In the autumn of 2018, members of the diplomatic corps from Nicaragua, Guatemala, and Honduras, officials of the ROC Ministry of Foreign Affairs, and burn rehabilitation specialists from Latin America gathered in Taiwan to attend a conference sharing the results of the “Training Program for Latin America Burn Rehabilitation Professionals.” The dedication of the Sunshine Social Welfare Foundation (SSWF) in providing services to burn victims has led to excellent results in nine Latin American countries.

The Sunshine Social Welfare Foundation unselfishly shared its techniques for fabricating “pressure garments,” putting smiles of confidence on the faces of the seamstresses who acquired the skills to make the garments.

Distant friends

At the 2007 World Burn Congress in Canada, Marie-Claude Pelchat, international affairs manager for the SSWF, got to know the Asociación Pro Niños Quemados de Nicaragua (APROQUEN), which also is focused on helping burn victims. Decades ago, chairwoman Vivian Pellas and her husband went through burn rehabilitation after surviving an air crash, and this experience prompted them to found APROQUEN, to provide rehabilitation services, free of charge, to Nicaraguan burn survivors and people with facial disfigurements.

Most people in Latin America are poor, and they live in simple dwellings made of wood or sheet metal. Often there is only one room, and since this is both the living space and the cooking space, children play right next to the cooking fire. When you also consider that many people use oil lamps for lighting and are in the habit of burning trash on the spot, children could easily get injured in a fire if they get at all careless. This means that in Latin America there are frequent burn accidents, with most of the victims being five years old and under.

APROQUEN is also a training platform for specialists in burn treatment from Latin American countries. After comprehensive evaluation, the SSWF decided to work with APROQUEN to train burn rehabilitation specialists from Panama, Guatemala, the Dominican Republic, Honduras, and Nicaragua, with the training to be done in Nicaragua. Over 6,000 burn survivors are assisted in these five countries each year, and the curriculum planning for the training courses has been focused on their most urgent and impactful problems.

Vivian Pellas, director of the Asociación Pro Niños Quemados de Nicaragua (APROQUEN), a group that assists child burn patients, started the association based on her own personal experience with burn rehabilitation, and has devoted herself to upgrading the quality of burn treatment in Latin America. (photo by Jimmy Lin)

The training program gets underway

The SSWF decided that courses in pressure garment fabrication skills would be the first stage of the training program, which lasted from 2011 to 2014.

When burn damage reaches the dermis layer of skin (second degree burns or higher), hypertrophic (thick and wide) scars will increasingly appear on the skin’s surface as the wound heals, and some will even cause contracture of the joint tissue. It is necessary to continually perform rehabilitation in order to allow the burn patients to return to their normal lives as quickly as possible.

Scar hyperplasia (scar proliferation) goes on inside the body 24 hours a day, and will only stop when the scar is mature. This usually takes from one to two years, but can take even longer, and during this period the patient needs to wear “pressure garments” to flatten the scars, making these very basic assistive devices. In the past, Latin America lacked adequate skills in making pressure garments, causing many child burn victims to refuse to wear the clothes, leading to poor results in rehabilitation.

The fabrication of pressure garments is not like making ready-to-wear clothing. It affects the treatment of the patient’s wounds and scars, and can only be done with the assistance of medical staff. Therefore in Taiwan the SSWF uses teamwork, with the rehab therapist measuring the patient, drawing up a pattern, and evaluating the condition of the injuries in order to choose the most suitable type of clothing and pressure for the patient. The job of making the actual garments is then turned over to a seamstress.

But because there is insufficient manpower in Latin America, the whole process of making pressure garments is done by the seamstress alone. Because seamstresses are not well educated, they lack adequate knowledge related to scars and burns. Therefore they make pressure garments the same way they would make ordinary garments, and often either not enough pressure is applied, so there is no effect, or the pressure is excessive, causing the patient’s wounds to break open.

Sung Yu-li, deputy director of the SSWF’s Taipei Rehabilitation Center, guided seamstresses from Latin America to learn pressure garment fabrication step by step from scratch. The method used by the SSWF is very strict. Measurements must be taken about once every five centimeters, so that for an adult’s trousers, for instance, the circumference is measured at about 20 points. After measuring the patient’s body it is necessary to calculate the degree of scar shrinkage to be aimed for based on the patient’s condition, and then make a pattern.

Sung Yu-li also explained to the trainees the causes and development of scars, and instructed them in how to choose appropriate garments and degrees of pressure for each patient. Sung offers the following example: For a patient with burns on their chest, people will intuitively choose a vest-type garment, but if the arms are not wrapped, the garment will not be able to apply enough pressure on the chest, making the therapy less effective. This is why sleeved upper body garments are the best choice for these patients. She hopes that by taking care over details like these, trainees will be able to create the most appropriate custom-made pressure garments for each individual burn survivor.

Four years of training raised the pressure garment fabrication skills of the Latin American seamstresses, winning affirmation from the parents of many child patients. Children can now play and learn happily and comfortably while wearing their pressure garments. Meanwhile, the training also raised the seamstresses’ self-confidence and sense of accomplishment.

photo courtesy of SSWF

The next step: Hand rehabilitation

Most burn victims in Latin America are children, and the hands are a major tool for children to develop and explore their worlds. “Once the hands, which are relat­ively complex, no longer function properly, then the disability has a greater impact,” says Lu Ching-yi, re­habilita­tion supervisor at SSWF’s Tao­yuan‡Hsin­chu Service Center. She and ­Hsiao Feng-yi, general rehabilita­tion supervisor at the SSWF’s Taipei Re­habilita­tion Center, were sent to Nicaragua to imple­ment the second stage of the rehab professionals’ training program by offering courses in hand rehabilitation to rehab therapists from eight Latin American countries—Panama, Guatemala, El Salvador, Honduras, Columbia, Peru, and Mexico and Nicaragua—from 2016 to 2018.

Lu and Hsiao insisted on starting their instruction from the most basic anatomical structure of the hand. Only in this way can the cause be determined when the hand becomes deformed, and only then can one correctly choose the most appropriate and effective rehabilitation therapy.

Hsiao Feng-yi and Lu Ching-yi use discussions of clinical case histories as a method to teach trainees how to apply scientific principles when evaluating cases, in order identify problems, design therapy plans, and achieve therapeutic goals. Seeing how medical knowledge is applied flexibly to different cases enables the trainees to understand the need for a careful, detailed approach to each patient’s condition.

In the past the trainees often just took a shot in the dark, intuitively treating whichever part of the hand appeared to be malfunctioning, without any overall foundation for evaluating problems.

Through the instructors’ discussions of a variety of case histories, the trainees steadily built up their ability to reason logically about clinical cases. José Adrian Ruiz Aguirre, a physical therapist at the New Civil Hospital of Guadalajara in Mexico, shares his own personal experience: After the training he is able to complete evalu­ations more quickly, and he can more efficiently locate critical problems. And Grazia Bruni, rehabilitation director at the Fundación CRISAQ in Honduras, says: “Thanks to this training program, each day I can see the patients’ progress with my own eyes. For us, being able to continuously make advances is a precious experience that money can’t buy.”

The SSWF hopes that, through sharing of skills, the seeds of love can be spread across Latin America, so that a smile of hope can appear on the face of each and every patient suffering from burn injuries.

Step by step, Sung Yu-li guided her trainees through the process of tailoring custom-made pressure garments for each patient, from taking the individual’s measurements, calculating the desired degree of scar shrinkage and making a pattern, to cutting and finally sewing the material. (photo by Jimmy Lin)

Step by step, Sung Yu-li guided her trainees through the process of tailoring custom-made pressure garments for each patient, from taking the individual’s measurements, calculating the desired degree of scar shrinkage and making a pattern, to cutting and finally sewing the material. (photo by Jimmy Lin)

Step by step, Sung Yu-li guided her trainees through the process of tailoring custom-made pressure garments for each patient, from taking the individual’s measurements, calculating the desired degree of scar shrinkage and making a pattern, to cutting and finally sewing the material. (photo by Jimmy Lin)

Trainees split into groups to practice making assistive devices for rehabilitation. In this photo, the extensor tendon for a finger is drawn on the hand as they learn about hand rehabilitation.

Trainees split into groups to practice making assistive devices for rehabilitation. In this photo, the extensor tendon for a finger is drawn on the hand as they learn about hand rehabilitation.

By training burn rehabilitation professionals, the Sunshine Social Welfare Foundation is spreading love to Taiwan’s diplomatic allies and enabling patients in Latin America to receive better healthcare services.