Bubbles in the Operating Room – Psycho-Social Service in Children’s Hospitals

A long white corridor crosses the department, intersecting with another. Grey light shines on naked walls; mumbling voices can be heard behind the doors. “This is the surgical department of the Tsitsishvili – Children´s New Clinic,” Marleen Hemmert, a volunteer at the Hospital, explains. “In this department, most of our patients have to recover from hard operations and often can’t even leave their beds.” After a walk through the confusing labyrinth of look-alike corridors, there is finally a child-friendly space to be found in the basement. Here, the kids can have a break from their clinical surroundings, play with other children or the volunteers, paint something and feel like a child again.

The playroom is part of the program of psycho-social services in children’s hospitals which is slowly being implemented and recognized in Georgia. There are just two hospitals, both in Tbilisi, working with a psycho-social approach: JoaAnn’s Medical Center and the Tsitsishvili Children’s New Clinic. In 1996, the first department started its work, shortly followed by the oncological center, which offered hospital school programs for long-term child patients. Today, the initiative offers three different services in two hospitals and tries to make the stay for child patients, and their parents, easier. The service works with the children in multifaceted ways and tries to approach each child individually regarding their needs, wishes and problems. The staff of the psycho-social service program, psychologists and child life specialists are part of an integrated hospital service following the main aim to help the patients and their families to cope with the stress of the procedures, their health problems and to provide a patient and child-oriented environment.

GEORGIA TODAY had the chance to meet Khatuna Dolidze, head of psycho-social service at the JoAnn´s Medical Center, and Salome Tskhvitava, head of psycho-social service in Tsitsishvili – Children´s New Clinic for an interview.

Dolidze was one of the first advocates in the field of psycho-social service in children´s hospitals in Georgia, there from start to present and promoting its importance for children and their parents as well as for doctors and medical staff.

“Research has proven that you need fewer painkillers when you have psycho-social service. It is a fact that non-pharmacological methods do a great job,” she told us.

Dolidze, Tskhvitava and their teams provide holistic care for the children at all phases of the patient’s process, from preparation, attendance during surgeries and finally helping them with the challenges during recuperation.

“The preparation process is very important. Kids who are prepared are calmer, less stressed and more cooperative with the medical staff.”

In the preparation phase, psychologists come to the child and try to find an individual way to talk with them about the upcoming surgery. A helpful method is the ‘medical play,’ an educational method to show the children, with the help of a special doll, what their procedure will look like. A child friendly approach and age-appropriate language is very important, finding reassuring (non-frightening) descriptions and words. The therapeutic value is extremely high since the play aims to cover all their fears and misbeliefs. Another well-liked method is exchanging with other children who had similar surgeries, or the use of real medical instruments as toys.

“It all helps to dampen the children’s fears and prepare them mentally for their surgeries. Sometimes, they even want to take the medical instruments home to show them to their siblings and friends!”

Before this service was implemented, no-one explained the child patients what the surgery would mean for them, so often they would become extremely stressed and scared. The doctors neither had the time nor the training to deal with the children’s fears and the parents in such cases became overprotective, telling their children it “wouldn´t hurt at all,” which often had a negative effect.

“We get very positive feedback from parents. Now, they even choose our hospitals specifically because we can help them to deal with the situation and find a way to communicate with their children. The parents see that their kids feeling more comfortable knowing what the surgery means for them.”

The medical staff and especially the doctors also give very positive feedback and include the service in their procedures, especially in the surgical departments.

“In the beginning, it was very hard to introduce the service [to doctors]. Now, they are asking for our assistance in the surgical department and intensive care, recognizing the positive effects of our work.”

Despite the countless positives, the implementation of psycho-social service is a very slow process. 90% of the hospitals in Georgia are private, which means that each manager must be approached individually and persuaded of the effectiveness of the program.

“If the Ministry of Health published recommendations for the hospitals to show the great value of the service in the pediatric field, it would help to a great extent. There would be no need to explain to each hospital management the effects and advantages again and again, and we could do our work more effectively.”

The psycho-social service also accompanies the children into the surgery room to provide distraction during the medical procedures. Helpful tools are toys or even bubbles, so the level of anxiety is decreased. The surgeons can do their jobs more productively when the children are cooperating, and fewer artificial methods and drugs are needed.

In the JoAnn’s Medical Center, the psycho-social service has five staff members, a playroom and play corners distributed throughout the hospital. The Tsitsishvili Children’s New Clinic has just recently tried to expand the program, as a lot of the departments are not yet designed to be child-friendly.

Salome Tskhvitava has worked since 2017 to establish a better service in all the departments of the hospital. The recent plans contain a redesign of the surgical department, as the current surroundings are still far from child-friendly. The sticking point for the remodeling is to decrease the level of ‘negative stress’ and to lower the risk of a trauma resulting from hospitalization. The current financial capabilities of Georgian hospitals can only cover the absolute necessities. Due to that and the urgent need to bring change, a fundraising project called ‘Make The Surgical Department Great For Them’ was initiated to raise the needed money. The clinic works in cooperation with the Samaritan Association of Georgia (SSK Georgia) and the Arbeiter-Samariter-Bund Germany. The project aims to create a surgical department which can make the children’s lives easier and minimalize their stress. The current plans involve a repainting of the grey floors to brighten up the whole area and to provide two new play corners for those unable to get down to the basement playground. Small things can effect a big change in these children’s lives, just like bubbles in the operating room.

Donations are welcome to help and create a child-friendly surgery department in the Tsitsishvili Children´s New Clinic:

THE SAMARITAN ASSOCIATION GEORGIA

Bank Name: TBC BANK

SWIFT: TBCBGE22

IBAN: GE24TB7532436080100008

By Lisa Maier