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 :)
Sunday, March 17, 2013
Monday, March 11, 2013
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...
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...
Thursday, February 28, 2013
Week 2: Thinking outside the box
It is hard to believe that a whole week has passed since my last community based rehabilitation prac in Mariannridge! Today was our second week working into the community. While we are still trying to find our feet and figure out what our role is in the community, it is getting a lot easier and more enjoyable- particularly as we are learning to ask questions instead of just assuming things! Feedback and input from our supervisors is really useful and we are constantly being challenged to think outside the box.
Over the last 3 years of our training, we have learned to rely on our expensive audiological equipment. However, living in a 3rd world country, the reality is that one day we may be placed in a hospital or assessment centre that doesn't have this equipment, or we may have to wait months for our audiometer to get fixed, with no back-up machine. It is also likely that we may need to work out in a community that does not have electricity. The thought of not having a screening audiometer is quite intimidating!
So we are currently in the process of discovering our role in community based rehabilitation without an audiometer... we realise that this requires us to research activities that can be used to improve on the children's auditory memory, discrimination skills and the like, as part of early intervention for those who are at risk for delayed development, learning problems, hearing loss and auditory processing disorders.
We were able to incorporate some of our aims into the games that the occupational therapists and speech therapists were already wanting to play in the creche. A game of "Simon Says", with multiple-part commands was played. The children had to remember what all 3 instructions were before following through with the actions. We were also able to have 'Story Time', where we asked the children details about what we had just read. This was to target their auditory memory.
Once our time was up at the creche, we headed back up to the Cafe/community centre where I finally decided to introduce myself to the knitting ladies. I feel that we are sometimes so focused on getting to our location, setting up and accomplishing our aims, that we miss out on things along the way- such as a simple greeting and introduction. It only took 1 minute of my time, and before I was finished explaining what we were doing in Mariannridge I had been ushered towards another lady to discuss the concerns that she has with her son's hearing, and a few minutes later another lady approached us about motor and speech concerns that she had with her son.
I left those conversations feeling more connected, welcomed and understood by the community as a student audiologist, even though I had only spoken with a group of +-10 ladies. I definitely need to remember to go into the community each week with a humble attitude, remembering that I am there to serve them, and that a smile and "how are you" can go a long way!
The box being our screening audiometer.
Over the last 3 years of our training, we have learned to rely on our expensive audiological equipment. However, living in a 3rd world country, the reality is that one day we may be placed in a hospital or assessment centre that doesn't have this equipment, or we may have to wait months for our audiometer to get fixed, with no back-up machine. It is also likely that we may need to work out in a community that does not have electricity. The thought of not having a screening audiometer is quite intimidating!
So we are currently in the process of discovering our role in community based rehabilitation without an audiometer... we realise that this requires us to research activities that can be used to improve on the children's auditory memory, discrimination skills and the like, as part of early intervention for those who are at risk for delayed development, learning problems, hearing loss and auditory processing disorders.
We were able to incorporate some of our aims into the games that the occupational therapists and speech therapists were already wanting to play in the creche. A game of "Simon Says", with multiple-part commands was played. The children had to remember what all 3 instructions were before following through with the actions. We were also able to have 'Story Time', where we asked the children details about what we had just read. This was to target their auditory memory.
Once our time was up at the creche, we headed back up to the Cafe/community centre where I finally decided to introduce myself to the knitting ladies. I feel that we are sometimes so focused on getting to our location, setting up and accomplishing our aims, that we miss out on things along the way- such as a simple greeting and introduction. It only took 1 minute of my time, and before I was finished explaining what we were doing in Mariannridge I had been ushered towards another lady to discuss the concerns that she has with her son's hearing, and a few minutes later another lady approached us about motor and speech concerns that she had with her son.
I left those conversations feeling more connected, welcomed and understood by the community as a student audiologist, even though I had only spoken with a group of +-10 ladies. I definitely need to remember to go into the community each week with a humble attitude, remembering that I am there to serve them, and that a smile and "how are you" can go a long way!
Saturday, February 23, 2013
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!
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!
Saturday, February 9, 2013
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% ;)
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?
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?
Sunday, February 3, 2013
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!
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