Thursday, January 6, 2011

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.

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