Here are the short videos of the trip that Skyelar MacLeod, documentary filmmaker, did for us.
Working with the Korle Bu, University of Ghana, cleft palate team (3 min.)
AAC professional development day (3 min.)
Effiduasi unit school for students with intellectual disabilities (3 min.)
KNUST Disability Center (2 min.)
Friday, January 20, 2012
|Mrs. Serwah Quaynor with Cate Crowley at AACT|
We spent the morning of our final day in Ghana visiting the Autusim Awareness, Care & Training Centre in Accra. The director, Mrs. Serwah Quaynor, is a parent of a child with autism. She established the organization in 1998 after finding limited options for her son. When we arrived, the children were singing, dancing, and playing drums outside during worship time. Mrs. Quaynor gave us a tour of the preschool and primary school classrooms, the walls covered in daily schedules and AAC materials for the children. Some of us inquired about volunteer opportunities while others purchased artwork, cards and bookmarks created by the students, with proceeds benefitting the school. Currently, the center relies on tuition fees and fundraising as it receives no government funding.
|Kevin, a student at AACT, proudly displays his artwork.|
We returned to Forte Royale for the last time to pack and load up before stopping by Korle Bu Teaching Hospital. We surprised Dr. Laing and the cleft palate team with a DVD of a public service announcement put together by Skye McLeod. The DVD showcases the high quality of cleft palate repairs performed by the team at Korle Bu and can be used in outreach programs to raise awareness of the extraordinary work performed by the Ghanaian cleft palate team.
|Claudine trying banku|
The trip really would not have been the same without our guide, George, our driver, Alex, and our entertainer, Nicholas. A big thank you to all of the doctors, hospital staff, teachers, patients, family members, hotel staff, and anyone who helped us along the way, for being extraordinarily welcoming, educating us, and making our journey possible. Thank you also to our supervisors, who each offered their own expertise to help us develop our clinical skills. And to each other, for working collaboratively and helping each other grow as clinicians.
We will never forget our time in Ghana. Medase pii!
We left Kumasi at 4:30 in the morning, and slept soundly as our expert driver and navigator led us through thick fog and heavy traffic, around familiar potholes, and past Liberian refugee camps. Our rush back to Accra was temporarily interrupted by policemen who noticed the speeding bus, but we paid the ticket “on the spot” and were back on the road on time to meet the surgical team in the Reconstructive Plastic Surgery and Burns Centre at Korle Bu Hospital.
The surgical team was gracious enough to wait for our arrival to begin surgery for several cleft lip and palate patients. Our group divided into three teams based on academic and clinical experience with cleft palate, and took turns observing Dr. Paintsil, Dr. Laing, and Dr. Ampomah repairing cleft palates for an infant and then a six-year-old.
As the first group observed Dr. Paintsil, he told them the patient’s background, and explained each step of the surgery. This group observed the repair of the infant’s cleft palate, who had previously had his lip repaired. Dr. Paintsil told the students that the child seemed to have typical cognitive development, and that since the repair was being done so early, he would most likely speak almost typically after he healed. Dr. Paintsil also introduced the students to the other professionals in the room, including the scrub nurse, Comfort, the orthodontic surgeon, and several medical students. The students in our group were impressed and inspired by Dr. Paintsil’s thorough knowledge of his craft. He was very savvy about speech production, and pointed out all relevant anatomical structures to the students, including several muscles, the lateral pharyngeal walls, and the tonsils. He explained that since the oral muscles are so important for feeding and speech, he uses non-absorbable stitches when repairing the muscles to ensure that the closure will hold.
The teams from our group that were not observing surgery were upstairs providing speech, language, and feeding therapy to the cleft lip and palate patients and their families. The students saw several children of varying ages, and one adult. When evaluating the children, the students would often first ask the parent to open their mouth, and would look at it with a flashlight. After seeing their parents cooperate with the student-clinicians, the children were more comfortable and willing to show us their clefts or repairs. Many of the youngest children had already had a lip repair but were waiting for their cleft palate repair, and sessions with these children mostly consisted of feeding therapy and recommendations to encourage production of sounds that can be produced correctly even with a cleft, such as nasal sounds and vowels.
Many of the older children had already had complete repairs, and were given articulation evaluations and recommendations. One child, age six, was a student-clinician’s dream come true. She had had a cleft of the anterior part of the secondary palate repaired two months earlier, and was otherwise very healthy. Her cleft had been discovered because her speech “didn’t sound right” to her parents or teacher. She was very intelligent, as was her father, who had been listening carefully and noticed her difficulty producing /s/ and /t/ sounds. The student-clinicians also asked her to count and say the ABC’s, and discovered that she had difficulty producing “ch,” “sh,” and /f/ sounds. She watched the student-clinicians very carefully as they showed and explained to her correct tongue placement and airflow techniques, and was able to imitate every sound correctly after only a few tries. Her father had also been watching closely, and practiced cueing her correct sound productions using the student-clinicians’ techniques. The students gave the family lists of facilitative sound sequences and words to use alone and then in sentences, so she could practice her speech at home. The shy child smiled several times as the session concluded, and her father beamed back proudly.
|Dr. Albert Paintsil|
It was a long day, and our dinner that night was the first meal we ate. But thanks to our ever-expanding knowledge base and cultural awareness, most of us already felt fulfilled.
Wednesday, January 18, 2012
"Disability is not Inability"
The title of this blog entry is a phrase we have repeatedly heard during our time in Ghana. One might find this strange since we have learned throughout our coursework that in Ghana, having a child with a disability is often perceived as a curse or punishment for wrong doing. We were first introduced to this phrase at the professional development workshop we participated in with the unit school teachers. Many of the teachers cited this phrase in a survey they completed at the end of the session. It was further expressed this morning by Dr. Anthony Kwaku Edusei PhD., a project manager in the Masters program at the Centre for Disability and Rehabilitation Studies (CEDRES) at the Kwame Nkrumah University of Science and Technology (KNUST). He graciously gave us a tour of the facility and information about their programs.
The Centre, the only facility of its kind in Ghana, focuses on training professionals and conducting research within the field of special education and disability. They are trying to create opportunities and improve quality of life for the disabled population. Albert Osei Bagyina, one of the speech-language therapists in Ghana who we have been working with over the past several years is a lecturer at this center. The students who typically enter the Masters program have backgrounds in health, law, social work and education. Our esteemed colleague, Belinda Bukari, is currently enrolled in this Masters program. We had the opportunity to wish her and her fellow students luck before their final exams!
Dr. Anthony Kwaku Edusei explained that in addition to the Masters program, the school is offering an undergraduate degree in special education. A short training program is also available for those who wish to learn more about working with individuals with disabilities. Parents are encouraged to enroll in this coursework to increase their confidence when caring for their children with disabilities. The center is collaborating with the greater university community to increase awareness and acceptance of children and adults with disabilities. CEDRES is now offering an elective class to all undergraduates at KNUST that focuses on improving attitudes toward disability as part of their special outreach initiative. It is clear that their efforts have been effective as Dr. Anthony Kwaku Edusei stated that the response from the community to CEDRES has been overwhelmingly positive. Our group was pleasantly surprised and overjoyed to learn that the view of individuals with disabilities in Ghana is beginning to change. In Ghana, disability will no longer be perceived as inability.
"Next Stop.. School"
As we arrived at the Unit School for our third and final day, excitement filled the air as we were greeted by smiling faces and warm hugs. The children were eager to start the new school day with us as they quickly found their seats. One of the teachers explained that several students did not attend school due to the “cold weather”. For those of you currently experiencing the North East winter, a cold Ghanaian day is 75 degrees… jealous? We continued to work closely and collaboratively with the teachers to build and expand the curriculum and concepts of the past two days. During attendance the children jumped out of their seats when they recognized their personal nametags. Later, these nametags were used to teach additional concepts. We were excited to see the curriculum that was created by previous groups from Teachers College continue to thrive.
The students proceeded to work on various activities developing their writing and language skills. We used a multisensory approach through reading, singing, writing and movement. We were extremely impressed with the children’s high level of engagement within each task. We worked with the teachers and modeled new interactive ways to use the material. The group integrated the previously learned concepts to ensure future mastery and sustainability. Next, we separated into small groups. We modified the new games funded by Wyncote Foundation that the teachers received at the professional development retreat this past Saturday. We incorporated many concepts into these games such as categorization, number concepts, matching and prepositions. It was evident the children were enjoying themselves, seen through their ear-to-ear smiles. Many of the general education students were intently watching the lesson through the window, assisting and encouraging the students in our classroom. This was so exciting to witness as it displayed an increased acceptance and awareness of students with disabilities. As our short school day came to an end (did you know Ghanaian school days end at 12:30 pm), we left with a sense of inspiration and encouragement from the interactions we had with the teachers and students.
Cleft Lip and Palate in Kumasi
It was a busy afternoon for the team, as they saw 19 patients back-to back! Of the 19 patients seen, there were several that stood out as especially interesting cases. One infant, just weeks old, presented with a bilateral cleft of the lip and palate. The doctor informed us that his weight was not the required 10 pounds needed for reconstructive surgery, so he had several more months to go before having his lip repaired. However this child was very engaging as he made eye contact and even smiled to several of us in the group. Another interesting case was a little boy who came with his mother. The child was scheduled for a surgery in the next couple of weeks, as he presented with a unilateral cleft of the primary palate. Dr. Obiriyeb informed all of us that after repairing the child’s cleft lip, he was going to “begin working with the mother.” This boy’s mother had tempromandibular stenosis, meaning the jaw had fused together so that she couldn’t open it for speech or eating. We were all amazed when thinking about how she has dealt with such a condition. The last patient that was seen was a little boy who had undergone major surgery that involved a resection of a portion of the face due to an infection that spread, as well as reconstructive surgery of the face. During the assessment, we were able to observe the patient being decannulated from the tracheostomy tube, which was especially interesting for those of us hoping to go into the medical field. All in all, this afternoon was excellent experience and preparation for Thursday, which involved more cleft lip and palate therapy!
Tuesday, January 17, 2012
The groups that were assigned to Komfo Anokye Teaching Hospital, our day commenced at approximately 8:15 am. We traveled by taxi from the Engineering Guest House through the busy morning streets of Kumasi to the Hearing Assessment Centre at Komfo Anokye. Those who were at the school the previous day had an abridged version of the extensive cultural greetings that many of us took part in the day before. The majority of the patients we saw were young children diagnosed with mild to moderate hearing losses who were in the process of trying to obtain hearing aids. One case that deviated from what had become typical of our caseload was that of a 26 year old woman named KL who had been diagnosed with a profound bilateral sensorinueral hearing loss. KL was accompanied by her mother’s friend who expressed much concern about KL’s condition. She stated that she knew about the center for some time now and felt that it was her duty to bring KL in for an evaluation. KL communicated with us through translations provided by her friend who spoke “Twi” and “Housa”, KL’s native language. Translations were possible because KL was an effective lip reader of the languages “Housa” and “Gonja”. We watched as the family friend over articulated words said for the purposes of emphasis, while KL looked attentively and responded in her native language of “Housa” in a low voice.
Our interview was conducted by asking our translator to translate our questions into “Twi” for the friend's comprehension. The message would then be translated into “Housa” by the friend and delivered to KL. KL would respond in “Housa”, the friend would translate what she had said into “Twi” and our translator would then relay the final message to us in English. With such an interview process we realized that our questions had to be short and direct to obtain salient information, while ensuring that little was lost in translation. We learned that KL had a sudden onset of hearing loss following a severe headache which she described as “heaviness in the head” and later her hearing gradually worsened to the level that it is now. KL is currently a hairstylist in the city of Kumasi. She had traveled from the north in order to seek work as a means of earning money to treat her hearing loss. The session consisted of primarily counseling and explanations provided by KL. We were informed that KL was unable to read or write because she was kept from attending school as a result of her hearing loss. We learned that her biggest communication issue was understanding people who spoke “Twi” because she only understood “Housa” and “Gonja”. She informed us that she had minimal issues when it came to her work because the hairstyles that she specialized in had the same name across all languages and therefore she was able to provide her pricing accordingly for individual customers.
As students our biggest challenge was identifying the lines that separated our scope of practice from that of the audiologist. As future speech language pathologists we did not have the authority to recommend or not recommend hearing aids and could not specifically explain the benefits and disadvantages of her receiving a hearing aid due to the fact that this is mainly the role of the audiologist. Our main goals were to facilitate communication through the use of AAC and to increase the volume of her words and phrases. Increased volume was targeted through the use of breathing strategies and self-monitoring. Initially the latter was facilitated by another individual, providing visual cues of whether she should increase or decrease her volume. This feedback would enable her to continue communicating in her native languages more effectively. AAC, specifically the use of a communication passport would inform others of the languages KL spoke and the best ways to communicate with her. What we found to be amazing was how well KL had compensated for such a degree of hearing loss but what was troublesome to us was that she was not afforded an education as a result of her disability/difference.
On our way to the Effiduase school today, our tour guide, Mr. George Odoi, educated us about a revolutionary woman, Nana Ya Asantewaa. We passed by a statue of her and her home, which sparked the lecture. According to George, Nana was a woman who led a small army of men to fight against the British during colonial times. She was caught by the British, locked in Senegal, and never returned home.
When we arrived at the school, the students were already present and seemed excited to meet us. In two hours, the students learned the animals, the song, "O'McDonald Had a Farm", and the name tag activity. Some children had difficulties following the teacher's directions to repeat words during the vocabulary activity that one of the children could only say "at" for "cat". Ms. Miriam Bigorri suggested to use phonemic awareness to help those children learn new words and it worked for them as they picked up the new words soon after. Later, we went outside where children in the general education classrooms were playing football and chasing each others. We sang and danced with the children from the special ed classroom and other children on the playground joined and laughed with us. At that moment, I knew the children from the special ed classroom were accepted by their peers. Afterward, we quickly practiced how to use the AAC market cards with the children before we went to a local market. At the market, people were very friendly to the children when they used the AAC cards to purchase vegetables. A mother of one of the children worked in the market and proudly informed us that she was the child's mother. We ended our day at the school at noon and sang the 'good-bye' song to each other.
After lunch at the Culture Center in Kumasi, we headed to Ahwiaa, a craft village, near Kumasi. It rained as we were almost there. When I was thinking if it was going to rain a lot and interrupt our schedule later on that day, it stopped without a sign just like when it came. There were only a few drops scattered along the road and after it stopped raining, it looked like it didn't rain. Mr. George Odoi said that it might be the only rain they have in Ghana when it's not the rain season. The owner of a craft shop, Mr. Kuanme Opuku, greeted us and took us to the place where they make crafts. The carpenters were making chairs at that time. He explained the procedure of making a chair and informed us the types of wood (I.e., white cedar, red cedar, mahogany, and ebony) when making different kind of crafts. Every chair has a similar shape and size, but with different Ashanti symbols, such as "Gye Nyame", meaning "except for God"; "Sankofa", meaning "go back to your root". According to Mr. Opuku, Sankofa is the most popular symbol among all.
Our next stop was a village which specialized in Adinkra symbols. Adinkra is a process which entails the use of traditional ink known as adinkra aduru. The ink is placed on carved symbols and then pressed onto selected fabrics and even pottery. The symbols depicted are generally common proverbs, historical events and even attitudes and behaviors related to the symbols selected. Adinkra was originally produced by the Gyaaman clan of the Brong region, and was initially used by royalty and spiritual leaders for special ceremonies such as funerals. The adinkra aduru ink is created by boiling the bark of the Badie tree along with iron slag. Adinkra printed cloth is used for other occasions in Ghana such as weddings. The word Adinkra means good bye, which is related to its original use for funerals. We then visited another village which is said to produce the best Kente in Ghana. We saw the intricate process in which Kente cloth was made. The weaving machines which were made of wood, were equipped with thin strands of thread, and stood in a house which appeared to be located in the center of the village. We were informed that the process of making Kente cloth and designs was one that was long and required much skill. If an individual is creating a symbol or writing a word, he must create the image backwards and upside down in order to achieve the final product desired, which adds on to the difficulty of the weaving process. After adding on to our knowledge about the extensive Ghanaian culture we made our way back to the hotel.
Ms. Belinda Bukari came to our hotel in the evening with her colleagues in the program of MS in Disability and Rehabilitation Studies to give us a class about her work with children with intellectual disabilities in Kumasi. She started the special education classroom in the Effiduase unit school with the help of a foundation and churches. At first, Ms. Bukari encountered challenges in her community when educating people to send children with disabilities to her school. But people didn't understand her actions and were not willing to accept the children with disabilities that many people actually pulled their children with normal development out of her school. People in the village also believe that Ms. Bukari would be cursed by working with those children, and they rushed to see if her newborn baby was born with deficits after she gave birth to one of her sons. Of course the baby was born healthy, who we met at the hotel. Although, she faced more difficulties later on, she never gave up. Because of her persistence of developing the special education classroom, people in her community embraced her actions and sent children with disabilities to her school. Later on, more and more people joined her work and helped her develop the special education classroom. Additionally, not just people from Ghana but also from the other parts of the world have been very supportive. For example, she mentioned Professor Cate Crowley and her graduates students from Teachers College, Columbia University bringing new techniques and materials, such as AAC cards to the school when they visit Ghana annually since the first visit, 5 years ago. Overall, I believed that what really moved Ms. Bukari was probably her love for children with disabilities as she said "There is no motivation (of doing this work). If you like it, you do it."
As our meeting with Ms. Bukari and her colleagues came to an end we were interrupted by the sound of a drum in which we heard a bang and several seconds later bang ba da bang and wondered who in their right mind was drumming in the hotel’s courtyard. We soon realized that this interruption was not at all an interruption but instead a surprise performance arranged by Professor Cate Crowley and Mr. George Odoi. We all left the conference room and saw a live drumming band seated at the head of the courtyard. Everyone was overwhelmed with excitement and was genuinely surprised. The head of the band, who we had met earlier at the craft village, Kuanme Opuku greeted us and introduced his drumming group and dancer. We were then given an introduction to the dance we would soon learn. The dancer initially used slow steps and arm movements that were held close to her body. She wore a long two piece garment that barely swept the ground. As the beat sped up so did her movements and as the drummers indicated their change in pace with distinctly space beats she stood pounding the air with her fist waiting for her cue to commence. We spent a fair amount of time watching attentively at the dancer’s movements. Many of us attempted to imitate, initially with little success and others opted to freestyle. Before we knew it we were all dancing to the beat of the drums under a florescent full moon, however cliché that may sound. By the end of the session we all had received an intense unexpected workout, said our farewells to the band and dancer and went back to our rooms to prepare for our fifth day in Kumasi.
~Sih-Chiao Hsu & Claudine Petit~
Monday, January 16, 2012
After a comfortable night’s sleep in our hotel in Kumasi, Monday morning found us eagerly anticipating our two new placements. As Amy mentioned below, one group of students boarded the bus to head to the Effiduasi School, which serves children and adolescents with developmental disabilities. The other two groups of TC students crowded into several cabs to make the journey to Komfo Anokye Teaching Hospital located in the vibrant city of Kumasi. As was true of our entire first week in Ghana, both experiences proved to be nothing short of amazing…
Realizing that there were many other patients to be seen, our large group quickly broke into smaller sections and got down to work. With the insight and guidance of our supervisors, we saw a variety of young patients, including children with expressive language delay, autism spectrum disorder, hearing impairment, and apraxia of speech. A particularly challenging and touching case involved a 3-year old child who recently lost her ability to walk, talk, hear, sit up and eat after an extended seizure less than a month ago. We felt moved by the resilience and strength displayed by this young girl and her mother, and were able to provide recommendations regarding the type of linguistic input that would be necessary prior to and after the child received hearing aids.
Although the day was filled with similar obstacles and challenges, including dependence on interpreters in order to communicate with many families, the deep love and concern of the parents continued to shine through with every patient that entered the door. Pride seemed to be another common theme amongst parents, highlighted by one father who, after learning how to withhold bubbles and appropriately model the 'b' sound, heard his daughter use her voice to request something for the first time in his life.
Every day, we continue to realize that the short time we have with each patient is only beneficial due to the support, motivation and commitment of their family members. The strong involvement that parents and caregivers have during our assessments, interviews, and development of treatment plans for home carry-over is essential to the success and improvement of every patient we see here in Ghana. We plan to bring this mindset back with us to the U.S. when working with clients and their families in the future, regardless of the setting or the client's diagnosis or age. And for this we say "Maydasay" (thank you) for another day of priceless lessons.
We arrived at the Hearing Assessment Centre of the hospital after maneuvering through the typical traffic (since most Ghanaians wake up between the hours of 4am and 5am, everyone had already been up for hours). There we met Albert Osie Bagyina, who had also made the 4-hour journey from Accra to Kumasi, as he does every week to see patients. Albert proudly introduced all 14 of us to most of the staff, as is customary in Ghana when arriving somewhere new.
Before breaking into smaller groups, we assessed our first patients as one collaborative group. The 4-year old twins, who entered the therapy room with their father and brother, began exploring and interacting with several students immediately. A detailed parent interview revealed that the twins were born 2 months premature, weighing 3.5 lbs. at birth, and suffered from moderate to severe hearing losses, one worse than the other. In addition to lacking auditory stimuli, the twins appeared to have visual problems as well, limiting their sensory input to primarily touch. Although our group was large, we continued to work together to engage and assess both girls individually through the use of bubbles and singing, building off the knowledge and clinical judgment gained over the past week. With the concept of sustainability in mind, we were able to provide techniques and recommendations for the father to continue to implement at home. Specifically, we stressed the importance of increased language input to support the girls' sensory difficulties, including the use of eye contact, exaggerated facial expressions, gestures and sounds, modeling simple language consistently, the use of music and singing, and following up with vision and hearing testing, primarily regarding the use hearing aids. After the twins' thankful father expressed his deep gratitude as he wished for our safe return to the U.S. later that week, we reflected on how the girls' development demonstrated the importance of a multidisciplinary approach to therapy.
|One student models a gesture for a nonverbal child|
|Students gather background information about the child|
|Students assess the child, interview the parent & write recommendations|
Akwaba! We are all feeling a little more Ghanaian every day thanks to the continued guidance from our guide George Odoi. He continues to share the traditions of Ghana with us every opportunity he gets. As each day passes the impact of the work going on in Ghana becomes more and more apparent to all of us who are here participating in the clinic and school. I came here to gain clinical experience and to help educate the parents, children and adults who come to see us in the clinic. I now realize that the Ghanaians I have seen in the clinic and schools have taught me more in two weeks than I could ever teach them in a lifetime. After speaking to a number of my colleagues in the group, it is clear that so many of us share this perspective.
The group split up today and one group went to Komfo
Anokye Hospital in Kumasi to support the speech therapy clinic and the other traveled to the Unit School at ( established by Belinda Burkari). Effiduasi Methodist School
We made name tags on the spot for the students that did not have them and then sang the name song and all the students clapped and sang along. We also had the students participate in a role play activity with the AAC cards to prepare them for our field trip to the market. It was clear that the students have practiced with the cards and were excited for the field trip to the market. The group continued to be amazed by how much the teachers are able to accomplish with so little funds for materials and supplies.The highlight of the day was taking the students to the market. Each group member took two students and assisted them as they produced their picture card for the item they chose to purchase (okra, onions, tomato, red pepper and fish). To see the sense of accomplishment on each student’s face was priceless. Effiduasi’s students are breaking the stigma of having a disability in Ghana. A mother of the students was working at the market and was so proud of her child when she saw us there shopping.Trips to the market allow then to demonstrate their skills and allow them to make a valuable contribution to their families and community. One market transaction at a time, the students are demonstrating that they are not cursed and that their condition is not contagious.