The last blog. For a few weeks. MERRY CHRISTMAS!!

The last blog for a few weeks - hope you are still enjoying and reading it and please pass on the details to others who can read through past ones and find out a little more about what speech therapists do!


Some funny things from the week:

Conductor on the matatu was asked by an elderly lady to pick up her crazy chickens and pass them to her. One proceeded to pee all over the poor guy.

A mother of a 6-year old child I saw for the first time last week told me her child told her that she saw a Mzungu (White person/Foreigner) and gave me the name Mr. Confidence which was lovely considering I suspect selective mutism and it’s likely a key thing she needs!

I knew a lot of the pubs/bars sell condoms to promote awareness and protected sex but looking atop the fridge at my local there are not only condoms available but headache tablets as well. What more could you need to prepare you for the night/next morning!

Some facts from the week:

There has been a Doctor’s strike which at the time of writing has lasted 5 days. They are asking for a 300% (yes, THREE HUNDRED, that’s not a typo) raise but are willing to negotiate (!). I’ll mention this later so I won’t go into it here but essentially it means nothing can be diagnosed or altered for anyone in the hospitals and people are being discharged left, right and centre due to nothing being done and people are not coming to hospitals either due to this, even if there is something serious happening.

A new personal record for me - 29 people in a matatu. It’s meant to be 14.

Newspaper article - “Of 9700 registered persons with disabilities in Murang’a North region, only SIXTEEN have benefited from the pot of money the government has put aside to support these people”. I assume the main problem here is lack of promotion/knowledge as essentially all these people have the right to a disability living allowance.

I’ve been told by 3 separate groups of  parents that their nippers have called me Uncle John this week!

I turned 28! (Thanks for the messages people!)


Amongst many bits and bobs during the last week before my 3-week hiatus (can not wait!) is the following good and bad stuff!

Highlights:

Parents. The vast majority of the parents I have been working alongside have been so receptive and willing to listen and try things that I’ve been blown away to be honest, especially considering it was one of the areas of difficulty I was expecting to face up against working out here. A couple of great examples from this week are the parents of the children at the hospital (see last week’s entry) who have done an amazing job carrying out oral hygiene instructions and this week both of the kid’s oral infections have all but disappeared! J Another example are the parents who actively support what I am doing by phoning me (sometimes a bit too much though!) to enquire about when they can next see me or joining me whenever I ask them to because I want a meeting/training with both staff and parents present. Absolutely brilliant.

Jalaram School! I’m just blown away really by all the people I have worked with connected to this school (I.e: staff and parents). Similar to as mentioned above they have been so willing to be open with discussion and motivated to not only get involved/learn but also to go above and beyond by asking questions and wanting as much information as possible. During a first meeting with a mum at the school, where I wanted to take a case history and give advice (I had already observed the child twice), Jalaram’s headmistress, without me asking, sat in on the entire one hour or so session, taking down notes on everything that both myself and the mum was saying, both for her benefit but also to pass on to the teachers she told me at the end. Simply brilliant. Both of the new clients at the school who I mentioned last week (two sisters, 4 and 6, and a 16 year-old boy) were also observed/assessed and parents spoken too. The sister’s mum was given my number and she proceeded to text me with what was essentially some essays explaining her concerns and voicing questions about her children which led me to arrange a home visit which I thought I could not do due to time constraints. Due to the amount of information I needed to take, the fun I had playing with and assessing the girls and mum’s queries the visit ended up being over 2 hours long and finished at 6.30pm but was nothing but a pleasure! :) On a related note (in case people are interested) the 4-year old I have no concerns over but the 6-year old has expressive language delay, some delayed phonological errors and I also query selective mutism due to her presentation at school, home and during assessment.
The 16-year old has a multitude of difficulties - from fine motor skills inhibiting his writing, to poor reading skills, some difficulties with understanding (inc. some mild hearing impairment) and some voice (uncontrollable pitch changes) and phonological difficulties. His openness speaking about these difficulties was a real blessing and gave me a lot of information that (with his permission) I’ll be passing on to the staff during the training booked at the beginning of January - ideas to support him in class e.g: slower dictation or handouts as he does not possess the fine motor skill to write quick enough, a stricter control on noise in the classroom as he mentions a lot of his difficulty understanding is due to other people speaking even though he sits at the front of the class. The plan here is to do the above and in addition provide specific phonological activities to support his pronunciation.


Lowlights

The Doctor’s strike - I could bang on about this for an age and get a bit aggro so I’m gonna try not too and essentially say it’s ridiculous that the government pay some professions here so little, especially when the government officials are some of the highest paid in the world, and on the flipside that these doctors are demanding/expecting such a hike in salary and also are happy to ditch their parents in need for what sould seemingly be a period of weeks. Due to this, as mentioned, the only thing being done in the inpatient wards are the nurses are giving the meds as dictated prior to the strike and are keeping an eye on patients as they do not have the right/training (this is what I can make out anyway) to change anything/diagnose/request tests etc.. As a result, people are discharging themselves and people who need to see Doctor’s are not coming in to hospital as they know/feel nothing can be done until this strike is over. Absolute madness.

The treatment of one of my clients - A new client who is 3.5 years old, who I observed briefly to have sensory issues, attention difficulties, and global language delay (delay in both receptive and expressive language - he is not understanding as much as you would expect at his age and is has only acquired the use of one word - “mummy”) is being beaten and locked inside the home. From the mother’s point of view she is beating the child when he is not playing nice, breaking things, refusing to eat etc.. and locking the child inside due to safety reasons - if the door is left open he will just walk out and aimlessly walk. I did my best to explain some of her child’s difficulties and that although we are from different cultures, the majority of the things he is being punished for are things he is not doing on purpose/does not realise it is wrong and beating him is not helping. I always try and tread carefully around this subject as beating/caning is widely done here and I don’t want to break the relationship I had built up with the mum by being too forceful/opinionated on this issue although I believe this treatment of children to be totally uncalled for full stop regardless of culture/parents/children. I think* she understood the rationale behind what I was saying and at times either looked embarrassed by what she was doing or was not wanting to listen to me - either way my overall feeling was that she did really care for her son and wanted to take on advice but due to not having the knowledge previously, not having support, working full-time and trying to cope with a child with a variety of difficulties (her neighbours won’t let him play with them/their children etc..) has led to this type of control/punishment. I also explained how important play is and that means play and exploration both inside and outside the home and that play should be fun not just for the child but for her aswell and she should play with him outside with other children his age, such as the neighbours communicating to them the difficulties he has, the reasons he acts certain ways, his strengths and why it’s important for him to be involved with others, with herself their to support/supervise. I am very much looking forward to hearing from her at the follow-up I intend to do in January.

My hospital in-patients - the two kids who I wrote about last week and briefly above - M, The girl with multiple infarcts and sickle cell is far more awake/alert and is moving her mouth a lot more this week :) (which has allowed mum to support the clear-up of her oral infection) however she is still not safe on anything oral, showing no swallow whatsoever at the point of  feeding (teaspoon of water), with visual discomfort and other signs of aspiration present. The other child, C, who I started on extremely small amounts of oral feeding has had to be made non-oral again. It was a really difficult choice for me - as there are no doctor’s in I did not have as much of a MDT decision as would have been ideal - but the following issues all lead me to believe it would be better to not risk aspiration and chest infection then continue getting his oral processing and swallowing back on track:
1. He had a fever the night before and his alertness and thus his ability to process and swallow food was very delayed compared to the previous assessment
2. These fevers are constantly ongoing (every 2-3 days) and thus if it is affecting his swallowing as much as seen, for mum to follow a feeding plan would increase risk during these times of fever/reduced alertness and fatigue
3. There are no doctor’s in to support
4. I’m away for 3 weeks so cannot re-assess the client and support mum

And that’s me DONE. Only a short one today as the week was a bit of a wind-down week plus I’m knackered and didn’t fancy writing so much!

Tomorrow morning I head to Nairobi before on to Tanzania and Zanzibar, returning 3rd Jan. First stop - a 4 day safari in the Serengeti :) !

I truly hope everyone has a lovely December, including Christmas (those who celebrate it - MERRY CHRISTMAS) and New Year

Love you all and I‘ll be back on the bloodroot in 3 weeks or so all being well,

Jon x

Top 3 songs played on Itunes shuffle whilst writing this:

1. Giving up on love - Slow Club
2. Speak Slow - Tegan and Sara
3. Bedroom eyes - Dum Dum Girls

Hospital, Homes and Hell's gate

Hey gang,
Penultimate update before I go on a wee travel (details below), it's been a busy couple of weeks (no change there!) with big changes in my schedule and lots of new experiences of environements and clients alike! Hope you enjoy it all..

Some facts from the last few weeks (some do not make for light reading I‘m afraid):

1 in 6 babies born in the first 6 months of this year at Kisumu’s largest hospital were HIV Positive. ONE in SIX.

1 in 27 pregnancies (at the same hospital) in 2010 resulted in the death of the child

I’m now trained to give breastfeeding advice to Kenyan mummies!

I saw my first ever new-born baby - approximately 3 minutes old!

I saw my first ever giraffe in the wild - came out of nowhere (I mean, we were in a national park, not just walking down the street) and was about 20 ft in front of us galloping away down the road. Chased it briefly on the bikes we were on. Felt like a kid again - Picture Elliot in E.T pedalling away.

Had my first proper thanksgiving - VERY unsure about pumpkin pie.

I’m booked to go to Tanzania and Zanzibar over Christmas and new year, then fingers crossed climbing Mount Kenya near the end of Jan.

My return to the U.K is currently Feb 14th. Valentine’s day was not picked on purpose for some romantic shenanigans. Though who knows ;)


The days gone by:


Infant and young child feeding nutrition
I was so happy to have snuck onto this 3 day training held at the hospital. The focus was around breastfeeding (how to/difficulties with), nutrition, breast milk vs. formula (hopefully I don’t need to tell people this but breast is best! Formula sucks/is evil) and HIV Transmission through feeding. It was a really fascinating insight into an area of interest that we don’t find out much at all about as we train as SLT’s.
I’m hoping to research/get a friend to send me info from the UK as although the presenters seemed on it and the info was really helpful/solid I just wanna make sure what I was told is something I can carry over worldwide or whether some of the info was Africa/Kenya specific. The final day included “practical” which straight away made me think we were gonna be expressing milk from mother’s breasts or something (!) but it was doing ward rounds of the 3 baby units:
Labour ward - Does what it says on the tin
Nursery - Newborns who require extra support
Post-birth (I almost wrote after-birth but don't think it was called that!) - Beds where parents (all mothers - didn’t see a single father) stay a few days after birth and where others who require support stay for longer e.g: Ill mothers, C-sections

Needless to say, although I haven’t been in a unit/dept like this back home I assume it’s rather different - Labour room was crammed to the rafters with one particular lady vomiting and whaling in pain without anyone really attending to her. We were showed into the delivery room where a new mother had literally just given birth. The child was barely a few minutes old, wrapped up underneath a heater, whilst mum was standing there in discomfort, surrounded by a not particular soothing environment of blood etc. Not exactly what I was expecting but it was an experience nonetheless! The nursery only consisted of a single child who was hooked up to all sorts inside a unbelievable warm room (think sauna crossed with an incubator for baby chicks). This child was born over a month premature and weighed 1kg at birth. Underweight is considered less than 2.5kg. The child looked like a baby doll and was and probably will be the smallest baby I will ever see - To try and put it in perspective the kid’s feet were smaller than the size of my thumbs, legs similar width to a crayon and torso around the size of my palm. Fingers crossed the little guy makes it. Finally, in the post-birth wards were ten’s of day old cuties with mostly smiling, happy mum’s :) The one lady that stood out amongst the rest was a 15 year-old who had just had twins. If I could’ve taken a photo of her, it would not look out of place in the dictionary next to a definition of “proud”. I know proudness isn’t exactly something that you can show/see explicitly like happiness but the smile on her face, the way she was lovingly looking at her twins, her giggling with joy when people asked her about them almost got me all teary. I doubt I’ll ever forget her.

The Weekender - Welcome to Hell
After a couple of home visits on the Thursday I was off for some fun in the horrible sounding Hell’s gate. Highlights included a mate’s ridiculous attempt at putting up a mozzie net, going on a good 40km cycle ride  (cycling is NOT my sport), doing a 2 hour hike in a kick-ass gorge (which was used in a tomb raider movie don’t you know!) and seeing a huge load of animals - faves being the huge adult giraffe that jumped out in front of us and raced us down the street a bit whilst we were on our bikes, zebras and a hippo which we saw near our camp at night time..

Hospital
Back in for my usual stint but had an O.T who normally works in the paediatric ward come and whisk me over to her unit to see 2 kids for swallowing assessments. It’s truly brilliant to have staff who have listened to training and acting upon it :) ! The two kids have very different diagnosis’ but both have been on an NG tube (feeding tube that goes through the nose) since being in. M is 6 years old and has been in hospital for almost 2 months. She has had multiple cerebral infarcts (stroke) is sickle cell anaemic and is severely malnourished. The day before I saw her she had a convulsion (which are said to not be common for her) and her NG tube removed (why, I have no idea - I’ll get to that in a mo). C is 11 years old and has been in the ward for almost 3 months. He came in with meningioencephalitis (meningitis and inflammation of the brain) from which he has had several complications. He is still on an NG tube and is very underweight. Neither of the children are particularly alert, have difficulties with mouth control (M has clenched teeth the majority of the time), cannot support themselves at all physically and seem to have little to no understanding of spoken language. Therefore there are a LOT of difficulties they are likely to be having with eating/drinking (especially considering they have not had any oral intake for months) and a feeding assessment would proved to be difficult. The first thing I wanted to do was have a little look inside their mouths, which was a challenge in itself, to check the condition of oral hygiene. Both had severe oral thrush and there and then I didn’t want to risk doing any feeding until this clears up as aspirating (food/drink going down the wrong tube into the lungs) on anything can take this infection down and increase chances of illness which in the case of these 2 is definitely not a smart idea. I explained everything as best I could to all involved and when I returned on the Friday, low and behold C’s mouth was looking absolutely grand! J After a small feeding assessment, C had a good, slightly delayed swallow with no overt signs of aspiration and felt that starting him on a very small amount of oral intake would be a good idea so hopefully things will start picking up with C and his nutrition/enjoyment of life etc.

M however was not safe on any liquid - not only does she have very limited movement creating difficulty to give her anything orally, she had no swallow on a small amount of water and one day I came in her mum had just given her a small spoon of very thick medicine (like a gel) which is for her oral infection - she had an incredibly delayed swallow with very gurgly, heavy breathing ( a sign things are trapped/going down the wrong way) and the majority of the medicine seeping out of her mouth over the next 10 minutes or so. Considering her condition, her malnourishment, her oral thrush (probably causing pain when things are in her mouth ) and lack of oral movement/swallow it is unbelievable that they took her off an NG tube in the first place - so I explained all this to mum and nurses and got her back on an NG plus told everyone NO ORAL intake and that includes the oral thrush medicine which is a real head-banger as the drugs they use for this at the hospital only come in droplet form (which would be better/good to put onto a linen cloth and dab) or this gel. However the first one they tried for weeks with no results so the only other option is this gel which needs to be coating the mouth and swallowed. Something she cannot do/is dangerous for her.

The other really crappy thing is that the hospital want to discharge both kids as “they have been in beds too long” / “we have done all we can” which I guess how things work out here but there is just simply no way I would condone these kids going home with NG tubes in and relying on parents to clean/take regularly to a clinic to change the tube etc.. I simply don’t see the training being put in place for them. Additionally, just there conditions in general, drug intake, need for support etc.. It’s really really difficult/sad to see these kids be possibly moved out of the hospital when they desperately need the support.

School Training
Most of the schools are shut til January but I managed to sneak in one last training session at a private nursery attached to a school. All 7 staff members, the headmistress and the mother of the child I have seen there turned up and were really interactive and interested in the session which is great. It’s also so important and good for parents to be there with teachers to discuss ideas, know what the teachers should be doing to support etc.. Was actually pretty chuffed with how it went and off the back of it I got an email from the head of the main school who has requested I do a full staff training in January and had 2 calls from kid’s parents (a 4 year old at nursery and a 16 year old in school) asking when they could see me/giving me permission to work with their kids! So next week Weds I’m returning to observe/meet these kids, meet parents for case histories, speak to their teachers and check-in with the nursery staff who came to training.

Home visits galore
I planned to see 12 kids (from ages of 6 up to 19) at home before I disappear on holidays and managed to book in 7 over Thursday and Friday just gone. These home visits are specifically for those parents/children who attended an Autism workshop a few weeks back (some parents came as they wanted to know about communication systems rather than their children have an Autism diagnosis) to see how things were going and to continue/re-iterate/check their understanding of a few communication systems I have started to with certain children. It also is a massive help from my point of view to get to know the children better through observation and informal assessment (many I have only observed very briefly), seeing them in a different environment and observing the toys they may have/play with and the way they interact with family members. Below are some pics of the visits.

And that’s my lot!

Next week I’ll be continuing home visits, working at the hospital and spending two days shadowing a paediatric nurse and a social worker respectively to get a better idea of what they do/how they work here. After which I’m off to Tanzania and Zanzibar from Dec 12th to Jan 3rd give or take so my blog will be taking a hiatus.
I’ll check in next week before buggering off though!

Happy December and wintry times to most of you (am a bit jealous of cold weather at the mo!)
Love you all,

Jon x


Top 3 songs on Itunes shuffle whilst writing:

1. Little Shadow - Yeah Yeah Yeahs
2. Public Pervert - Interpol

3. Fear of Drowing - British Sea Power

Breasts, work and play

JAMBO!!!


Hope this update finds everyone just fine and dandy... As with previous update I’ve been doing a half decent job of occupying my free time with non internet/computer related activities and also just think highlights/lowlights is the way forward rather than boring the life out of you guys with day-by-day plays especially when I’ve gotten into a routine of seeing some clients on a regular basis.

Funny/interesting stuff from today (there was so much today I thought it would suffice!)
Soooo to start off with today, Monday, I managed to get myself onto a 3-day early childhood feeding course at the hospital and along with an entire day of learning about the world of breast-feeding were some absolute crackers harked out by the presenters/staff present:

Presenter: If there is only one small bed in the house not big enough to accommodate all 3 child, mother and father who should sleep in it?
Staff member: The child and mother should sleep together, for bonding and breast-feeding. On the floor.

Presenter (about 30 times in the space of 2 hours): If Obama can do it, why can’t you? Say yes we can. (I’m not quite up to date on my politics but I don’t think Barack has been trained/giving out breast-feeding advice)

Presenter: (every time when giving an example difficulty with breast feeding): So will you help this woman? (probably the most ridiculous question I have ever heard considering the staff present (Mostly paeds, midwives, obs/gyn) and it is never rhetorical.

Presenter: What colour should baby poo be? Yes, yellow. Like scrambled eggs. (there goes my appetite for one of my staple meals here)

Some fairly interesting facts that no doubt you will never need to know but are pretty interesting regardless:
0 out of 16 public hospital facilities in Nyanza province (where I live and work) are considered “baby-friendly” according to UNICEF / WHO guidelines

A common belief here is that witches at marketplaces (yes, it’s oddly that specific) bewitch new mother’s breasts which causes the clearer, more watery milk (“foremilk”) that is at the beginning of every feed. Due to this many mothers get rid of it even though it is nutritionally great for a kid just not as good as the dense white, nutritionally higher milk that follows (“hind milk”)

In some tribes/cultures the baby cannot be breast-fed until the baby has been named. This priviledge falls to the father and sometimes does not take place for days or weeks after birth. In these cases the child is fed salty and sugary water instead.

In some tribes/cultures once a Kenyan becomes a mother and produces milk, one breast’s produce is strictly for the father and one breast for the child.

60% of all Kenyan mothers are anaemic

Calcium and Iron are not pals. In the presence of calcium, Iron’s nutrients cannot efficiently absorb into the bloodstream and body. The presenter stated if you drank a glass of milk with dinner every night for 6 months your Iron content would reduce by around 25% (not sure how accurate this statement is mind!)

Highlights:
The child who I took to the epilepsy clinic as she was being dosed up to the eyeballs with drugs has been changing her intake and after never seeing her awake (even when O.T’s are going to school on her), she has been eyes open the last 3 times I’ve seen her!! :)  The dosages are still being altered but I hope to start to observe and give advice to mum in the next few weeks.

Training has continued to go great, especially at the two schools I previously mentioned where I delivered an Autism specific workshop. Disciples of Mercy have been great and responded to my request to have as many of the parents and relevant staff be there one morning so that I could not only give a brief hour long information session on Autism but also introduce some strategies that I could show to both parents and staff and they could then practice whilst I was there :) It was kinda a bit hectic but at least it’s a start and the most functional, easy way I could give information to a number of people whilst getting parents introduced to each other for some good old fashioned support. The tentative plan (though I’m not sure if time’s gonna make it possible!) is to home visit all 8 kids in the autism unit before I dissapear for Christmas to follow-up the session and take photos of things around the home to use in communication books and visual timetables.

I delivered pretty much the same workshop at Lutheran which could only happen on a day kids weren’t in (so teachers were free) but therefore couldn’t get parents along. However, the lovely headmistress was trying to organise a load of parents to come in tomorrow for me to mention the importance of attending the epileptic clinic  and give an autism workshop to relevant parents! Why can’t all heads be like this! Unfortunately this had to be nixed as I managed to get onto this early childhood feeding course which was an opportunity to good to miss really.

As I’ve mentioned previously a very high percentage of children I see at the hospital have swallowing difficulties, and along with this (for nearly all of them) one of the factors, if not the main factor, is oro-motor difficulties - difficulties with movement and or co-ordination of head/neck/jaw/lips/tongue. These difficulties also account for a number of non-verbal children I see within the O.T department. Therefore I was very thankful to have arranged for my supervisor to come down to attend to some of my clients, whilst I got a chance to learn a load about oro-motor activites and exercises that can begin to support children with the aforementioned difficulties. One of the most difficult things out here is probably the amount of children I see with sensory issues or oro-motor difficulties, neither of which I’m specifically trained for (being newly qualified) and it can be a bit intimidating/difficult when I don’t have much information or activites to do with these clients especially when it is their main difficulty/priority.

Over the past week I’ve had a number of clients referred to me from all areas of the hospital which is simply brilliant. It makes me think that at least some people have knowledge not only that I am here, but more importantly what I do and the types of clients I work with. An O.T who only works out in the field brought a non-verbal 7 year old to see me from their home a few hours away and from various other personnel I had 2 very different adult stroke referrals this past week with one being a lovely young man (32) who is exhibiting global aphasia (difficulties with both receptive and productive language) with very common characteristics such as word-finding difficulties (causing non-fluent speech) and some fluent unintelligible jargon-like speech. He has an unbelievable brother who is looking after him and takes notes at all meetings and is using all the word-finding strategies I introduced them to on my first meeting (examples such as talking around the word e.g: what category is it in? What size is it? What colour? What is it’s function? And giving a phonemic prompt - the first sound of the word). The client is great because even though he is obviously struggling with the impact of the stroke, he has a really good sense of humour and realises (at times) when he has made a mistake/when sounds don’t come out right and can laugh at himself. Something which I think is incredibly important when something as life-changing as a stroke happens. As a side note it’s also great to work with adults too as this is an area which I always thought I would go into and although I love working with kids, in my heart of hearts I still think adults is where I want to be.

Playtime :)
A couple of weeks back I bustled off to a place called lake baringo for the weekend with a motley crue of americans and brits (some of which are in a pic below). Although we only stayed for a single night, the 7 hour journey there and back was an absolute joy made awesome by getting to know each other (a number of people I’d never met before), drinking beer (don’t worry, the rental van came equipped with driver!) and playing games such as Kenyan road bingo (e.g: spot 4 people on a motorbike, an entire living room of furniture on a tuk-tuk etc.), The place we stayed was absolute heaven, the communal food was mind-blowing and drinking into the night on our pier overlooking the lake was beautiful. Even gotta see a hippo about 15 ft from our pier munching away for a good few hours :) The day we left we went on a little hike taking in some breathtaking landscapes and a couple of scorpions, rock hyrax and a snake. Good times.

Continuing weekend fun, this past one, on the Friday went out for some live traditional music and even got a little dance on (yes, I did have a number of tuskers) before Saturday was a day of afternoon drinks and games. About 15 people joined in am afternoon of corn hole (thank you America for introducing me - look it up before you assume it’s something rude), Stickcup (thank you Canada for introducing me) and a quiz hosted by yours truly (Thank you England for being the country I grew up in). Absolutely lovely stuff.


Lowlights

The only real lowlight was me being a bit on the ill side for the good part of a week which meant having to cancel on clients, appointments and rearrange my already frantic schedule! Oh and I’ve been writing this in the dark cos there’s something really weird going on with the power and the lights have been on then dimming then switching off every 45 seconds or so constantly for the past 3 hours. It’s even more annoying then having no power. And it’s taking me about 3 times as long going back over all the spelling errors. Effort!


Plan for the week is looking pretty eventful as am on this childhood feeding course until Wednesday, doing 2 or 3 school visits on Thursday if possible as nearly all the schools close up this week until January followed by a thanksgiving dinner (!) before Friday to Sunday going to a national park called hells gate for a bit of camping and wildlife. Woooooooooooooooooooo.

PS: Reached 1000 views!! Thank you all for continuing to be interested in my word vomit and work!

Huge hugs to all,

Jon x


Top 3 songs on Itunes shuffle whilst writing:

1. American Slang - The Gaslight Anthem
2. Love Is Rare - Morcheeba
3. Here I Dreamt I Was An Architect - The Decemberists

Life and Death

Firstly please check my last post again if you fancy it as I've added some pictures :) !


As I’ve been enjoying a little bit of time away from the soul-sucking, time consuming world of the wide web it’s been 2 weeks since my last update so to make things a little more palatable and less boring I’ve just gone for some highlights and lowlights of weeks past.


Highlights:
After seeing a plethora of clients with epilepsy/seizures/convulsions that I was particularly worried about I arranged to support two of my clients at a monthly Saturday epilepsy clinic (situated in a barn! See below). I was specifically worried about these clients as they were still having anything up to 5 seizures a day even thought they were on a cocktail of drugs that were meant to be treating the condition. Additionally, the child I was most concerned about was sleeping almost every hour of the day only to wake up for feeding and was on far too many drugs for her age, causing this constant state of sleep. When enquiring about it, the dose had just been put up again the week gone by, nothing has changed regarding the convulsions and the doctor told the mum “it’s better she is asleep than awake and having convulsions”. Absolutely ridiculous considering she has not/cannot learn anything when not awake.
The Doctor was amazing. He explained to me how he treats clients he sees - using mono-medication therapy as drugs tend to interact with each other, stepping the dosage up every month if the parent’s diary shows no improvement in severity/amount of seizures. If the dosage limit is reached for the person’s age/weight and no large positive effect has taken place the dosage is stepped down to nil and an alternative medication is trialled.
I was pretty shocked that EVERY single new client we saw were taking a lesser suitable medication than than the doc would recommend, a mix of medications (a no-no), the wrong dosage or taking the tablets are the wrong time of day (many take half a day to kick in). The reason for this was likely to be due to negligence or people wanting to make as much money as possible. Incredibly wrong on all counts.
Both my clients turned up which was great as well as 2 other kids I had previously seen in clinic or hospital and then during the session I recommended 3 parents to bring their children to see me for speech/language/feeding difficulties, all of which came to see me on the following Wednesday. Crackin’ stuff.

After being a bit here there and everywhere for the first few months work has settled down a little into a semi-routine! By settled down I don’t meant the amount of work but after seeing a number of different schools I have decided upon a few schools to roll out extensive training to and hope to dedicate at least half a day to on a weekly basis. These were decided by type and need of clients and motivation of staff/teachers. For example, Joel Omino School where I have been a good number of times over the last month is a mainstream school with a large amount of stammerers, so after arranging a number of meetings with the students, teachers and parents I shall now predominantly be going on a monthly basis for the stammering group.
So, over the past 2 weeks I have observed meal-times and in-classroom teaching within a special unit of 70 children at a private school (Disciples of Mercy) and a school for the “mentally handicapped” (Lutheran). I then carried out eating and drinking difficulties training for 17 and 31 staff members respectively (pictures of the Disciples training and a weird thing in the lab it was held below). The training went really well and not only was the feedback kind but all staff and principals want me to continue coming back for training on a weekly basis, which although something I intended/hoped to do is great to have that motivation/interest/encouragement from staff.
This coming week I am doing general SLT stuff/in-class room strategies for Lutheran, Dysphagia training (swallowing difficulties) for 25 staff from across the whole of the hospital I work in and then following-up next week with Autism training for staff and parents (who I’m getting the principals to drag in!) in both Disciples and Lutheran where I hope to give information and advice before introducing some of these strategies (Such as visual timetables or the start of training towards a picture exchange communication system - PECS) in the classroom with teachers and parents on hand to watch and take part :)

Speaking of Joel Omino, not sure if a low-light or a highlight but held the monthly stammering meeting and was a bit gutted to see only 2 pairs of parents turn-up however did manage to round up all the children who stammer in the school to watch a brief English documentary on stammering which I think was really good for them to see that people from all over the world, both young and old stammer, stammer in all sorts of ways and don’t let it stop them from carrying on their lives. The highlight here really are one of my client’s parents who have both come to everything I have arranged and are so brilliant in not only wanting the best for their son but also for all the children at the school who stammer and are very outspoken against how terrible it is the teachers are not getting involved (this occasion for example I went to the staff room 5 minutes before starting and at least 5 said they would come, none did) and said that they are really thankful of everything I am doing and to “not give up” which really is the type of thing I’m meant to be saying to the parents, not the other way round!


Towards the back end of last week I had 3 home visits I decided were important enough to travel/fund. Two of the referrals were from staff at Disciples immediately following my training which once again is just mind-blowingly great. They were for eating and drinking difficulties - one child, Jack, who has been off since July was immediately flagged when I mentioned some symptoms, they pointed out he has had recurrent chest infections, and the other a child called Victorine who I noticed was not being fed at break-time even though she was in the group that needed feeding assistance. I was told anything that they try to feed her she vomits. The other child has been diagnosed with autism (I query this as she possesses some social skills such as eye contact, reaching to hold hands etc.. though does have a load of other characteristics common with autism which is why I’m sure she has been diagnosed this way!) and is approaching 7 years of age, is non-verbal and although has sensory issues has some great strengths with taking/receiving items and can sit and concentrate for a few minutes at a times which makes her a great candidate for starting PECS.


Lowlight
Jack.
As I had not been given his record/case history the only thing I knew was that he had been ill since July, had a diagnosis of Cerebral Palsy Quadriplegia and was having chest infections. On arrival to Jack’s house the first thing I noticed was how painfully thin he was and that he seemed to be having non-stop small convulsions every few seconds (these started a week ago and had not stopped, even with medical intervention). Jack’s legs were as thin as my wrists and I could put my thumb and forefinger around them even though I have pretty small hands. I would’ve estimated he was around 7 or 8 years of age but when I asked Mama Jack she informed me he was 16 (I later found out his weight over the last month ranged around the 20kg mark). Mama Jack was prepared for my visit and so we began the feeding assessment. Without going into too much detail, Jack was aspirating on both liquid and mashed consistency (normally the safest for people with eating and drinking difficulties) and could not chew so solids were not a safe trial. He had no swallow whatsoever on mashed food and only had a very delayed, weak swallow on liquid and with every mouthful of anything he took, in part some was going into his lungs. In addition, he vomited up (seemingly) anything that was going into his stomach, with not only the food coming up but also a lot of mucous.
In as gentle a way as possible I informed mum of what exactly was happening, why I was so worried about Jack - he was seriously malnourished and as things stand anything he takes down is making his condition worse by going into the lungs or he is vomiting it up so he essentially is getting zero nutrition. Mum was very receptive, understood my explanations and concerns and it was arranged that the very next morning I would meet them at the hospital to see what we can do. This is the first client I have had where I did not know/could not do anything to help. Unlike others where maybe I’m not quite sure what to advise or do, with Jack there was literally nothing I could do and also I was not even sure what could be done at the hospital because in the western world Jack would likely be put on a PEG (a tube feeding directly into his stomach) but here this doesn’t exist as far as I know and the alternative - a NasoGastric Tube - is only recommended for short periods of time.


The next morning I got the call from Mama Jack and spent the day from 9am til 2pm with them (until I had to leave to do my stammering group). The reason I wanted to be with them was to explain to the doctors what I have seen and what I’m concerned about as it seems that for Jack at least people were only treating him with whatever ailment he came to them with. He had been in the hospital 5 times in the last 2 months with Malaria, Cerebral TB, high fever, convulsions and yet he was treated for that particular ailment via drugs and sent away. It seemed like no-one had questioned the fact this 16 year old was incredibly malnourished or that his breathing was constantly gurgly let alone not found out any of these problems from mum. I can only assume this otherwise he would’ve been in hospital care.
So I explained everything to the first Doctor who kind of ignored me a bit and said the convulsions are what’s needed to be sorted first (in line with my thoughts above), whereas when I repeated this to another Doc who came over he immediately recommending getting him on an NG tube and in-patient care. I further explained everything to the 7 trainees and other doctors that came to surround Jack’s bed as he was having blood samples taken (which was excruciatingly painful to watch as they found it incredibly hard due to his condition) and sugar syrup pumped into him. At one point when I pointed out how malnourished he was for his age mum was asked his age. When she replied 16 there was a look of disbelief/disgust by all surrounding the treatment table and mum was asked a further two times to clarify his age. That’s how shocking his weight was, even to those who work day in day out in these facilities.  A chest x-ray was also taken after which they were waiting to be taking to in-patient care when I had to leave. At 2pm I wrote a note for the mum to show to all that work on/with Jack and informed her I would phone tomorrow to see how things were going. 


At 6pm the mum phoned me in tears and merely said “the boy is dead” before hanging up.


Considering all the difficulties Jack had and his condition it was not unexpected however after getting him to the hospital and being transferred into in-patient care I was really hopeful this was be the start of something rather than the end.


I received a message today from the social worker who I worked alongside for Jack’s visit passing on a message from Mama Jack that she was really appreciative of everything I tried to do for Jack and would like me to be at the funeral.


Rest in Peace Jack.

And that was the week that was

Hey hey hey, here’s another bit of chicken scratch as one of my friends calls my beautifully awful handwriting…

Funniest things from the week

Me: I’ve got to go soon. Thought the match was meant to statt at 9am and it’s almost 10 now.

Jim: What time is it?

Me: 9.55

Jim: So it’s still 9.

When giving a poster for International Stammering Awareness Day to a new local establishment run by the local representative I was asked if I got permission from the government for giving out info…. My reply: “errrrr, no” . . “You could get arrested you know…. (cue awkward silence) … but I’ll cover for you this time”

Was told that a few weeks ago at the meeting in Uganda as I was busy shovelling food down at lunchtime a lady opposite me told a colleague: “I like him… He eats like a Kenyan man”.

Last Sunday when having a kick-about at half-time during a tournament I was goaded into having a pop at goal. Struck it beautifully, came off the underside of the bar and the makeshift goal proceeded to collapse in comedy-like fashion: bar came crashing down, then the right post flopped down and the left followed suit.

Twice now there has been some odd kinda witchcraft like chanting just outside my house at stupid o’clock in the morning… Very tempted to grab a look but probably not the best idea as 1. The front gate gets padlocked at night (fire safety hazard woo-hoo) and 2. They may be chanting about me.

Picked up a huge snail (about the length of my tiny girl-like palms) for a photo. It proceeded to pee/slime everywhere.

Monday - School canvassing

After a lovely morning at the hospital seeing some clients new and old I spent the afternoon trooping around some of the major schools in Kisumu explaining what I do, giving information regarding Saturday’s stammering awareness event and encouraging the principals as much as I possibly could to pass on the information to relevant pupils and parents and all staff. The response I got was very mixed, which in my humble opinion is pretty representative of that seen in the majority of teachers/school staff. One principal looked like he hadn’t been to sleep in 3 days and would rather have been having his fingernails pulled out than listen to my speil, whereas 2 principals in particular were incredibly lovely and receptive, asking questions regarding my work and immediately flagging up a few students/families who they will contact. Come Saturday, students from both of these schools turned-up :)

Tuesday - Home visit

My first proper home visit was today and it is hopefully going to be a sign of things to come as I have started to clear by Tuesday’s for home/school observation purposes (previously Tuesday was a mish-mash day and as home visits are not as efficient time and money-wise as school visits I hardly had any). One of the reasons for this home visit is that the parent has been looking for a SLT for a long-time, she is extremely passionate, receptive and motivated for her child (age 5) and is also the head of the parents committee at Disciples of Mercy School where I will be doing some training in the next month. On a slightly selfish note, it is also really nice to be able to see a child on a regular basis and work across environments on specific short-term and long-term goals. 

This first visit was explained to the mum as an observation to get to know the child better (the referral information/diagnosis merely says “intellectualy challenged” , see how he plays with mum and sister (if there is opportunity to play in the house) and to do an informal assessment of his receptive and productive communication ability. Like many of the kids I see the child has fairly significant sensory issues and during the hour or so I was at the house he only sat/stood still for a maximum of 30 seconds or so and each of these longer periods were due to noises outside the window which he had to go and see/hear/explore. One of the major discoveries from the session was  the child’s receptive language skills (I.e: understanding of spoken language) were far below that reported by the mother. It can be a little difficult at times to explain things like this to family, especially when she believes he understands basic commands and many basic words but when observed, non-verbal cues (such as following others actions, understanding through gesture) was how the child was understanding and a basic assessment showed his understanding of basic nouns was the equivalent of guessing. In addition to this I also breached the subject of potentially using a non-verbal means of communication for her child. At his age, with good tongue movement, an encouraging motivating environment but still very little spoken language (only screaming/crying/open vowel sounds and mama, baba and tuk-tuk - but the words are not used for any particular purpose/intent)  plus a good set of non-verbal communication skills (both understanding and use of gesture, facial expresion, passing and taking objects) a non-verbal way of communicating is likely the way forward. Considering the amount of information I gave mum, strategies for her to use of the coming week and the possible emotional distress of the news given (early in the session she said “I can’t wait to hear my baby speak”) she was incredibly understanding of everything and extremely thankful for the service I am providing. Again, like other times I always feel really quite humbled and embarrassed considering the amount of time and effort she has spent raising her son in an environment with likely little support or information and yet she is praising me for doing something I’ve been trained for and have come out here to do as a job… Maybe I’m just bad at taken compliments but still find it weird to be thanked for stuff!

Wednesday - Supervision!

My supervisor/best friend in Kenya (!) came to clinic to observe my work to make sure I wasn’t doing anything horrendously badly. It was also an opportunity for me to continue my ongoing training in oro-motor exercises as a lot of children I see require this to increase stability, movement and control of the jaw, lips and ultimately tongue and having Rachael down allowed for me to see her giving advice to parents. Afterwards we went through the day with some lovely positive feedback J and some things to improve on which is lovely to know when out here on my own most of the time! We also went through the Royal College of Speech and Language Therapists Competencies which is something expected to complete afterr graduating within a year of your first job. As Rachael is RCSLT qualified and has the experience, I’m lucky enough that if she thinks I have the competency of certain points in the guidelines (there are loads!) they can be signed off whilst I am out here working. All require evidence and some simply aren’t possible due to the work I’m doing here but the good news is I have already has 2 signed off! Woooo hooooo! We also discussed some of the others I hope to achieve once Rachael sees more of my work and I can provide solid evidence to the RCSLT. A lovely day finished off with a lovely drink :)

Thursday - Prep for Saturday, Ultimate

Today was all about prepping for Saturday so I won’t bore you about making things and how great I’ve become at using a photocopier. In the afternoon I met up with some fellow mzungus to play a bit of ultimate (a cross between netball and american football played with a Frisbee. I’ve just read that back and it sounds both mental and a pretty bad explanation of the game but as I type away without deleting stuff it’s staying in!). Was real nice to meet a few new folks and have a bit of a stretch out of the legs - will hopefully be playing weekly and seeing some of these guys regularly (the main man with the discs has a birthday tomorrow evening that I’ve been invited to).

Friday and Saturday - Drinking, walking and stammering.

Finally the weekend has come around and Friday evening myself, Leigh (my newish neighbour / person who will get bored of seeing me in approximately 3 weeks), 2 of her mates and Rachael all went out for a buffet-tastic Indian where we joined up with a couple of the guys from Ultimate and their friends. Following eating until I felt almost ill we headed to Josh’s (American Frisbee throwing birthday boy). 60” T.V plus Rock Band and beers = where am I cos it’s not Kenya. A palace of a house which is nicer than any I have ever been in anywhere in the world filled with a nice gathering of mzungus was a bit weird but the homebrewed beer, passion fruit vodka and home-baked cupcakes and pies made me relax a wee bit! Got home at 2am before dashing through some sleep and waking before 7am for a cancer charity/awareness walk which I roped the aforementioned group of folks who I went to the Indian with along to. Arrived on time as wanted to get cracking, head home for food, shower and stuff before zooming across town for the stammering event. Don’t even know why I thought it might kick-off on time cos nothing does here… the guest of honour arrived an hour and a half late so we picked up a massive sweat whilst doing an extended warm up with a crazy mr motivator type (non brits - look him up) and the ever increasing hotness of Mr.sun. Luckily the walk itself was only about 6 km I reckon rather than the “10km” it was meant to be so had plenty of time to get home, sorted and worried about the stammering event!

Special thanks go to Leigh, Rachael and Stella who came to help out at the stammering event aswell as Josh, Jen and Sam who came to learn a bit about stammering and entertain the kids J So with these guys at my back the event went well with about 60 adults and children turning up to collect information (which I encouraged them to read on the spot so they could ask speech therapists any questions whilst there), come to brief presentations I did on stammering and listen to a few adult stammerers speak of their experiences. The adult stammerers were the big hit of the day with their presence provoking a lot of questions and discussions which was great as it is so important for the kids, parents and teachers (though was a little disappointed with the turnout of this group of people from Joel Omino School itself :( ) to see that stammering should not affect your ability to get through school, get a good job, get married and do all the other mundane things we achieve before passing into the next life! The people who came heard about the event through different means including some who heard about it on the radio (!), but the thing that probably made me smile most, bar some lovely feedback from folks, was approximately 20 children from a school I visited coming by school bus, half of which were stammerers and half of which wanted to know more. It’s always nice to know some of the people you chat to are this receptive and motivated to take on board the information I gave out, encourage their students to come along and provide transport. Fan-blooming-tastic! :)

And on that smiley note I’m off! As mentioned apologies for lack of photos (for the moment) and I hope no-one is being driven nuts by early Christmas paraphernalia and songs on the radio yet.

J xxx

For more information on the teeny speech and language charity I’m working under please check out: http://www.yellowhousechildrens.org/ 

Top 3 Itunes songs on shuffle whilst writing this:

1. Dashboard - Modest Mouse

2. I won’t back down - Tom Petty and The Heartbreakers

3. Sunrise, Sunset- Bright Eyes

I can die a happy man! :)

Funniest soundbytes of the week
Classical music playing in a matatu. It tends to be rap, reggae or the occasional random western pop song (Gym Class Heroes, JLS and weirdly enough Phil Collins are big players at the moment)

Me: “Jim, why aren’t you dressed for football?”
Jim: “I’ve got typhoid”
Me: “Oh”

Head of a school: “This is X (he looked about 14 years old), best coffin maker in the school”

The different relationship titles I’ve been called since being here: Son, Son-In-Law, Brother, Husband, Boyfriend. Just to clarify to friends and family alike, none of these are correct in the true sense of the words and I have not become attached to anyone through dating, marriage or adoption.

Monday - Feeling unwell L!
For the first time since arriving I’ve been feeling a little off kilter. Not sure if it’s the malaria tablets side effects, the increasing hotness, something I ate or other but hot and cold sweats, feeling tired 24/7 and generally not feeling my normal (if that’s what you can call it) self… Writing this as of the weekend and I’m still having the weird sweats and having funky dreams but feeling right as rain on the whole J


Tuesday - Disciples of Mercy (not a horror movie viewing but a lovely private school)
Disciples of Mercy is a  mainstream private school a little bit out into the rural countryside, it has a special unit of almost 70 children. It is beautifully kept and is essentially a little town within itself with an attached vocational training centre, chemist, hospital and church. These children are split into specific classes (sensory/attentional difficulties, Cerebral Palsy, Autism and 3 classes of general special needs according to age/ability of those without severe enough difficulties to be placed in one of the aforementioned specific). All the children have been assessed at the Education and Resource Centre to be placed here (unlike Pandpiri) and all the staff I met were really enthusiastic and passionate about the work they do which is fantastic. The headmistress is really keen for me to do as much work as I can here and unlike other head s who welcome me and let me do what I want, she showed me around explaining some of the potential things I could do, difficulties they have, asked me what would be best for the kids and my timeframe - e.g. training or 1:1 etc… Really great to have someone so gung-ho and interested/enthusiastic in having special needs work be done. The plan is to go in next week to look through all the children’s records, observe some classes and then plan a training workshop for the staff members that is as relevant as possible to the clients at school. The headmistress has already asked if I would dish out a few full day training sessions at the end of November when school breaks up for December. Ideally she would like me to do this for all the staff (not just the special educators) and also some of the staff from the attached small hospital and church who may work with relevant clients.

Wednesday - CP feeding and a particularly interesting client at clinic
Managed after an age to see the CP class at Joylands Special School at Lunchtime for a feeding observation. Much to my delight when I got there half the class had beans and the other had veg and ugali (consistency a bit like a harder stodgy mash) and when I asked why this was it was because “those that can’t chew don’t eat beans”. Starting off on a positive note yippee. During observation all but one of the 14 kids could self feed (which is great as self-feeding compared to another person feeding reduces risk of coughing/choking/chest infection due to the child being able to control pace and size of food etc… but also I imagine it’s a lot more enjoyable to be independent as well!) with two having some difficulties through poor posture and/or eating too much food at too quick a pace. I pointed this out to the staff and that if possible could the person who feeds the one child who cannot self-feed keep an eye on and remind these 2 children to take small, slow mouthfuls and be sat upright. With the child being fed, he does not possess the fine motor or gross motor control to grip or feed himself and additionally has very reduced neck and head strength/control meaning he can only hold his head upright for a few seconds at a time. The lady feeding him started off with fairly large sized mouthfuls and putting more food into the clients mouth on request - when he opened his mouth, even when there was still food remaining that had yet to be swallowed. Within the first few mouthfuls he began aspirating (coughing due to food/drink going down the “wrong way” towards the lungs rather than the stomach) at which point I asked if I could interrupt and give a little advice. After giving my two cents, to which I’m very grateful the staff member was very receptive to, the child did not aspirate for the remainder of lunch J It is very difficult to attempt to totally change a lunch menu etc.. but many of the children struggle with certain types of consistency (one girl had huge problems with the strighy veg but no problems with the ugali) so I’m planning to ask the school if they may purchase a blender to be used for the certain children which hopefully wouldn’t take too much extra time/effort but yet would ensure safety and enjoyment of eating for the kids.

The aforementioned interesting client was a 3 year old who has excellent social skills (eye contact, appropriate smile, handshake etc..) but who from the single assessment session I did with him does not seem to have a concrete understanding of basic words (nouns) but the interesting thing about him is that his spoken language is complete jargon. Unlike babbling, he looks directly at you and has a conversation with you, complete with prosody, tone, different length “words” but all totally jumbled up word sounds, none of which make sense. Additionally he presents with echolalia - the process of hearing a sound and repeating it without processing meaning - however he copies the syllable structure/prosody/tone of the word but as with his natural spoken output the sounds are completely different to what was originally said. For example I said “aaahhh”, he said “mmmmm”, I said “baaaa”, he said “tuhhhh”, I said “mmmm”, he said “aaaahh”, I thought I’d repeat the sound “mmmm” to see if his output was the same again; he said “puuhhhh”. Positively, he uses basic gestures to communicate needs such as hunger/toilet and can understand through use of basic gestures also. As the family live directly in between Kisumu and Vihiga I have passed the case on to Racheal as she has 4 years experience over my next to none and makes sense!



Thursday - School visit and the first ever Stammering group in Western Kenya!
My plan for the day was to visit 2 schools - the first was Pandpiri a large school (1600 pupils) with a recently attached special unit. I visited a few weeks ago and the two biggest issues of the unit was that half the children shouldn’t be there - they should be in their normal mainstream class with extra support from teachers during or after class in the areas they are struggling in and that the person in charge of the unit was the deputy head who is not trained as a teacher, only 3 months into special education training and has other jobs to do as deputy and thus the kids do not really have much structure/learning in the class with long periods of time left alone. On my arrival I was delighted to see that the children I mentioned that I felt would benefit more being in mainstream had been moved out of the special unit :) ! Working with the Department of Education we are trying to get funding for a professional and appropriate full-time teacher to take the special unit rather than the situation in which the school currently finds itself in. The rest of the time there I wrote up an individual advice sheets for 3 children who would benefit most from specific strategies and support when the teacher is giving instructions (e.g: always show objects or gestures together with instructions, use slow simple language etc..) or when the children are attempting to answer questions (e.g: give time, choices, use phonological prompts) aswell as the level at which these particularly children have solid understanding and the level at which work should be done, that they are developing into.

The second school was where I had planned to hold a stammering training/group as I saw 14 children 2 weeks ago with stammers. This was the first ever meeting of it's kind in Western Kenya and I can die a happy man thinking I've actually achieved something pretty decent(!), the key is to carry it over month after month including after I leave! After getting all my resources printed I rushed across town on the back of a bike in the scorching hot sun, adding to the sweat already building from the nerves! When I arrived there were maybe 4 parents which I thought better than none but there were no teachers to be seen. This really worried me as the main crux of the training/meeting was support strategies for the children in class and for the kids, parents and teachers to discuss difficulties,.. After almost 45 minutes of rounding troops up we ended up with 15 pupils (of the reported 17 who stammer), 9 parents (7 of which were fathers which was a total surprise as 95% of the people I see are brought by mothers and mothers alone) and 6 teachers (all the form teachers of the stammers bar one child). I thought the session went quite well with some hands up points to show the teachers/parents things that could really help. There is a well-used model within the Speech and language profession of an iceberg to describe overt issues with stammering (those we can all see and hear - above the water) and those covert (the feelings of the people we cannot know - underneath the water). It is widely thought that the covert feelings as those that need working on to reduce the overt features (e.g: If the environment is accepting and knowledgeable of stammering and the student is supported in class they will feel less worried/fearful etc.. and will potentially speak more/stammer less. As icebergs aren’t exactly common in Africa I switched the model to a crocodile which one od the kids thankfully drew for me - whilst asking the students on a word to describe the feeling they have surrounding their stammer these are what came out: Ashamed, strangled/constricted, why am I different?, afraid of what others thing/teasing. Another quite powerful moment I thought was when I asked everyone to take a few minutes to read some poems written by some Kenyan stammerers - the information was provided by the Nairobi stammering group. Below is the one that I think holds the best impact/feeling -

I’ve not been me.

My heart beats faster,
My chest pounds with terror and worry,
As I hold up the phone,
To dial and stir up a conversation,
My lips swell, eyes close,
As I struggle through “Hallo”
Oh what a frustration!

My tummy fills with anxiety,
My name stuck in my throat again,
A flutter of desperation,
How do I introduce myself?
Switch words, avoid others, hand signals,
I silently whisper to self,
Wishing I didn’t have to do this.

Oh, I despise this thing!
This thing inside me,
That’s bound me with tight grips,
That’s made me its prisoner,
Silently, I wish it was easier,
To say my name, to say “Hallo”,
To speak my mind, to raise my voice.

Time alone, I spend,
Wishing I could control my speech,
To hold discussions in class,
To read aloud without panic,
To express my interests,
Without a sunken heart,
Without a desire to run,

By Everline Muthoni, 24

To finish off with each of the students got to sit down with their teacher and fill out a form which had different circumstances in class e.g: reading aloud, answering the register, answering questions and they could tell their teacher how best to support them, below are some pics of them filling out the information which will be shared across the whole schools staff hopefully:

As we were taking a photo for the record, I asked everyone to hold up a poster for “International Stammering Awareness Day” and an event held in Nairobi. Out of nowhere one of the teachers, in fact the teacher who was the original reason for me visiting the school exclaimed “we should have our own”… and thus next Saturday will be an informal picnic type affair and I’ll be doing my best to spread the news to schools in Kisumu where kids, parents and teachers who are affected or interested in stammering may come along. I’m even getting a shoutout on Kenya’s no.1 radio station on Wednesday courtesy of the Nairobi group who are being interviewed!

Friday - Kakemega training
Went to a lovely place a few hours away to watch the 2 SLT’s from just north of me do a training session to around 30 teachers from different schools. Was really helpful to see a full-day training session, different ways of presenting, giving examples etc.. which will all really help contribute to the training sessions and information I give our across the district.

In other news, I’ve been venturing out at night-time quite a lot with my little mobile phone torch to meet friends nearby… I feel much safer and comfortable after having done it a few times but I still make sure I’m in by 10 which I’ve been told is kinda the deadline for safety in the neighbourhood! Also it is just getting hotter and hotter. Got sunburnt today for the first time (which is a miracle considering how pasty I am) and it will get worse through til February. Hot hot hot.

Loads of love and hugs

J xxx

For more information on the teeny speech and language charity I’m working under please check out: http://www.yellowhousechildrens.org/

Top 3 Itunes songs on shuffle whilst writing this:
1. Fine - Alkaline Trio
2. If you got the money - Jamie T
3. The horizon is a beltway - The Low Anthem

My first training session! (and some other bits)

Only a shortish post to catch-up-to-date before I get lazy!...


Funniest sayings of the week

“My son-in-law, have you washed your hands before eating? . .  I am being serious - I want to see my grandchildren”

“We Kenyans, when it comes to taking a drink or food, we give you a “choice”, like tea or coffee. There is no choice in not taking something”

Places where people have thought I come from on first guess: U.S, Italy, France, Israel, Germany, Holland.


Thursday - First ever training session!
I carried out a 2-hour training session for 13 members of staff (11 O.Ts and 2 ENTs) at the hospital where I work. I found it really difficult to try and fit into 2 hours the most basic relevant things about speech and language therapy (developmental norms, things to look out for and also some specific client groups/difficulties I’ve seen a lot of in the hospital) but it went pretty well so was dead chuffed! There were a couple of things I definitely wanted to drill into the staff concerning facts that are widely believed here that have little to no evidence behind it. Firstly, that cutting a tongue-tie leads to improved speech (I did a true or false quiz and all 13 people thought this was true) and secondly that a very strict diet (cutting out all wheat, dairy, many many fruits, nuts amongst literally hundreds of foods) leads to a reduction in autisitc behaviours. It was nice being able to talk about these things and discuss them (there were a few questions et.c.) without feeling like I was insulting the way things are done here by clearly stating the facts/evidence and comparing for example the very limited research on the role of diet in children with autism in the U.K and Kenya (at times completely opposite!). At the end I asked for feedback as this was the first time I;ve done anything like this and whether true or not one lady said it seemed like I’d been doing training for years and another commended me and gave me some ideas for the next session which was awesome. The guy who helped organise the training, Wesley Snipes look-a-like Winston (see previous posts) is so keen and motivated for me to do as much as possible and stood up at the end to give thanks and that anytime I want to do training “we are in” before saying how important they feel it is given the lack of service and knowledge here. It’s so so so great to have someone like Winston in my camp, someone genuinely interested and passionate about not only my area but special needs in general and I am unbelievably thankful for that.

Friday -  Oromotor stuff and Hospital tea
As mentioned, working with swallowing difficulties is something I’m doing a lot of here and for some unknown reason to me I’m massively fascinated and drawn to this area of speech therapy. Whether it’s the fact that there is a risk to life involved which makes it seemingly more important, whether it’s because it’s fairly medical based or whether it’s due to the fact I love food so much that I have a passion for people to enjoy and be safe when eating/drinking food it’s definitely an area that at the moment I want to train further in. Many of the children I see have limited tongue movement so oro-motor stimulation/movement is something that may be of use both for the act of eating but also making a variety of speech sounds and this week I saw a child of 7 who had no difficulties receptively, excellent non-verbal communication (gestures, pointing, facial expression) but could only make bilabial sounds (b, m, p) and vowels. Although there is nothing in the case history I took that would account for this lack of movement, it seems likely to be one of, if not the reason the child cannot say any words other than mama, baba, pi (water). As I’m newly qualified and not specifically trained in any areas yet, I gave my supervisor a ring as this is an area she has lots of training and experience in and rather than giving some generic ideas to promote tongue stimulation and movement I was given some straight forward basics that are part of an entire oro-motor program which hopefully we will follow through with the client and fingers crossed maybe see some results :)

After a fairly normal day at the hospital I took tea (that’s how everyone says it here and it’s rubbing off on me!) with a few of the staff and talked about life in general. Similar to above, one of the O.T’s, David is so passionate about his job and special needs that he has a stipend for travel and lunch but essentially volunteers EVERYDAY at the hospital, leaving his house (which is miles away) at about 5am to start by 7.30. Winston on the other hand has a paid job at the hospital but as he is supporting a family of 3 (fairly small considering we are in Kenya) he works most of the time at the weekend doing private work to earn more money - as Winston put it “Kenyan’s don’t relax when it come to the weekend, they hustle”. After hearing from my supervisor at the EARC that many teachers in special needs are not passionate/bothered/care about the area but have just trained in it because the pay is better it really is lovely and encouraging to find people such as those who I work with at the hospital who care about their clients and genuinely enjoy working with them.

Weekend - Properly relaxing!, a night out and surprise surprise footy!
For most of this weekend I have been a bit of a lazy bugger but doing a lot of needed chilling out, reading (1984 is pretty awesome - who would’ve known non-comic reading could be fun haha) and spending more than my normal measly budget on some delicious western foods including one of the nicest chocolate milkshakes I have ever had which I practically inhaled. Saturday a.m awake and at 'em by 7am to meet the kids and walk to town for our final game of the season - ended up a pretty fair 0-0 which makes us finish 3rd for the season. As I've said everyone takes footy so seriously here and I subbed off 3 kids in the second half so as many of the kids as possible could play in our final game. I wasn't quite expecting a little backlash by a couple of sulky kids who were taken off even though I explained to them why I was taken them off - not cos they were playing badly but because we are a team and everyone should take a part in the last game of the season. Children need to be children out here I feel sometimes and many are grown-up before their time due to the amount of independence they have or responsibilities they have at home/within the family. In addition to all of this, the seriousness that people take football makes matches a bit of a pressure cooker where I think fair enough we want to win etc.. but these kids are under-10 and should be enjoying it first and foremost rather than anything else! Saturday night I was invited out with my new best mate - who am I kidding, my only mate in Kisumu - to meet a load of peace corps volunteers who were in town for a night out. Was slightly taking aback when stepping into a room full of white people(!) but after a few drinks and being the only non-american/peace corps person it was pretty easy to regain all the social skills that have run away from me over the past 2 months - ended up going to a bar/club til 2am chilling with beers and chatting the night away - only my second time out since getting here pretty much so was real nice to do something a bit different J Annnndd up-to-date today, Sunday, been continuing my new found love of reading non-comic material, watching a bit of footy, embarrassing myself by thinking I saw the biggest avocado in the world which was actually a papaya and writing this! Looking forward to a skype with the Fagan clan tonight as it’s been a while! Just hope electricity continues it’s good form for the evening!

Have a wonderful week everyone and thank you for continuing to be bored enough to read my ramblings,

J xxx

For more information on the teeny speech and language charity I’m working under please check out: http://www.yellowhousechildrens.org/

Top 3 Itunes songs on shuffle whilst writing this:
1. The same old innocence- Architecture In Helsinki
2. La - Old Man River
3. Don’t stand so close to me - The Police