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!

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 :)

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!

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...

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!