HOMEWARD BOUND

On Jan 13th, we woke up around 5am to start our 6 hour journey back to Accra to work with the cleft palate team in the Korle Bu Hospital. Once we arrived, we were split into small groups. Each group consisted of at least 2 clinicians who assessed the speech and language of 2-3 clients with cleft lip and/or palate. Afterward, we broke for lunch and reviewed each of our cases to practice our presentations to the cleft palate team. This review helped many of us relax and feel more prepared to present in front of the many members of the cleft palate team (e.g. Maxillofacial surgeon, orthodontist, nutritionist, dentist, pediatrician, otolaryngologist, dental nurse, speech pathologist). The meeting was conducted by the craniofacial surgeons: Dr. Laing, Dr. Ampomah and Dr. Paintsil. As each of the patients was called into the meeting, one graduate clinician reviewed the presenting issues related to speech and language, which included the current structural status and level of function. We also provided recommendations regarding speech and language therapy. As graduate clinicians, we felt fortunate to have this unique opportunity to be involved in this meeting as members of the cleft palate team were very supportive and appreciative of our participation.

After our long days at the placements, we would find time to get together for class and reflect on the day. Our Program Director, Cate Crowley, would lead the discussion which focused on our required readings along with several analytic questions. She posed this loaded question that had many of us students thinking:

"What did you not know before you came to Ghana that you learned on this trip?"

One student replied, "I learned a lot of information from other graduate clinicians which included looking at cases in ways I never would have before." She elaborated by saying that everyone brings new perspectives, experiences and knowledge from their own personal and diverse backgrounds. Another student stated that it is an interesting time to be in Ghana as the educational system is beginning to recognize the need to support those with disabilities. She added, "It would be interesting to see how this movement will evolve."

This past week, we spent a lot of time at the Effiduase Unit School with the Head Teacher, Belinda Bukari. Despite the movement towards supporting those with disabilities, Belinda feels a lot of opposition as a teacher of children with special needs. Every child in her classroom is allotted 4.50 cedi annually, which is equivalent to around 3 dollars in American currency. Yet, the school should get four times that amount for each child with a disability. It is clear that she is up against both cultural and financial obstacles, which has been a battle fought alone. Over time, she has gained support from the community and even receives free air-time on the radio to discuss the importance of educating children with disabilities. Another student stated, "Teachers in Ghana like Belinda do so much with so little when some schools in the USA do so little with so much." Another student also reflected on her experiences in Belinda's classroom and stated, "No words can describe how influential Belinda is." She added, "When you walk into her classroom, you instantly feel loved." Belinda teaches over 30 children at a time who vary in age and abilities. She has taken on a job which many would see as impossible. We all felt privileged to watch this extraordinary woman skillfully foster a learning environment that positively impacts all her students while making it look so easy.

Another student discussed how she learned more from the people of Ghana over the two weeks than she could have ever learned in a classroom. She stated, "We took so much more away from this experience than we could have ever possibly given." Someone else added that she felt that most of the parents of children with disabilities and the adult clients we saw throughout the trip generally appreciated our suggestions and recommendations despite preexisting beliefs about individuals who are disabled. Our interpreters (whom we referred to as our "cultural brokers") joined the discussion and stated that they also learned a lot during the clinical experiences. One interpreter stated that prior to working with us, he believed that a disability was caused by a curse. Now, he has learned that rehabilitation is a possibility and plans to share this experience with many people in his community.

Additionally, a student discussed her thoughts about sustainability. She compared her past experiences of international work to this trip. She stated how disappointing it can be when you invest a strong effort into facilitating projects abroad, but the program does not continue when you leave. Yet, our professional collaborators, like Belinda Bukari and Clement Ntim (Head Teacher at the Unit School in Nkawkaw), continue to use language stimulation activities and materials that were implemented in previous trips to Ghana. They greatly appreciate our input and plan to implement our speech and language recommendations from this year. Although there are only a handful of speech language pathologists in Ghana, there is a general understanding and respect for our profession. For this reason, The Komko Anokye Teaching Hospital in Kumasi plans to begin their first masters level program in speech and language pathology in the fall.

On Jan. 14th, we were fortunate to have a meeting with Hon. Alex Nathan Tettey-Enyo, Minister of Education and Member of Parliament Ada Constituency. Other representatives in attendance at this meeting were Mr. Stephen Adu, Director of the Basic Education Division, and Mr. Patrick Otaah, Acting Deputy to the Director of Special Education. Together with Cate Crowley, they discussed the educational infrastructure and how more financial support is necessary to provide quality education to children with special needs, especially in the Unit Schools. Hon. Tettey-Enyo discussed their plans to provide an effective educational system for all children. He elaborated by stating, "It is our constitutional duty to stop social injustice in Ghana." We knew that this meeting was important because an agreement was made to increase the financial allocation to each child with a disability in the Unit Schools. When we were leaving, Mr. Otaah thanked us for our participation and stated, "This meeting was a dream come true."

Afterward, we went to the TV 3 Television Station where we picked up our Clinical Director for the Ghana Program, Miriam Baigorri, and a graduate clinician, Christina Lam. They were interviewed by the news team about our work in Ghana. Then, we had our last Ghanaian meal with our tour guide, interpreters, bus driver and bus mate--George, Frank George, Nicholas, Richard, Steven and Francis. Graduate clinicians stood up and gave speeches to thank each of them for all their help and support throughout our service trip. This was followed by a lot of dancing and singing to live music at the restaurant.

Before heading to the airport, we stopped at the infamous Holiday Inn in Ghana—where President Barack Obama stayed during a recent visit—for a meeting with Hon. Naa Prof. John Nabila who is the Chief of the Northern Region, President of the National House of Chiefs, and Member of the Council of State. Chief Nabila is an old and dear friend to my uncle, Emmanuel Noggoh. For this reason, he graciously sat with our team and discussed his position as Chief in Ghana and his responsibilities as the President of the National House of Chiefs. Specifically, he informed us that a Chief has an important duty of being the liaison between the people and the government. Conveniently, a meeting amongst top Ghanaian officials was being held at the Holiday Inn so Chief Nabila introduced us to Dr. Kenneth L. Brown, who was the former US Ambassador to Ghana and currently the President of the Association for Diplomatic Studies and Training. After having the honor of introducing ourselves to these prominent political figures, they all commended us on our work in Ghana and strongly promoted our return to help more individuals with communication disorders.

Last Day in Kumasi

The traffic seemed to be easing up this morning as if Kumasi had finally embraced us, streamlining travel to do our work. By the afternoon however, it was back to bottleneck traffic, the only benefit being the easy purchase of plantain chips, coconuts, and chocolate by the wayside.

This morning, half of us went to Komfo Anokye Hospital, and the other half to Effiduase School. When we arrived to the school around 9:15, many of the students were still proudly wearing the name tags that were made the day before. We modeled an attendance activity for Belinda using the laminated name tags and the “home” and “school” display boards with pockets that we had created the previous night using medium weight sheet protectors, clear packing tape (to join the sheet protectors and to laminate the front and back), staples (to create the individual pockets), and ribbon (to hang them up in the classroom).

Each of the individual name tags had a child’s name paired with a symbol (e.i. pineapple, bicycle, star). The idea being that as the child sees her name tag, she will first begin to identify her name by recognizing the symbol. After being able to consistently recognize her name via the symbol, the teacher will cover the symbol and place emphasis on the first letter of the child’s name. The child will, in this way, learn to recognize the letters in her name, and generalize the graphic awareness to the names of her peers and to other words.

We continued the work of yesterday’s group and went outside into the common play yard to engage in an activity with some of the general education classrooms. As we walked to the yard, we saw children peeking out of the classroom doors and windows. It didn’t take long for them to come out and join us. We formed a large circle and sang the name song in which everyone takes turns jumping into the middle of the circle to dance when their day is called. In Ghana, you are given a name according to which day of the week you were born. For example, the name "Kofi" is given to male child who is born on a Friday.

After playing a few circle games, we took the children from Belinda's classroom to the market to provide a functional context in which to use AAC. The cards depicted items like cassava, tomato, onion, plantain, fish, palm nuts, and cabbage. We were overjoyed to learn that the children were still using the cards from last year, in fact, one of Belinda’s assistant teachers had created more cards that far surpassed ours in artistic form. Every child had a chance to make a purchase. Some of the vendors recognized a few of the children. This was wonderful to see, as it meant that they go to the market with their parents and are not confined to the house.

One of the vendors even mentioned to Belinda that she wanted to enroll her niece into the Effiduase School. This gesture was extraordinary as it demonstrated the shift in mindset that Belinda created in her community as a result of her inexhaustible dedication and advocacy to children with disabilities. Belinda recounted that as little as a few years ago, people would stare at her and whisper when she walked by. Now they ask her to read prayers aloud during the church service!

In Ghana, children are expected the go to the market to buy food for the family. This is a challenge for many children with disabilities who are often viewed as unhelpful when it comes to making purchases at the market and other household tasks. It felt revolutionary walking to the market with the children knowing that they were accomplishing a task meaningful to their families and to the community. It was an incredible last day at the school.

In the afternoon, we went to the Cleft Palate/Craniofacial Clinic at Komfo Anokye Hospital and joined our other half to observe patients in consultation with Dr. Alexander Acheampong, a surgeon/lawyer/dentist who studied with Dr. Peter Donkor, the head of the department (and esteemed author of one of the journal articles included in our coursepack). Most of his patients were infants but he also saw a 34-year old man who wanted to get his cleft repaired in preparation for marriage, and an 18-year old girl who was brought by her classroom teacher. He discussed each of the 10 cases with us and answered our questions.

Dr. Acheampong explained that the lip repair is the most crucial surgery for an infant because it helps the mothers to bond more closely with their child. When the child's face appears more normal, a mother is likely to provide better care. One of the patients was a 1-year old child who had already undergone cleft lip repair and was awaiting a palate repair surgery. The mother reported that the child had finally been accepted into the family and had been named "Blessing Santua."

At times, even after a lip repair, a child may not be accepted into a family. Dr. Acheampong mentioned that 6 months ago, he had adopted an infant with a cleft lip and palate who had been rejected by his family. He named the child "Peter" after Peter Donkor, his mentor. We were touched by the doctor's commitment to his patients and congratulated him on his recent fellowship award to work at the University of Michigan.

In keeping with our typical schedule, we sat down for lunch around 4:00. Upon boarding the bus, George Frank, one of our traveling interpreters, put in a “hiplife” (a contemporary Ghanaian music genre) cassette and we traveled back to the hotel. Now we are enjoying sparkling drinks and bubbly conversation…

KUMASI DAY 2!

Today was our second day of placements in Kumasi. We split into two groups and set out at 8am to either the Unit School at Effiduase or the Komfo Anokye Teaching Hospital. While half the group continued to evaluate patients at the hospital, the other half continued work at the Unit School.

Upon arrival to the school, students came up to the bus and greeted us with hugs, handshakes, and smiles. Just as Belinda approaches all activities with praiseworthy energy and excitement, she was eager to implement new strategies with materials that we made for her class last night. One of our main goals for the day was to help the general education classroom understand the meaning and implications of disabilities. When we entered this classroom, we asked the students what they knew about disabilities. Some responded in Twi that disabled people are those who do not have a body part. One surprising response was that a disability is when a person has a knife stuck in his/her body. We expanded that definition, divided the students into groups, and asked them to pretend that they had disabilities such as not being able to speak, see, hear, walk, and use their arms. We then encouraged the students to help one another during a beach ball game while pretending to have a specific disability. After this, the Unit School students and general education students came together and engaged in a similar activity. It was refreshing to see all the general education students help the Unit School students during the different activities, even those who had initially been hesitant to play with the Unit School students. By the end of the activity, the children were one big, united group.

After our placements ended for the day, we visited an Adinkra village. We watched women pound tree bark to a pulp with thick tree branches around five feet in length. A dark liquid was produced when this pulp was boiled, and this was used as the ink for stamps originally used for symbolic depictions during funerals. Some of us made our own patterned fabrics with these special stamps! Our final stop on the way back to the hotel was a visit to a Kente cloth village. We saw men weave cloth on wooden looms used to make intricate Kente cloth strips, some of which take many months to complete.

The evening came to a close by another ‘assembly line’ during which we prepared more materials for the Unit School followed by a discussion with Belinda. She explained how she had initially recruited students to her school by physically going to families in the community after word-of-mouth referrals. She commented how people have gradually accepted and learned to appreciate the roles of both her and her students in their community. She concluded with her hopes of successful transition of some of her students into general education. Her strength and resilience amazed us all. Listening to her speak about all the opposition she has faced and continues to face was both heart-breaking and empowering. She is a model for all of us.

Next Stop: Kumasi!

We awoke this morning refreshed and excited for our first full day in Kumasi. Following breakfast, the students and supervisors split into two separate groups. One group boarded the bus and headed over to the Unit School at Effiduase to work with children of various ages who have special needs. There, they met with the head teacher, Belinda, and divided the students into groups depending on language abilities. For every 6-8 students, there were two student clinicians leading activities designed to stimulate language and evaluate the individual needs of the children in the classroom.

The other group of students loaded into taxis and headed over to the Komfo Anokye Teaching Hospital where the group was further divided into two small teams. Patients and families were interviewed and assessed, and recommendations were given that could be practiced in the home. One of our patients was 26-year-old Nathaniel, who had recently entered the seminary and was studying to become a priest. Nathaniel explained to us that he had stuttered since he was a child, and was interested in learning strategies to help improve his fluency. He was talkative and friendly, and seemed very eager to learn. Our group was excited to share with Nathaniel some techniques that he could practice, especially before meeting new people, and when speaking in front of his audience. After reviewing our suggestions, Nathaniel enthusiastically put them into use by saying, “Today I met with the people from America!” He thanked us each wholeheartedly, and we were all very confident that he would be spending his life moving parishioners with his words.

After our clinical work, with our minds buzzing with ideas and thoughts about all that we had encountered, we headed to the Pempeh Jubilee Museum where we learned about the Asante culture. There, we marveled at photos and artifacts and were enlightened about the cultural values of the Asante people. Throughout the cultural center, we explored beautiful handmade goods and visited many local artisans who were working tirelessly at their crafts. It was there that we met Joel, a local artist who was painting a portrait of an African village. Due to his physical disabilities, Joel sat in a wheelchair and painted breathtakingly beautiful pictures using a paintbrush that extended from his mouth. Many of us bought his artwork, which Joel happily signed on the spot, and we left feeling very lucky to have met such an amazingly talented man.

On our bus ride back to the hotel, we sang traditional Ghanaian songs while beating rhythms on the handmade drums that had been purchased at the local market. The monotony of traffic was made much more tolerable as everyone enjoyed some delicious local snacks, including crunchy plantain chips, sweet bits of sugar cane, and water from freshly chopped coconuts. As we shared food, we also exchanged our ideas about the work that we would be doing over our last few days in Ghana. Back at the hotel, we organized an assembly line and feverishly began preparing materials that we will bring to the classroom tomorrow, including large, brightly colored nametags that will support literacy and language. We are excited to return to our placements tomorrow to move forward with what we have started!

Nkawkaw

After a relaxing night in Ho, we began our journey to a unit school in Nkawkaw. On the bus ride to Nkawkaw, we passed a myriad of communities separated by lush forests. The communities all contained naturally-made shacks where the villagers sold fruits and vegetables, bags of purified water and other knickknacks. We stopped at one road side stand where we tried a local favorite, Xboloo, cornmeal smoked in banana leaves with shellfish. Traffic, bathroom breaks and the condition of the roads delayed our arrival at the unit school. We arrived at 2:00 and were introduced to Clement Ntim, who had been waiting with his students and students’ parents since 12:30. Clement was nominated 2010 Special Education Teacher of the Year for the work he has done in the Nkawkaw unit school. Clement’s mission, similar to our mission at Teachers College, Columbia University, is to educate, not only students and parents, but fellow colleagues in order to assure that all persons receive quality services. Last year, Clement organized a professional development team with over 100 teachers from various locations in Ghana.

The Nkawkaw unit school meets in a small, dark building. We were greeted by over 20 smiling children and many more welcoming hands. The materials closet was empty as schools for children with disabilities are given limited funding from the government. The room was filled with posters of activities of daily living (e.g., going to the bathroom) and communication strategies (e.g., greeting someone with a hug). Clement reported that the majority of the students were able to utilize these posters despite their moderately severe to severe disabilities. Our role was to provide quick speech evaluations and strategies to improve the communication needs of each child. The stigma towards children born with disabilities was evident in some cases. One parent stated that he did not believe children in the United States were born with disabilities and others asserted they, or their child, had been cursed. Therefore, we also offered the parents facts about disabilities. We made identification cards for the students out of simple index cards laminated with packing tape. We also provided Clement an Augmentative Alternative Communication (AAC) binder with teaching materials. Additionally, three of the students presented with hearing loss, but were not previously able, due to lack of transportation and/or general knowledge, to have their child’s hearing tested. Therefore, we made arrangements with the parents of these children and the closest hospitals. We also worked with the students in the classroom, teaching new songs with movements, including “The Itsy Bitsy Spider,” “Head Shoulders Knees Toes,” and “B-I-N-G-O.” The students were eager to learn these tunes, in addition to teaching us their own.

The students, parents and teachers displayed their gratitude with a prayer—giving us thanks and their best wishes for the remainder of our time in Ghana. We then continued on our journey to Kumasi where we are spending our nights at the KNUST School of Engineering Guest House. After settling into our rooms, we held class in the conference room to speak about our experiences at the Nkawkaw unit school.

- Written by Jacqueline Schmieder

Monkey Business

Today we woke up bright and early to get ready for our day’s adventures. It was a one and a half hour bus ride to Ho, during which we learned various Ghanaian songs. Between all the dancing and singing, we are becoming quite the musicians on this trip. Maybe discovering new side jobs for some people, who knows!

We arrived at the Tafi Atome Monkey Sanctuary at about 9:15 AM and met our tour guide, Kerobin. He graciously welcomed us to the sanctuary and explained that the monkeys are considered sacred in the village and protected by the Fetish Priest. After a brief introduction, we walked down a dirt road, passing many villagers and their shops along the way. Once in the forest, Kerobin demonstrated how to grip the banana firmly while leaving the perfect amount for the monkeys to peel it right in our hands. This may sound like a simple task but it is definitely an art form which must be mastered (let’s just say, my first banana was snatched pretty quickly. I guess some of us were too busy dancing and singing to master this art as well). While many of us began to raise bananas near the branches following Kerobin’s model, others simply attempted to woo the monkeys by making our own interpretations of their monkey cries. One by one monkeys jumped from branch to branch in order to eat the bananas directly from our hands (one monkey even jumped on Elaine’s shoulder to peel the banana more easily!).



Once further into the forest, Kerobin explained more history about the monkey sanctuary and the people of Tafi. Traditionally, the Tafi are idol-worshipers who can be traced back to four district groups. They believe that a couple hundred years ago, when migrating from Central Western Africa, the monkeys followed them to their new community. Because these were the only animals to make the journey alongside the Tafi while en route, it was believed that the monkeys embodied their peoples’ idols. Christian missionaries viewed this relationship between the Tafi and their monkeys as sacrilegious and made great efforts to kill off monkeys from the area. It was not until 1996 that wildlife conservation put forth efforts to protect the monkeys of this area.

We then ventured off to meet the Fetish Priest who lives approximately 2 kilometers from the monkey sanctuary. When we arrived he insisted on getting us all seats before we could begin our conversation. Once everyone was comfortably seated, he discussed his job and how he was appointed as the Fetish Priest. He graciously answered our various questions and described how only he, the Fetish Priest, is allowed to enter the room of the gods (which is where people must go to have their spiritual requests granted).

After saying our goodbyes to the Fetish Priest, we hopped back on the bus to head to the Wii Waterfall. We walked through a series of winding dirt paths passing papaya, plantain, and pineapple trees along the way. After crossing several bridges, we began to feel a light mist in the air and knew we were getting close.

The waterfall was magnificent, spanning hundreds of feet up with massive amounts of water gushing down every second. Many people jumped right in and swam under the ice-cold waterfall, while others opted to stay closer to the shore and enjoy the scenery. After relaxing on the shore, taking in the stunning view of the falling water and its reflecting rainbows, and indulging in opportunities for cheesy group photo shoots, we packed our bags and went back through the rainforest back to the bus.



It was a great day, and we are all looking forward to our furthered clinical experiences that await us tomorrow in Kumasi.

Internet Access

To our dear friends, family, and followers,

We're so thrilled that you've been following our work, and love that you're able to "be here" every step of the way with us! We'd like to mention that internet access has been extremely difficult to come by, so please don't worry if we're unable to post consistently. We're making an effort to keep this blog updated as best as we can. :)

Love,
Us

Onward, Ho!

After experiencing our first African rainstorm last night, we slept in ‘til 9 o’clock this morning and awoke to yet another palate-tickling breakfast of eggs, toast, fresh fruit, tea, coffee, and delightful conversation. We then paid a visit to the Special Education Division of Ghana’s Ministry of Education. It really is amazing, the breadth of work we’re gaining experience with here on our trip -- from cleft palate surgeries to educational policy.

Madame Rosemond Blay, the Director of Special Education, and Mr. Patrick Otaah, the division’s acting deputy, welcomed our group with open arms into their office, which was adorned with posters and plaques displaying motivational statements such as “A deaf person can do anything except hear” and “A teacher directs the hand, opens the mind, and touches the heart”.


Once situated, Cate explained to our hosts what it is we do with the medical and educational professionals we’ve been collaborating with while in Ghana, such as Belinda and Clement at the unit school in Kumasi. Cate shared with Madame Rosemond and Mr. Otaah her White Paper written about the special education system in Ghana, as well as the Teacher’s College article highlighting students’ work here last year. (Click links to read.) In turn, Madame Rosemond and Mr. Otaah shared information regarding the structure and current initiatives of the Special Education division, one of ten divisions under the Ministry of Education.

Great efforts have been taken to establish numerous residential schools throughout the country for students with special needs, including vocational schools where dedicated teachers train students in specialized trades. Such trades include carpentry, sewing, and pottery, among many others. In a country where students would remain in the public school system four 20 or 30 years without graduating, these vocational schools have highlighted the strengths of, given skills to, and graduated students to be contributing members in their communities. This has revolutionized the traditional views of persons with disabilities in the country in an immense way, prompting people to realize that people with disabilities are capable of learning, that they do have strengths which they can contribute to society. ‘Twas quite powerful!


Now, we sit aboard our "luxury" bus, making the 5-hour journey eastward to the village of Ho. As the golden sunset creates a glow behind the silhouettes of African trees on the lush green horizon, some of us catch up on sleep missed over the past week while others watch a Ghanaian film featuring cameos of our very own Cate Crowley and several of last year’s team from Columbia. Here in the back of the bus, we’re teaching our Ghanian friend Nick how to speak with a Brooklyn accent and rap the intro from Fresh Prince of Bel-Air. Outside, countless villages of varying cultures zoom past our eyes, and their inhabitants wave excitedly at us as we pass. I could stare out this bus window for hours.

Day Three at Korle Bu

We began our day at Korle-Bu hospital with a visit to the plastic surgery unit. Cate had arranged with the director of the unit to allow us to observe Dr. Ampomah perform cleft lip and palate surgeries. We were all extremely grateful for this unique opportunity as we were all very aware of the fact that we would never get the chance to scrub into a cleft lip and palate surgery back in the states. We split into 3 groups: 2 groups went back to the Ear, Nose, and Throat clinic to see patients while 1 group stayed behind in the “surgical theatre” to observe a part of the surgery. We rotated groups every hour so at the end of the day everyone got the chance to be a part of the magic. When it was my group’s turn, we stripped down to our underwear, bras, and money belts, and exchanged our clothes and shoes for scrubs, hairnets, surgical masks, and hospital slippers. After an obligatory group photo, we entered the theatre. Dr. Ampomah invited us to stand around him as he operated on a tiny person wrapped from head to toe in green cloth, with only the nose and mouth exposed. We learned that the child on the operating table was a 1.5-year-old girl with an unrepaired cleft. With patience and humor, the doctor described the anatomy as well as each step of this life-changing surgery to us. The procedure involved cutting through and suturing 3 layers of tissue including the nasal, muscular, and oral layer. He talked us through each stitch, cut, and suction, and we were able to witness the child’s palate built like a house—one layer at a time. What a brave little girl!


Inspired and enlightened, we returned to the Ear, Nose, and Throat center to see more patients. Caleb, one of the clients from our first day at Korle-Bu, came to see us again this afternoon. We were anxious to show Caleb and his mother how to use a talking photo-album to enhance his communication abilities. We explained to Caleb’s mother that the album would be used like a communication book, and will help Caleb express himself using language. His mother’s face lit up with hope and excitement as we explained the idea behind this device. She was so eager to learn how to use the picture album to help her son. Caleb learned how to use the album in mere moments, and we cheered and clapped in excitement as we watched him communicate. Not a single face in that small, hot therapy room was without an ear-to-ear smile. Days like today certainly fuel the hope that our work here will endure and enable our clients and their loved ones to live better lives.

---------------------------------------------------------
Case study: Judy
Judy, a smiley 10-year-old, came to see us with her mother and her mother's English-speaking cousin. The mother's cousin, Emanuel, explained to us that Judy was slow at learning. He offered an explanation for Judy's delays by saying that her mother gave birth to her at a late age--32. Judy's mother handed her schoolwork over to us while Emanuel told us that Judy has been struggling to learn in a regular-ed public-school classroom in the Volta region (Easternmost region).
Judy's notebook was filled with circles and lines, and her exam papers had circles drawn all over them. She had occasionally gotten lucky and circled the correct answer on the test form, getting a 60% score by some miracle. We were tempted to recommend that Judy play the lottery, given her luck.
This is also when we learned that Judy and her family had traveled since 3 in the morning to come see us at Korle-Bu hospital in Accra. Incredible, isn't it?
As we interacted with Judy, coloring, completing a peg-board, and exploring picture books, we realized that Judy had some essential strengths: her eagerness to learn and please buzzed through the therapy room.
We explained to Judy's mother and Emanuel that Judy both needed and craved language stimulation. We suggested that Judy's mother engage in daily conversations about the school-day as well as everyday events with Judy. We explained the difference between open-ended and closed-ended questions to Emanuel. We said that a question like "are you coloring?" would not elicit a lot of language out of Judy. Emanuel lit up and said "that's right! 'what are you doing?' would be a better question!" He was really getting and even expanding on our recommendations! We also suggested improving Judy's expressive language by expanding her utterances. For example, while looking at a picture-book, when Judy said "green pepper," we instructed Emanuel to elaborate on her utterance by saying "I will cook the green pepper and eat it on the plate." Judy repeated after Emanuel and looked up at us for reinforcement. We were all smiling incessantly as she made eye-contact with us.
As we continued to model our recommendations to Judy and her family, Emanuel excitedly told us that we are going to turn Judy's mother, who is a hairdresser, into a teacher. We believe it!
We asked Emanuel if he knew any schools for children with special needs available in the Volta region, and he said that he wasn't sure. We promised to look into this and contact him if we found a school for Judy near her residence that would better fit her needs. Our supervisor, Miriam, talked to the director of the ministry of education and discovered that there were 2 unit schools near the Volta region. Unit schools are public classrooms within regular-ed schools for kids with special needs. This school model is similar to a self-contained classroom in a regular-ed school in the US. There are 24 unit schools in Ghana.
We were happy to contact Emanuel and Judy's mother with this exciting information so that they could continue to support Judy in reaching her fullest potential.

Day Two at Korle Bu

Today was the final morning of our stay at Yegoala Hotel. After dealing with ‘waterless’ showers and other minor mishaps, Cate made an executive decision to have our tour guide George make arrangements for us at another hotel. Once we finished packing and bringing our luggage downstairs from our rooms, we all gathered for breakfast at the hotel restaurant. Our breakfast consisted of eggs-omelet style, two pieces of toast, pineapple juice, coffee, and tea. During breakfast, Cate encouraged us to share our experience from the first day meeting clients at the Korle Bu Hospital. Each group had different experiences and our conversation allowed us to discuss and share any questions, concerns, or ideas we thought would help us in assisting future clients during our stay in Ghana.

After completing a wonderful breakfast we arrived at Korle Bu, the teaching hospital in the city of Accra. We quickly separated into our four groups, unpacked all of our therapy materials, and prepared for our clients. Similar to our first day at Korle Bu, each group saw an average of 2-3 clients, ranging in age and varying in types of communication disorders. Each group conducted interviews with the patient and/or family member, performed assessments, and made recommendations to improve the presenting communication disorders of the client. Collectively, we felt that our work at Korle Bu was successful and we are all looking forward to another productive day tomorrow at the hospital.

At around 3PM, we all packed up our therapy materials and headed to the dining lounge for the University faculty. Like yesterday, the lunch was a buffet style consisting of chicken, fish, vegetables, noodles, and Joloff rice. Everyone enjoyed their meal and managed to unwind after successfully completing a busy, yet, fulfilling day of work at the hospital.

After our lunch, we then headed to the tourist market in Accra to buy arts and crafts, textiles, jewelry, and other handmade Ghanaian items. When we arrived at the market, we were immediately bombarded by the vendors trying to sell us their merchandise. As we went from vendor to vendor, we saw many beautiful hand crafted art, jewelry, and clothing. Through the narrow aisles we walked and listened to the sellers calling out for our attention and gently tapping on our shoulders to persuade us to buy from their shop. Although intimidating to some at first, we adjusted to our environment in a matter of minutes and began to bargain prices for various items. Before leaving the market, many of us were able to get great deals on Ghanaian handmade masks, drums, jewelry, and clothing, right from our bus window. We all had a blast interacting with the sellers and bargaining prices quickly became a newly discovered skill for most of us.

We then left the tourist market and made our way to meet Dr. and Mrs. Ofosu-Amaah. Thanks to Brooke, we were given the opportunity to meet Dr. Ofosu-Amaah, retired chairman of the board at Korle Bu Hospital. After contacting Dr. Ofosu-Amaah earlier this week, we were cordially invited to his house in Accra. When we arrived at the house, we were greeted with a warm Ghanaian welcome. 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 amazing to have a conversation with two cultured, intelligent, and highly-respected individuals who have done great things in Ghana and other countries. Before leaving, we all took pictures together to capture this memorable moment and thanked the Ofosu-Amaah’s for their hospitality. Brooke, who is a close friend of their son, presented them with a wonderful basket to show our appreciation for their kindness.

We finally arrived at the Unique Palace hotel and got settled into our rooms. At 9PM we gathered around the pool to have our daily discussion of our articles featured in our course pack. We had an amazing discussion about children with disabilities and the need for speech and language services in Ghana. Personal experiences as well as different perspectives and opinions were shared during our conversation. At the end of our meeting, many took a swim in the pool and had a bite to eat. Others decided to rest after a long day and/or reflect on their experiences by writing in their daily journal. Overall, it was another exciting and busy day in the beautiful country of Ghana.

- Written by Danielle Lake