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 ;)

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 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...

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!