Over the River And through the Woods to the Czech Republic I Go

579E8A0D-E8CC-4D5E-9481-2BD8BB1C6631

I greatly anticipated my fourth visit to collaborate with the Klicek Foundation in the Czech Republic. The cold weather brings to mind the song from my childhood of traveling via horse and sleigh through the woods to grandmother’s house. For me, it meant taking a new route flying to Prague via a stop over in Zurich, which provided me with my first glimpse ever of the majestic Swiss Alps. I had no idea they covered such an expanse.

CDF40A0D-488F-4108-8E01-D14B2DF58BFD

Our adventures began immediately, as Jiri and Marketa Kralovec included me in some important errands along the way from Prague to their home in the small village of Malejovice.  The Klicek Foundation has secured a plot of land close to the Motol Hospital, on which they will build a new hostel for parents of sick children visiting Prague for specialized medical care. Our assignment for the day was to measure the distance between several trees and a wall, so that an engineer could design the parking lot to meet the requirements of the environmental council.

FFC80548-4A0B-4039-8B44-303EBADBC8A5

And so, armed with measuring tape and a clipboard, we gathered the necessary measurements. We then wound through the city, making stops at two publishing companies and an electronics store, where we gained sustenance in a lovely cafe to tide us over before the hour long trip home to the village.

Molly the dog and the many cats greeted us, and there was hot homemade soup waiting on the stove and a crackling fire in the green ceramic fireplace. Having missed a night’s sleep on the plane, I was happy to fall into bed in the dark country night, and I slept deeply without remembering my dreams until rising early for a full day’s work the next morning.

The first scheduled event was a gathering of three schools that are housed in one building in Prague. There are two secondary schools, one for nursing and one for social work, and a college of nursing. The students came together in a chapel at the school of nursing Jana Paula 11, and we presented a workshop on the value of play and the psychosocial needs of children in hospitals. The room was jam packed with young people, and the more interactive we got, the more engaged they became.

575A7739-1AE8-4F8E-9855-EF702C3AB20DC4F5A927-08A1-4171-93FA-0DE401A317DD1538D3CA-1211-4828-A325-536E85E5D194

Following this seminar, I accompanied Jiri and Marketa to a city council meeting where they advocated for permission to build upon the plot. There are many steps to take before they can announce the council’s approval and begin fundraising for their project. A well known actor, David Vavra,  who also happens to be an architect, is designing the building.

Following a challenging meeting, we headed over to the famous Old Town Square, to the medieval building that houses the Skautsky Institute. There we hosted a gathering of hospital play specialists that also included the medical director of a hospital on the northern border, a book publisher, and a British law student studying abroad at the Charles University. We discussed the challenges facing the profession, many of which involved issues of racism regarding the care of Roma families. The thorough marginalization of the Roma leads to trust issues between the families and the staff. The play specialists often feel overwhelmed by the intersectionality of the many societal factors that impact the lives of Roma families.  They feel helpless in the face of such poverty and hopelessness.

The law student, of Roma heritage, adopted by a British family, is researching the educational inequities and racism that Roma children face in Europe. He hopes to champion their cause as he progresses in his profession. He had connected with me after reading my blog about the children of Chanov — such a small world after all

BBFFA6B8-DD9C-46A8-A858-148E3C8569CD8523667D-1E56-4E59-926F-77B0F6237816

Child Life & Nursing: Practicing pediatric psychosocial support in Novy Jicin

 

IMG_2754

My recent visit to the Czech Republic, sponsored by the Klicek Foundation, included a return to the Mendelova Nursing School in Novy Jicin. This time, Maria Fernanda Busqueta Mendoza joined us from Mexico, and 50 students participated in our seminar, making it a great opportunity for global learning and a multicultural exchange of ideas. As you can see from the first photograph, the students were a lively bunch, and they eagerly participated in the highly interactive time we spent together. Jiri Kralovec served as our interpreter and his son, Jiri, touted  by Foto Video Magazine as this year’s hottest photographer on Instagram, documented our learning. Most of the photos below are his work.

Jiri and his wife, Marketa, started us off by sharing information about  the importance of play for hospitalized children and the history of their efforts to bring hospital play to the Czech Republic.  It has been a slow, uphill battle to change the hierarchal and disempowering bureaucracy of their medical system.  I followed with an introduction to the field of Child Life, the role of child life specialists in hospitals, and the possibilities for collaboration with nurses. I spoke about the role of play and community in the healing process, before moving on to some illustrative activities.

Sharing our own memories of play is one way to deepen our appreciation for the role of play in our lives and in the lives of children. I asked the class to think about their own childhood memories, using their five senses — what do they remember about their play environment? Did play occur inside or outdoors, or both? Were they playing alone, or with others? Did they play with toys, loose parts, or their imaginations? Are there sounds, smells, tastes or textures associated with their memories? What feelings are evoked in sharing them? The students paired up and took turns both sharing and listening to one another.

img_0161_34278312173_o                                                                                                                         (photo by Jiri Kralovec)

IMG_2757

Armed wth a deeper awareness of the value of play, the students were now ready to learn a bit about how to make procedures less frightening for children. I have always wanted to use role play as a way to demonstrate all the things that can go wrong during a procedure, and how minor changes can make things easier for medical staff, children, and caregivers. I took this opportunity and asked for volunteers. One young man played the patient. We instructed him to lie down and asked three others to pin him down to the table, much like medical personnel are likely to do when a child receives an IV. We demonstrated how the very act of being forced into a prone position increases one’s sense of vulnerability and loss of control.

img_0068_34278362593_o                                                                                                                        (photo by Jiri Kralovec)

Add to that several adults talking at once, loudly over any protests you might make, telling you to stay still, not to cry, to be a big boy, not to look…. and you get the picture. Chaos, stress and shame accumulate to make for a disastrous experience for all.

img_0086_34958080191_o                                                                                                                      (photo by Jiri Kralovec)

But there are some simple things that nurses can do, either alone or in partnership with play specialists, to change the outcomes of such procedures. It doesn’t mean that the child won’t cry, but it is more likely that the child won’t suffer emotional trauma, will return to baseline quicker, and the nurses can feel more successful and less like they are causing the child undue suffering.

IMG_2762

With these tips in mind, the students enacted a better case scenario, where the parent has a supportive role in positioning the child for comfort. The child is upright and held in a calming hug, rather than being restrained on the table. The child is given some choices, such as which hand to try first for the IV (the non dominant hand is preferable), and whether to watch the procedure or use a toy or book for distraction.

  • Electing one person to be the voice in the room,
  • encouraging the child to breathe deeply and slowly,
  • narrating each step of what the child will feel,
  • explaining how a tiny plastic catheter, not the IV needle, remains in the child’s hand to deliver medicine,
  • staying away from comparative or shaming statements,
  • and showing empathy

are all ways to provide psychosocial support, making the experience less traumatizing and painful for the child.  Accumulated painful and traumatic medical experiences can make children phobic and avoidant of medical care.

img_0106_34278333913_o                                                                                                                    (photo by Jiri Kralovec)

 

img_0112_34924601682_o                                                                                                                        (photo by Jiri Kralovec)

We also spoke about non-pharmacological pain prevention and reduction. The interactive component of our lecture surely made our important information memorable. The action and laughter surely made more of an impression than a power point! We all reflected together about  how even adult patients can benefit from choices, information and empathy.

Back to the topic of play, we explored ways for the nurses to instill playful interactions into their communication with pediatric patients. Rapport building and distraction through the use of hand games is one way that they can put a child at ease. I demonstrated several hand games, and asked them to show me some of theirs as well.

img_0194_34924549252_o                                                                                                                        (photo by Jiri Kralovec)

Our time with these wonderful students ended all too soon. We posed outside of the school for a photo with some of the Klicek Foundation hospital play specialists before heading to the historic square down the street. Around every corner of this country is a beautiful scene, no matter where you are!

img_0208_34701662250_o                                                                                                                       (photo by Jiri Kralovec)

 

img_0009_34245201294_o                                                                                                                         (photo by Jiri Kralovec)

 

Caring in Cameroon

search    10443980_1029035760443758_744098783317545831_n     search

When we observe anything in this world, our perspective is tightly interconnected with our cultural context. As we grow from the egocentrism of childhood to a more expansive view as adults, we may see that not everyone comes from our circumstances, shares our belief system or our way of doing things. At the age of 52, I was a late bloomer in my foray into other cultures. But travel to New Zealand and the Palestinian Territories in 2014, and speaking at the first International Summit on Pediatric Psychosocial Services began a process that continues today. I have learned that “Child Life” has many names and forms across the globe.

As I cast a wide net with my blog, trying to see how I can do the most good, it occurred to me that I could use it as a platform for getting out the good word about what people are doing in other countries to make life better for children in and out of hospitals. So every so often, I will choose a country and share the story of a colleague who is holding the torch of kindness to dispel the darkness of fear and pain for sick children.

My first spotlight is on Macdonald Doh, my honorary son and a head nurse in the Emergency Department of the Yaounde Gynaeco-Obstetrics and Pediatric Hospital in Cameroon, Africa. I met him at the CLC Summit where he represented his country along with 45 delegates from all over the world.  In Cameroon, there is one doctor to every 10,000 people, as compared with 2.4 doctors per 1,000 in the USA. Continue reading