Exemplar

Effleurage and petrissage: Holistic practice in Thailand

Pamela van der Riet
School of Nursing and Midwifery, Faculty of Health, University of Newcastle, Callaghan NSW

PP: 227 - 228

Article Text

While exploring complementary therapies on study leave in northern Thailand I visited a government-run community hospital that practises holistic medicine combining traditional medicine with the use of complementary therapies. Health care staff of the hospital focus on preventative health care and rehabilitation for the community through both in-patient and out-patient care. Meditation, aromatherapy, herbal therapies, Thai massage and macrobiotic diet are some of the complementary therapies used at this hospital. At this small community hospital holistic practice is not rhetoric and involves a strong interaction between mind, body and spirit. The following exemplar illustrates this.

I was privileged to visit the rehabilitation centre at the hospital where I was involved in massaging two children, aged 12 years and 6 years. Both children where outpatients and had cerebral palsy. The children were unable to verbally communicate. However, through their bodily language during the massage they were able to communicate pleasure and somatic expressions of relaxation and comfort by smiling, their breathing became more even and slower and they were able to provide eye contact. Furthermore during the massage therapy muscle spasm was reduced and their contracted little limbs were notably less contracted and stiff.

I applied aromatherapy oils and the techniques of gentle effleurage[1] and petrissage[2] to both children. The massage was done with both their mothers involved in the massage. The mothers used the techniques of Thai massage and I used a combination of Thai massage and my knowledge of traditional Swedish massage[3]. Thai massage has existed for over a thousand years and has been influenced by Asian countries such as India and China (Chia & Chia, 2005).

Thai massage involves deep massage and stretching of the body not dissimilar to yoga-like stretches. During the massage pressure is used from the therapist's thumbs, elbows, palms and feet. Numerous physical and psychological benefits of Thai massage have been identified in the literature. Many of these mind body benefits include reduction of heart rate and blood pressure, reduction in stress, increased blood supply to organs increased flexibility, relief of stress and depression and improved immunity (Chia & Chia, 2005; Health Source, 2004; Supatra, Nuppawan, Nitaya, Prapasri, & Jirayingmongko, 2002).

At this community hospital families and carers play a central role in the care of both in and out patients. Both mothers had been taught Thai massage at the hospital. Through the application of massage I could see that the massage also relaxed the mothers and while we massaged the children the mothers felt relaxed enough to open up about the hardship and stress of managing their everyday existence and caring for their brain injured children who, over time, showed no improvement. The stress of trying to cope with their children was evident in their discourse[4]. However, the mother of the six-year-old boy said that the rehabilitation centre had changed her life as she no longer had a desire to abandon her child. Prior to coming to the rehabilitation centre the mother of the little six-year-old disabled boy would imagine ways of leaving him so she was free of her child. This mother had been given an encouragement award from the hospital for being such a good carer and proudly told me about this award. Both parents said that they felt supported by the staff and no longer alone.

At the Thai community hospital the use of holistic practise involving mind, body and spirit shows the potential for health outcomes that improve both the patient and carer. The mothers I have described were able to re-frame their thinking about ways to care for their child and with the assistance of hospital staff introduce particular therapeutic methods to assist their small children to express physical signs of pleasure and relaxation.

The physical therapy of massage helped relax not only the children but also both mothers as they felt the actions they were engaged in was rewarding for their child. I also felt a sense of reward and relaxation in massaging these small children and was transported to a space of peacefulness and intimacy. Importantly, for the broader context of health care the holistic practices engaged in at the community hospital have a 'ripple' effect within the community through hospital staff teaching carers the application of physical therapies and by encouragement and motivation assisting families to deal with health care issues in a positive way. Encouragement and motivation works on the spirit and mental aspects of the individual and should not be forgotten in planning health care. It is an important aspect of holistic practice that is often overlooked in western health care.

There are lessons to be learnt from this family carer's project at the community hospital in Thailand. In Australian healthcare there are many opportunities to apply massage and aromatherapy. For example, I have used the massage techniques of gentle effleurage and petrissage and aromatherapy while sponging, showering and turning patients. These techniques have promoted relaxation for palliative care patients. One of the cautions though is that for this particular type of patient their bodies like the children in this exemplar are fragile so massage techniques need to be gentle.

[1] Effleurage is the French word for gliding or stroking. It is a very soothing movement and may be superficial or deep. Generally it is used at the beginning and the end of the massage. This stroke 'accustoms the patient to the touch of the operator and allows sensitive fingers to search for areas of spasm and soreness' (Tappan 1988, p. 69). Effleurage is a stroke I have used a lot with palliative patients and is very calming. It is often interspersed with other techniques and for best effects it needs to be rhythmical.

[2] Petrissage 'consists of kneading manipulations that press and roll the muscles under the hands' (Tappan 1988, p. 7). It is a type of compression movement where one picks up as much of the muscle and lifts it away from the bone attachment. Your hands should work alternatively in rapid succession.

[3] I have a Diploma of Remedial Massage and also recently completed a two-week Thai massage course in Thailand.

[4] Communication was facilitated through interpretation by a Thai nursing colleague who had accompanied me to the hospital.

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