Giving Peruvian Children the Power of Communication

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In March, I traveled to Lima, Peru, with our Mercy College communications disorders program director, Helen Buhler, and a team of 27 physicians, surgeons, nurses, technicians and other SLPs. We were there as part Mercy College’s partnership with Healing the Children, Northeast, which provides primarily surgical services to children in need in the United States and abroad.

Over the week we were there, 37 children had surgery; some had traveled for 7 days to reach the hospital. We SLPs worked on parent training, peer training and direct service delivery. Here are some excerpts from the blog I kept during our visit.

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I cried when Dr. Manoj Abraham—a surgeon from Vassar Hospital—put the last stitch into the baby’s lip.

On Friday, Helen, Marianella Bonelli—an SLP and Mercy alum—and I visited with all the parents on the ward. For those whose children had had a lip repair, we celebrated together, admiring their beautiful babies. For those who had their lips repaired but still would need palate surgery in the future, we also gave advice on helping the kids develop good speech habits now to establish good airflow from the mouth after the palate is closed. We worked directly with the kids who had newly closed palates and their parents, teaching about how to bring the sounds out through the mouth and not the nose. Needless to say, there were many therapy materials, toys and goodies passed around, ensuring we went home empty handed but the kids did not.

After speech rounds, we put on fresh scrubs and went to surgery. Dr. Abraham was operating on a baby with a cleft lip that went up into her nose all the way, and welcomed us to observe him.

He was putting this baby’s nose together, carefully making it match the other side as much as possible. He worked some more on the deep layers of the lip, making sure it would be able to have free movement. Then he sutured the philtrum, the raised line that runs down from your nostril to the beginning of the red part of your lip. Suddenly, this baby had a sweet Cupid’s bow of a mouth…a mouth that would pout and pucker, shout, whisper…

Even though it was my second time in the OR and I thought I was over it, I cried and cried. Writing this now, I’m crying again.

What a gift.

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As I came into the speech office (a commandeered storage room), I saw Helen doing…arts and crafts? 

Helen always says we do cowgirl therapy on these trips—shooting from the hip. When an 11-year-old girl with cerebral palsy arrived with very few spoken words, and those few only intelligible to her mom, Helen created an old school low-tech augmentative communication device. She used paper, a sheet protector and some of our speech materials to create a board with some basic vocabulary.

The mom was thrilled to have a way for her daughter to communicate some wants and needs to others in her life. Helen showed her how to create more pages for the board as the child mastered its use. The mom’s eyes were shining—it was so obvious that the board would be implemented immediately.

Based on a quick evaluation, it was clear that the child understood a lot more than she could say, so we hope this is a way she can start to “say” something to the world at last.

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We also worked with a four year old boy with hearing loss due to a malformation of the external and middle ear. He has had recurrent ear infections and had drainage from one ear. He was taking an assortment of antibiotics, and his mom had a thick folder of medical records with her. Although his audiological testing shows a hearing loss, he is not currently a candidate for surgery (Dr. Ryan Brown graciously gave him an exam on the fly to double check).

Helen spent some time with the mom, teaching about behavior management, and I taught her about sign language. I taught them three signs: “go,” “more” and “eat.” The kid chased me around the grounds of the hospital, as we worked our way over to our surgical consult, and I would only run if he signed, “go.” We went from hand-over-hand to slight physical prompt, to following a model for the sign “go.”

The mother was shocked at how positive our interaction was—he was laughing as he chased me. Soon, this kid will experience the power of controlling his world through communication.

Score one for the speech department.

Shari Salzhauer Berkowitz, PhD, CCC-SLP, is an assistant professor at Mercy College in Dobbs Ferry, N.Y. She is an affiliate of ASHA Special Interest Groups 10 (Issues in Higher Education) and 17 (Global Issues in Communications Sciences and Related Disorders). Her research interests include cross-language and bilingual speech perception, multi-modal speech perception and integrating technology and instrumentation into the communication disorders curriculum.