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

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