Back at Mariannridge- with Spread the Loaf!

First week back at Mariannridge! It was great being back at the preschool and seeing all the kids smiling faces. We were greeted with a stampede of hugs on arrival, with shouts of “hello teacher!”

We were also so excited as we have new audio screener! And our other screener had been repaired, which meant that we could now bring 2 screeners into the community- we brought one to screen at the preschool, and the other to the clinic.

We had a few spare minutes while the teacher was finishing off the morning session in the small room that we usually use for screening, so we took a walk down to the café to see the ladies who run the soup kitchen. I have been helping one of my close friends (who is a student speech therapist currently doing her Community Based Rehab block) with an NGO that she has started called Spread the loaf. She raises money through donations and raffles, and we then buy a few hundred loaves of bread to hand out to people in communities that are in need.  This July, Rotary have helped us out with some sponsorship, which has enabled us target more communities. We decided that Mariannridge will be one of the communities that we distribute bread to this round, and the ladies who run the soup kitchen were delighted to hear the news! 

After discussing our plan for Spread the Loaf, we headed back to the preschool where we started screening the age 4-5 year olds with our NEW screener. This was the youngest group that we had been screening, and we found that with a few children we had to switch to play audiometry, which they then responded well to. As always, we had a bit of trouble with the background noise, but it is just one of the things we had to accommodate for. 

Saturday came with much anticipation and an early start, as we had to collect and pack just under 1000 loaves of bread into the 2 Bakkies (Thats pick-up trucks, for any non-South Africans reading this ;) ). We made 3 stops in various communities, meeting with people of influence who would ensure that those who were most in need received bread. These stops included 1000 Hills Community Helpers, a pastor down in the valley, and someone who is involved in a orphan housing project in Ntshongweni.

This is only about half of the bread that we distributed! Team Speech-Audio!

Mariannridge was our last stop, were we met up with one of the ladies who runs the soup kitchen and is involved in the knitting project. She has such a heart for the community and was definitely the right person to connect with to hand out the bread, it seems that she knows everyone! Mariannridge have an online forum where they can express their concerns and community news, so between the forum and word of mouth, those in need were able to collect bread :)

Our final stop- Mariannridge!

I think that it is important for the community to see that even though we are students, we aren’t just in the community because we need to fulfill the requirements for our degree, but because we have a genuine care for helping people and improving the community. The reason I have gone into the field of audiology is because I love working with people and want to make a difference in people's lives- sometimes that difference can be made in ways that do not include an otoscope, audiometer or hearing aids but random acts of kindness that might meet someone's need at just the right time!

So this week was exciting and different for me in Mariannridge, both as a student audiologist and as someone who wants fully grasp the community aspect of our Community Based Rehabilitation clinic.

'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! 

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!

Term 2!

Its been one of those weeks when I have worked with a lot of children! In fact, I didn't see any adult patients at all! Working with children is messy! This week resulted in my Saturday being spent disinfecting all of the toys I use for assessment and therapy...everything-from blindfolds for games at the creche to blocks to teddy bears-has either been drooled on, put in a kids mouth or used as a tissue...But every time I am able to complete a hearing screening or assessment, or achieve my aims in a therapy session, I am reminded that it is WORTH it!

A new group of speech therapy and occupational therapy students have joined us, as the last group has moved on to a new prac. While I am starting to feel quite settled in to the creche and community, it is a whole new experience for the speechies and OT's who have just started. This week we spend a lot of time explaining and discussing what we have found to work in therapy in the creche, including taking note of the children who need a bit of extra attention during activities. I am learning how to share information that we have discovered over the past 6 weeks, while still leaving room for creativity, new ideas and different perspectives from the new students. I would hate to get stuck into the rut of doing the same games and activities every single week, instead of having our creativity challenged to make our 3 hours at the creche the best 3 hours of those children's week!

This week was significant because OT and Speech and Language assessments have been completed in Rainbow creche! Individual therapy programs are starting to unfold for those who show significant delay- as opposed to group therapy where we target very general aims. Group therapy still goes on for the rest of the Grade R's (5 year olds), where we have been focusing on development of auditory skills, fine and gross motor skills and language development. I still have to learn a lot about the cultures and socio-economic backgrounds of these children in order to ensure that the instructions and stimuli used in our activities are relevant. I feel as if we were not really on top of our game this week with some of the stimuli, and this showed as the children lost focus easily.

We should be completing the hearing screening at the creche in the next session. So far we have identified many children with impacted cerumen, and have nearly finished developing an information letter to be sent home to the parents...the reality is that the parents wont be able to take their children to the hospital for cerumen management, so we are trying to suggest alternatives, such as using olive oil or cerumen softening drops. To be honest, I don't even know how many of the parents will spend money on olive oil or softening drops... so if anyone reading this blog has any other suggestions for cerumen management in this community, share the ideas! I get frustrated that so many children in communities in South Africa don't get the help and intervention that they need!

It seems as though this prac might be changed up a bit, as new locations within the community are added...I am excited to get involved in other parts of the Mariannridge community!