What does hand washing have to do with Audiology?

It was an exciting day at Candy Floss, as we arrived with a black bin, finger paint and props for our skit. We had decided to do a workshop on hygiene at the preschool as we felt that this was an area that a lot of the children did not know about, or practice.

Our main motivation for conducting the workshop was from the hearing screening results. We have found that many of the children fail tympanometry as a result of fluid in the middle ear cavity, and most of the children came in for testing with a running nose or a cough. Through hand washing the spread of germs is prevented, which means that children will be less likely to get a cold or the flu, and therefore less likely to get ear infections. We also noticed that there are no handles on the taps in the bathroom, so hand washing is not a consistent activity.

Many organisations have conducted research on the impact that hand washing can make. UNICEF found that hand washing with soap can prevent respiratory infections (which often result in fluid in the middle ear) by a quarter. The Centre for Disease Control and Prevention found that hand washing not only prevents sickness and diseases that can lead to death, but their research has shown that children who were given intensive hand washing promotion for 9 months, later reached developmental milestones 6 months earlier than the children who did not receive the hand washing promotion. You can read more about it here.

I recently came across a Youtube video of a project called Hope Soap that has started in South Africa. It is worth the watch, I LOVE the idea and it is sure to put a smile on your face :)

We started the day by dividing the children into their 3 different age groups so that we would have smaller groups to control, and started with a skit. The message of the skit was that we should wash our hands before eating, after using the toilet, playing outside, sneezing or coughing, picking up rubbish or petting animals. It was done in a fun, light hearted way, and we got the children involved by singing songs about hand washing with corresponding actions. Next our speechie friends did a hand washing demonstration on the correct way to wash hands and invited some of the children up to demonstrate what they had learned to their class.

We continued the workshop by giving some tips on ear care, such as not using Q-tips/ear buds. Even the teachers were surprised to hear that they should not be used to clean ears! Next we went on a litter hunt with the children and encouraged them to keep their environment clean and tidy. If you haven't read my post where I talk about the litter in the area and the preschool, here are some photos for you...

Litter in the play area after break time

Litter in the community

Once our hands were nice and dirty from picking up litter, we got all of the children around to wash our hands and practice what had been taught. It was slightly chaotic as they were all pushing to get to the front of the line, but at least they were enthusiastic about it! We had also bought a black bin that we were going to get the children to finger paint, however we ran out of time! The children are definitely looking forward painting it this coming Thursday.

I really hope that this small workshop will have made a BIG impact on the children at this school!

Teach a Man to Fish

This week I was involved in screening at Candy Floss, but before getting started I took a walk down to do a home visit follow-up. I had done an otoscopic examination 3 weeks ago on a young man with impacted cerumen and left instructions for him to get cerumen removal drops, so that I can eventually do a hearing screening on him. Myself and Lesley (another audio student) had gotten our hands on some cerumen management tools from the department and were hoping to use them on this follow-up home visit. Once we arrived at his house he told us that he hasn't bought the drops or oil yet...but then his mother came through with drops that she had purchased yesterday. It may have taken 3 weeks, but I was so glad that she had bought it! Not just because he needs to use it, but because it means that the family took our advice seriously and is taking responsibility for the sons hearing health. Since he hadn't yet used it, we decided that would will return in a week when the wax is softer, and then attempt to remove it.

Back at Candy Floss I spent the remainder of the morning conducting hearing screenings with a few of my classmates. Most of the children had type B or C tymps, and a one had impacted cerumen. These findings are consistent with what we have found in previous weeks in the other children, and its high prevalence is of concern to us. Many of the children have upper respiratory tract infections which are leading to fluid build-up in the middle ear and conductive hearing loss. We have been discussing this as a group and have planned a hygiene awareness day at the creche for this coming week, to educate the children on simple things like washing their hands after using the bathroom, to decrease the spread of bacteria and viruses.....hopefully it will be very creative and a lot of fun!

The more I become involved in community projects, both through university and outside in my own time, the more I am learning about making a sustainable impact. Helping people out and meeting an immediate need IS necessary, but just like that saying "Give a man a fish and you feed him for a day, but teach a man to fish and feed him for a lifetime" we can make more of an impact if we create something sustainable.There are a few projects running in South Africa that follow this principal- such as The Heiffer Project. In Mariannridge, we are realizing that the most sustainable difference that we can make towards hearing health care is through education. So far, we have taken part in 1 workshop with the community workers, aimed at educating them on the causes, signs and impact of hearing loss. By communicating this information with the ladies who are actively involved in the lives of people in Mariannridge, they are able to share their knowledge with others. We are running a second workshop this coming week at the Preschool, targeting issues surrounding hygiene. Our final workshop will be in collaboration with the Speech and OT students aimed at parents of children aged 2-6 on development.

It is going to be a busy few weeks leading up to the end of our Community Based Rehabilitation prac, I hope that we can use the short amount of time that we have left to make an greater impact the community!

Language stimulation at Candy Floss Preschool

We spent the whole morning at Candy Floss preschool on Thursday, and I was exhausted! I don't know how the teachers at the preschools manage! It was filled with giggles and story telling and games and hugs, and 3, 4 and 5-year olds, and tears and snotty noses and children fighting and dirt and grazed knee's. I have a new appreciation for preschool teachers!

We tried to follow the children's lead with their activities, and incorporate language development into their play. For example, when they were playing with hoola-hoops, we could target spacial relations, such as next to, inside, and outside the hoola-hoop.

We read a few stories with them, and this time we made sure that we were not confined to the words on the pages in front of us. We eventually had all the children acting out their routine of washing their faces, brushing teeth etc. We used the most animated facial expressions and this really kept the children interested and having fun! The aim of this was not just to stimulate language development, but to create an awareness of personal hygiene.

We did a few rhymes with the different groups, and it was interesting to note the difference between the 3-4 year olds and the 4-5 year olds both in the rhymes, language abilities and participation. It was easy to spot how much being in preschool for an extra year has impacted on the children who are older. With this being said, there are many children in the community who do not have any sort of schooling until they enter grade 1, and at this stage they are far behind the other children.

We are busy planning to host a workshop for parents, and through our tutor's guidance are learning a lot about working with the students from OT and Speech, what we should and shouldn't include, who should be invited, and they kind of material that should  be made available. There is lots of planning to still be done!

Women's Day in Mariannridge

Myself and a classmate arrived early to the community this week as we took our own transport, and decided to use our spare time drinking tea at the cafe and catching up with the ladies from the soup kitchen/knitting project until the rest of our class arrived. As the next day was Women's day, I had bought some pins to hand out to the ladies.

"I am an extraordinary woman"

Once we arrived at the cafe we met a group of people, many of whom were high school students, who are out from Shanghai on a 10 day trip to work into the various communities in the area. They too were going to be spending some time at Candy Floss Preschool after their tour of the community.

After our cup of tea, we headed up to Candy Floss. The children were in the hall watching a puppet/magic show. Those whose parents had not paid the R15 for the show were in a separate room, so we decided to do some language stimulation and story telling with them. We used a lovely book that incorporated different sounds, which enabled us to include more auditory aims into the activity. It was a bit difficulty working with so many children in a small room, as there were only 2 of us and a wide age range, but we managed to hold their attention for just long enough to finish the story. We then headed outside to the playground to do activities where the children would learn through play. These activities included "Simon says" and songs such as "ring-a-ring-a-rosy". Songs help to develop rhythm and rhyme, which are crucial for speech and language development, particularly for those learning a second language.

Halfway through the morning we headed back down to the library to help set up for women's day gathering, where the community worker had asked us to speak to the ladies about hearing loss. We set up tables, a 'pamper station' with nail polish, hand cream etc. and tea and coffee. The ladies who had been invited were all involved in helping in the community, such as community workers and ladies from the soup kitchen. It was so great being able to serve them and treat them to an enjoyable morning, as they are usually the ones serving others in the community.

Some of the ladies, gladly posed for a photo for my blog

Soon the room was filled with the aroma of coffee, laughs and chatter as all the ladies were seated around the tables. We began by explaining some of the causes of hearing loss, and informed them that if they feel that they have a hearing loss we will be available to do hearing screenings every Thursday. We then went on to explain the role that they can play in their community with regard to hearing loss, particularly in children. This included informing them about signs of hearing loss in children (not responding to loud noises) and milestones that are affected by hearing loss (such as the appearance of the first word around 12 months of age, 2-word utterances around 24months of age) and causes of hearing loss (Otitis media, congenital hearing loss, medication etc.). The information was welcomed by the ladies, and we ended off with a question and answer time before heading off home and leaving them to enjoy the rest of their women's day celebration.

We Walk

This week involved a lot of walking around the community. I would never normally walk around my community, but for some reason I love taking walks around Mariannridge, down to the library or to see the ladies knitting outside the cafe, or walking to do a home visit. Maybe it's the adventures that I find along the way, and the interesting people I get to meet. Sometimes it is rough, like the times when we walk through groups of teenagers smoking all sorts of things, or cross the road trying not to attract the attention of the stray dog with the gaping hole in his leg, or are greeted by an intoxicated individual giving hugs. At 10am. Sometimes the walks are beautiful, with the amazing warmth of the winter sun shining down onto us, children running up to greet us with the biggest smiles and giggles, and community members sharing about how much they love their community and the people in it. Cars stop out of pure kindness to offer us lifts up the hill, and we see primary school pupils utilizing the play area that the OT students put together. Our walks are ALWAYS interesting!

I have been thinking a lot about why there is such a strong sense of community in Mariannridge, compared to the community that I live in. Maybe it is because people live closer together, where as the houses in my community are separated by high brick walls or electric fences. Maybe it is because people in Mariannridge rely on each other more- families are far less likely to have nanny's or child minders in Mariannridge, so everyone looks out for everyone else's children...which reminds me of an African proverb:

In Mariannridge, it really does take a village to raise a child. Children can be so easily exposed to bad things in the area, but at the same time can learn important lessons, skills and values from those around them. For some of these children, it does take a village, as their parents are no longer around. So maybe it is because there is a greater need or reliance on those around them. Or maybe it is because people walk. I think that community happens when you walk.

I found this image a few weeks back, and I have been thinking about it a lot.

This week while walking around we went to find a young man who, according to some of the ladies in the community, has a hearing loss. We found his house and he came to the door, and was more than happy to hear that we had come to investigate his hearing. Within a minute I was conducting otoscopic evaluation outside his house, while he sat on a small broken chair. I am slowly getting used to these 'informal' environments that we work in at Mariannridge! Otoscopy revealed impacted wax in the right ear and what looked like could possibly be exotosis in his left ear, however there was some wax which prevented me from getting a clear view of his ear canal. We then explained some of the reasons why wax can accumulate in ear canals, how it can affect hearing and how to get rid of it. I have learned that most people from this community who have impacted cerumen will not go to see a medical professional for its removal, for various reasons such as travel time and expense, and the long waiting time at the hospital. So instead, we recommend individuals to either purchase cerumen removal drops from the chemist, or to use olive oil, and try to follow up a week or 2 later to see if that treatment has been successful. We wrote down the name of a few products that he could use, and we will be back in 2 weeks to see if the cerumen has made its way out of his ear canals. We will then be able to do a hearing screening to see if it is necessary for him to be referred for a full assessment. 

After this we headed up to the library, waited around for a few minutes for the library to open and then, together with student speech-language pathologists, met with the librarian about taking some of the children from the preschool on an 'outing' to the library where we would have story time. We could easily do this at the preschool, however we feel that there is value in getting the children excited to spend time in the library, with the hope that it would encourage reading and literacy development. We were given days and times that we could use the library, and hope that this small outing with the preschool will happen!

Back at Candy Floss preschool, we took groups of six 4-5 year olds at a time for some language development activities. These activities included simon says (using body parts), musical statues (for auditory awareness) and identifying picture cards while expanding vocabulary. We made sure to incorporate our aims into physical activities such as running and following commands on the jungle gym to ensure that they did not get bored or loose concentration, and to facilitate learning through play.

It was another great week spent in the community. The weeks to come should involve some of the community projects that we are currently planning for.

Back at Mariannridge- with Spread the Loaf!

First week back at Mariannridge! It was great being back at the preschool and seeing all the kids smiling faces. We were greeted with a stampede of hugs on arrival, with shouts of “hello teacher!”

We were also so excited as we have new audio screener! And our other screener had been repaired, which meant that we could now bring 2 screeners into the community- we brought one to screen at the preschool, and the other to the clinic.

We had a few spare minutes while the teacher was finishing off the morning session in the small room that we usually use for screening, so we took a walk down to the café to see the ladies who run the soup kitchen. I have been helping one of my close friends (who is a student speech therapist currently doing her Community Based Rehab block) with an NGO that she has started called Spread the loaf. She raises money through donations and raffles, and we then buy a few hundred loaves of bread to hand out to people in communities that are in need.  This July, Rotary have helped us out with some sponsorship, which has enabled us target more communities. We decided that Mariannridge will be one of the communities that we distribute bread to this round, and the ladies who run the soup kitchen were delighted to hear the news! 

After discussing our plan for Spread the Loaf, we headed back to the preschool where we started screening the age 4-5 year olds with our NEW screener. This was the youngest group that we had been screening, and we found that with a few children we had to switch to play audiometry, which they then responded well to. As always, we had a bit of trouble with the background noise, but it is just one of the things we had to accommodate for. 

Saturday came with much anticipation and an early start, as we had to collect and pack just under 1000 loaves of bread into the 2 Bakkies (Thats pick-up trucks, for any non-South Africans reading this ;) ). We made 3 stops in various communities, meeting with people of influence who would ensure that those who were most in need received bread. These stops included 1000 Hills Community Helpers, a pastor down in the valley, and someone who is involved in a orphan housing project in Ntshongweni.

This is only about half of the bread that we distributed! Team Speech-Audio!

Mariannridge was our last stop, were we met up with one of the ladies who runs the soup kitchen and is involved in the knitting project. She has such a heart for the community and was definitely the right person to connect with to hand out the bread, it seems that she knows everyone! Mariannridge have an online forum where they can express their concerns and community news, so between the forum and word of mouth, those in need were able to collect bread :)

Our final stop- Mariannridge!

I think that it is important for the community to see that even though we are students, we aren’t just in the community because we need to fulfill the requirements for our degree, but because we have a genuine care for helping people and improving the community. The reason I have gone into the field of audiology is because I love working with people and want to make a difference in people's lives- sometimes that difference can be made in ways that do not include an otoscope, audiometer or hearing aids but random acts of kindness that might meet someone's need at just the right time!

So this week was exciting and different for me in Mariannridge, both as a student audiologist and as someone who wants fully grasp the community aspect of our Community Based Rehabilitation clinic.

'Hunting down Hearing Loss'

Myself and my good friend and fellow student audiologist Lesley began this week's prac in Mariannridge with the aim of finding members of the community with hearing aids in order to start up a group aural rehabilitation- we aimed to 'hunt down hearing loss' in Mariannridge. We thought that the best place to start would be by asking the ladies down at the cafe. These ladies are very involved in various projects in the area, such as the Thursday soup kitchen and the teddy-bear knitting project for children who are victims of rape. They were able to give us the names of 4 different people of various ages who use hearing aids or have hearing loss. It was interesting to note how differently thing work in small communities- everyone knows everyone! It was great being able to chat to these ladies and find out more about what the do in the community. They were pleased to hear about this blog and gladly posed for a photo for it :)

Two of the amazing ladies who work into the Mariannridge community

Before leaving, 2 community members who were at the cafe had concerns about their hearing and wanted to talk to us about it. As we only had our otoscopes on us, we did otoscopic evaluation and then offered advice on which public hospital to go to for a hearing evaluation. This was slightly challenging as one of the community members could only communicate in Zulu, and my Zulu speaking is not yet at a level of having full-on conversations! Thankfully the ladies who run the soup kitchen were willing to help translate for us :)

After obtaining the names of people in the community, we headed over to Mariannridge Primary School to find out if the office staff know of any children who potentially have hearing loss or use hearing aids. The staff were very helpful and suggested that we print out some forms that the individual teachers can fill in to give us accurate information.

Mariannridge Primary School

On our way back up to the clinic, we were greeted by some children aged (I'm guessing) 2-4yrs, who excitedly ran across the road to give us hugs! While I love all the hugs we got, I was slightly concerned about them not being supervised...and running across the road without looking! Thankfully the roads aren't busy in the community, but it just takes 1 car...Anyway, Lesley and I spent some time tying their shoelaces and having 4-year-old conversations with them, and attempted to teach them how to cross the road safely. They seemed to understand, said 'good-bye'...and ran straight across the road without looking again!

Once we had reconnected with the rest of our group, we decided that it would be of greater benefit if some of us went down and did some language stimulation and auditory skills development with the children playing on the road. Plus, at least we could watch over them for an hour or so and prevent them from running across the road! By the time we got back, he children had run off on another adventure, so we headed back to the cafe/library area to look for other children who were not at school or creche. Before too long we had 5 young children join us, so we took them into the library and learned shapes, colours and animals, using a book and an iPad. The librarian was so welcoming and has asked us if we will run a story book session in the library with one of the creches in the area some time. This is a great opportunity for the speech therapy students to join us for a team approach :)

I really enjoyed this week, interacting with various people in the community. I am starting to see the benefit of building a relationship with people in the community, even though we do not work directly with them for assessment or intervention it is so helpful knowing people who are aware of how things run in the area and know everyone else in the community. It is also so encouraging to see how people, such as the ladies who run the soup kitchen and knitting project, care about the community and are making a difference in people's lives!

Home Visits in Marrianridge

This week I got to experience something new during my prac in Mariannridge- Home visits! I accompanied 1 OT and 1 Speech student to the home of a man who suffered a stroke 9 years ago, and then again 5 years ago.

Making our way through the community for home visits

We arrived and his sons were more than happy to welcome us into their home. We were able to observe the environment that the patient spends most of his time in, and see how his sons care for him. Our main objective was to conduct a behavioral hearing screening on him to identify if there is a need for further audiological assessment.

I had perviously spoken with the speech therapy students and received information on his receptive and expressive language. They had also been able to offer me insight into his cognitive functioning and ability to follow instructions. The general feel was that sometimes he is able to follow instructions well, and other time he is unable to. I had expected that getting behavioral results during screening may be a bit difficult, but it was worth a try!

Thankfully the house has electricity, so I was able to use the screener. Otoscopy and tympanometry were conducted without any resistance from the client, as he appeared to understand what we were doing. With this being said, the son mentioned that the client sometimes gets a bit fidgety, and therefore he encouraged his father to keep his head still.

The OT and Speech students were able to advise me on what responses the client would physically be able to perform. Their previous assessments revealed that the client has no speech at all, and communicates solely through gestures and head nods and shakes. The OT's found that in their assessment, the client performed the majority of gestures with his left hand, the hand that has been less affected by the stroke. It was for this reason the client was asked to give a 'thumbs-up' in response to the auditory stimulus.

Unfortunately the patient was unable to give reliable responses, despite extensive time being spent on conditioning to the task. I am going to have to try and get hold of the OAE screener so that we can get reliable results.

I learned a lot from this home visit. The reality of an individuals situation hits you so much harder when you are their in the environment, speaking one on one with family members and those who are affected by the situation. It was encouraging to see the love and support that this individual has been receiving from his sons, and how despite not being able to communicate verbally or through many gestures, he is still very much a part of the family!

I really hope that I get the chance to be involved in more home visits in Mariannridge- they are the best and I LOVE being able to connect with people out on prac :)

Prevention is better than cure

This week my group was at Candy Floss preschool. We were greeted with literally 40 hugs each on arrival!

Not having a separate classroom to take the class to, and wanting to keep the class away from the room where hearing screening was taking place, we decided to stay outside and sit the children in the shade of the tree. They didn't want to sit on the dirty floor, so we made a plan and collected the tyres that were lying around and used those as seats. It worked well!

One of our main aims was to run a mini 'workshop' on ear care with our grade R's (5 year olds). Our aim was to teach them about not putting things (including ear bud's/ Q-tips) into their ears, not listen to very loud music and to care for their ears. Prevention of hearing loss is better than cure! We created a big poster with them, which was then put up in the hall to remind the children of what they learned that day.

Having fun making a poster on ear care!

The children seemed to enjoy it, particularly the localization activity that we added in at the end! The children took turns being blindfolded and had to find the clinician (or 'teacher' as they call us!) who was using the shaker (a tin filled with a few popcorn kernels!). We were working outside so we had plenty of space to work with. Once each child located the clinician, they were given a picture of an ear to stick onto our poster. The children were very proud of their poster :)

At one point, we asked the children who they should tell if their ears are paining. I expected them to all say their mom or their dad- but as they began to answer I remembered that many of the children in this are have a different family structure that the one that I was raised in. The answers that came out included "aunt, big sister, cousin, granny, grandpa". There are many reasons why these children may not have given "mom" or "dad" as their first answer. As I had experienced at the clinic a few weeks before, an aunt had taken her nephew to get his medication- his mother was probably working, so the aunt then took the responsibility of bringing him to the clinic.

Some of the children might not actually live with their parents. According to Statistics South Africa, in 2011 there were 2.01 million orphans because of HIV/AIDS. Other times, parents have to go work far away, so children are left to live with a family member. Whatever the reason (and I'm sure there are many different reasons in that class) it was a gentle reminder of how different life may be for the children in this area.

We ended our session with some activities targeting rhythm and rhyme, identification of syllable patterns (through clapping along to each syllable of the rhyme) and a game of "I spy" to focus on developing skills in alliteration.

Despite it being a large class, I was surprised at how well they listened and participated. I think it helped that the activities required the children to be quite active and did not go on for too long. Before leaving, we gave some bookmarks on ear care to the teachers and principal - I hope that they will be used both for their own benefit and for the benefit of the children, since they see the children every day and we are only there for a few hours once a week! One of the teachers expressed that she has a concern that one of the younger children in the preschool might have a hearing loss. I am glad that they are willing to work together with us in identifying those that may be at risk- we aren't able to screen the whole preschool because of time constraints, but if we use a team approach and communicate with the teachers I'm sure that our screening program will be more effective in identifying those who need attention!

On a side note, an observation that is made every year (and recorded in the yearly handover file) is that there is a lot of litter in the area! The occupational therapy students have done a great job so far in organising more bins, however I think creating a cleaner community is going to take a lot more effort and education that we realise! The litter was something that I particularly noticed this week...

Litter lying around the bins...

The litter after snack time at the preschool

I am looking forward to something different next week- a home visit to a stroke patient in the community!

“There is chaos. Kids are not coming to school"

The community had a very different atmosphere this week...schools are closed as one of the teachers unions, SADTU, have embarked upon a "chalk-down"...which has resulted in no lessons being taught in some schools across the country. When there is no school, the children don't have anywhere to go, so many of them spend their time playing on the side of the road, sliding down banks on cardboard boxes and following us to our prac venues.

Perfect day for sliding down the hill on cardboard boxes!

An online newspaper reports: "A Mariannhill primary school principal said his staff were “just sitting” in their classrooms. “There is chaos. Kids are not coming to school" (News24).

It really is sad, as there is talk that this may continue for at least 3 weeks, and may even become aggressive. What I was most concerned about was that the children were just wandering the streets without supervision. This area is known for drugs, crime and abuse, yet there is no-one checking up on the children! 

This little girl wanted to know why we were 'running away from her' while she followed us to our prac.

On a happier note, we walked past Mariannridge Cafe to say a quick hello to the ladies who sit and knit at the cafe each week. They knit teddy bears for children who have been abused, that are given out at R. K. Khan Hospital. This week the UKZN nursing students were busy setting up for their antenatal program by the cafe. Everyone was in such a good mood, and the ladies were so proud of their massive pile of knitted teddy's that were on display!

Setting up for the Antenatal Program

The pile of hand-knitted Teddy's that will be given out to abused children at R.K. Khan Hospital

 

I am learning more and more about what it means to be part of this community. I LOVE the interactions that I have with people while walking between prac venues, and seeing the difference that people are making in Mariannridge. It is extremely different to the community that I come from- I am used to living behind high walls, fences and security, and driving to the shops, where you may bump into someone you know...if something happens in my community, you hear about it in the newspaper or Facebook! In Mariannridge, there are no walls or fences surrounding the houses, you walk everywhere and meet people on the way who will update you on any news!

Candy Floss Pre-school was also chaotic this week, but I still loved it! We arrived during their break time...the children had so much energy and just loved the attention that they got from us. 

Tyre racing at Candy Floss!

When their break time ended, we began screening hearing, which is proving to be slightly difficult in the noisy environment. Hopefully next week we will be able to make arrangements with the teachers to move their class to the other side of the room so we can decrease the noise level. As expected, many of the children present with impacted wax...I am holding thumbs that their parents will take our referral letters and advice seriously! 

Candy Floss!

This week I would like to introduce my blog readers to the new venue for community based rehabilitation- Candy floss Preschool! If a name like that doesn't make you smile...well, then you must be diabetic ;-)

There are a few things that I observed during our first session that I found interesting. First, there are a LOT of children here! The building in the above picture is big hall/church where children have their school lessons during the week. There aren't any dividers to separate the hall into different classrooms and block out the noise- it literally is one big building with a few different classes happening at once! I get the feeling that there are actually too many children for the venue- from what I observed on Thursday, the classes rotate- one class will be playing outside while the other class eats at their desks.

A few other interesting observations:

• The children love to push old car tyres around the playground. They find it such fun! And if another child takes their tyre, it means war! I would love to see if the occupational therapy students can incorporate some of their aims into an activity that includes these tyres...Im sure the children would LOVE it!
• The teachers are really helpful! They have shown us all of the patience in the world when we have gone to them with questions or requests and are really pleasant to work with.
• These children might not have the most health-consciouse parents...the bins are filled with empty chip packets after lunchtime. Literally filled to overflowing- the children go through a lot of chips! This is slightly concerning, as these chips are not the most nutritious, and are packed with flavourants and preservatives...not the ideal food for 4 and 5 year olds to be eating, particularly while they are at school!
• There are both English and Zulu speaking children at the preschool. This means that we have to be prepared to do screening, language and auditory skills development in both languages...taking into consideration that we do not have an interpreter this term!
• It is LOUD! Outside, inside...there are happy energetic children everywhere, which is going to make it a bit difficult to conduct hearing screenings. But Im up for the challenge!

Some of my goals at Candy Floss creche for Term 2:

• To learn all of the teachers names and greet them before I begin the session. This might seem like something small and insignificant, but recently I am becoming so aware of how other professionals perceive us as audiology/speech therapy/ OT students and professionals. I never want to be that professional who pitches up to a venue and does my own thing without even greeting those in charge. I would rather spend an extra 2 minutes building rapport with the other professionals, be it a preschool teacher, nurse or admin staff, than having that extra time for my session. At the end of the day, we need to have a good relationship and mutual respect for each other and the different professionals, and I feel that this 'small' step will show endless benefit.
• To have a mini-awareness session with the children about ear care, in particular about not putting anything in their ears! This is well needed as we have already identified a child with tissue stuffed into his ear in the first week.
• To become more proficient in instructing in Zulu. Its just one of those things that I have to continually work on to give the children and all of my patients the best service that I can. There really is no way around it as an audiologist in South Africa- and Im ok with that!

Candy floss ir right across the road from the clinic, where I will be based every second week. We spent some time there this week, doing otoscopic examinations, speech and language screening with the speech therapy students and giving advice to parents on ear care.

From my experience there this week, I think that our focus may be on creating awareness about hearing and counseling parents on how to stimulate language development. We are planning on making some posters and pamphlets on ear care and language development to leave in the clinic and stick up on the walls- the patients generally have a 4 hour wait before they are seen, so we may as well give them something to read during their wait :)

Its been a good start to the second term, we have so many things to get started on!

Term 2!

Its been one of those weeks when I have worked with a lot of children! In fact, I didn't see any adult patients at all! Working with children is messy! This week resulted in my Saturday being spent disinfecting all of the toys I use for assessment and therapy...everything-from blindfolds for games at the creche to blocks to teddy bears-has either been drooled on, put in a kids mouth or used as a tissue...But every time I am able to complete a hearing screening or assessment, or achieve my aims in a therapy session, I am reminded that it is WORTH it!

A new group of speech therapy and occupational therapy students have joined us, as the last group has moved on to a new prac. While I am starting to feel quite settled in to the creche and community, it is a whole new experience for the speechies and OT's who have just started. This week we spend a lot of time explaining and discussing what we have found to work in therapy in the creche, including taking note of the children who need a bit of extra attention during activities. I am learning how to share information that we have discovered over the past 6 weeks, while still leaving room for creativity, new ideas and different perspectives from the new students. I would hate to get stuck into the rut of doing the same games and activities every single week, instead of having our creativity challenged to make our 3 hours at the creche the best 3 hours of those children's week!

This week was significant because OT and Speech and Language assessments have been completed in Rainbow creche! Individual therapy programs are starting to unfold for those who show significant delay- as opposed to group therapy where we target very general aims. Group therapy still goes on for the rest of the Grade R's (5 year olds), where we have been focusing on development of auditory skills, fine and gross motor skills and language development. I still have to learn a lot about the cultures and socio-economic backgrounds of these children in order to ensure that the instructions and stimuli used in our activities are relevant. I feel as if we were not really on top of our game this week with some of the stimuli, and this showed as the children lost focus easily.

We should be completing the hearing screening at the creche in the next session. So far we have identified many children with impacted cerumen, and have nearly finished developing an information letter to be sent home to the parents...the reality is that the parents wont be able to take their children to the hospital for cerumen management, so we are trying to suggest alternatives, such as using olive oil or cerumen softening drops. To be honest, I don't even know how many of the parents will spend money on olive oil or softening drops... so if anyone reading this blog has any other suggestions for cerumen management in this community, share the ideas! I get frustrated that so many children in communities in South Africa don't get the help and intervention that they need!

It seems as though this prac might be changed up a bit, as new locations within the community are added...I am excited to get involved in other parts of the Mariannridge community!

Week 4: Listening Program

Week 4 at Rainbow Creche! This week it was only the student Occupational therapists and Audiologists at the creche, as the Speech therapists were conducting assessment at another venue.

We have been looking at doing listening activities with the children in the creche to develop various auditory skills. Up until this point, the only clinical therapy I have done as a student audiologist has been speech therapy, language therapy and currently, aural rehabilitation. So again, I felt challenged and slightly out of my comfort zone, not knowing where to begin. Thankfully, I have found a program for preschool children that is soley focused on developing auditory skills.

The program can be downloaded for free off the UK's Department for Education here. The activities are quite lovely! Many of the activities are active, which is great for us as we can add in some goals for OT and Speech therapy. Reading through some of the activities, I am learning to think more creatively about activities and developing listening skills.

We started this week off by making bunny ears with the children, which were used to make the children aware of their ears and listening during later activities. The children were required to colour in a template- which incorporated fine motor skills, while we whispered instructions to them. Whispering requires the children to actively listen and pay attention to what is being said (This worked out well for us as we had to keep the noise levels down for hearing screening that was being conducted next door).

Before beginning the session, we met and discussed how we can correct the children if they are colouring incorrectly, and how to encourage better listening and concentration. I feel that this was highly beneficial as the OT's and audio's each learned something from the other profession, that enabled us to actively participate during each activity. I learned about identifying if a child is using the incorrect grip when holding a pencil, encouraging the children to rest their hand on their page and move their wrist while colouring, and that children should be using longer crayons and pencils, as opposed to small stubbs, as this will help to develop the right grip. The OT's also explained how different hand strengthening exercises can be done using playdough that will aid in the development of fine motor skills.

As student audiologists, we were able to share with the OT's about getting a child's attention before explaining an activity, encouraging them to sit still and not talk while listening, and gently holding a child's hands while talking to them if they are finding difficulty in sitting still and paying attention.

I feel that this time of sharing before beginning activities should be done each week, so that we are able to learn valuable skills from each other that we can apply both to CBR and other clinics.

This week we were able to begin hearing screenings on the children. We decided to start with the children who are most at risk for having a hearing loss (eg. child with cleft palate, delayed fine/gross motor skills, and those who battle to follow instructions). This required us to consult the OT's, as they have spent more time with the children than us. Our aim is to screen all of the children, but since we are only there once a week, it may take a while to accomplish this. One of the children that the OT's suggested that we screen first did not pass the hearing screening and is being referred for a full diagnostic assessment. I now realise how beneficial a team approach can be for identifying those at risk.

We wont be at the creche this coming week, as it is human rights day! I look forward to being back the following week, with our full team :)

Week 3: GO TEAM

We had a busy morning at Rainbow Creche this week! It is a great feeling to arrive and see the kids faces light up when they see our team. We arrived earlier this week, which meant that the children were all eating their breakfast. It was interesting to note that they were all given porridge before they started their day, and I can only imagine that in an impoverished community, ensuring that the kids tummy's are full can make such a difference in how they perform during the day.

Our team, made up of audiology, speech therapy and occupational therapy students spent our extra time discussing how we can each achieve and incorporate our aims into the activities that had been planned for the day. We are slowly learning how to incorporate the aims from each discipline into each activity, however it is proving to be a bit tricky! I feel that we are improving as we get to know the other people in our team better- moving from being 3 separate teams of OT, Speech and Audio towards one big team. It is also becoming easier to share ideas between the disciplines as we leave room for input, correction and ideas from others!

I am learning a lot about occupational therapy and the kind of activities that they use to help children develop fine and gross motor skills. I'm also learning valuable skills from the OT's such as how to use the resources around me to create activities. The creche has a room full of equipment such as hoola hoops, blocks and rope, which the OT's have been using for different games and activities- hoola hoops for spatial relations (Getting the children to stand inside the hoola hoop, infront of, behind...) and blocks and rope for balancing activities. They also recycled cardboard from cereal boxes to create a 'threading through cardboard' activity for fine motor skills.

Working with so many children brings a lot of challenges. While most of the children are engaged and participating in the games and activities, there are always 2 or 3 who aren't. Some of the children don't speak English, so if we forget to repeat the instructions in Zulu they don't understand what is required of them. There are also a few that seem to be way behind their peers in different areas of development, every now and again we notice that we have forgotten about them in the group and they haven't even started the activity. Then there are the children who have a LOT of energy- if we take our eyes off them for 1 minute they end up at the other end of the room throwing their shoes at the other kids ( Okay, that exact scene hasn't happened yet, but I wouldn't be surprised if it did!). But we are beginning to find our way around these issues, and hopefully within a few weeks we will know exactly what each of these kids needs to keep them engaged. This week I learned that choosing one of the children who tend to get distracted, and sticking with them for the whole activity makes a tremendous difference, instead of bouncing between kids as they stop participating. We have a large team, so if we are each able to give our attention to one kid the activities might go even smoother.

This week I am working on letters to send home after screening to the parents/caregivers of children with impacted wax. It has been brought to our attention that the local clinic does not do syringing anymore, so the likelihood of parents/caregivers taking their child to the closest referral hospital for wax management is quite small (For most caregivers it means missing a day of work & school, paying taxi fare for 2 people and waiting hours for their appointment). I hope to be able to explain what impacted wax is, as well as explain treatments that are more relevant (an likely!) for their situation- such as using wax drops or olive oil to soften the cerumen.

I am learning a lot about considering the circumstances of the people in the communities that I am working in before making the typical referrals...and I think that is one of the big lessons we are meant to learn while doing this prac...being relevant, applying what we know to each individuals situation and meeting people where they are at...

Week 2: Thinking outside the box

It is hard to believe that a whole week has passed since my last community based rehabilitation prac in Mariannridge! Today was our second week working into the community. While we are still trying to find our feet and figure out what our role is in the community, it is getting a lot easier and more enjoyable- particularly as we are learning to ask questions instead of just assuming things! Feedback and input from our supervisors is really useful and we are constantly being challenged to think outside the box.

The box being our screening audiometer.

Over the last 3 years of our training, we have learned to rely on our expensive audiological equipment. However, living in a 3rd world country, the reality is that one day we may be placed in a hospital or assessment centre that doesn't have this equipment, or we may have to wait months for our audiometer to get fixed, with no back-up machine. It is also likely that we may need to work out in a community that does not have electricity. The thought of not having a screening audiometer is quite intimidating!

So we are currently in the process of discovering our role in community based rehabilitation without an audiometer... we realise that this requires us to research activities that can be used to improve on the children's auditory memory, discrimination skills and the like, as part of early intervention for those who are at risk for delayed development, learning problems, hearing loss and auditory processing disorders.

We were able to incorporate some of our aims into the games that the occupational therapists and speech therapists were already wanting to play in the creche. A game of "Simon Says", with multiple-part commands was played. The children had to remember what all 3 instructions were before following through with the actions. We were also able to have 'Story Time', where we asked the children details about what we had just read. This was to target their auditory memory.

Once our time was up at the creche, we headed back up to the Cafe/community centre where I finally decided to introduce myself to the knitting ladies. I feel that we are sometimes so focused on getting to our location, setting up and accomplishing our aims, that we miss out on things along the way- such as a simple greeting and introduction. It only took 1 minute of my time, and before I was finished explaining what we were doing in Mariannridge I had been ushered towards another lady to discuss the concerns that she has with her son's hearing, and a few minutes later another lady approached us about motor and speech concerns that she had with her son.

I left those conversations feeling more connected, welcomed and understood by the community as a student audiologist, even though I had only spoken with a group of +-10 ladies. I definitely need to remember to go into the community each week with a humble attitude, remembering that I am there to serve them, and that a smile and "how are you" can go a long way!

RidgeCity Week 1

We have finally started our Community Based Rehabilitation (CBR) practical sessions in the community! My community is Mariannridge (AKA RidgeCity), located just outside Pinetown.

It wasn't the smoothest start, as we (Student audiologists) weren't able to access the hearing screening equipment before leaving. But none the less, we were able to get involved in the local clinic and preschool. Armed with our otoscopes, gloves and alcohol swabs, we worked together with the student speech therapists who were conducting speech and language screening on all of the Grade R's (+-5 year olds) at the Preschool. We were able to do otoscopic examinations and oral peripheral examinations on all of the grade R's in the first half of the morning.

We identified a few children with impacted wax, and many more whose teeth were decaying. Oral hygiene may be an area that we need to create some awareness in, particularly from the speech therapists point of view!

I really enjoy working with preschool children, they come up with the funniest things, and otoscopic evaluations and OPE's can always be turned into a game. And if all else fails, the reward of a sticker is a sure way to gain compliance!

Some of the children do not speak english. Whilst there were Zulu-speaking students around who could have been used as translators, or taken over the examinations all together, I decided to take on the challenge and have fun putting my limited Zulu vocabulary to use. It didn't go so badly, I was able to get my instructions across and complete the examinations.
I really do enjoy trying to speak Zulu with both children and adults: some of the reactions are priceless! I also find that it is a great ice-breaker!

The second half of the morning was spent in the local clinic, observing the facilities and how the clinic runs. One of the things that stuck out to me was a sign in the waiting room that read: "Waiting time is 3-4 hours". It really does become a whole-day experience, it can't be fun waiting that long! Particularly when you have small children with you!

All in all it was an interesting day, and I look forward to returning next week!

International Ear Care Day: 03/03

The 3rd of March is International Ear Care Day! It seems like not many people have heard about it, or really know what to do about it (I only heard about it on Friday), so maybe we can share some ideas on how we can each play our part! 

The theme for 2013 is "Healthy Hearing, Happy Life - Hearing Health Care for Ageing People"

The 3rd of March has been selected because the two "3's" represent ears. Unfortunately this year the 3/03 falls on a Sunday...But I'm sure if you want to "shift" it by a couple of days it's no big deal :) And for those working in schools, Im sure you don't have to stick to the theme 100% ;)

If you would like to read up on what WHO says about it, click here. 

My audiology class had a massive brain storming session yesterday to see what we could come up with, and eventually decided that we would divide our class between two old age homes in the area, where we will perform hearing screenings, give a brief talk on ear and hearing care, hand out some pamphlets, bookmarks and other free stuff and leave time for Q&A's. We are still working on bringing a 'fun' element into it...so if anyone has awesome ideas, send them this direction!

It is a really great opportunity to reach out to the community and raise awareness, and there are so many ways to get involved!

Have you participated in International Ear Care Day before? 
What ideas do you have to share with Students, Audiologists or Teachers who want to participate and help raise awareness this year?