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!

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.

“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! 

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!

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!