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!

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!