Caring for Burn Victims in Beijing

Yiu 1Dripping with sweat, I stood next to my classmate, Tara and a few members of the HandReach team, smiling in awe over our success in transforming plastic tubing, an old table cloth, and left over Velcro, into a functional neck splint for our new little friend. Having been severely scalded, the Watusi collar we made would help to minimize the scarring from his burns and preserve the range of motion in his neck by preventing the development of contractures. As Aimee began to fit the collar, Qi translated to the hospital staff how to adjust it, and Stephanie, a child life specialist, entertained our friend with a continuous stream of bubbles. We had not been at the hospital for long before curious parents from the Burn Unit began to crowd the doorway, eager to see what HandReach could do for their children. While they waited their turn, the kids would run across the hall, drawn in by the warm music and laughter echoing from the large meeting room where Laura, BJ, and Chris had started painting a huge collaborative mural with the kids. It was a fun and lively environment to be in, and an incredible experience to see physical therapy, occupational therapy, nursing, child life, and art therapy working together to support the recovery of these children.

HandReach is an international partner of the pediatric burn unit at the China Air Force Hospital.  Comprised of dedicated volunteers from a variety of disciplines and institutions, they aim to provide the best practices available in acute, reconstructive, and psychosocial care to children who have suffered from traumatic injuries, burns, and amputations. Recognizing my interest in burn care and their mission, HandReach invited me to accompany them on their week-long trip to Beijing, where they would share their expertise with the hospital staff on burn care, develop therapeutic relationships with the kids, discuss the foundations for a new Child Life Program, and organize trips to Shriner’s Hospital in Texas where a few kids would be receiving free burn and orthopedic care. The organization also assisted me in setting up a co-op with the Air Force Hospital that would begin once the team departed. It was an inspiring and unforgettable experience working with HandReach, and in between finding creative ways to make splints using limited resources, playing games with the kids, trying questionable foods together, and shuffling around tourist sites under Beijing’s beating heat, we quickly became close friends with the hopes of meeting again on another HandReach trip!

Once the team departed, Tara and I stayed in Beijing to start our co-op on the pediatric burn unit. We rotated through the operating room, intensive care unit, and rehabilitation rooms, and worked closely with the children and their families from admission to discharge. Coming straight from a six month co-op in the Burn/Trauma Unit at Brigham and Women’s Hospital (BWH), I was excited to be able to observe the differences in burn care, therapies, and protocols cross-culturally. Dressings changes for a second degree burn at BWH, for instance, could be done by nurses and typically involved a mixture of Xeroform petrolatum gauze and a triple antibiotic cream. In Beijing, it was only in a doctor’s scope of practice to change dressings, and they preferred to use a yellow powder from a lotus plant called ‘Fu Chun San,’ which they believed would help reduce pain, promote cell proliferation, and prevent infections. They also used noticeably less pain medications compared to American standards, which at times gave me palpitations whenever I assisted with dressing changes. A doctor explained to me later though that their conservative use of pain medication was attributed to the commonly-held fear in China surrounding opioid dependence, and a reluctance from patients to report their pain. I was also surprised to see how involved family was in every aspect of patient care, including toileting, feeding, and assisting with physical therapy exercises – regardless of whether the patient was 3 or 30 years old. It was definitely a first for me to see a family member snap on sterile gloves and proceed to wash down wounds in an inpatient setting! I realized early on that with every experience I would encounter, no matter how accustomed I thought I was to seeing a ‘routine’ procedure performed, there was always more to learn within the cultural context.

The next two months flew by and throughout our stay, the Chief of Surgery encouraged us to see and participate in whatever we were interested in. In the OR, after we helped the nurse prep the patient, we were often invited by the surgeons to scrub in for a better view and were treated like family. While I had cared for burn patients in the intermediate and intensive care settings in Boston, this was a completely unique and breathtaking experience for me to be able to see their surgeries! In just our first week with the surgeons, we had been exposed to postage stamp grafting (where we had taken skin from the patient’s belly to cut postage-stamp pieces to cover the burns on his legs), a bilateral z-plasty (where a Z-shaped incision followed by the drilling of long Kirschner wires into the fingers were placed to increase mobility for a girl’s contracted hands), and a limb amputation. It was an incredible learning environment filled with opportunities to get a better understanding of the variety of surgeries done for burn patients and the types of surgeries performed at different stages of recovery. And during our 2.5 hour lunch breaks (yes, that’s not a typo!), we would eat with the surgeons, and they would ask us about America, give us the names of places around Beijing to visit, teach us how to suture, and answer any questions we had. Communication proved to be one of the most difficult parts of the trip, as my Mandarin was very rusty and my Chinese medical terminology was inexistent. However, with the help of translator apps, and the staff’s astounding patience to understand whatever I had to say, I always had my questions answered. Soon enough, I even began to pick up the Chinese words for needle holder, scalpel, hydrogen peroxide, iodine, dermatome, pig skin graft, among many other things, and automatically started grabbing  for various tools, dressings,  and solutions in the OR when needed.

On days where there were no operations, we would go over to the rehabilitation unit where we continued to set up arts and crafts for the kids to keep them entertained while they waited for their therapist to become available. It was a little difficult trying to find more ways to help at first because the OT/PTs were all extremely busy and hesitant to put us to work. After a few days of watching them though, I decided to ask one of the therapists if I could perform all her wax therapies. Wax therapy was used to help relieve the stiffness and aches that come with scarring by heating the collagen fibers in the scars. She watched as I prepared the slabs of wax, covered them in garbage bags, and wrapped them around her patient’s legs with Ace wraps. Surprised that I had picked it up, she asked if I wanted to do a scar massage on a girl whose pelvis had been severely burned, and had just gotten out of surgery for a contracture release. Before I knew it, she began to trust me  with a list of different ultrasound therapies, scar massages, heat and wax therapies to help her with and asked if I could supervise a few of her kids’ assigned physical activities for the day. I broke a sweat every time I worked on the rehab unit from that point on, but I loved working with the kids and seeing them get better!

Staying with the kids and their families throughout every stage of their hospital stay, I fell in love with my work. I found some of my biggest role models in the smallest of friends who demonstrated to me what it truly meant to resilient. Hearing their heartbreaking stories, then watching them push through the painful dressing changes, scary surgeries, and rigorous physical therapy, only to pop a smile on their face at the end of the day was extraordinary to witness. During one therapy session, after I had spent over an hour trying to console a screaming girl in pain, her friend walked in, did a couple yoyo tricks, reassured her that she could pull through, and calmed her down within minutes. Although young, they understood what each other was going through and knew how to pick each other up. Their attitudes and willingness to work towards their goals while supporting each other was very moving to see. Needless to say, it was extremely difficult leaving these kids and whenever I think about them every so often, I feel like jumping on a plane to Beijing.

I went into this trip with an open mind and never expected it to be as inspiring, touching, and rewarding as it was. This co-op not only provided me with an opportunity to network and work in an interdisciplinary team within a specialty I’ve grown to love, it also provided me with a unique window to compare healthcare systems, practices, cultural values, and health determinants cross-culturally. I got to observe patients from admission to discharge in the ICU, OR, and rehab setting, which gave me a more complete perspective of burn care that I previously had not experienced. In addition, I became a lot more comfortable working with children and families, and I was able to converse comfortably with Chinese patients when I came back. I also started to see myself less as “just a nursing student,” as I shared my own experiences working on a Boston burn unit and utilized my connections at BWH to provide their therapists with more information about OT/PT in the Burn ICUs – an area that they were keen on learning more about. As I finish off my final semester at Northeastern, I feel motivated to learn as much as I can from classes, work, and my senior practicum at Mass. General Hospital’s Burn Unit so that the next time I travel, I will be able to make a bigger difference, provide better care, and give back all that I have gained from my experiences. I am so grateful to have met all the surgeons, nurses, OT/PT, the kids and families I worked with in Beijing, and I hope to continue to work with HandReach after I graduate. Hands down, one of the most meaningful and worthwhile experiences I’ve had!

For more information about HandReach, check out their website: http://www.handreach.org/

Heidi Yiu, Nursing

(All pictures posted have photo-releases and permission from HandReach and parents to use.)