Cleft palate surgery

Today was an especially exciting day. We started it off with an extravagant breakfast of fresh fruit, eggs, and toast, compliments of our hotel for the inconveniences of the previous night and early this morning. We arrived at Korle Bu Hospital at 9am once again, but this time headed to the Plastic and Reconstructive Surgery unit across from the ENT unit. As speech -language pathologists, we rarely see the actual surgical processes for cleft palate, even though we study the surgical procedures thoroughly in classes and textbooks. This is because SLP’s role takes place primarily with pre-operative recommendations and post-operative recommendations and therapy.

Today, however, we would be in the O.R. -- not an observation gallery! -- to closely watch every incision and suture of several cleft palate surgeries, mere inches from our very eyes!


We were briefed on the day’s surgeries and headed to see a few speech/language clients. As with the past two days at Korle Bu, the cases were extremely interesting, and it is amazing every time we see tears well up in a parent’s eyes, or even a parent’s excitement to implement recommendations we give to them at the end of the appointment. These cases are always the most promising, as our short stay in Ghana is useless if the training we provide and the techniques we share are not carried on by parents and local health care providers after our departure. Sustainability is key!

Now for the juicy stuff.
** Warning: surgery pictures coming up!**

At approximately 1pm, we headed back to the Plastic Surgery unit, stripped down to our bras and panties, then donned scrubs, scrub caps, sterile crocs, and masks in preparation for the surgery. We snapped a mandatory photograph,

then headed into the O.R. (or, as they call it at Korle Bu, the “surgical theatre”). With my nose mere inches from the patient’s bloody open mouth, I stood captivated, holding my breath as the surgeon swiftly and deliberately snipped, pulled, stretched, and sutured within the oral cavity. Dear Lord, was it amazing!!

Of one patient, I was able to snap a photo before


and after.


Then, I got a few “during” photos of another patient.



A-may-zinggg. We left the last surgery early to grab our regular 4pm lunch/dinner at Korle Bu, and we were able to try fufu, the traditional Ghanian dish we’d been hearing so much about. I was neither impressed nor disgusted. Rather, it tasted to me like rice mochi in a tomato-ey soup! What did impress me, though, was watching George eat fufu with his hands, using his finger to mash the fufu, his thumb to create a depression in the middle of the mass to hold the soup (not unlike the “volcano” style of serving mashed potatoes and gravy back home), and bringing it to his mouth and devouring it with such class. It is definitely a mastered African art!

After our meal, we visited the Artists Alliance, an exhibition of countless of talented Ghanaian artists’ work. I was most awestruck by the impressionist paintings by Ablade Glover that were displayed and sold for thousands of cedis. Several of the girls purchased small items such as cards, beads, textiles, and accessories before we headed back to Unique Palace to repose.

Danielle and I lingered by the pool earlier this evening, trying to catch a WiFi signal in order to publish her post to our team blog, and we noticed the ever so miniscule drops of rain that disturbed the pool’s glassy surface every few minutes. We worked to edit the blog over the snail-speed connection, when suddenly we heard a muffled rumbling, steady and muted. As we exchanged quizzical looks, the rumbling grew progressively louder, and quite rapidly, too. ‘Twas a matter of seconds, and it sounded as if a train were approaching us. “Run!” we shrieked simultaneously, and even as we darted the short 50 feet across the courtyard, we became drenched in the sudden monsoon-like rain. Never before had I witnessed such a sudden and isolated rainfall. It was almost as if there was an isolated storm cloud, being blown 40 miles per hour across the West African sky!

And so we’ve experienced our first sub-Saharan rainstorm, ephemeral as it was. ‘Twas yet another amazing day in Ghana, a country that is undoubtedly building itself a special place in my heart. Good night, world!

Dominic

One of the clients we saw at Korle Bu Hospital today was Dominic, an 8 year old male who presented with reading and writing difficulties. According to his aunt’s report, Dominic has been held back in school for three consecutive years due to delayed reading and writing skills. He appeared to be shy and reserved at the time of the assessment, as evidenced by lack of eye contact and quiet demeanor. However, Dominic’s aunt reported oral language skills to be age appropriate.

Toward the beginning of the session while the parent interview was being conducted, we attempted to establish rapport by using a wordless picture book to elicit oral language from Dominic. We pointed to the illustrations and asked Dominic the question, “What do you see here?” which was followed by an accurate response of “man.” Then, we asked him, “What is the monkey doing?” which was following by the correct answer of “taking keys.” It was unclear whether Dominic’s limited oral language production was due to delayed language skills, shyness, or a combination of the factors.

When asked to verbally identify written letters of the alphabet (i.e. C-A-T), Dominic was hesitant and only produced the names of the letters in imitation of our models. We used crayons and pieces of paper to create alphabet flash cards, and laid the cards “C”, “A” and “T” on the table in front of Dominic. With maximal modeling and repetition in a rhythmic pattern, Dominic was able to spell the word (e.g. C-A-T) and imitate the individual letters sounds (e.g. “kuh” – “ah” – “tuh”) approximately 20 times, as we used the hand over hand method to guide Dominic’s finger to tap each corresponding card.

To further facilitate phonological awareness and knowledge of letter-to-sound correspondence, we laid the cards for a rhyming cognate of “cat” (i.e. “bat”) in front of Dominic and repeated the process. Dominic demonstrated stimulability for this learning method and we invited his father to practice the method with his hand over Dominic’s. After practicing the method with both Dominic and his father, we as clinicians discussed ways to incorporate this activity into Dominic’s daily routine. His father enthusiastically stated, “I will make it my work to teach him these skills.” Letters of the alphabet on separate index cards were given to the father along with a demonstration of how simple it is to make these materials at home.

As Dominic and his family parted ways with the clinicians, both parties felt confident that the methods and recommendations introduced in the session would be implemented and continued at home to facilitate Dominic’s acquisition of literacy skills. The information and methods introduced during the session were also shared with Albert, Korle Bu Hospital’s speech-language pathologist, to support sustainability. Over all, Dominic demonstrated great potential for learning, and with practice and steady progress at home, Dominic can hopefully move forward in the academic setting, as well.


After our work at Korle Bu, we enjoyed a late buffet-style lunch on the hospital grounds and headed to the vibrant and culture-rich marketplace of Accra. It’s a sure tourist trap, where we are prime targets for eager vendors, simply because of the color of our skin. Here in Ghana, a popular (and apparently socially acceptable) way of addressing me is “my sister from China”, or simply “China”. Love it.


Lisa and I kept one hand on our money pouches as we snaked our way through the kiosks of locals selling jewelry, paintings, woodwork, and much more. While Lisa unleashed herself upon the plethora of bead necklaces, I made a beeline at each stall for the earrings and bracelets, picking up a few to bring home to the lovely ladies in my life!


Before heading back to the bus, I picked up a set of wooden elephant, rhinoceros, and swordfish ornaments, hoping that inspiration will strike when I get home and I can work them into a craft project of some sort!

With a mere hour allotted to shop, we headed back toward the bus, but not without being bombarded by vendors galore, hands full of items – mancala games, goat skin drums, African masks, etc. They called to us through our bus windows, lowering their prices as we insisted “no, not interested”. There was a point – not sure when – when their prices dropped so low that our attention was caught, and thus began a twenty minute session of shopping through our bus windows! It was quite a fun experience, and it was then that we realized we should’ve never de-boarded our bus in the first place!


As our bus pulled out of the marketplace, we sat in our seats, surrounded by more Ghanaian goods than we had bargained for, and headed for the residence of Dr. and Mrs. Ofosu-Amaah. Thanks to Brooke, we were given the opportunity to meet the retired chairman of the board at Korle Bu Hospital, and he and his wife graciously invited us into the sitting room of their home.

It was interesting to get the perspective of Ghanaians of a different socio-economic status than other Ghanaians we had met previously, in the fishing village, for example.


During our visit, we asked questions about Ghanaian culture and Dr. and Mrs. Ofosu-Amaah shared their life experiences and current views on education and healthcare issues in Ghana. It was enlightening to have a conversation with two cultured, intelligent, and highly-respected individuals who have accomplished great things in Ghana and abroad!

Upon our departure, we presented them with a basket of fruit and baked goods, as a token of our appreciation, and headed to our new hotel, the Unique Palace, where we were the very first patrons. This might sound like a delight, but as the Unique Palace had pushed its grand opening forward a week to accommodate us, we encountered problems such as unfinished plumbing, heater tanks that “exploded”, and drains that were still sealed with plastic wrap. Oh, this African adventure gets more and more interesting by the day!

We held class in the pool tonight among the Vegas-style light-up palm trees (the epitome of luxury here in Ghana), but adjourned early on account of the mosquito swarm that came to feast upon us. My roomie, Cassie, and I chatter into the evening as we type up our journal entries. We pause intermittently to pile our things onto the various articles of furniture around our room, because the tank of our toilet is steadily leaking water (clean, thankfully!) into our bedroom. All part of the experience, my dear.

First day of work!

The fourteen of us sit here in the Yegoala Hotel’s dark and empty restaurant, tuned to the local news station, in hopes of catching the brief news segment on our work here in Accra. The station, TV3, sent a reporter and camera crew to Korle Bu Teaching Hospital today to spread the word about services being offered for individuals with special speech and language needs, and to raise awareness regarding the learning and functioning potential of children and adults who have disabilities.



We arrived at the very modest ENT (ear, nose, and throat) “wing” of the Korle Bu Teaching Hospital early this morning to meet Albert, who is one of the two speech-language pathologists in all of Ghana. He is an elderly man in his 70s, with eyes that smile through is rimmed spectacles, and although he retired ten years previously, he has been working through his retirement because there is such a shortage of SLP services in Ghana. Albert travels weekly between Accra and Kumasi, a five-to-six hour drive, so that he is able to provide services at both hospitals, Korle Bu and Komfo Anokye. His dedication to the people of Ghana is so inspiring, and it’s truly an honor to collaborate with him.

After walking through formalities and snapping a group photo, our team was divided into small groups, ours supervised by Dorothy. We assessed and provided recommendations for a number of clients, mostly children whose parents’ concern ranged from lack of spoken words to disturbing behaviors to illiteracy. We also evaluated several adults with various disorders. It really took us a half an hour or so to get our feet on solid ground, working out the kinks of assigning roles, covering assessment bases, and working with translators when necessary. Each evaluation began with an interview to assess main concerns of the parents or the patient himself, which was followed by clinician interaction with the patient to determine age-appropriate skills that were or were not present. As clinicians, we discussed sustainable strategies and treatment, then shared our recommendations with the parent, modeling the various activities and techniques with the child.

Our first client of the day was 4 year-old Kalib, who presented with speech characterized by jargon, rote language, and decreased social intent. Though his creche (preschool) teacher expressed no concerns, Kalib’s mother described him as “always wandering, never interacting with other children, and always placing items in his mouth.” Kalib regularly followed simple directions such as “close the door” and “get the big cup”, but did not respond to “who” or “where” questions, make eye contact with people speaking to him, or use language to request objects or actions -- all skills that should be well established in typically developing children; also all typical characteristics of children with autism.

We came up with various therapy techniques to stimulate and encourage language, all simple and low-tech so that they could be carried out by Kalib’s family members at home and in their everyday environment. Kalib’s mother was incredibly receptive and grateful for our suggestions, and expressed that she believed these approaches would be motivating and fruitful for Kalib. Additionally, we provided her with flashcards (easily replicated in case of loss, as we had created them during the session with markers and cardstock) so that she could use AAC (augmentative alternative communication) to facilitate Kalib’s language development.

After a rewarding first day of seeing patients, we were taken by George to a local fabric market where we could select fabrics, and have tailor-made outfits customized for us. What was most exciting was browsing the selection with Miriam, one of our clinical supervisors, who is choosing a fabric for her wedding gown!


As for myself, I selected a gorgeous mustard-yellow and white floral swirl print, what I’d like to call “Anthropologie-meets-Africa”, for a flowy skirt. It was a quite a bit more than I’d hope to spend on fabric, but the purchase was justified by the fact that I’ll probably never again have the chance to have a custom-made skirt from Ghana, right?

The seamstress is here taking our orders and measurements, while we watch ourselves on national television. Unreal. This is a huge thing for speech/language pathology in Ghana! As for us, we’re quite a silly bunch, with our cameras in hand, snapping photos of the screen. :)


11:34 pm
So as I showered tonight, one hand holding the spout above my head and the other hand lathering shampoo into my hair (normal), the water pressure gradually decreased until there was only a trickle slowly dripping from the spout (not normal). I finished off my “shower” with bottled water, and joined my team to find that our entire hotel is waterless. Quite the predicament. Cate has made the executive decision – we’re switching hotels in the morning. Farewell, Yegoala!