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A Visit to Juntendo University Pediatric Services

In February I visited Juntendo University Medical School's pediatric ward and clinic in Tokyo. Having been a Nurse and Child Life Specialist I was eager to identify with the workers who take care of children and are dedicated to reducing the effects of the traumatic hospital experience. I remember vividly how as a five-year-old I was taken to the clinic to get my tonsils removed. In those days clinics were fitted with adult-size equipment. No one thought that as a child I could understand what was going to happen and everyone thought that it was best never to refer to the event afterwards. But when a child experiences trauma, it can leave a lasting impression that is relived whenever a similar situation, like hospitalization, occurs. I still remember vividly that tonsillectomy. Modern Pediatric hospitals strive to make the hospital seem a safe and secure place and minimize the residual effects of the trauma. Juntendo Pediatric services are exemplary in these regards.

Dr. Yuichiro Yamashiro, Professor and Chairman, Department of Pediatrics and Adolescent Medicine of Juntendo University escorted me off the elevator into his clinic. Had I been a child, I would have beamed seeing life-size paintings of my familiar "Hello Kitty" painted on all the walls at my eye level. I might have touched the figures or expressed my glee at seeing those colourful cartoon characters. My mother might have reminded me of TV stories and pictures that I'd seen which would prompt happy thoughts. I'd probably bounce down on the waiting room furniture which was padded and comfy and was appropriate for my height. The smiling Doctor and Nurse would lead me into an examining room. I would notice a row of toys on the windowsill and the Doctor's nod would indicate that I could choose one to play with. "The boys choose a dinosaur or the express train," Dr. Yamashiro said with a smile. But there was a doll I might have chosen since I liked to act as a care-giver. There were three sizes of chairs. One was suitable for a two to three-year-old, one for an eight to ten-year-old and one almost adult size for an adolescent. I'd feel that people here knew I was coming and wanted me to be comfortable and happy. I'd feel safe. I could trust the Nurse and Doctor who took my hand and explained what procedure was about to happen while they led me to the laboratory.

Dr. Yamashiro was grinning as we got off the elevator to visit the ward. "Hear that? Hear the piano in the playroom?" When we entered one of the Secretaries had volunteered to play the piano. A three-year-old girl was marching around keeping time with toy symbols. Other children sat on their mother's laps as the mothers helped the weaker ones manipulate a bell or symbols in time with the piano. It seemed an effort for some to smile, but they cuddled close to mom and the corners of their lips turned up. The songs were familiar and several joined in singing. Each child was given a hug by the pianist and sat on her lap as she allowed the child to strike the keys to make sounds. One little boy wasn't ready to relinquish his time. He grinned broadly at the sounds his fingers made. The music session allowed each child to participate at will. Nothing was being done to him. He was in charge of marching around, singing or doing what he felt like doing, which is important if the child is to have self assurance to aid his body to heal.

I met Noriko Hayata, the Child Life Specialist. Adults tell the story of their traumatic visits to a Doctor over and over until the pain subsides. Children don't have the vocabulary to talk about the frightening things that happen to them. They use a doll and play out what is going to happen or what has happened. "Ken, you need an IV (intravenous drip)," the child tells the doll and he uses a toy syringe to punch the doll's arm and tapes the needle with the IV bottle to a supporting board, just like it had been done to him. When the child plays the treatment over and over, the memory becomes less traumatic. It becomes a procedure he knows he can handle. The Child Life Specialist arranges these play sessions with dolls and hospital equipment. From the paintings around the wall of the playroom, I saw that Ms. Hayata encouraged the child to paint and talk about his understanding of what is going on so that misunderstandings can be corrected. The Child Life Specialist is a stand-in for an absent mother during procedures and is another person who represents security to the child.

Dr. Kyoko Tanaka, Pediatrician, is a Play Specialist. She has written a book in Japanese. The book has pictures and dialogue which will help the parents, Nurses, Doctors or Child Life Specialists sit down with the child and explain procedures. The book is a universal tool. Today anywhere in the world a child could experience having an ECG (Elector Cardiogram) or a MRI (Magnetic Resonance Imaging). She has promised to translate it into English.

Dr. Yamashiro explained that the Juntendo Pediatric unit is a teaching unit which deals with conditions that are hard to diagnose or treat. Obviously this center not only focuses on understanding and treating rare diseases, it teaches the need to provide a safe haven, a place where children can control some aspects of daily life and a place where they can express their fears and feelings though play. Such comprehensive care could only blossom with a Doctor like Dr. Yamashiro at the helm; one who understands the needs of children and cares. The physicians studying at this university and the children who are under the care of Juntendo Medical School Pediatric Services are in good hands.
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