Zarina Shaikh
North Staffordshire Hospital, Stoke on Trent, United Kingdom

Maxillofacial trauma is a very large subject, so I decided to narrow down my project to a study of childhood trauma and its psychological sequelae. I approached the North Staffordshire Hospital (NSH) Maxillofacial Unit as it is one of the busiest in the Midlands. Dr. Stephen Worrall, Consultant and Senior Lecturer in Oral and Maxillofacial Surgery at the NSH, kindly agreed to allow me to spend four weeks at the department under his supervision.

Having designed the study and sought approval from the hospital, I began the lengthy task of gathering the records of all the children aged 1-18 years who had suffered maxillofacial trauma in the last three years. I systematically organised, read and recorded the notes of 116 patients. Then I designed and distributed questionnaires and organised clinical interviews, under the guidance of the clinical psychology and play therapy departments. I sent letters to the parents of the patients, inviting them to attend a short interview or fill in questionnaires.

In the next week, I was able to spend time in theatre and in the clinic with the maxillofacial surgeons. I had the chance to speak to patients who had suffered horrific injuries and observed the psychological impact on patients who look virtually unscarred from the outside after surgery. One patient had been shot in the side of the head; miraculously the bullet missed all vital structures and the surgical repair was so good that the scars were virtually invisible. Having spoken at length to the patient, I realised the significance of my project, as very little research has focused on the psychological effects of maxillofacial trauma in children.

The analysis was in two parts: first, I recorded the data from the questionnaires and then I interviewed patients who had agreed to attend clinic sessions. The main problem was a relatively poor response rate which made it impossible to justify the results statistically. This was rather demoralising as I had not only sent prepaid, addressed envelopes to each household, but I sent questionnaires for a second time to all of the non-responders (again with prepaid, addressed envelopes).

Because I used a range of methods of data collection, I was able to observe the advantages and disadvantages of each method. For the young children (1 – 10) I designed a simple, short questionnaire based on faces with expressions corresponding to various feelings – happy, indifferent and sad. This questionnaire also included a box for the children to draw pictures of themselves to assess whether they were aware of their scars. The results showed that the questionnaire design was easily applicable to young children, but that the portraits were not a very accurate method of predicting the level of awareness of disfigurement in young children. For the older children (11-18) I designed a visual analogue scale; the results from this were more precise and informative and made it easier to detect psychological problems.

By far the best method for psychological assessment was the clinical interviews of children and parents. These revealed acute and chronic psychological sequelae in children of all ages. It was interesting to observe how much parental behaviour can influence psychological sequelae following trauma. The children who were reminded of parts of the traumatic event tended to have a distorted memory of it, which was not necessarily accurate but based on the accounts of their parents.

Due to the considerable difference between the questionnaires for the younger and older children, it was not possible to make valid comparisons between the psychological sequelae in the two groups.

The project gave me a valuable insight into the complexities of designing and carrying out a scientific project and the difficulties of trying to assess the psychological status of a group with such diverse levels of literacy and understanding. As well as the clinical knowledge that I gained, I also got a first-hand insight into everyday life at a busy maxillofacial unit. I met a stream of friendly people who made my visit one of the most enjoyable and challenging things that I have ever done. Who says staying in England is dull?

Zarina Shaikh 2003