By: Sau-Ling Tsui, Registered Physiotherapist, currently working in Toronto, volunteering with EMAS

Yunnan is a province in Southern China that borders Vietnam, Laos, Cambodia, Burma and Tibet.  Kunming is the capital city of the Yunnan Province, with a population of 3.5 million and many more people in the surrounding countryside.  Surrounded by mountains on three sides of the city and a large lake on the other, Kunming lies on a high plateau that boasts of temperate weather year round.  It is known as the City of Eternal Spring, with the temperature never wandering far from 18 degrees Celsius.  The city is surrounded by beautiful natural scenery. 

Besides the Han majority, there are 24 different minority groups in Yunnan because of its location.  The cultures and religions of each group are very distinct.

Disability and Rehabilitation

While the city has modernized, there are still areas that are lagging behind.  In the latter areas, in hilly regions, it is common to see an entire family living in a one-room house where there is a fire in the middle of the room, used for cooking and for warmth.  Infants and toddlers left unattended are highly susceptible to hazards while adults work outside.  The fact that these burnt victims survive is a miracle in itself. 

Since there is no national health care system, people depend mainly on company benefits.  It is notable that most of the minority groups are farmers and they are self employed.  So initially, the burnt victims are cared for in local hospitals or by use of folk medicine, however, later on in the recovery, due to poverty or unavailability of health care in the villages, many develop severe contractures, disfigurements, resulting in non-functioning hands, arms, legs and feet.  There are children and young adults with birth defects such as cleft lips, cleft palates, moulds, facial and body abnormalities, amongst others.  As a social stigma still remains for the physically handicapped, many victims do not obtain education, and are left with no employment, no hope and no future.

Man before and after surgery

My husband and I joined EMAS China Southwest surgical team for the past five years.  EMAS (Evangelical Medical Aid Society) was founded in Canada in 1948 by a group of Christian physicians, dentists, pharmacists, nurses, and rehabilitation personnel for the purpose of sending and providing medical equipment and supplies to health care centres overseas.  Currently, EMAS has projects in Angola, Nigeria, Ecuador, Haiti, Jamaica, Cuba, Vietnam, Philippines, India, China, Romania and Ukraine.

This year, our team had 45 participants; of this, there were six physicians, five OT/PTs, two pharmacists, a dietician, pre- and post-operative nurses and general helpers.  Ninety percent of the participants came from Canada, while a few were from the United States, United Kingdom and Australia.  As a team, we brought medical supplies, provided pre-operative, surgical, post-operative care, keloid injections and wound care.  We completed 61 surgeries in a two-week period, including corrective surgeries on hands, legs, neck and face, as well as skin grafting, cleft palates and cleft lips.  Our rehabilitation team was responsible for splinting, instruction of exercises, gait training, education regarding patient conditions, etc.

Some cases that struck me particularly were the following:

A young teenage girl had no hope for her future schooling and social life because of a large hairy mole that grew rapidly, covering the right side of her face.  Our team surgeon had an opportunity to perform a large skin graft which healed well, transforming her into a beautiful, confident girl, who now attends high school in the larger city and has plans for her future career.

A playful, intelligent five year old Tibetan boy had apparently crawled into a fire when he was six months old and as a result, suffered severe burns to his face, head, back and hands.  He was so disfigured and his hands were so non-functional that one might have looked away.  He often wore a hat and looked down towards the ground.  Surgical reconstruction of his eyelids and skin grafts to his hands were done.  Today, although he is still far from looking like other children his age, he may eventually have a glass eye possibly more ophthalmology surgeries and he will have a future.

A young man who suffered severe burns to his lower limbs resulting in severe knee flexion contractures was unable to stand up straight and had to beg for a living.  After two series of surgeries, splinting and gait training, he is now walking with no mobility aid and is holding a regular job.

Young children with cleft lips and cleft palates are often malnutritioned and have speech difficulties.  After surgical procedures, they have a chance to attain proper nutrition and improve their speech, thus having brighter futures ahead.

Many of the patients have very high pain tolerance thresholds and are also very cooperative and grateful.  It has been a joy to work with them!

I mainly assessed, educated and treated patients pre- and post-operatively.  As a rehabilitation team, we made splints (for hands, legs, elbows, neck collars, etc).  We also did gait training, demonstrated exercises, and educated parents and local staff to carry on future care.  Occasionally, I was consulted to see neurological patients of all age groups.  When we had extra time, we did some home visits both in the city and in hilly villages.

We were up at 6:00 am, off to work at 8:00 am, and often returned to our hotel at 9:00-10:00 pm.

Despite that the team was comprised of different professional backgrounds and that teammates hardly knew each other prior to the trip, we found ourselves enthused and that we worked well as a team.  We ensured that we always took a team approach with a focus on our patients and family members.  Most of the families had never been to a big city before, let alone seen so many “foreigners”, and some did not speak or understand the national Chinese language.  At the end of our trip, seeing their transformed faces, smiles, and new found confidence were the most rewarding experiences that we received.  We felt privileged to be able to serve them.

This has been my fifth year joining the team.  During my first year, I was the only rehabilitation member, so I found it challenging to do the splinting and other rehabilitation activities with limited facilities and equipment.  This year, we had three physiotherapists and two occupational therapists to share the load of work.

My hope is that more volunteers from all health care disciplines will be able to join the EMAS surgical teams, each providing their own expertise in an interdisciplinary team.

If interested, please contact EMAS at:

30-5155 Spectrum Way
Mississauga, Ontario
Canada
L4W 5A1

Tel: 905-625-4457
Fax: 905-625-1812
Email: www.cmds-emas.ca