Friday, January 20, 2012

Our Last Day in Ghana

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
Finally, we joined for our last meal together in Ghana at the Cockpit Grill. Many enjoyed their last fill of jollof rice and red red, while the more adventurous opted for banku. In the meantime, we danced to the two main Ghanaian songs we have come to know and love, the catchy chart-topper Waist and Power and the popular dance craze Azonto. Finally, the time came to say our thank yous and goodbyes. Our supervisors Cate, Miriam, and Pam presented each of us with a Certificate of Completion and we sang all of the traditional Ghanaian songs that we have perfected over the course of the trip in-between sentimental speeches.

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.

Adonzo


We will never forget our time in Ghana. Medase pii!

-Christin Chambers

Back to Korle Bu; Cleft Palate Surgery and Therapy- January 12th

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 
Dr. Laing
Following therapy, we participated in a cleft palate conference, held monthly, attended by the surgeons, nurses, orthodontic specialists, anesthesiologists, and other professionals such as speech- language therapists, audiologists, and Ear Nose Throat doctors.  This conference was a multidisciplinary approach to treatment in full glory, with Doctors Laing, Paintsil, and Ampomah leading, and all other specialists contributing knowledge and recommendations.  A student-clinician from our group presented on each patient who had been seen for therapy, and information and recommendations were shared.  Recommendations included speech and language goals, as well as referrals for additional surgery, dental work, audiology appointments, and neurological evaluations.  The surgeons asked us questions about our observations and recommendations, and occasionally quizzed us on our cleft palate knowledge!  One important piece of information gleaned from this meeting was that our feeding recommendations had to be adapted.  “In the tropics” bottle use is not encouraged, because bottles can serve as breeding grounds for bacteria due to the heat and/or poor hygiene.  The students took this information into account and modified their feeding recommendations during subsequent presentations. 
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. 

-Charity Delsie

Wednesday, January 18, 2012

Our Varied Experiences

"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.
-Samantha Harris

 "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. 
 -Ashleigh Ayars

Cleft Lip and Palate in Kumasi

This afternoon was an interesting one for our group! We had the great opportunity to observe the weekly cleft palate and craniofacial clinic with Dr. Solomon Obiriyeb and his surgical team at Komfo Anokye Teaching Hospital in Kumasi. Everybody met up after a busy morning of therapy, and ate a quick “on the go” lunch on the bus before heading to the hospital. We were led to meet Dr. Obiriyeb, who greeted us warmly and ushered us into his consultation room, where he would be having check-ups’ with his patients with cleft-lip and palate and other craniofacial abnormalities. It was a bit of a squeeze for the whole group, but worth it for this informative afternoon! The patients mostly consisted of infants and toddlers accompanied by their parents, who were seen one by one by Dr. Obiriyeb. These check-ups were both pre-surgery appointments and post-surgery. It was so interesting and exciting for all of us to be able to apply our knowledge we learned in our Cleft Lip and Palate Therapy course, and see in-person examples of cases!!



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!
-Taylor Knotts

Tuesday, January 17, 2012

Culture and Therapy: The Best of Both Worlds

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

New Placements, New Lessons

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…  

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. 
The 4 year-old twins interacting with student clinicians

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
     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. 

Students gather background information about the child
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.

Students assess the child, interview the parent & write recommendations
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.

-Kate Bither
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 Effiduasi Methodist School ( established by Belinda Burkari).
 The professionals working in the Unit School at Effiduasi Methodist School continue to inspire just as the doctors in Korle Bu. They have such an amazing ability to do so much valuable work with so little funding. We arrived in the sweltering heat and were greeted by the beautiful, enthusiastic smiles of the students we have traveled so far to meet. The children started school a day early because they knew we were coming. We were all so impressed by the continued progress that the teachers and assistant teachers are making with the students. It was clear that the students have continued to build on the lessons taught and the materials left by last year’s team. We were all thrilled to see the giant books were worn from being read every day, and that the students have come to know and love the stories.

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.

We traveled to the Cultural Center in Kumasi for lunch and to share and reflect our experiences. George showed us how a real Ghanaian eats fu-fu. A couple people in the group were courageous enough to try fu-fu.  The day ended after a little more shopping with a spectacular view of another African sunset

~Amy Erickson

Thursday, January 12, 2012

Sunday Fun-day in Kumasi

After a successful, yet exhausting Saturday, we were all thrilled to sleep in.  Many of us slept at least eight hours with perhaps a small interruption from a friendly neighborhood rooster in the early morning.  By 9:30am we began trickling into the dining room for breakfast.  As more arrived, we reflected on the past weeks events and excitedly discussed our new surroundings to explore on this beautiful Sunday in Kumasi.

Refreshed and well fed, we made our way out to the pool at our temporary accommodation and received our fill of vitamin D and story time.  Shortly after, we were off to settle in at the Engineering Guest House at KNUST (Kwame Nkrumah University of Science and Technology).  Those of us who had time quickly checked out our new hotel rooms and reported positive findings to the rest of the group.  At last, we were ready to enjoy a day off from all of our hard work!

Post scene photo with the actors
With a short drive, we found ourselves in a large artisan market with shops selling various goods from jewelry to woodwork.  George Odoi had explained to us that Joel Kwadwo Acheampong, one of the artists, was unable to use his legs and arms but was able to create his paintings by holding a paint brush with his mouth.  Unfortunately, Joel wasn't at the market today but we saw some of his paintings and made sure we would be able to meet him during our next few days in Kumasi.  Many other shops were closed and as we were preparing to move on to another market, we notice a few people filming something.  George made his way over and asked a few questions.  Next thing we knew, we were starring in a scene in a Ghanaian movie!  The movie told the story of a blind man who had been orphaned at a young age.  A handful of us had lines in the scene and the director helped us through our 15 minutes of Ghanaian fame.

After a brief water and snack break, it was back to our mystery adventures in Kumasi.  With some more luck and bargaining, we found ourselves at a festive music event where performers were sampling new music.  There were hundreds of Ghanaians in attendance including a chief from a small village in the North.  George had explained to us that people from the audience would be taken from their seats and brought up to the stage.  With persuasion from the host of the event, friends would then have to help "bail" them out with donations.  The donors would bring money to the stage and place it upon their head, which was seen as a sign of respect.  One of our own, Skye MacLeod performed clarinet on stage with one of the Ghanaian musicians and while he performed, we each went to the stage and placed money on Skye's head.
Skye MacLeod jamming on stage in Kumasi
Some Ghanaians joined in and helped support Skye.  However, stiff competition was yet to come as a small boy of about 7 years came to the stage.  The crowd went wild.  He sang two great songs (one including the alphabet!) and blew us away with his dance moves.  Needless to say, people were running to the stage to praise his performance with donations.

We spent a little while longer listening to performers and being entertained by the host's enthusiastic mannerisms and intonation, although we were uncertain of what he was saying since he was speaking a native language from Northern Ghana.  Before leaving, two students mustered up the courage to delve into the events a little bit further.  One student was taken from the crowd and earned her donations to be freed and rejoin the group, while another joined the musicians, embracing the music and engaging in traditional African dance.

On our trip home, George explained to us how tribes in Ghana often receive different markings to help identify their tribe.  Although this isn't as common today, some still practice it and a number of students had asked about the different types of markings that they had noticed.  Interestingly, being in "Ashanti land" (Kumasi), we discovered that Ashanti's have a great disdain for tribal markings because there is a rule that no royalty can have marks on their bodies.

At the end of this adventure packed first day in Kumasi, we enjoyed our typical dinner of rice and chicken or fish.  We learned our groups for our next three days in the Komfo Anokye Hospital and Effiduasi Methodist Primary School's "Unit School" and held a short review of the cleft palate course that many of us had taken this past summer.  Winding down, we each headed off to our new rooms to rest up for an exciting week two of clinical work in our new location.

-Dana Peterson

Professional Development Teachers Retreat (Program for AAC) Day

January 7th, 2012

Clement Ntim showing communication passports
The day started off as we woke up early in pitch black darkness, heading to Nkawkaw 5:00 in the morning. Today was a special and important day for all of us (including Ghanaian special education teachers) as the Professional Development Teachers Retreat (Program for ‘AAC’ Day) was held in Nkawkaw. The purpose of the professional development retreat was to share language skills and knowledge with the special education teachers and do collaborative work with the Ghanaian colleagues in order to enable students with special needs to learn at higher levels. All the TC SLP students spent the night before preparing educational materials (e.g. name tags, name tag holders, AAC cards) for this significant event. Due to lack of sleep and exhaustion, many felt tired and dozed off in the bus until we arrived at the Osankwa hotel at 10:00am. However, as we got closer to our destination, we became alert with alacrity as we noticed two figures standing and waiting in front of the hotel. They were Belinda Bukari (Head Master/Teacher at a Unit School) and Clement Ntim who also were in charge of leading the professional development retreat. They warmly greeted us when we arrived at the hotel. When entering the conference room, we noticed that the room was packed by eager Ghanaian teachers who came from unit schools of many regions.
When the teachers retreat began, Clement initially acknowledged Cate Crowley and Miriam Baigorri’s endeavors and great efforts as he referred them as the “brain[s] behind this whole wonderful event” and showed deep appreciation of their hard work to make an educational and social change in Ghana. An introduction of the Communication Passport regarding its term, use, purpose, and needs for target populations was presented by Clement Ntim. His transparent explanation and passion for the aids that can be provided to children with nonverbal or limited verbal communication was impressive and straight to the point. He emphasized the value of the passport and the significant impact it will bring upon students who use it. The other teachers expressed deep interest and eagerness to learn about this communication system as they nodded their heads frequently while taking notes or pictures. Afterwards, the teachers and students broke into small groups to create a Communication Passport with collaborative work. The teachers were specifically instructed to select an appropriate candidate of Communication Passport from their class in advance to the retreat. Each group presented their Communication Passport with refreshing ideas and thorough details that amazed not only the TC students but the clincial directors and supervisor. 
Belinda introduced name tags with symbols and provided literacy and language activities that can be used and taught the teachers a simple song that can be used during attendance. The TC SLP graduate students also shared additional activities that could be applied monthly during attendance or classes for other subjects. Afterwards, AAC market cards were distributed to the teachers with information on how the AAC can be effectively used in practical settings. Toward the end of the teachers retreat, all teachers that participated in this professional development received a certificate to honor their work in Ghana and also their achievement in acquiring educational knowledge and skills. Thanks to the Wyncote Foundation, we were also able to purchase educational resources and books and distribute them to the teachers along with the certificate. The teachers retreat was a huge success. 
Here is a 3 minute video on the day
http://www.youtube.com/watch?v=ocJMBbD6r0g&feature=youtu.be

African sunset
We then continued on our journey for the final destination of the day, Kumasi. The plan was to stay at the KNUST School of Engineering Guest House. Unfortunately, when we arrived at the guest house, the manager made a mistake of reserving our rooms for the following day. Having no choice, we needed to seek another hotel accommodation for the night. The closest place was called King’s Tower, but running out of luck, we could not be able to get ourselves rooms. One colleague was witty enough to quote at that moment, ““All this in and out, back and forth, is worse than being in a relationship”. While heading toward another hotel, we were fortunate to see a beautiful African sunset. The red sun hung low in the sky, looking as if it was nested comfortably above the lush forests with beautiful tropical trees, creating a magnificent view. The African sun put a nice, pleasant smile on our faces making us forget about our worries for a moment. But then, back to reality, we kept on searching for another hotel the hope to have a place to rest. Our final stop was the Treasure Land Hotel, a place where Cate had mentioned to us a funny story about a Peeping Tom (or a Peeping Kwami) at this hotel. Hopefully, nobody will have the thrilling experience of meeting this mysterious figure.
It was a long day but nonetheless a memorable day that we won’t forget. We are looking forward to another adventurous day at Kumasi tomorrow.


Binna Lee

Sunday, January 8, 2012

Day 4 at Korle-Bu Hospital

After breakfast, we left the hotel to Korle Bu Hospital like the past three days.  Students separated into their groups and started working with patients.  Each group saw approprixately 2-3 clients with different types of communication disorders.  Similar to the past few days, we conducted parent interview, assessed the patients, and made recommendations.  Today was less busy because George informed us that people in Ghana prefer to rest on the weekend including Friday.  Hence, there were less patients today.

Three students were assigned to the audiology clinic, where they performed hearing screenings.  Seven students visited the Reconstructive Plastic Surgery & Burn Center, where they read books to children, who had surgery.  These students visited the 5 months old baby, who had his cleft palate repaired on Wednesday.  It was observed that his grandma was feeding the child in an improper posture.  Subsequently, one student recommended and educated the grandma the proper feeding position (i.e., upright position) and food consistency (i.e., thicker liquid).  It was imperative to discuss the anatomy briefly because milk and water were coming out of the child’s nostrils.  It was reported that the child also has an opening in the secondary palate.  Therefore, the student explained how everything is connected.

After placement, we went to the Dean’s Guest House for lunch.  Our clinicial director, Miriam Baigorri, asked us to reflect on the first day and the last day, share what we learned, and what do we want to improve.  Many students thought about the questions while enjoying their lunch.  One student stated, “I learned a lot because I haven’t had a placement.  It’s so different compared to the clinic at home because we’re assigned to work with the same client throughout the semester.”  Another student replied, “I think my clinical judgment has improved significantly within the four days.”  She elaborated by saying how she exhibited difficulty identifying individuals with a disability initially.  Collectively, all students felt they have improved in making clinical judgments, conducting parent interviews, assessing the patients, and providing appropriate recommendations.  

We returned to the hotel around 3pm to pack for our next destination, Kumasi.  We all got together at 5pm to discuss tomorrow’s schedule and to prepare for the Professional Development Retreat.  Most people went to bed early because we have to wake up at 4:30am.  We are looking forward to our placements in Kumasi!!

-Yuk Lan Peng

Thursday, January 5, 2012

Third Day at Korle-Bu

Our day started with extra excitement and alertness, anxious to keep up with the schedule for today without any delay. As excited as we were to see the new patients waiting for us at Korle-Bu Hospital, we also had another big event of the day in the back of our minds; it was the meeting with the Minister of Health of Ghana, Hon. Joseph Yieleh Chireh. We were blessed with the amazing opportunity through one of our colleagues, Christin Chambers, who was able to arrange the meeting with the Minister of Health through her fortuitous acquaintance. So all of us were packed and ready for the hospital earlier than usual to make sure that we had time to see all of the patients by noon, for which was when our meeting was scheduled.

When we arrived at the hospital, we were divided up into four groups with our three supervisors and with one group joining the Audiology clinic to participate in the hearing test procedures. It was evident that the student clinicians have increasingly become more confident and effective in treating a variety of patients at the hospital, even through the pressure added by the cameras and reporters from TV-3 channel that had gotten there early before our meeting with the Minister of Health. One of the most memorable patients today was a 19-year-old male who has stuttered his whole life before coming into the Korle-Bu speech and language therapy clinic for the first time today. He demonstrated with a severe stutter during his initial assessment for speaking and reading. However, with the use of the techniques introduced by the student clinicians, such as the easy onset and Melodic Intonation Therapy, the patient was able to produce sentences and read with perfect fluency. During the interview with TV-3 right after he came out of the therapy room, he commented that he “feel[s] a lot more confident now," and that he was "glad that [he] was here."

Our meeting with Ghana's Minister of Health
With another day of adventures and excitements at the hospital behind us, we moved to the place where the meeting with the Minister of Health was held. Veronica Adjei kindly arranged this meeting for us. First, a warm word of Akwaaba (welcome) was given by the Minister of Health as well as a few other board members of the Ministry of Health that were able to join us in our meeting. Then, Dr. Crowley and a few members of our team spoke briefly about our past few years of experiences in Ghana, some of our current goals and accomplishments, and about some future, long-term goals regarding the speech and language services in Ghana, such as the establishment of the Speech and Language Pathologist training programs in Ghana as well as a possible pilot program for providing speech and language services from the United States to patients in Ghana through the use of Skype. The constructive and positive responses from the Ministry of Health throughout the meeting has unveiled a vast amount of opportunities and potential for further development of independence and sustainability for the speech and language services in Ghana.

Sowah Tetefio, Celestine Sappor, Amy Erickson,
 Pres. Victor Asante, Sheila Zotorvie, Dr. Cate Crowley,
and Dr. Emmanuel Kitcher
However, meeting with the Minister of Health was not the last crucial event of the day. Thanks to another colleague of ours, Amy Erickson, our team had been invited to have a meeting with a member of the Rotary International club in Ghana by the pool-side at a four-star hotel. We were able to discuss with them about the current and following collaborative projects regarding the Audiology department at Korle-Bu Hospital as well as the new SLP training program in Ghana.

With all the exciting events and meetings aside, famished students were happy to end the day by shopping for some groceries of our individual preferences at reasonable prices (unlike the drinks and salads at the four-star hotel...) at the Accra Mall. We will surely have enough food and snacks to sustain us through another adventurous day at the hospital!

-Jinyee Kim

Wednesday, January 4, 2012

Day Two at Korle Bu!

We arrived eager for our second day at Korle Bu hospital (the 3rd largest hospital in Africa, with around 2,000 beds!) having an idea of what we would experience, with heightened confidence and enthusiasm. Upon entering the hospital, we were greeted by the stroke victim that some of the students had evaluated the previous day. He suffered a stroke 2 years ago, leaving him unable to express his thoughts through speech; however, through assessment, the students found his strengths lie in his comprehension and compensatory communicative abilities, using a variety of gestures, pointing, and intonation of vocalizations. Although he was able to get some wants and needs met, he lacked a more productive communication system that would allow him to communicate socially. After our strenuous day of therapy at the hospital, the students, motivated by this man's story, strengths, and deficits, stayed up late constructing a personalized booklet for the purpose of alternative and augmentative communication (AAC). They used many of his interests, such as football (that's soccer for those Americans out there reading this), favorite foods such as fufu (a traditional Ghanaian dish, not a bunny rabbit), and family members, to create various pages for his book.

Although we felt accomplished and excited to share our patient's new book with him, we were apprehensive about whether or not his family would see the value of it as a significant means of communication since we learned in our classes here in Ghana that the Ghanaian culture holds eloquent speech in high esteem. Our fears were put to rest immediately upon witnessing the reactions of the patient and his brother to the page depicting football pictures (i.e. foul, team names, good game/bad game, etc.). Those smiles were truly worth the trip to Africa. Not only was the patient excited to explore these new avenues of communication, but his family began to recognize him as a viable communication partner once again. We recognized even moreso that this would truly be a sustainable system when we suggested that the family add items to the book that they thought would be useful, and his brother without hesitation named several more favorite foods and mentioned that he knew someone who could draw them on the extra pages of the book. One student guided the patient through using this new communicative system and how it can progress over time, and worked with the family to model its use. Another student dispelled the previous notions that the family held that his symtpoms were caused by a disease, by explaining the incident that occured in his brain, and what he can expect in his recovery.

Imagine that this was only our first case of the day! Next we split into three groups with our supervisors to see the remaining patients seeking our help. One group ventured off for a tour of the facility and to meet with other rehab specialists, such as physical therapists and audiologists. In an unexpected yet exciting turn of events, a few of the students were offered the opportunity to view a cleft palate surgery, and quickly scrubbed in. While the students jumped at the chance to see this live surgery after learning about it in our cleft palate class back at TC, our documentary film maker, Skye, agreed in the spirit of filmmaking while the color drained from his face.

Meeting with the Chief Executive of Korle Bu Hospital
When given the option to rest at the hotel after all our hard work or to meet with the Chief of the hospital, we all mustered up the energy and decided, "when in Ghana...!". At the meeting, we applied all the rules we had learned about Ghanaian etiquette. Dr. Crowley scared us enough in our first meeting for us to remember NOT to cross our legs! Fortunately we remembered this tip, among others, such as the way a group is always greeted by counterclockwise handshakes with the right hand. Stay tuned tomorrow for more details on this and what's to come... hint: you may want to ask your cable providers for access to Ghana's TV-3 to see the TC students in action with a surprise guest!

-Alana Krieger

Our First Day of Clinical Work in Ghana!

Ready for our first patient!
The day we have all been waiting for has finally come.  After breakfast at the hotel we briefly discussed our plan for the day before heading on our bus.  We drove only a few minutes to Korle Bu Hospital, where we met Albert Osei Bagyina, who for decades was one of the very few practicing speech language therapist in Ghana. (nb: in the past several years a new Ghanaian SLT qualified in England and is practicing in Ghana, a U.S.-Trained SLP moved to Ghana approximately 6 months ago, and 3 Ghanaians who were sent to England to qualify by the University of Ghana have recently returned to Ghana and are waiting to begin work.) Albert was very welcoming and informative, explaining his role at the hospital and his plan for us while we are here!

We then began to see patients who have come to the hospital to see our therapist team.  Although we broke our big group into 3 smaller groups for the majority of the time, we began by evaluating 2 patients together.  The first, a toddler who arrived with his mother said few words, such as 'yeah' and 'bye' and pointed to objects he wanted without sounds, was assessed as having a language delay.  After discussing his development with members of our team, the mother was given recommendations to expand his speech by modeling 'bi' for 'biscuit' and waiting for him to respond.  The more he does this, as well as other techniques, the more he will connect saying a certain sound, and eventually a word, for a specific item.

The second, a school age boy who has had hearing aids for 2 weeks had problems articulating /s/ /k/ /r/ /z/ and /t/.  The team worked with him by isolating the trouble sound in a word, such as 'seal', by running his finger along his arm while saying the /s/ sound for tactile stimulation.  As the parents were very attuned to his speech abilities, they were able to give detailed information about his school life as well as progress since he has had his hearing aids.

While in 3 smaller groups, there were a variety of cases we were able to assess and evaluate, including individuals with Cerebral Palsy, Aphasia due to a Stroke, Expressive and Receptive language delay as well as many other communication disorders.  This gave us all the unique experience of working with different patients of different ages in the course of just a few hours.  We all came away from our first day of clinical work in Ghana with a sense of accomplishment that we were able to help parents and family members communicate better to their loved one, as well as more ways their loved ones can communicate with them!

After a busy morning at the hospital, our team, along with Albert, enjoyed a wonderful lunch while outdoors, learning more from Albert as well as discussing our plans for tomorrow.

Proverbial Coffin at Artists Alliance
The rest of the day was enjoyed by all, going to the W.E.B. duBois Memorial for Pan African Culture, visiting where the African American leader lived and was buried with his wife.  We then drove to Umanye House where there were many beautiful paintings, beadwork, items of clothing and carvings for sale by a local artist alliance. The most intriguing pieces of art, however, were the coffins, which are called Proverbial Coffins.  These amazing coffins are made into shapes very specific to the deceased lifestyle, or a symbol of their clan or tribe.  Coffins on display at the alliance included a Coke bottle, Nike sneaker and tiger!  It would not be unusual in Ghana for someone to be buried in a Nike sneaker coffin if they were a well known basketball player.  Aside from being functional, the amount craftsmanship and artistry displayed through these coffins is truly unparalleled.

We ended the day by going to a local market where fabric, shoes and food (as well as many other items) were sold before heading back to our hotel for dinner and discussion about the day. Tomorrow is sure to bring more rewarding experiences!

- Shemaiah Villani