"Mama you are so strong"

I sat in awe as I heard the horrific story of how the Mama in front of me came to lose her hearing. She fumbled beneath her scarf to point out the rugged scar on the side of her head where the bullet had entered, and bravely told me the story of how the gunman, her own husband, had pulled the trigger. First aimed at her, then at each of her children, and finally at himself.

"Mama you are so strong"

The physical scar is quite something, and I thought it a miracle that she is still alive, but what gripped my heart was the strength and determination that is getting her through each day. She beamed with thankfulness at each small action that was taken to help her- from removing impacted wax to rescheduling her different appointments for the same day to avoid multiple trips to the hospital. I'm thankful that I got to meet this lady. I'm thankful that audiology services are made accessible to her because of community services, and I'm thankful that I get to play a small role in giving back a part of what was taken from her on that day. The social situation that many of our patients find themselves in makes one consider what we actually have to complain about.

Community Service 2014

It has taken me quite some time to figure out my password and sit down to write about what Ive been doing for the last few months... 5 months, in fact! I don't know if time goes really fast for everyone in the working world, but I honestly find it hard to grasp that I am nearly halfway through my year of community service!

Over the last few months I sat through and (thankfully) passed my final year oral exams to finish off my Bachelor of Communication Pathology in Audiology. Such an incredible feeling of accomplishment after 4 years of studying! On the 1st of Jan I moved to the South Coast of KwaZulu Natal to begin my year of Community Service at a small but friendly District hospital.

If anyone is wondering why and what community service is, let me set the record straight: It is in no way related to the community service that is given as punishment for breaking the law, and no I have not been to jail! (People have asked...haha!). Community service is a year that most health professionals in South Africa are required to do after completing their degree. A lot of us are placed in rural areas and it becomes quite an adventure! The year is very community focused, which means that we are not limited to working in our hospital, but visit the smaller clinics in the surrounding communities as well as do home visits. We often have to leave our car and walk down hills and muddy terrain to get to our patients!

Amazing views on the road to Tonjeni clinic.

I work closely with an occupational therapist, physio therapist and speech language pathologist on our clinic and home visits, all of whom are also doing their year of comm serve and make the adventure that much more enjoyable! Our community visits are quite unpredictable, and we are learning to just take everything as it comes as we reach out to those in the community who need us.

Rehab team home visit out at our furthest community

Some days we see more cows than people.

Community service has been the most fantastic experience so far, and I am learning to be an audiologist in often less-than-ideal settings and situations. It sure forces me to think outside of the box and problem solve! I can't wait to see what adventures the rest of the year has in store... if I find some time in between hiking to waterfalls, swimming in bilharzia infested rivers and taking full advantage of living 600m from the beach, I may post updates more frequently ;)

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!

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!

Setting the scene: The 1st world-3rd world country

I am only one, but still I am one. I cannot do everything, but still I can do something; and because I cannot do everything, I will not refuse to do something that I can do. - Helen Keller

I love South Africa. The amazing beaches, friendly people and warm weather. I get to suntan by my pool even in winter, or study in my hammock outside. The latest Fro-yo franchise has opened 10 minutes away! There are so many cultures that add to the flavor of beautiful South Africa! The South Africa that I live in is a first world country, and very comfortable.

10 minutes down the road, things are quite different. Its a 3rd world country, uncomfortable to see, let alone to live in. POVERTY. I begin to dislike South Africa, or rather, the situation that the majority of the beautiful South African people live in. HURT. Literally every person you meet has been affected by HIV/AIDS in some way. Grandmothers or older siblings look after young children, as their parents have passed away. Children may walk kilometers to get to school, in broken school shoes, carrying nothing but a pencil and dirty work book in their school bags. BROKENNESS. Statistics (Rape Survivor Journey) tell us that in South Africa there is more of a chance that a woman will be raped than learn how to read! Sub-standard living conditions, lack of public healthcare facilities, alcoholism, gang violence, FEAR.

As a student audiologist I realise that if I am going to meet people where they are, I have to have some understanding of the situations that they come from. No matter how much I have learned about the hearing and vestibular system, auditory pathologies, electrophysiological tests, hearing aids, aural rehabilitation, Deaf culture or the like in my 3 years of studying, there is still so much value in understanding the community and issues that surround their everyday life. If someone is late for an appointment, it may be because they had to leave home at 4am, walk 10km and catch a taxi. If they seem unresponsive in therapy it may be because there was no food at home and it's impossible to concentrate!

3 and a half years ago while on a mission trip in a small village in Mozambique, I was in a situation when I learned this lesson. I came across a mother, her toddler and baby, sleeping on a mat in the sun outside their mud house. I went over to offer a friendly greeting, only to notice that the toddler had a severely infected eye. The child was crying, her eye was oozing, with flies sitting on and around it. It was a heartbreaking sight. Once I got hold of our translator I was able to establish that the toddler had not yet been brought to the clinic! I was angry and couldn't understand how the mother could leave her child's eye like that! I was also angry that the mother was not making any attempt to wipe her child's oozing eye and keep the flies away! It was only later that I discovered that the mother was also sick, and that's why she was unable to calm her crying child. It is likely that she no longer had the energy to keep wiping her child's eye and shoo the flies away. I asked why she hadn't brought the little girl to the clinic yet- she simple had no money for a taxi or the doctor! Thankfully we were able to return early the next day and drive the family to the clinic 20 minutes away. We were able to pay the consultation fee for them- about 6 Meticais each (+- 3 Rand/ 20 US cents), including medication, and buy them some food to help them regain their strength.

If only I had known the extent of the situation before feeling angry and judging the mother! But nonetheless, it was an experience that I was able to learn from. I hope that I am able to give my patients and members of the community enough of my time to fully understand their situation, to show empathy and respond in kindness instead of judgement. There are so many factors that contribute towards the brokenness and poverty of individuals in South Africa. Each story is different, each life is precious and the future of each person can be brighter than it may look right now! Hope can be brought to every situation!