A Look Back: Fun at Camp
By Debbie Bunch
It’s a time-honored tradition in homes all across the nation: As soon as school is out, the kids don shorts and t-shirts and head off to summer camp. In the past, however, one group of children was usually left standing in the doorway, forced to wave goodbye to their healthier peers due to medical conditions that, for them, made summer camp an impossibility.
Not anymore. Thanks to literally hundreds of respiratory therapists and other health care professionals who volunteer their time every year, these children now have summer camps of their very own. Two such camps in South Carolina and New York — one for kids with asthma and the other for children on mechanical ventilation — serve as shining examples of how these camps are bringing joy into the lives of kids while delivering important information and education to them and their families as well.
A perfect solution
A summer day camp seemed like the perfect solution. Not only would it provide enough time to disseminate all the information the group wanted to deliver to the kids and their parents, it would also give children who might not get to go to camp a camping experience. The group contacted their local American Lung Association (ALA) representative, Sally Catlin, for advice on the best way to organize the camp; and she suggested basing the program on Camp Puff ’n Stuff in Charleston, SC, which is one of the oldest residential asthma camps in the country. They took that program, modified it to fit their unique needs, and Camp Sea Breeze was off and running.
“A general consensus was made that eight to 10 hours of class time would be necessary to present the information,” says Chapman. “Approximately two hours per day are set aside for instruction. The rest of the time is used for physical activity and arts and crafts.” The camp was initially funded by the BMH Foundation and the ALA, along with donations from the community, says the manager. Once it gained a successful track record, the Foundation decided to pick up the entire tab. “The Beaufort Memorial Hospital Foundation has awarded funding indefinitely,” says Chapman. While campers do pay a small fee, scholarships are also available, making the camp essentially free-of-charge to many participants.
Campers are solicited in a variety of ways — flyers are handed out in schools and churches and notices placed in the newspaper — but the majority of the kids arrive at camp via their pediatrician’s office. “Criteria for acceptance to the camp consists of ER visits, hospitalizations, or more than two doctor visits in one calendar year for their asthma,” says Rehkop, noting physician approval is necessary for camp attendance.
Parents are required to attend an orientation session lasting about an hour and a half the evening before the camp begins. Rehkop and Drs. Manos and Coleman (who serves as the camp medical director) go over anatomy and physiology and cover asthma medications and how to use them properly to avoid symptoms. The session is vital to improving the lives of the kids, says the therapist, because often parents know little more about their child’s asthma than does their child.
“After the orientation … they feel more in tune with the early signs and symptoms of an asthma attack and how to treat them,” she says. The physicians believe the parent session — along with the camp itself — has done a lot to reduce ER visits and medical office visits alike, and also report that when they do see campers in their office, both they and their parents are better informed, resulting in shorter office visits and streamlined care.
The day starts with peak flows, MDI instruction, and therapist evaluations, says Chapman, followed by an education class. Then kids and counselors alike gear up for a field trip, which can range from swimming, hiking, and climbing walls to bowling, kayaking, roller-skating, and beach activities. The idea is to have fun — but also to test the kids in real-world situations.
“We want to have activities that provide physical challenges for the campers,” explains Rehkop. “This allows the therapists the opportunity to evaluate the camper’s response to their asthma triggers — such as exercise, dust, grass, humidity, and hot weather conditions.” If a camper shows signs of distress, the respiratory therapist will perform an immediate assessment, have the child administer the appropriate medications, and initiate some relaxation exercises. Once the child is rested, he is allowed to resume the activity, under close observation by the therapist. Children who have problems are then classified as high risk, says Rehkop, and “we educate the parents and notify the child’s pediatrician for further follow up.”
Chapman, Rehkop, and their colleagues have traditionally kept track of camp outcomes via pre- and post-camp questionnaires. This year, the group initiated a daily oral questionnaire instead, which they believe is helping them gain an even better understanding of how well the children are learning about asthma and how to avoid its symptoms. The group also evaluates asthma ER visits and hospitalizations on a regular basis to determine the ongoing impact of the instruction delivered at the camp.
Carey and his colleagues joined the physicians and other key players, including the Ranch’s medical advisory board and pediatric ICU nurses from Albany Medical Center, in initial discussions to plan everything from accommodations, patient/family needs, and equipment and gas supplies to emergency response and camp activities. The need for a strong RT presence was clear from the start. “Vest, Cof-a-lator, aerosols, CPT, suction, vent maintenance, medical gas therapy, pulse oximetry, troubleshooting … our skills and expertise are critical to this type of camp,” says Carey.
With the plans in place, the group put the word out that the first camp would be offered that summer; and applications began coming in, some from as far away as Minnesota. “We ended up with eight kids, ranging in age from four to 15,” says Carey. “Four were vent-dependent full time, two vent-dependent overnight, one NIPPV-dependent, and one oxygen dependent.” Having parents and siblings along helps provide peace of mind to parents who might be wary of leaving their medically fragile children while at the same time giving everyone a respite from the stress and strain of caring for children with medical complexities.
Something for everyone
Andrew Slezak, RRT, clinical educator for cardio-respiratory services at Albany Medical Center, volunteered at the third session of the camp held last June and agrees the experience is one that is hard to match. “The work is very demanding and takes a big effort, but the smiles and laughter coming from the kids and their parents make it more than worth it.”
This year’s camp was the largest yet, says Slezak, with more than a dozen children and their families on hand. As in previous years, the children delighted in the camp activities; and their parents and siblings enjoyed themselves as well — taking part not only in events planned for the ventilator-dependent children but also in activities designed just for them. “Massages were provided for the parents in hopes of temporary relief from the stresses of caring for a vent-dependent child. Siblings were able to play softball, hike, and test their skills on a high ropes course built specifically for their use,” says Slezak.
Fulfilling a rite of passage