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!

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.

'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! 

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?

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!