Hanging on a wall in the lobby of Shriners Hospital for Children in Philadelphia is a colorful patchwork quilt stitched together by the staff. It conveys the love and hope children receive when they pass through Shriners’ doors. “Operating Room—Straightening the curves life throws you,” reads one square of the quilt. Another proclaims, “All children have special gifts—Occupational Therapy just helps unwrap them.” Yet another shows a park drawn in crayon, complete with trees and a swing set. In the middle of the park is a circle with a line running diagonally through it. Inside the circle is the word “Crippled” and a child’s crutch.
The Philadelphia hospital is just one of the 20 Shriners Hospitals for Children in the United States (Canada and Mexico have one each). Shriners hospitals provide high-quality care each year for children at no charge to their families. Running the Shriners system costs over $1 million a day, but remarkably, Shriners finances its network with zero help from government or insurance companies.
Shriners is unique in another way. In a field where cost-control is a top priority, and where rationing of services is increasingly the norm, Shriners lets doctors call the shots. Philadelphia-area orthopedic surgeon Dr. Scott Kozin says Shriners has “never said ‘no’ to me for anything I need for a child. If I need some special equipment that costs $7,000, Shriners has never turned me down.” At other traditional hospitals, Kozin explains, insurance companies or the federal government often tell doctors “how many [prosthetic] arms or wheelchairs that child can have over a certain amount of time.” Kozin finds that a bit hard to swallow: “It’s like saying your child can only have a pair of sneakers once a year.”
Adds Sharon Rajnic, administrator of the Shriners Hospital in Philadelphia, “One of our spine surgeons does tutorials for spine surgeons around the world who come here to learn what he’s doing. If we were dealing with an insurance company they would say [for liability reasons] ‘No, you can’t do that.’ We don’t want anybody saying [that].’”
A Tradition of Philanthropy
Better known for their funny red hats and their travelling circuses, the Shriners—a fraternity of Masons that has counted presidents Franklin D. Roosevelt and Gerald Ford among its members—have been supporting hospitals for the past 80 years. In 1919, they voted at their annual convention to establish an official Shrine philanthropy, originally named the “Shriners Hospital for Crippled Children.” Prior to that, most Shrine Temples would give to their own individual charity and, on occasion, the whole fraternity would donate to earthquake or war victims. In 1921, the Shrine conventioneers voted to expand their fledgling hospital into a network of children’s hospitals, with the whole thing financed from a $2 yearly assessment on each Shriner. Hospital construction proceeded so quickly that 14 hospitals were up and running by 1930.
Today, 18 Shriners hospitals provide orthopedic care (three of these also have spinal cord injury centers); three treat burn victims; and one provides both burn and orthopedic care. The first Shriners burn hospitals opened in the late 1960s in Cincinnati, Boston, and Galveston, Texas. The fourth opened in Sacramento in 1997. The Shriners also maintain three spinal cord rehabilitation centers, in Philadelphia, Chicago, and Sacramento.
Each hospital treats children in a specific geographic region (including regular staff visits to islands in the Western Pacific and the Caribbean), but also conducts clinical research and trains doctors in the treatment of burns and orthopedic disabilities (2,500 doctors have received residency education or postgraduate fellowships). In 1997 alone, more than 23,000 children were admitted to Shriners orthopedic hospitals or burn centers, and 239,337 children received care on an outpatient basis.
Philadelphia’s Shriners hospital currently has 9,000 active cases, including children from Puerto Rico, Greece, Poland, and Russia. The original hospital, built in 1926, has been replaced by a new building that opened in 1998. Typical of Shriners hospitals renovated or completely rebuilt since the mid-1980s, the Philadelphia hospital adjoins an academic medical facility, the Temple University Children’s Hospital. There is no legal connection between the two, but Shriners pays Temple for the use of certain diagnostic technology (such as MRI and CAT Scan machines) available at Temple, and being so close makes it easier to transport Shriners patients for testing. About half of Shriners hospitals are now close to academic medical centers.
Near the hospital’s surgery wing of three operating rooms, children recuperate in the post-op room among windowsills lined with Teddy Bears and other stuffed animals. On any given night, there are between 35 and 50 children sleeping at Shriners, which has 280 full-time staff members. The parents of younger kids may sleep at their child’s bedside, while parents of older kids stay at nearby apartments. There is a terrace playground for toddlers, a recreation room with air hockey and pool tables, a teenager lounge (complete with blaring rock music) and other activities all designed to make life a little better for kids who have endured more hardship in their brief lives than most adults.
The Driver’s Lounge is usually a busy place occupied by volunteers (mostly Shriners) who may have driven a child from Virginia or New York for treatment. These volunteers may wait the entire day while a child’s artificial arm or leg is replaced or adjusted or a doctor checks the progress of a spinal operation.
Congenital disabilities account for about 70 percent of the Philadelphia hospital’s patients; the rest have suffered some form of trauma. Sometimes there are more than a dozen children in the Spinal Cord Rehabilitation Unit for children, which was created in 1980—the first of its kind in the United States. “They get intensive rehabilitation and many times they may need surgery,” says Kathy Goodstein, director of media services for Philadelphia Shriners. “It may be surgery on their arm to change how their arm works so they can function to feed themselves if they’re a quadriplegic to give them [some] independence.”
Sometimes even the smallest step toward independence is of immeasurable value to the patient and his family and friends. One small child recently brought to Shriners had no use of his arms and legs but could move his feet and head. Biomedical engineers and technicians at Shriners came up with a device that attached to the top of his wheel chair and was connected by wire to his foot. By moving his foot, the device worked like a mechanical arm and gave him the freedom to feed himself, comb his hair, and brush his teeth.
In this way, Shriners serves as a kind of “Army Corps of Engineers,” custom-fitting wheelchairs, designing and producing prosthetic ears, hands, arms, legs, and feet tailored to the specific physical and emotional needs of the child. One little girl, for instance, who wore a flowered print dress when she was fitted for a prosthesis, had the same design printed on her new arm. Other children have cartoons laminated onto their artificial limbs.
Gone are the days of the wooden arm attached to a hook. Shriners’ battery-powered “myoelectric” arm (cost: $6,000) with a realistic looking hand attaches to the child’s own muscle and must be replaced frequently as the child grows. The child then learns to control this muscle to send an electrical signal through the arm to a motor which can open and close the hand. To become comfortable with their new limbs, kids and their parents go to the Shriners-run Myoelectric camp, staffed with occupational and physical therapists, located outside of Philadelphia. Last summer a group of five- to eight-year-olds camped for a week of fishing, bike riding, crafts, and other therapeutic activities such as puzzles and playing Mr. Potato Head.
Spinal cord injuries are often devastating to children and their families. Rehabilitation is often a long, grueling process, requiring long-term, intensive physical and emotional therapy. But a promising research project underway in Philadelphia to restore some mobility in spinal injured patients is called Functional Electrical Stimulation (FES). Spinal injuries disrupt the electrical communication between the brain and the muscles located below the injury. FES is a technology of artificial sensors that sends electrical current to specific muscles, causing them to contract. A small group of paralyzed children have volunteered for the demanding FES project and have committed to stay at the hospital for up to a year. The goal is to give these children upright mobility (which itself has enormous health benefits) and enhance their self-esteem so they can stand in their kitchen at home and reach things in the cabinet or perhaps walk a very short distance.
But FES research is still in its infancy, so wheelchairs will continue to be the greatest source of independence for paralyzed children and adults. At Shriners, a typical child is first cautious with their new chair. Before long, though, they are speeding around the hospital hallways. Getting kids comfortable in everyday situations is the purpose of Shriners “Independence Square.” Funded by a $300,000 grant from the Widener Foundation, the Square is a simulated small town that patients with wheel chairs, braces, or walkers maneuver through. It has a grocery store with a checkout cashier, an ATM bank teller machine, a small movie theater, and even a car and the front of a bus. Children also travel along different sidewalk surfaces such as concrete and brick, and different grades of ramps.
Every day, Shriners hospitals are doing miraculous work, whether treating a child severely burned by a house fire or a child born with acute limb deformities. Shriners is bettering the lives of children—putting smiles on their faces—and is doing all this privately without help from Uncle Sam. Now that’s truly great philanthropy.
Daniel M. McKivergan is associate editor of Philanthropy.