- I literally had ants in my pants in my first week. An invasion in my clothes bag meant around 100 biting ants crawling everywhere. After I thought I’d deeted them all to the grave I proceeded to put on some boxers… 3 short seconds later and 3 bites around my inner thigh made for some very quick stripping and some uncomfortable sore spots.
- The one and only time I have and ever will enjoy someone calling me “mzungu” - last week a teeny tiny girl looked up at me with disney style wide doe-eyes and shrieked “mzungu” in a similar way a spoiled European kid might shriek “doggy” at Christmas.
- My co-coach at footy wearing wigan socks and a hull shirt. Anyone that knows anything about football would find that funny as they are both laughing stocks ;) (no offence intended any fans out there!)
Friday - Hospital
So due to the amount of clients in need (rather than me personally in demand!) I’m back in hospital for the 3rd time this week! The main reason for returning this week was to see some clients as soon as possible who were reported to be aspirating on their food and drink (coughing/rattly breathing/gurgly voice due to intake going “down the wrong way“ into the airway and lungs). Both of the clients I had penned in to see came back to my delight although I quickly realised it was because they had an appointment with the O.T anyway… I asked both child’s parent/primary caregiver to bring in a variety of textured foods and liquids they normally feed the child so I could observe firstly how they are being fed (posture, speed, size of spoonful can all contribute to aspiration) and how they are coping on the food/drink (I.e.: What they are doing to the food and drink in the mouth and in the swallow process). One of the parents scampered before I could see her which leads me to believe she might have forgot to bring stuff but the other brought everything I asked for AND carried out the advice/strategies I asked her to try during the week :) Absolutely delighted with it all, especially the feeding assessment which helped me to not only see her feeding and offer some advice but also to show/explain to mum the differences between textures and why her child was struggling on some but not others.
As I was already in the hospital and there were clearly some new children who were having communication difficulties and also likely swallowing difficulties due to reduced muscle tone/stability/co-ordination I ended up seeing a load more clients
Weekend - Football crazy
Cut a long story short my entire weekend was all about football as had my first matches watching/coaching the under 10’s and under 18’s. Saturday morning, 7am, up and at ‘em to meet some of the boys and the head coach, Antonas, at our field to walk the hour to the town park. The reason this happens is because for approximately half the kids, they cannot afford to spend 20 ksh (about 15p) to take a bus down and the team itself has no funding or anything. But who’s complaining when we had a bit of a laugh, a good chat and a one hour walking warm-up down to the park. Unfortunately for the under 10’s our opponents didn’t turn up (tho we had a little warm-up - see below) so although we bagged 3 points the kids were gutted that they didn’t get to play L As soon as that was done we walked all the way back to ours as the under 18’s had a friendly to which I got involved with a bit of refereeing in the 2nd half whilst looking like a right sore thumb (see pic of the team below). Team lost 3-0 but only 2 of the first team were playing as big last match of the season tomorrow.. Yes, they really take footy so seriously here that they rest players for a friendly. Next day, the big match looked like it was gonna turn into a mud bath with the heavens opening, gale force winds and thunder abound but luckily it held off for a pretty scrappy not too entertaining 1-1 which finishes us in 3rd for the season. The biggest piece of action actually came when two of our players who were not on the pitch got into a right barny - I stupidly suddenly became a coach and thought to myself, I’m not having any of this and got in between them trying to hold them apart. Whilst stuck in the middle of this violent tango one of the guys full on punched the other and then head butted him too before things were kinda broken up. In hindsight was a right silly thing of me to do but I had a proper “teammates don’t mess with each other” hat on!
Monday - Hospital
The day started off similar to Friday with two returnees, carrying a load of foodstuffs ready to do some feeding! Yipppee!! J Following this I checked up on another few clients I saw the week before asking about how strategies are going etc,.. as well as seeing a number of new clients including two particular cases that are not particularly common to the work I will be carrying out here / clients I‘ll be seeing:
A young girl of 4.5 who seemed to have been burnt very badly from the middle of her forehead down to just below her bottom lip encompassing the central part of the face where all the features lay. Due to scarring/damage she had very little space to see through, in place of a nose was two flat against the face nostril holes and the majority of her top lip was missing. After taking a case-study (and seeing the behaviour of the child), the information given revealed the child has unbelievable sensory issues and had, for lack of a better word, scratched her face off. This started 3 years ago and seemingly it was the first time she had seen anyone. The plan (from my job viewpoint) is to first see her for a feeding assessment as mum reports many problems with feeding/coughing and then start to work with the O.T’s to reduce her sensory needs (they are specifically trained in this area here) as this combines with a lack of focus/attention which would prohibit any meaningful work upon a communication medium for her at the moment - as reported and under brief obs/attempted assessment the child can only an open mouth “aarrrggghh” type scream and doesn’t seem to be using it for any particular communicable intent. I also referred to the ENT (Ear, Nose and Throat) team as due to her lack of nose and missing top lip I wonder if this is having any effect on breathing and possibly a factor of difficulty with controlling breathing effectively when eating.
A man in his mid fifties who had a head injury (assault) approximately 2 weeks ago was referred to me by the adult O.T team. After taking a case history and discussing his condition with both himself, wife and son the two reported concerns were speech sounds and word-finding problems (not being able to recall words that are known to the client). I did a brief assessment using whatever I could find (book, spoon, doll, ball, pen, train, mobile phone) whereby I asked him in turn to name each item. Some of his speech sounds were jumbled but he could name 4 of the 6 without problem, however he could not name ball or train, even with facilitation. When I checked his understanding he could correctly point to all the objects named without difficulty. I also asked him to name as many animals as he could in 30 seconds to which he could name 5 and colours to which he could only name 2. As the client lives far away I urged them to come back and see me in 2 weeks so as to see how his speech and recall are as “time heals” - he could not say anything for a number of days following the assault - and the family could use the strategies I recommend over the next 2 weeks. These centred around the client and the family having time for him to speak, to talk around the object itself if cannot remember the name (I.e. what is it’s function, size, colour) and the formation of the name (e.g: what sound does it start with, how many syllables) as these factors are all interlinked in the complex web of brain structure that stores and recalls information thus solidifying and aiding the memory process. When reading or copying others the clients speech sounds were generally better so this was recommended as a practice strategy as was use of a mirror and breaking down longer words into syllables to produce each part slowly and correctly as longer words and joining together words were the most difficult things for the client to perform (as reported and observed). I am very much looking forward to seeing them again as they were a really nice amiable family that although cared a lot and supported the client, they also all had a good giggle when he couldn’t remember basic words or mispronounced things badly. That may sound a bit harsh but I think it’s so important to have a good sense of humour in these things and the client himself was the one leading the cacophony of laughter most of the time too!
In the evening ended up taking the football sesh alone and will do until Thursday as the other coach is away… wee bit daunting with around 25 kids between the age of 8 and 12 but they just bloody love training and kicking a football around so as long as I try and make sure we have a bit of a laugh and a game at the end of the session they are pretty much good as gold :) Therefore today we had some wheelbarrow and piggyback races as part of the warm-up hehe. Will rock british bulldog and stuck in the mud this week I think! I’ve also introduced 2 rules: If anyone calls me mzungu instead of my name - 10 press-ups, and if I catch anyone chucking rubbish on the floor the same. No harm trying to change a bit of the mentality out here bit by bit!
The only down point was one of the under 18’s got kicked out his house and is having problems with family issues and was really kinda angling to stay at mine and asked me what he should do - I gave the advice I’d give anyone/what would I do myself and explained why I simply couldn’t take him in for the evening to which I think he understood. Pretty tough on the old heartstrings especially after seeing some of the clients I saw today and then after saying bye to him being approached by a boy who gave his name, said he was an orphan with nowhere to stay and asked if I could help. Probably the toughest day emotionally so far.
Tuesday - Paper and Intros
Apart from seeing a client that was booked in to see me in the morning (4.5 year old, Cerebral Palsy, Speech delay) I spent over 2 hours pooling together resources, printing and photocopying in prep for tomorrow’s assessment day, school visits on Thursday and a client I’m seeing Friday. Following this, I was introduced to the CP class at the school I’m kinda based at (where I’m hoping to hit up lunchtimes/feeding as the first priority alongside classroom strategies to aid communication) and then 3 other local schools - one for the “mentally challenged”, one mainstream school with a special unit of 12 pupils attached (the school has 1600 students with only 24 teachers - MADNESS!) and a mainstream school where two kids I saw at assessment last week go (one stammered, one slow processing), both of whom were having trouble with staff due to their communication issues. I’ve bustled my way into almost immediately returning to 3 of the 4 places mentioned above on Thursday to observe the classroom environments, give out some information and set-up a date for training in the near future.
Wednesday - Assessment day
Similar to last week with a load of different clients from 9 til 2ish with one returnee who needed to be assessed further to be placed at a specific school or unit within a mainstream school most suitable for her. This child (8) is an absolute sweetheart with some tendencies that are commonly seen in autism (repetitive play, lack of imagination in play, lack of understanding others point of view/feelings, non-verbal, huge sensory issues) but also has a variety of behaviours that do not fall under the label of autism (excellent eye-contact, some social skills present through giving and receiving objects and hugging). Anyways, the reason I’m mentioning all this is two-fold. Firstly, people here are VERY quick to throw the label “autism” at many clients but in general the staff very much like to give labels to children and they do this bluntly in front of parents - “Jon - Autism yes?!”, “Jon - What is your thoughts on diagnosis?”. My second point is related to the first, whether they do this because of the job they are in or whether this would be done regardless, the EARC’s primary roll is to assess and place children accordingly and therefore, unfortunately, the diagnose (and label especially) is important to place within a unit for Autism, or a class for Cerebral Palsy etc.. I have three times in the past week and a half had a little 5 minute polite passionate rant about treating each child as an individual and not as a label. Even if they do happen to be under a label - Down’s Syndrome for example - each client is different so the intervention put in place will be unique to that individual not a pro-forma plan that is given to any child with that label. Rant over.
Had 2 lovely call’s this evening (which makes a change from being hassled by random call me-all-the-time-man):
- a father who I contacted earlier to let him know I’ll be visiting his son’s (stammerer , 7) school tomorrow to observe and speak to staff called me back to tell me his son is excited to see me and go to school tomorrow. He than said his son wanted to speak to me to which he said a few words to me and I asked if it was o.k to see him tomorrow to which he gave a lovely smily sounded yes :)
- had a random lady from a university call me to ask if I could help set-up a speech and language therapy course there! It would be the first course in the whole of Kenya and would take a LOT of effort, funding, promotion and especially resources (there are no Kenyan national SLT’s here and not so many in Kenya full-stop - possibly less than 20 in total - so to have the skilled staff to lecture will be a major issue). However it’s absolutely amazing that a uni is interested in getting something up and running and that the work SLT’s in Kenya are doing is being recognised woop woop!!!
The next week
So tomorrow I’m off to visit two schools for observations, offering advice to staff and hopefully book a training session and recommend any children (with the need) to come to assessment day with parents. Then Friday I’ve got hospital in the a.m and then seeing two clients in the afternoon, a stammerer (20) who I met on a minibus who lives round the corner from me and another client (7) reported to have problems with muddling up word order in sentences, also very close to me. Then break phheewwww, off to Uganda :) from Sunday til Thursday for a meeting of the East African Speech and Language Therapy Committee (which is just getting started essentially) and a bit of a travel and celebration of Rachael’s birthday! Can’t wait.
So shall be giving bloggin a break for about a week as won’t be bored as sin in the evenings ;)
Tutaonana (see you later) xxxxxxxx
Top 3 Itunes songs on shuffle whilst writing this:
1. Remember me - British Sea Power
2. Kisses and thugs - Super Mash Bros.
3. Inner meet me - The Beta Band
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