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~

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