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.