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
Lovely to hear your news- let us know what you are up to in future- it's great that you gained so much,
ReplyDeleteas well as all the time and effort you put in to work in Kisumu.