen gave Buvi guidance and showed her work principles that will be useful back in India.

For Buvi, the training was an eye-opening experience. During courses and book readings, Buvi was introduced to important theoretical concepts and knowledge, which were then placed in practical context by Karen during clinical observation. For example, she gained a better understanding of burn acute phase care and how reconstructive surgery will affect post-burn rehabilitation. She was also introduced to splint production and was able to start making some splints. But more importantly, she now has a better picture of her role within the Center and what should be her work priorities, and she also has gained confidence in her capabilities. She has also started thinking about what changes or improvements can be made to enhance the efficiency of rehabilitation services, not just when clients come to the Center, but also earlier, immediately after hospital discharge, to educate patients and family members about the importance of rehabilitation.

At Sunshine Foundation, Buvi was able to find guidance from peers to help her build her burn rehabilitation capabilities, and she found a mentor in Karen. On the last day of training, Buvi said something that moved everyone: “I was like a rough stone, but now I feel like you have shaped me and sculpted me.” In the course of her daily work, Buvi would sometimes wonder and doubt about whether she chose a correct approach or made a right decision, but now she has gained the kind of confidence that comes from enhanced professional knowledge and skills. Sunshine will continue to accompany Buvi in this process of learning, with another visit to Chennai being scheduled for early 2014, as well as regular SKYPE meetings to answer her questions or discuss specific client cases.

Buvi practicing splint making techniques

Buvi with her "mentor," Karen Fong-Yi HSIAO

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Oct 31, 2013
Helping burned children in Central America 4

By Marie-Claude Pelchat | Project Leader

A new pressure garments makes a world of difference

Since Sunshine started organizing pressure garment production trainings in Nicaragua in 2011, we have relied every year on “models” who help out by letting us demonstrate measurement and garment adjustment techniques. For the past two years, we’ve had “little models” selected among the burned children receiving rehabilitation services at our partner’s APROQUEN clinic. But because this year our goal was to demonstrate how to make a women’s vest, we called upon an adult model to help out. M. readily answered our call for help.

From feeling suffocated and constrained…

Having sustained scald burns over a year ago on 40% of her body, M. has benefited from the rehabilitation services of APROQUEN, including pressure garment services. For a year now, she has been wearing a men’s pressure garment vest, for want of a better option. When we met M. to demonstrate measurement techniques during the first day of training, it was immediately obvious that she wasn’t comfortable. The vest was not only too tight, but it also constricted and flattened her breasts, making it hard for her to breathe normally. Also, the movements of her arms were limited and she wasn’t able to raise them as she wished. One of her scars was still painful, and the constant pressure of the garment on it was unbearable. We could see her physical discomfort and the emotional toll that it was taking on her. Try to imagine having to live 23 hours a day for a whole year with a garment so tight it suffocates you and restricts your every movements…

Demonstrating measurement techniques to teams from each country took some time, all the while M. had to stand up, with quick 5-minute pauses between teams. Sometimes she felt cold, sometimes she felt hot. When we thanked her for agreeing to take part in this project and sacrificing some of her comfort, she replied that if this means that she and other women burn survivors can benefit from better fitting garments, then the sacrifice is very small but very much worthwhile.

…to feeling free and comfortable

Four days later, M. returned to try on the garments made by each team. The atmosphere was full of excitement and expectation. For the seamstresses and therapists, this was the culmination of a four-day, intensive and grueling training. For M., this would possibly be the answer to her prayers for more comfortable garments.

M. first tried on the garment made by the Sunshine team as a demo. When she came out, she had a huge smile on her face and we immediately knew how satisfied she was. She started to move her body, swaying her arms up, down and sideways, elated by the fact that she was now able to move so freely. Most importantly, she was able to take deep, big breaths without feeling constrained thanks to the bra cups integrated in the garment. This continued as she tried on the garments made by each team. The whole process felt a lot like a Miss Universe pageant with M. exiting the fitting room under our cheers and applause, sporting the garments made by the teams from Nicaragua, Honduras, Guatemala, Panama and Dominican Republic.

When asked to compare her old garment to the new garment, M. said: “Awful, simply awful. The difference between the two is abysmal, you can’t compare!” The best compliment that M. made was that she didn’t feel like she was wearing a pressure garment because it fit so perfectly to her body shape, giving enough pressure without hampering her movements or her breathing.

M. felt liberated, like a heavy burden had been removed from her shoulders. The smile on M.’s face, her comments and the way she moved so freely allowed all those present to truly witness the tremendous change that a good pressure garment can produce on a burn survivor’s quality of life, and how this project is so valuable for transforming the lives of many other burn survivors in the region.

The Sunshine team with participants

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Oct 22, 2013
Helping burned children in Central America 3

By Marie-Claude Pelchat | Project Leader

Enhancing quality of pressure therapy services

Actual training for burn rehabilitation professionals in Central America officially began on October 5, 2013. For this year, the focus was on making pressure garment vest for women, the particularity of the vest being that it is perfectly adapted to women’s anatomy, thus ensuring better fit and comfort. But because of this, it is also the most difficult type of garment to make.

Precision of measurement: Multiply the points of measurements to enhance precision in terms of size and fit.

The Sunshine team led participants through the first step for making pressure garments: measurement. Precise “anatomical landmarks” must be identified on the body, which is then measured in all possible lengths, widths and circumferences. Therapists are quite familiar with these landmarks, but for seamstresses, it takes some time to remember each landmark’s name and position. And because there are more measures, this method also takes more time than the original method used by the seamstresses, but in the end it ensures better accuracy.

Adjustment of pressure: Use specific calculations to precisely add or reduce pressure given by the garment, depending on the scar status of the patient.

The second step is dreaded by both therapists and seamstresses alike: making the pattern. The idea of a pressure garment is to create pressure on scars and to do so, original measurements must be “shrunk” so that the garment fit more tightly. The seamstresses must first precisely calculate the shrinkage of the garment through various formulas, depending on how much pressure is required on the scar. Although necessary, this step can be intimidating, especially if you don’t like math!

Tri-dimensional pattern: Special pattern techniques to create tri-dimensional garments that offer better fit and better coverage over the scars.

With their new numbers in hand, the seamstresses can then proceed to drawing the pattern of the garment. For the experienced therapist of Sunshine Foundation, drawing the pattern for a woman’s vest might take 30 minutes but for the participants, it took two full days to learn all the steps of drawing the pattern. The reason why the process is so complex is that instead of making a “flat” garment with front and back pieces sewn together, we use many pieces to create a “tri-dimensional” garment that will fit better and provide better coverage on the scars.

The final step is sewing, and this is something the seamstresses are expert at! But there are still precise steps to follow to make sure that the garment is sewn correctly and fits well. The seamstress from Sunshine Foundation guided participants through the process, sharing tricks of the trade along the way.

Involvement of the therapist in the process: Ensure that burn rehabilitation knowledge is at the base of pressure therapy.

We can’t emphasize enough how pressure garments are not just “tight fitting clothes” but are instead an integral part of the rehabilitation program of the burn survivor. As such, knowledge about burn rehabilitation (how burn scars evolve and mature, their impact on physical functions, etc.) is crucial when making the garment: it’s the therapist that has the knowledge and skills to determine what kind of garment the patient needs, what level of pressure is adequate, etc. But in Central America, this heavy responsibility is almost entirely shouldered by the seamstress. That is why starting in 2012, we have expanded the training program to involve therapists who work as a team with the seamstresses throughout the whole training process, learning together the measurement and pattern-making steps. Therapists not only offer support to the seamstresses during the training, but this support also continues after they return to their country and face the difficult challenge of mastering and implementing the new techniques learned.

This kind of training is both physically and mentally demanding on participants because of the time involved, but also because of the amount of knowledge that must be absorbed. It is also demanding because it means that participants must leave aside their “old familiar” way of doing things and adopt “new unfamiliar” techniques. But participants have consistently told us that the effort is worth it and when they succeed in finishing their first garment, the sense of pride and accomplishment is their immediate reward.

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