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