Not yet on the medal stand

By Manuela Zoninsein | NEWSWEEK

Published Sep 6, 2008

From the magazine issue dated Sep 15, 2008

There are some 83 million disabled people in China, but the country has never been particularly hospitable to them. Why bother building subway ramps and bus lifts, the attitude has long been, for people who aren't expected to leave home? But when Beijing was awarded the 2008 Summer Olympics, the Paralympic Games, an event featuring 4,000 disabled athletes, came along with it. So in the spirit of the 12-day competition, which opened on Saturday, China's government raced to bring Beijing up to international standards, creating 16 special bus lines for the athletes, installing street-crossing signals for the blind and adding wheelchair-friendly subway exits. It even outfitted a section of the Great Wall with a ramp and an elevator.

But according to athletes and officials, Beijing is still a long way from being disability-friendly. Many sidewalks are uneven. Most curbs don't have ramps. And traveling halfway across the world might be easier for Paralympians than crossing Chang'an Avenue, the east-west artery where Tiananmen and the Forbidden City are located: the massive avenue, like many others in Beijing, has no crosswalk—and drivers don't brake for pedestrians. Oral Miller, an executive with the International Blind Sports Association, told NEWSWEEK he was warned by a guide to "run across the street, because they won't stop for you."

Although the head of the Paralympics organizing committee has praised the city for its efforts, not everyone is satisfied. IBSA officials say the hotel has no Braille explanations. They were depending on the Paralympic buses, but their hotel isn't included in the route. Esther Vergeer, a four-time wheelchair tennis champion from the Netherlands, had visited the Great Wall before—in 2007, on the back of a local stranger—and she was excited to make the trip on her own this time. But when she inquired, the wheelchair-friendly section was closed, with no explanation.

Working with children and their parents

The social worker in a pediatric patient emergency room (children's hospital) is likely to have a very different case load from that of his or her colleague in a general medical emergency room, but the latter may still include up to 20% children. As with adults, use of emergency rooms for children by their parents is often inappropriate, with studies of pediatric emergency rooms showing from 33-73% non-urgent cases. Many families use them for regular care even when other more appropriate sources are made available; hence, the social worker may have a regular group of families to follow. Greater use of emergency rooms is projected for the future, as 661,000 children lost medical assistance just in the year ending October 1982. Not only is the emergency room the only place available to them in some locations, but also the delay in preventive and routine care will mean that sicker children are brought in to the emergency room.

The role the social worker plays in the emergency room depends primarily on his or her location and on nurse / physician view of the social work function. While this is true of social workers in emergency rooms generally, the complicating factor here is the parents: they may not be the patients, but they need just as much care and attention as the patients. The social worker who is on-site can work readily with triage nurses to identify parents who need assistance. The social worker on call can try to set criteria for referrals, making them broad enough so that the on-call situation is manageable. (Evidence that it is not manageable, however, particularly from the medical staff, may help to get an on-site worker).

The reasons for emergency room visits by children, for both urgent and non-urgent medical care, include the following: respiratory distress and upper respiratory tract infection; acute otitis media ( earache / infection ); pharingitis / tonsillitis; gastrointestinal illnesses; fever; seizures / convulsions; viral illnesses; cardiac emergencies; allergic reactions; crises in chronic illnesses; trauma from falls; accidents; abuse; and poisoning. There is not an all-inclusive list but gives an idea of typical uses. The social worker, even in pure medical situations, can look for gaps in services at the hospital and try to fill them. Accidental poisoning, for instance, claims the lives of 300 to 500 children a year. Besides waiting with and supporting distraught parents, the social worker can provide concrete preventive aids. If the child is doing well and will be able to go home, the parents can receive not only instruction in the handling and storage of dangerous substances but also a sheet of the " Mr. Yuk " seals distributed by the Poison Control Center at the Children's Hospital of Pittsburgh and other poison control centers. These seals show a sickly green face with a grimacing expression. Children looking at them do not have a positive response. Recommending to the parents that they put Mr. Yuk seals on all containers with dangerous substances, whether or not they think the child can get hold of them, may make them feel more in control. Many children can understand the explanation that containers with Mr. Yuk seals have stuff inside that tastes bad and is bad for you. It is just this ability to combine small, concrete interventions with knowledge of the range of resources and sophisticated clinical thinking that makes social workers so valuable in the emergency room.