"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 ;)

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!

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!

Language stimulation at Candy Floss Preschool

We spent the whole morning at Candy Floss preschool on Thursday, and I was exhausted! I don't know how the teachers at the preschools manage! It was filled with giggles and story telling and games and hugs, and 3, 4 and 5-year olds, and tears and snotty noses and children fighting and dirt and grazed knee's. I have a new appreciation for preschool teachers!

We tried to follow the children's lead with their activities, and incorporate language development into their play. For example, when they were playing with hoola-hoops, we could target spacial relations, such as next to, inside, and outside the hoola-hoop.

We read a few stories with them, and this time we made sure that we were not confined to the words on the pages in front of us. We eventually had all the children acting out their routine of washing their faces, brushing teeth etc. We used the most animated facial expressions and this really kept the children interested and having fun! The aim of this was not just to stimulate language development, but to create an awareness of personal hygiene.

We did a few rhymes with the different groups, and it was interesting to note the difference between the 3-4 year olds and the 4-5 year olds both in the rhymes, language abilities and participation. It was easy to spot how much being in preschool for an extra year has impacted on the children who are older. With this being said, there are many children in the community who do not have any sort of schooling until they enter grade 1, and at this stage they are far behind the other children.

We are busy planning to host a workshop for parents, and through our tutor's guidance are learning a lot about working with the students from OT and Speech, what we should and shouldn't include, who should be invited, and they kind of material that should  be made available. There is lots of planning to still be done!

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.