SANTIAGO.- In the outpatient room of the Dra. Thelma Rosario Pediatric Burn Unit at Santiago’s  Dr. Alberto Grullón Hospital, a young boy sits stiffly in his mother’s lap, holding his arm gingerly away from his body and crying, a steady, keening sound.

“Why are you crying?” asks Julio Marte Sime, the unit’s medical director, an imposing figure in scrubs but with tenderness in his voice as he crouches to assess his small patient.

“It hurts,” the boy’s mother answers for him, and the child sobs quietly in assent, extending his hand to Dr. Sime. A tangle of black stitches seems to be holding the webbing between his thumb and forefinger in place, and the skin is raw and pink.

“Skin graft,” Sime comments, then pats the boy’s head and says cheerfully, “You’ll be alright.”

Sime isn’t just trying to placate a child’s fears. This burn unit in Santiago, the only one of its kind in the country, was recently declared a pediatric burn treatment and rehabilitation training centre for the entire Caribbean and Central American region because of its excellent standards of hygiene and care and the skill and enthusiasm of its staff.

“Burn treatment brings together many aspects of medicine: plastic surgery, burn surgery, physiotherapy, anesthesiology, psychology,” says Sime. “It becomes a monolithic coordination effort.”

The day shift at the burn unit begins at 8 a.m. with a meeting outside the nurses’ station. Everyone lines up and washes their hands at a fountain mounted on the wall; “we’re crazy about handwashing,” Sime laughs. Then the night staff brief the day staff on what has happened with each and every patient during the night. Patient records are meticulous and detailed, and unit statistics are calculated for research purposes.

They treat between 25 and 35 patients every month, and according to their findings, most are boys between the ages of three and five. Most come from rural areas and most have second-degree superficial burns, usually from hot water scalds but also from open flames and electrical fires.

About 18 percent of cases are the result of abuse, usually by the parents, Sime says, so social workers are brought in to interview the parents and child. Sometimes the children are released back to their families; sometimes they become wards of the state.

The unit is publicly funded and national, so patients are brought in from across the country; even Haitians are treated. “The most important thing for us is seeing the patients walking out the door on their way home again,” Sime says.

Physicians For Peace (PFP), an American non-profit organization that establishes medical training missions in developing countries around the world, signed an agreement with the Dominican Ministry of Health last month establishing the unit’s regional significance after a successful mentorship exchange with a group of 14 American doctors and nurses.

Dr. Steven Fisher, a burn rehabilitation therapist from Minnesota who participated in the mission, said the unit’s facilities “are as nice as anyone in the U.S. could hope for in a pediatric burn unit,” and praised its achievements in acute burn treatment, skin grafting and management.

He said the weeklong exchange in January was the first phase of a three-part PFP mission, to be completed within two or three months. “This first phase was really just to find out what their needs are, to see what they knew.”

Because burn patients have a high risk of developing contractures (limited movement of their limbs because of thick scar tissue) and disfiguring scars, rehabilitation training will be a high priority for the next phases of the mission, Fisher said. That includes the production and proper use of special latex garments and face masks that wrap tightly around the healing burn and minimize the formation of scar tissue.

The age of the patients makes getting the parents involved in rehabilitation an important factor, Fisher said. “You can’t explain to a child why they’re having pain, why they need to have discomfort in order to improve … the parents have to act as the therapist for the child in the home.”

Adds Sime, “It’s hard for the children because they don’t understand. The burns itch, the garments are tight and hurt them, so of course they cry, and the parents take it off.”

He slides a photograph across his desk of a boy with bulging ropes of scar tissue criss-crossing his back. “His parents took the garments off,” he says.

The unit costs RD$12 million per year to operate, but receives support from the Voluntariado Jesus con los Niños, which provides the special garments and other burn therapy equipment through private donations.

The PFP volunteers are also looking at strengthening the partnership between the Santiago unit and the Dominican Rehabilitation Association (ADR) in Santo Domingo, which employs a tailor and artificial limb maker who are highly skilled in the production of the special garments. In the next phase of the mission, Fisher said, “we need to really dig in and pick two or three people in Santiago who will become experts in that skill.”

The burn unit and PFP will also host a regional conference on burn treatment from April 2 to 5.