The final blog's down duh duh duhhh duh, duh duh duh duh duhhh

And here it is. The last blog. Some very short mostly non-work related lists about what I’ll miss, what I won’t and what the future holds (both for me and for Speech and Language Therapy in Kenya). So here goes, my last first things that spring into my head - it’s been quite nice rambling on with my thoughts and getting some lovely feedback to boot. So thank you for listening:


What I’ll miss

1. The people
Yes yes yes, I know it’s a bit of a cop-out but what I mean is actually less the great people I’ve met/worked with who I will also miss, but more the community spirit/general happiness I automatically associate with people from Kenya. Part of what I’ll really miss is the daily exchanges with people both known and unknown - “Habari?!”, “mzuri” - The equivalent of a hark back to how I imagine the olden days of people greeting each other jovially in the local community.

2. Lack of technology
Although it was an absolute saviour on many a night (laptop/internet) I honestly feel fair more relaxed without being around technology, feeling the need to constantly check e-mails/face book etc.. or more to the point wasting hours scouring through pointless articles and websites. I read more books in my 6 months out in Kenya then I think I have in the past 6 years and thoroughly enjoyed making a bit of time to switch off from technology to settle down with a nice cuppa and curl up with a book. Something I shall endeavour to continue whilst back (He says watching football on TV whilst typing away on a laptop with an iphone beeping away beside me).

3. The work
In a slightly selfish way, I’m going to miss the work for a few main reasons: Firstly, I’m not sure when I’ll be able to grab a job within speech and language therapy in the U.K and I love what I do and secondly, I feel like I made a bit of a difference out in Kenya and as many people have mentioned I have probably gained more experience and knowledge in the 6 months past than I will in my first few years of work. And I’m a geek for Speech and Language Therapy so loved having to do research across such broad and wide ranging areas, both Speech and Language related and not.

4. Being outside England
I’m a bit of a traveller at heart and find anywhere and everywhere infinitely more interesting/exotic than England I’m sad to say… So plonking down in a 3rd world country, with a culture I had not previously experienced, with very little support was something that I absolutely adored.

5. The food
Bit of a weird one as in general there is not so much variety in Kenyan foods. Let’s see.. Barbequed or fried meat, ugali (maize staple), sukuma (kale), cabbage, beans, green grams, chapati, samosas, rice… is pretty much it on the whole. But I loved it. Sure, at times I had huge cravings for all sorts (mostly cheese, sometimes odd random things  - mussels, pork pies) but really could have eaten chapattis, green grams and bbq meat forever. And gotten very fat.

Things I won’t miss

1. Getting hassled
Out in the streets. Outside my home. In my home. On the phone at 6 am. On the phone at 10pm at the weekend. There were some great advantages being a foreigner (especially when it came to work), but there were some huge disadvantages - mostly based around people wanting money/food, thinking because of the colour of my skin I’m rich or clients phoning me at all hours asking for money, wanting to date me (!) or asking when I will see them next/when will their child get better.

2. Mosquitos
See the first part of number 1. Hassle! Also being able to jump straight into a bed and not having my feet or head touching net is absolutely lovely. I’ve been home 5 days and still have a few itchy bites/scars/lumps remaining. Grrr.


3. Not having a fridge
No explanation needed. It’s pure joy being able to have allsorts of different food, being able to have cold stuff(!) and not having to eat everything immediately or have the same thing for dinner and breakfast otherwise it’ll go off.

4. Risk to life
I’m not over exaggerating when I say “risk to life” - you do get used to things and end up not thinking about it too much but there was on average a big matatu (minibus) crash that made the news every week or so with deaths and severe injuries.. I was taking one of these or sitting on the back of a motorbike/bike with a very unsafe driver in a very unsafe environment (no traffic lights, signs or rules of the road really) on average twice a day. It’s nice to feel a bit safer even though cycling in London is a bit dangerous! An anecdote to describe this nicely was someone who laughed at me when I said I failed my driving test. In Kenya there is no test - you just pay for a license pretty much. On a lesser scale, safety issues at night meant it was not advisable to go out after dark unless with a lot of people/in a very public place. The freedom of being back here is delightful.


5. Some of the scenes
As expected in Kenya there were some pretty difficult things that I saw that I will probably carry with me for a long time, if not forever. In many of the situations, some good came of many of these situations, whether it be a client “coming up”, families/staff learning more and working more efficiently together or other but equally in many situations there was no possible solutions or staff/families did not care or were not doing there job properly which proved to end in the worst scenario imaginable, death.

The future!

Kenya:
As it currently stands, there are a few universities in Kenya who are interested/enquiring about starting up a university course to train speech and language therapists :) The only course currently in East Africa started 3 years ago in Kampala, Uganda and from the ideas inception to the course producing therapists took in the region of a decade. Therefore although it’s brilliant that through X, Y and Z, speech and language therapy is getting noticed in Kenya it will undoubtedly take a very long time for a course to be active in Kenya as one of the primary issues is the government need to recognise the profession to provide funding for university courses and ultimately jobs within Kenya.
The remaining 2 speech therapists in Western Kenya will be toiling away until June but there will be another SLT/P carrying on some of the work I have started/set-up in Kisumu from the end of this month for 6 weeks :) additionally, come the summer months there will hopfully be another short-term volunteer who I am in the process of persuading to come to Western Kenya rather than Mombasa so fingers crossed! Lastly, I’ve been asked at the university I graduated from last year to do a presentation on my time our in Kenya so who knows, possibly there will be some interest in coming out like I did and there may be more continual support come September/August time with some luck! Please refer back to http://jonathanmlfagan.blogspot.com/2012/01/some-pictures-and-little-bit-of_6409.html
for some more facts and figures about speech and language therapy in Sub-Saharan Africa, particularly Kenya.

Me:

After eating far too much cheese and chocolate (I never thought there would be a day where I would say) the first few days I was at home.. I got straight back into work at a nursery school I previously worked at. They have been extremely lovely and I have been unbelievable lucky to have been given my previous job back until I get that magical job in speech and language therapy (a report on the BBC a few months back said only 20% of new graduates in the field get a job within the first 12 months :( ). So that has been absolutely great. Catching up with friends and family, having things to do in the evenings, enjoying the cold weather (though like a traditional Englishman I’m already complaining about it) and in general settling back into western life has been really nice so far. Hopfully it’ll continue and fingers crossed I won’t get itchy feet too quickly and I’ll get a job in speech and language therapy before too long.

For those of you who are interested and haven’t checked it out yet, there is a SLT/P E-book project I’m working on which is slowly but surely (hopefully) taking form - Please get involved if you are interested/can.

Last thing!

Thank you all for everything. I know I’ve done platitudes and all previously but I guess deep down I figure as blogs can’t always express emotions (and no emoticons are not good enough) repeating something enough times might make you guys think I mean it.

Loads of love and thanks for checking out my blog and supporting me!

Jon x

Top 3 songs played on Itunes shuffle whilst writing this:

1. The Lighthousekeeper - Get Cape. Wear Cape. Fly
2. Jolene - Ray Lamontagne
3. Floating Vibes - Surfer Blood

And that was 6 months in Kenya: A round-up.

So. 6 months has absolutely swooshed by and I’m currently in Nairobi doing some last minute shopping, getting some last minute hassling and having hot showers for the first time in one and a half months :) (flight out is tomorrow)

This is just gonna be a update/round up of workstuff and then when home I’m gonna write a little thing about what I learnt, what I’ll miss, what I won’t etc..

The past week or so has been very much a wind-down although has almost seemed as stressed as any other week of work! I only pencilled in 2 days of clinical work, a couple of days for writing up things and a couple of days to whiz around all the schools, clinic and hospitals I’ve worked at to deliver packs of information so there is something in place to continue to refer to and photocopy for parents/staff/clients.

Most of my time was spent in the hospitals and like most hospital days there were ups and downs:

Three of the clients I mentioned last week (in the bit about how great parents/spouses were) passed away. Two of these were expected, however one of the clients, E (14 years old), on the face of it was “coming up” as they like to say here, putting on some weight and being more alert to her surroundings. I asked if they knew the cause of death but the nurses did not know and said a post-mortem hadn’t happened yet. I’m not sure if post-mortems are common here and have a small suspicion that as with a previous patient a post-mortem will not happen and no official cause of death will be determined.

The now famous paediatric Client C has put on weight for the first time in approximately 4 months - the duration of his hospital stay. Additionally he is continuing to be very alert and awake every time I see him. Both these things are a huge turn-around to a few weeks ago. To follow on my feelings from last week (and I’m not blowing my own trumpet - just making a point I feel very strongly about), without my intervention C would still be sleeping/not alert almost all day, every day and his weight would not have come up which is vital for how underweight he is and the energy he needs to relearn things by being awake. To promote the point for the umpteenth time - this stuff should have already been taken care of my members of the MDT (multi-disciplinary team) and I am pretty sure it wouldn’t have been either. This is my feeling with a few specific clients I’ve worked with - that bottom line without me being around they would have died. And this just isn’t good enough - the state of some of the hospital care/knowledge, as mentioned in the last blog.

Considering C constantly has seizures and fevers which affects his swallowing function, I felt (and explained to mum) that considering the next therapist who may be able to check in on C will likely not be for 3 weeks or so I would not be happy to do a swallow assessment and give advice to start oral feeding (should the swallow be good) considering his swallow function could go down/become unsafe at any point due to his condition. However, on my final visit to explain everything to matron (which I started to do shortly after starting work at both hospitals), she told me that she had seen Client C’s mum had started to feed him small amounts of food orally.  It is always the job of the therapist to give information for client/carers to make an informed choice. C’s mum has a great understanding of English and has been truly amazing in her dedication to NG Feeding (with her recent acquisition of feeding charts she drags me over to look at them like a schoolgirl who has gotten an A* on a test!) and I feel she understands the risks of feeding and is likely doing it as she is in the knowledge that the longer C does not use his swallow, the harder it may be for him to reacquire it (I explained this) and for him to enjoy tastes. The BRILLIANT thing (Highlight of my week!) is that matron, immediately told me that she had sat with her whilst she fed him a very small amount of smashed food and gave advice on safer feeding “like you told us in the training session”. The majority of work I’ve been trying to do out here is with the mind-set of training others/giving information to promote speech and language therapy and to provide some sustainable information/training that parents/carers/teachers/hospital staff can continue to use after I have left. This is a great example and am very proud as there have been many examples of people taking on specific advice and making those changes but this is an example of someone taking on general information I’ve given and applying it functionally within their setting. Matron Jane I salute you! :)

Paediatric Client J, after waiting 2 whole days for an NG Tube, according to the records put on almost 1/3 of his body weight in just 2 days (10kg up to 13kg). On leaving the ward, one of the doctor’s involved in the whole “ugly” situation from last week said to me “oh, have you seen J? He’s doing so well isn’t he”. Mentally, I  was holding  my face in my hands, shaking my head in dismay and saying to her “well, considering he was not placed on an NG tube for 2 days I think your very lucky he is still alive, let alone doing well. And you shouldn’t seem so proud about it, because you  personally did very little to help the child”. In reality, I just nodded, smiled and said yes. The next time I went in J had dropped in weight to 11kgs yet had not been vomiting according to mum. It turns out that the original readings taken by the nutritionists (another sign of how inept they are) were done wrong and J had not put on all that much weight. The good news is that he is putting on weight, slowly but surely.

Also had my last ever stammering support group which although started slow with few numbers (due to a mix-up with staff over time and the fact we don’t get too many people come anyhow), ended up being a fairly successful meet discussing future plans/handover and managing to drag in a decent number of teachers to watch a video, listen to our heartfelt pleas of how important their contribution is and to get information. Special thanks to the pictured family of Thomas and his parents who have really been at the crux of the formation and continued presence of this group. Sterling work!

Round-up:
I had to write up a report of sorts for the Education, Assessment and Resource Centre (the clinic) to show the work I’ve gotten up to since being here. I’m very proud of what I’ve managed to do and have copied/pasted some of it below as well the things I would do differently if I could go back in time (there are few!):

An estimated 30 visits across 7 different schools - These schools ranged from special schools for the “Mentally handicapped” or “Physically Disabled” to mainstream schools with special units and mainstream schools who had children with various speech, language or communication problems All of the trainings given promoted Speech and Language Therapy and were specific to observations of students and teachings within the schools. Examples being workshops on Dysphagia (swallowing difficulties), Autism, Stammering, Basic Communication Strategies and feedback from classroom observations.

An estimated 25 home visits to a total of 20 children - These home visits were reserved for those who it was felt required observation within the home environment as clinic/school visit was felt to not give an accurate portrayal of the child. The home visits were primarily for selected children with diagnoses of Autism, Learning Difficulties, and Selective Mutism, Following these visits, parents/carers were given information and advice specific to their child.

Work was carried out at 2 hospitals in the Kisumu area,The Provincial and the District Hospital:

At the provincial hospital Speech and Language Therapy services were offered alongside the Occupational Therapy (O.T) on a weekly basis. Additionally, referrals were made to Obama Children’s hospital to see specific clients on a weekly basis. Although the majority of work was with children with Cerebral Palsy (C.P) or Autism, a number of adults who had CVA’s (Stroke) were also referred for Speech and Language Therapy. Basic training concentrating on Dysphagia (swallowing difficulties) was provided on 3 separate occasions - to O.T’s and Ear, Nose and Throat staff (ENT) (12 people), mixed hospital staff (16) and Doctors and Nurses from Obama Paediatric Hospital (28).

At the District Hospital Speech and Language Therapy services were offered on a weekly basis for a period of a month across all areas of the hospital. Basic training concentrating on Dysphagia (swallowing difficulties) was provided to 37 staff members from all areas of the hospital, the majority of whom were Doctors and Nurses.

At the Education, Assessment and Resource Centre (EARC) Speech and Language Therapy services were offered on a weekly basis. Working in a Multi-Disciplinary Team alongside specialists in hearing, vision and mental health, the EARC assesses children for the primary aim of placement in a school appropriate for their needs.

Western Kenya’s first ever Stammering Support Group has been running on a monthly basis since August with an average of 10 people per meeting. It is hoped this shall continue every month with at least one speech and language therapist from Yellow House (Vihiga) joining locals who will take the lead in running the meetings.

An event set-up for International Stammering Awareness Day brought over 50 children and adults to come together to learn about Stammering (workshops and guest speakers were present) and meet others who Stammer

Western Kenya’s first ever Autism Support Group was set-up in January with 16 parents and professionals attending. It is hoped this shall continue every month with at least one speech and language therapist from Yellow House (Vihiga) joining locals who will take the lead in running the meetings.

Overall it is estimated the Speech and Language Therapy Service set-up in Kisumu has:
Informally assessed (and given advice to relevant parties) approximately 200 children
Informally assessed (and given advice to relevant parties) approximately 30 teenagers
Informally assessed (and given advice to relevant parties) approximately 20 adults


A few things off the top of my head I wish I’d done differently:

1. Allocated my time in a better fashion! I was a little here, there and everywhere in terms of work and part of me really does feel that concentrating on a smaller number of schools but being a more constant fixture in them would have resulted in a better impact overall.

2. Similarly, due to splitting my time across so many areas/settings, a lot of the trainings I did were more a case of throwing as much information at as many parties as possible and hoping that some sticks. Taking a smaller number of schools and ensuring I was there for a full day once a week for example would have allowed in-class training and actually showing teachers the things I had spoken/showed within the trainings.

3. Started work at the 2nd hospital earlier - Weird as it may sound I really enjoy working in a hospital setting and the District Hospital’s staff were very welcoming, gave me so many clients who required some support and best of all were interested in the work I was doing (“who wants to learn, come and watch the mzungu doctor!) and were very good at taking on information and carrying it out promptly when asked.

4. Just an idea I literally just had, which I’ll be passing on to Rach/David (who are still in Vihiga until June and will hopefully be coming down for a number of days each month) and Carmen who has been persuaded to move to Kisumu for 6 whole weeks woohoo! To try and have a big meeting with a load of principals and/or teachers from all the schools I’ve worked at (and more!) to try to come to a sort of agreement that at each and every stammering support group and autism support group there will be at least 1 member of staff present. This would mean that there could be a rota of sorts so it would be officially sanctioned by the principal rather than “anyone going to the thing on Saturday? Nope. O.k”, which in turn should hopefully mean greater knowledge spread of these 2 areas, greater support for all in the groups and possibly lead to more people wanting to attend :)

And that’s a wrap folks. As mentioned, when home I’ll write a little mostly non-work orientated what I’ll miss/what I learnt about Kenya kinda thing.

Saying goodbye hasn’t been too bad because mzungus out here are fairly transient in the work they do unfortunately and in most cases it’s “goodbye, thanks, when’s the next one coming out / what happens next” which is how it should be and thankfully made saying goodbyes a little easier. However, saying goodbye to the wonderful Mr.O (see previous posts) and his family almost made me turn into a blubbering wreck - they have been truly wonderful to work with and I really hope to keep in touch with them.

Really want to say a million thank-yous to everyone who has supported me through probably one of the more stressful/tough times in recent years. This includes all those wonderful people I’ve met in Kenya (particularly those I’ve been working with), all the lovely people from round the world who have read this blog, those of you who have sent me lovely cards/parcels and comments/messages from friends and family.

Love you all tonnes,

J xxx

PS: Dear all SLT's/SLP's if you haven't already please join/check out the project I'm doing to promote what we do (no-one has a clue!) whilst also providing information to the general public - it's in the beginning stages but coming along nicely :) - http://www.facebook.com/groups/196799610418947/?bookmark_t=group

Top 3 songs played on Itunes shuffle whilst writing this:
1. Evening Kitchen - Band of Horses
2. Memphis Bell - The Prodigy
3. Latchmere - The Maccabees

Why can't you do your [insert favourite expletive here] job?! and other (better) tales

It’s the good, the bad and the very ugly (see aforementioned title) part 2. There were plenty of great things that happened since I wrote here last but alas you can’t have the ups without the downs. And unfortunately there were a few absolutely soul-destroying, infuriating and “I can’t even begin to put into words what I’m feeling” moments. In fact, I think that in general I’m a fairly laid back individual and for the first time in forever I actually went a little Incredible Hulk on some people… so let‘s start with all that nonsense, an interesting thought (I think!) on death and finish on the good notes!

PS: Apologies for a lack of photos this blog - a lot of work has been in hospitals with patients who are very poorly/palliative (end of life care) so I didn’t want to/it’s not appropriate to take photos. There are a couple and a video (!) at the end though.


Ugly:

Where to start?!…

I guess the main thing that covers everything I want to rage about is the title of this blog entry - “Why can’t you do your [insert favourite expletive here] job?”. The longer I spend out here the more I see people not carrying out their job fully. Whether this be a nutritionist seemingly being absolutely clueless about nutrition or more to the point professionals only focusing/looking at what their task is with a particular client and not looking outside of that specific task.

These are the things I have done this week that although on occasion may* be part of the job remit of the speech and language therapist (we do a lot of work across many different environments and alongside many different professionals) are not in general what I should be doing. As I mentioned last week - these people have common sense and are trained in these areas, it’s not that they are not/”this is Africa”:

Advise and take a client from the Occupational Therapy Department to the in-patient ward due to severe malnourishment (Client J: 7 yr old [had a cerebral infarct last year], 10kg. The optimum weight is 23kg). I honestly think that the O.T’s would have either just done their job  (O.T work) and send the client home or just said “you should go to the nutritionist”. To which the client would almost certainly have gone home (I had to spend a good 30 minutes explaining why the child needs to go into the in-ward and she still wanted to go home first to pick things up. I pretty much refused that option as felt she wouldn’t have come back)

Getting people to do things/bringing teams together. MDT work/Communication between roles is not something that is effective here, once again possibly due to the “this is my role, I’ve done my job” mentality. These are the stages in what I had to do with the above child - expect lots of angry CAPS LOCK (this is when I went Hulk-tastic on the staff). After getting the child into the ward and explaining everything to the doctor, she did her job - case history/admittance. I asked for a nutritionist to come and talk to the mum - the doctor said she would go and get one… 10 minutes later I go looking for a nutritionist. Who is hanging around in the nutrition room. The doctor didn’t mention anything to her. I round the both of them up to come and talk to mum together and all of us as agree as one big happy family (soon to go through a nasty divorce) that the child will be fitted with and IV drip for hydration/take bloods, a NG tube for feeding and be on a special nutrition plan for 2 weeks minimum. 3 doctors tried and failed numerous times to put an IV in his hands/arms as the child was so thin. Carmen, a visiting Speech Therapist said to me possibly his foot might be better… after seeing even more failed attempts I decided to speak out and first time they tried they got it in. He was then placed in a bed, all was well and I buggered off to do other work. As mum was very worried about the whole situation I popped in early the next morning to see how things were. HE STILL HADN’T HAD AN NG TUBE PUT IN. Due to this mum has been feeding her hungry child orally which was making his chest/breathing worse. I had a bit of a go at the staff, whose explanation was that when they went to fit one the mum said she was feeding him fine. “O.K - The food is going into the child’s mouth… and where exactly does it go from there?.. Yesterday we all agreed the child needed an NG tube as he is seriously malnourished and a feeding assessment (I saw mum again that day feeding) showed he is not safe on anything oral. WHY ISN‘T HE ON AN NG TUBE?” Explained to mum, the doctors and nurses. Right. Next morning I come in AND HE STILL ISN’T ON A (INSERT EXPLETIVE OF CHOICE) NG TUBE. I pretty much lose it at this point, tell the doctor in charge of that particular unit that “I’m not leaving until an NG Tube gets placed and that’s going to happen right now”. Less than 3 minutes later the child has an NG Tube. I can’t even begin to write how I felt that day and how I feel now just thinking about it. Mind-blowing ignorance/failure of responsibility. As I was there I also got hold of a nutritionist to immediately weigh the child and explain to mum the feeding timetable. That morning any professional I bumped into I explained that a child who desperately needed a NG Tube, after everyone agreed, did not get one for 2 days. Makes me ill thinking about it to be honest.

Had to place 2 children on Nasogastric Tubes (NGT) for feeding and en. These children are very malnourished, have no safe swallow, cannot support themselves and are not alert for the majority. Why are they not already on an NGT? Doctors, Nurses, Clinical Officers, Nutritionists?

Pretty much do some of the nutritionists work as they seem massively incompetent. In fact, a visiting speech therapist made this point. I have constantly been asking for nutritionist support for a number of children to which I have always got the reply - “yes, we are giving them special milk and porridge”. The fact is, without knowing the first thing about nutrition, I know that whatever this special stuff is it is not working - Paediatric Client C (who I have mentioned umpteen times) has lost a third of his body weight in 3 months and been on an NG tube the whole time. Whether mum is not feeding him as she should (I don’t believe this) and/or the nutrition support given is not enough (I strongly believe this) it is the nutritionists job to be in charge of this. Additionally, 2 types of food is not good enough for a child. Using cheap, easily obtainably resources  I’ve just started giving my own advice regarding using juice and avocado and smooth peanut butter, mashing/mixing with yoghurt and/or milk so it flows through the tube. This will give the children umpteen amounts more good fats and put on weight quicker.

C has been on numerous drugs for all sorts of things, has constant seizures and fevers and a lot of neurological things going on. Up until a few weeks ago he was sleeping/not alert for the majority of the times I’ve seen him. I enquired that I knew he has a lot of things going on but whether the amount/type of drugs he is getting is adding to this. The matron and doctor looked through the notes and said for his weight and his difficulties it is what he needs.. O.K, I’m not a doctor so fair enough. The times I saw C last week he has been a lot more alert then previously… I asked mum if anything had changed. Yep, they’ve changed his drugs. I literally don’t know the first thing about pharmaceutical stuff/drugs but again without looking outside of the job box - the doctor’s want him to have reduced seizures and so lump him with a load of drugs that are meant to help.

I’m not sure if I’m ranting too much but I just can’t understand where this lack of responsibility/carry through takes place and feel a lot may stem from how people view their jobs/tasks perhaps.


Bad ?:

Not really much to say here, more a couple of interesting thoughts around death and the way it’s viewed here and the possible after effects on hospital care. Carmen mentioned that she thought perhaps in Kenya, death is more easily looked upon/is a more common part of life here - this was after I’d seen 3 recently deceased bodies that week and one of the clients had lost 10 of her 12 children. My retort was that I definitely think there is a “healthier attitude” towards death as some may put it by a very short mourning period for most as it for many I think its fairly common for someone you know to die on a regular basis here (I mentioned my landlady has been to a funeral on average every 2-3 weeks since I’ve been here).

One effect of this is possibly that people are less likely to want to support their child and pay medical expenses, rather accepting the fate of death than a bill and looking after a child who will be more a hindrance than help in daily life. I very much feel this was almost the case with client J (above) who spent 4 months in hospital after a cerebral infarct which cost the family a lot of money. It was her main concern and mentioned it a number of times and was seriously taking her son home rather than foot a bill.

The other possible effect, of which I witnessed a lot of this week is lack of end of life explanation/advice/options. 4 adult clients I saw this week ( 3 of which are mentioned below) have very poor prognoses and are on/expected to be on palliative care shortly. All 4 of these clients have no swallow or a very very poor swallow (very slow, very weak) to speak of and in regards to advice/options there has been none. After I informally assessed and gave advice to the clients I sought to speak to staff members concerning there condition - the fact they should not be taking anything orally but yet are not on NG Tubes. For some it’s a case of they have some mobility and on previous occasions have taken out the tube, for others there has not been any attempt to make this happen. My gut feeling is that due to the condition of these clients there may not be any point in keeping them alive - at the cost of the hospital and family’s time and/or money. I spoke to the doctors/nurses about the situations of the clients and that it is likely that all these clients will die unless they are placed on an NG tube, but if they are likely to pass away then maybe it should be discussed with family members whether to try an uncomfortable NG tube for feeding with some hope of recovery or to let them be as comfortable as possible and not prolong life. And that it would be great if possible to explain options which doesn’t seem to be happening.

Like I mentioned, I feel this may be a cultural difference and just “how it is” here but it was nice to be able to find out a little more and to discuss issues like this that my not have previously entered the minds of some of the staff at the hospitals.



The Good (at long last!):

Paediatric Clients C and J 

They seem to be getting more alert and stronger by the day which is the first real step to possible recovery. Without energy or alertness it would be incredibly difficult for them to re-learn skills due to lack of focus, attention or energy to carry out tasks.


The Parents, Wives and Husbands of those in hospital

The carers of those in hospital have been nothing less then incredible in taking on the advice I have given to them. 4 stand out cases emerge that I’ll very quickly write about:

Client L, in the female ward currently has meningitis with complications and very little awareness and understanding of language and no expressive language to speak of and therefore all discussions were directed towards her husband. The husband has very good English and seemed to understand all information I provided on safer feeding (I also written notes for the client with what I have recommended as well). The following visit, he had her propped upright in her bed and feeding her  beautifully thick, smooth, mashed amounts of banana. Unfortunately this is one of the client’s I have just mentioned and he has decided/been persuaded to not try another NG tube fitting and is essentially choosing oral feeding even though she has no swallow to speak of and is very underweight. I do not see her staying alive for much longer as things stand.

Client E, residing in the paediatric unit is the child I mentioned last week. She is on an Nasogastric Tube (NGT) and I was personally worried about her level of nutritional input as the dietary requirements for her weight, as recommended by the nutrionist, were not being met by the mother. After checking in on mum and child, it was found that E no longer had an NGT,yet was not safe to swallow and although mum had done an phenomenal job of feeding her daughter the optimum nutrition and filling in the feeding charts I had put up, they were not replicated by staff as requested. After speaking to doctors to get an NGT back in and to the nutritionist on the benefits of the feeding chart and for them to be replicated both these things were done immediately and the next time I was in mum had a beaming smile on her face and very proud of her fully filled in charts. I will also speak a little more about this client later..

Both /Adult clients C and J’s respective wives do not speak English and upon asking them “English?” “Kiswahili?” “Dholou?” it was determined that C’s wife’s first language is Dholuo and J’s wife’s is Kiswahili. Alongside an appropriate interpreter (doctor/nurse) I gave showed them and gave advice upon oral hygiene (examples, cleaning teeth/gums without water/toothpast and applying oral gel medication in the safest way possible. They both have no swallow to speak of and therefore using water/toothpaste/too much oral gel is likely to be aspirated into the lungs) and basic guidelines for safer swallowing. I also asked the MCT member to write down in the wifes’ first language the information I was giving. To be giving information about something fairly serious, whilst your respective other has a very poor prognosis, by someone speaking a language you have no understanding of must be a fairly scary situation but they were unbelievable great in listening, asking related questions and immediately as I left started to put into practice the advice I’d given :)

Clinic
Although I’ve been shifting towards hospital work for the last few weeks, I’m still rocking the clinic on a weekly basis and it’s busy as always giving me a lot of different kinds of clients, both in age and diagnosis to informally assess and give advice.

Carmen
It was lovely to have an experienced Speech and Language Therapist shadowing me for 3 days - Some lovely feedback and some great little tidbits I picked up off her were really helpful.

And that’s it..!

Off to my last ever stammering support group and then a few more days of work and I’m done! It’s gonna be a little hectic as I’m trying to leave behind a pack of info at all the schools and hospitals I’ve been plus do some reports and other stuff so although I’ll be finishing clinical work very soon I’ve still probably got a chock-a-block week of sitting in front of the computer :( !

Here's a video of a lovely bloke I met during the conference in Uganda in January who kindly let me film him speaking about stammering and allowed me to share it with the world wide web as well as the stammering group:

Apologies for poor English, punctuation and nonsensical sentences - I just type away and don’t really check over stuff! Lastly here's a couple of pics - one of "the last supper" with the clinic crew and a feedback meeting at one of the schools I work at.

Take care everyone,

J xxx

Top 3 songs played on Itunes shuffle whilst writing this:
1. Shine A Light - Wolf Parade
2. Ghost Of Corporate Future - Regina Specktor
3. Head Cut Off - The 88