Looking back

With all the excitement of our final day, the rush to fit everything in - the meetings, the celebrations, the packing and the (extremely necessary) sleep - the final post had to wait until my feet were back on Canadian soil and my eyes were ready to open after a well-deserved day of rest.

The main goal of this trip was a clinical experience. An experience none of us would ever have gotten in Canada. Though few of us in the program had been lucky enough to observe for a half day at a cleft lip/palate or VPI clinic in London, the observations could never provide us with practical, hands-on experience in the area of cleft lip and palate. In Ontario, there are specialized teams at particular hospitals in only a few cities that even treat these children. There are a few very specialized speech-language pathologists working on these teams that get to be there from the beginning and intervene from birth. Afterall, in Canada these children are caught so early - intervention is at hand at the earliest moment and is accessible to any family that needs it.

A traditional placement might afford you some experience with a variety of clients - children of all shapes and sizes with all sorts of histories. But there is no traditional placement available to us that would allow us to intervene with this special population to work on resonance, compensatory articulation, nasality - not in such a direct, specialized, tangible way. We were right there, doing the therapy, assessing these children with feeding, speech and language difficulties - babies a few months old, babies with syndromes, teenagers with unrepaired clefts. We would be lucky to have even observed such intervention in Canada.

As a clinician in Canada, I am taking this experience and carrying it with me through every child I treat. I have truly learned what it means to collaborate with clients and families within a specific culture and to adapt my approach to fit the structural and functional abilities of each individual client. These very specific and special cases challenge us to think outside our box of "typical intervention" - out of our norms, out of our textbooks and out of our comfort zone. While traditional placements challenge us to put our studies into practice, this placement challenged what we know about typical (English!) development and what we take for granted about the typical children we see for intervention. It truly opened my eyes to special cases and our role as professionals in their development.

How do you do speech therapy with a teenager with a gaping hole in the roof of her mouth? I would never have had to ask myself that question in a typical placement, but I asked it Peru - and we answered it. We worked it out. We faced this huge challenge and I learned more about what it means to make a sound than I ever could have at home. I learned how difficult it can be, and I learned how valuable those skills are.

Placements always challenge us. Placements always aim to have us apply what we know how to do. We know how to do these things for children with cleft lip/palate - we are taught how to do these things; but when would we ever have the opportunity to use it without this placement in Peru? Likely never. I wish that everyone could have this opportunity to grow and experience this professional development. It is enlightening as a clinician to put your expertise into practice and to know that you have dipped your feet in to every area of your field, so that you know where you want to practice and you can find your nishe. Afterall, we all have the brains but we each have special gifts that lead us in different directions. How would you know where to go if you didn't know what your options were?

Thank you, Western, for the experience. For the opportunity to integrate my profession with social justice, participate in an interdisciplinary approach, gain critical knowledge about how SLPs practice in other countries, and bring our knowledge to a group of professionals and families alike that were eager to learn from us. It was an honour to bring them everything we could, but it was a greater pleasure to learn everything we did from each of them. I am a better professional - and a better person - for it.

the last hoorah...

Something I've come to realize about myself over the course of this clinical and cultural experience is that I still have so much to learn as a professional. There are so many nuances that can only be learned during a therapy session and as you get to know your client. These things cannot be learned from a textbook.

Another realization, perhaps on a deeper level, is that I do not want a predictable existance. I do not want to get so comfortable in my job that I surround myself in some kind of protected bubble where I am oblivious to the needs of the world. I want to make myself available for opportunities to serve abroad and offer my expertise where needed. As we have all come to realize over the last two weeks, we, as students and professionals, gain so much from experiences like this. We have all struggled with the feeling that we are gaining more than we are giving.

Una verdadera maravilla del mundo

The whole group is in Cuzco. The ladies from Western are currently enjoying a relaxed lunch in an internet cafe in the main square of the city. We have had a couple of jam-packed days!

We arrived in Cuzco very early on Saturday morning. After a looooong nap, we went horse-back riding in the mountains. Talk about fun! My horse's name was Chavo (slang term for guy in Spanish). After getting used to being on a horse, it was a great hour and a half. We got to see the rugged scenery of the Andes, which was quite breathtaking. After that we had the chance to take a photo of the whole city from high up on one of the cliffs. Then we got to explore the city a little bit. I get the impression that Cuzco is more like what people expect when they think of Peru... nestled in the mountains with Spanish style architecture. Finally the whole group of students (forty plus) with Solidarity in Action went out to dinner. A great way to finish the day.

On Sunday, we went to Machu Picchu. It is very deserving of its designation as one of the 7 new wonders of the world. It really is indescribable. I spent the time trying to imagine the city as it was before Fransico Pizarro and his conquistadores came to South America, and how it would have looked like when it was full of Incans (instead of back-pack clad tourists). It was tougher than I expected to tour, though. There were hundreds of stairs, and many were quite steep. We all certainly got a workout yesterday... but it was more than worth it. It was a day I will never, ever forget.

Gracias a todos!

We´ve finished up our week in Armomizar and I think the consesus is that we feel we have gained so much more than we have given. There are so many differences between Canadian and Peruvian culture that have allowed us to see and try things we may never have had the chance to back at home. The biggest contrast I´ve noted is the absence of strict confidentiality rules. We´ve all signed our lives away and made oaths to keep our lips sealed about client matters once we leave work. While I feel protected by the confidentiality laws we have at home, the open clinical environment here has allowed us to feel closer to our clients and given us the opportunity to see much more than we would have in a Canadian clinic. From what we have experienced, a typical Peruvian "consent" consists of a simple "Do you mind if we watch?" en espanol of course while a smile and a "si, si" from the client is the equivalent to their signature. We´ve been lucky enough to get to watch many different professionals, have teams of 3 clinicians working with each client and to involve entire families in therapy sessions. Everyone here has been so open to our presence that it has given us a broad variety of learning opportunities that I´m not sure we could have gained elsewhere. Raul, our Peruvian trip leader has told us many times that Canadians are almost too polite and Peruvians expect much more openness, we shouldn´t been afraid to ask questions. It has been a freeing experience to adopt this Peruvian way for the short time we have been here and to not worry about whether we have formal, signed consent for every client we work with or observe. While we as Canadians, have been careful to post only pictures where clients aren´t identifiable, I´m sure if we asked, we get a simple, "Si, si."

Scattered Thoughts

On Finishing at the Clinic
From Sue and Taz

Final good-byes were offered to kids, families and Armonizar professionals and staff.
Tears were shed, hugs, kissed, cards and gifts were exchanged. It was obvious that despite our short visit and language barriers positive relationships were established.

When we reflect on our week, we are all feeling that we have gained far more than we have provided - even in light of the fundraising, donations, hard work, preparation, Spanish lessons, hours spent developing tools and resources, rehearing in-services in Spanish, preparing and providing assessment and treatment sessions .........

So what do we think we´ve gained ....well to begin with a new found respect and appreciation for the challenges that professionals in developing nations deal with and work around everyday, a greater sense of thankfulness for what we have in Canada, an understanding of the meaning and nature of human relationships, an awareness that professionals here take on huge voluntary committments to clinics like Armonizar (where the ENT, dentists, SLP, geneticist, pediatrician all offer their professional services on a volunteer basis at evening consultations). A true testament that the sum is greater than the individual parts, and a living example of solidarity in action. We are sure that the students will share their own personal reflections regarding their week later in the blog!

We finished the day with a concert by local Peruvian musicians. Be sure to check out the FlickR account for a short video clip of the concert! Early night as we have to be up and out to the airport by 3:00 am to get to Cusco.

Lost in translation...un peu...

I have kept note of some touching moments and some humourous moments that I hope will bring a smile to readers.

Some things that have struck me...

Dedication.
One of our clients, a little girl who brings a great attitude and a big smile to speech therapy, informed us that she and her mother woke up at five o'clock in the morning to ride a bus for three hours to reach the clinic. Talk about dedication. A three hour bus ride for a one hour speech therapy session led in somewhat broken Spanish by two Canadian students. Talk about trust. These families value our services. They believe that we have something to offer their child, and place their faith and trust in us. What an honour for us.

Gratefulness.
Another client came to session with beaded bracelets and rings that she had made for Jana, Sue, and me. This was after only one assessment session with her. We had not even begun therapy yet and she was already bringing gifts of appreciation. I have witnessed a lot of this here in Lima. Grateful parents and children offering us gifts and hugs and kisses on the cheek at the start and end of each session. I think it puts our minds at ease; it reminds us that, even though we can't 'fix' the communication problem or answer all of the parents' questions, they do genuinely appreciate any help we can give.

Teamwork.
The girls and I have spent a lot of time reflecting on our cohesion as a team. We have benefitted from conducting therapy in pairs, and could not imagine it any other way. We have all our had our moments of uncertainty regarding our clinical skills or language abilities, but we've pulled together and kept each other going. Each of us plays a crucial role within the team, whether it's to provide comic relief, translation, a hug, or a reminder that, "We know a lot more than nothing!" What a great experience.

Some funny moments?

Frenglanish.
In her interactions with parents, clinic staff and cab drivers, Sue will throw in expressions like, "un peu" and "so" amidst her fairly fluent Spanish (she really is quite good!). This has provided us all with comic relief and I think it has started to rub off on the rest of us, un peu....

"Student Clinician"
A certain supervisor, who shall remain nameless, signed a "SOAP note" with the title "Student Clinician" instead of her own credentials. Talk about relating to your students! It had us all chuckling.

Aqui vamos...

I was unsure of what to write about in this, my first blog entry. The others suggested that perhaps I discuss the benefits and challenges of being the "translator" of the group. Here goes...

Of the 6 of us, I do speak the most Spanish. This definitely brings some advantages. I can easily convey what it is I want to say to the clients, their families, the staff at Armonizar, and even cab drivers! Coupled with that is my ability to understand what they tell me. It definitely facilitates the therapeutic process and makes interviewing families so much easier... I can't imagine how I would deal with it if I couldn't speak the language. I definitely take my hat off to the others for their patience, their persistence and their creativity!! I may do a lot of the talking, but I still couldn't imagine doing this without the others. You ladies are awesome!

The downside to the translation piece is the sheer exhaustion. I feel like my brain is split in half right now and as a result, neither half can operate as quickly or sometimes as effectively. It's always funny when I start forgetting words in English. Being pulled in multiple directions for translation purposes is tiring... but I know that it is all worth it!

I've been speaking Spanish since I was ten years old and it's something I've often taken for granted. I've been fluent for most of my life, so it's just a part of me. But I've never really used this part of me for such a worthwhile purpose. I never thought that when I was struggling to learn different verb conjugations (I still shudder at the thought of all those darn irregular ones) that they would come in so handy for a professional opportunity like this. I am truly grateful that I have this skill and that I can use it to help other people.

However, I am still looking forward to telling all my family in Mexico about how much I've been translating and how much Spanish I've been speaking :)

Hasta luego!

Yo hablo Espanol???

We spent our second day doing assessments and therapy at Armonizar today. As students, we're just learning the art of our profession, which is always a challenge when beginning a placement. What I feel I should have anticipated more is the challenge of conquering this feat...in another language. We all came with varying levels of Spanish. Adriana grew up learning Spanish from her father and we rely on her a lot for her fluency. Victoria and I have had various Spanish-related experiences but are learning that as time has passed between then and now, we're a little rusty. Sue has been absorbing all she can in 12 weeks of lessons prior to this trip while Taz is even newer to the language. Michelle is getting by with her Italian (quite nicely actually).

As SLP's, we learn to communicate and want to communicate. When conducting assessments and therapy in Spanish, our limited vocabulary can make this a challenge. Sue, Victoria and I have spent many hours in a room together over the last couple days, sharing clients and supplementing each other's sentences. I find myself speaking only in present tense. Victoria surprises herself with some long, fluent sentences separated by our more typical 2-word utterances. Sue sometimes speaks English with a Spanish accent. We all gesture wildly trying to make our point like a game of charades. We get by, but I can't help but think I would have more to offer if I spoke the language better. Nonetheless, our young clients smile and look to their parents for a Spanish translation of our "Spanish". Their parents nod and offer words when we can't find them. A local SLP, Elvira, sits in on our sessions and offers helpful phrases. Throughout a session, parents and children both appear to leave satisfied, with a "muchas gracias" and a kiss on the cheek.

While challenging, even with the language barrier, we're getting the job done and getting a small glimpse into what it may be like for some of our clients facing a communication disorder. Every day, as we help our clients with their speech, I'll learn probably twice as much from them towards improving my Spanish vocabulary. I'm so thankful for being able to participate in this experience and maybe along with "Armonizar" on my resume, I'll be able to write a little "Yo hablo Espanol" next to it.

A new world, a new day

It is hard to explain what we, as students, have experienced in the last few days. There was a comment made during our final evening meeting on the first full day in Peru that has stuck in my mind since I heard it. I believe it was Jana that said: At home we come across so much red tape when it comes to therapy... (or something like that). It resonated in my head - at home there is so much red tape and here there is nothing but a red carpet. It amazed me right away that the parents, the families and even the professionals we encounter have so much faith in us. So much hope, so much trust.

We're here to do our small part. To teach and to help, yes, but also to learn. I don't know that any of us could learn what we're learning each and every day...about love, respect, dignity and service. We spent years studying to be professionals and (what feels like) thousands of hours sitting in classrooms waiting to figure out exactly how it feels to be a speech-language pathologist (SLP). I don't know that we ever really expected this. To go beyond every book that we have read and every note that we have taken...and to hold a 5 month old child with an open complete cleft lip and palate in our arms, to take children from a shanty town to the park for the very first time, to give a child from the jungle a piece of candy and watch his face light up, to have a young girl who refused to cooperate in a therapy session draw you a picture as a gift....

We are all so thankful for this experience. I know that we went in to this first day of clinic with such a feeling of fear and anxiety (mixed in with all this excitement) because of the language barrier, because of the lack of experience in the area. We came out of this day, however, realizing what an honour it is to do what we do, to have the privilege to learn what/how we learn, and to come here to this wonderful place to do both those things.

Preparations and Play

Today was scheduled for rest and relaxation -the calm before the storm!!!
Students spent the morning in consultation with Sue and Taz preparing for the 12 clients that they will be seeing regularly throughout the next week. Will be seeing two returning clients from last year's program and at least 10 new clients including a 12 year old girl who continues to have an open palatal cleft (due for repair in 8 weeks)!

Afternoon saw students join the main group for an afternoon of fun with the children from the Shantytowns. You will notice from the shantytown photos the lack of horizontal play surfaces and greenery so this afternoon's program is an opportunity for these kids to experience parks and playgrounds with the Solidarity in Action participants. With 40 participants and 60 kids, I'm sure they will be a tired bunch on return!

First Day in Clinic

Today the students provided two of their caregiver presentations related to language and literacy development, at Armonizar. These presentations had been prepared by the students, in Spanish, prior to leaving. The students worked hard at relaying the information, responding to the questions and comments from parents, and interacting with the children, despite the obvious language barriers! They received a warm welcome from the audience and it was clear that everyone was interested and motivated to apply the strategies provided. Adriana rose to the challenge of providing on-line translation. Sometimes the other students (and clinical educators!) experienced some frustration at knowing the information but not being able to easily communicate it to the parents.

To relieve our translation fatigue, we finished the day with a trip to the Catacombs of the San Fransiscan Monastery!

Getting our Bearings

Day 1 has proven to be busy day for us all. We started early with a trip to the 'shantytowns' that rise into the foothills just beyond Lima. It really served to highlight the very dire circumstances in which some of children live. The shantytowns are home to many of the children who come to the clinic to receive services.

We followed this with an introduction to the people and families at Armonizar. We all were forced to put our Spanish skills to the test when we were provided with the 12 charts of the children who we will be seeing. All involved were welcoming and eager to have us in their clinic. Sue and a returning student from last year's trip were excited to re-connect with some of the children who were seen last year!

Speech Language Pathology Peru Clinical Placement 2009

Welcome to the Speech Language Pathology Clinical Placement in Peru Blog

This speech language pathology clinical placement follows on the successful Peru clinical placement that was completed by 3 second year students and their clinical supervisor in August 2008. This placement is a joint venture between The University of Western Ontario’s School of Communication Sciences and Disorders, Solidarity in Action (SIA), and Armonizar.

The 2009 Clinical Team

This year’s clinical team includes Michelle Colli, Victoria Lewis, Adriana Lopez and Jana Zalmanowitz.

UWO School of Communication Sciences and Disorders Clinical Faculty includes Susan Schurr and Taslim Moosa.

Who are our Partners?

SIA is an international Canadian based not-for-profit social justice organization that was started in 2006. To date, it has helped 16 Canadian universities and chaplaincies organize denominational and non-denominational social justice/academic solidarity trips, programs and experiences. SIA coordinates the clinical component of this trip with their partner clinic, Armonizar, and its executive director Alberto Garcia.

Armonizar is the first integrated initiative for the treatment of Cleft Lip and Palate in Peru. Its mission is to promote the physical, psychological and spiritual harmony of children with a lack of economic resources. The clinic receives clients from a wide catchment area and delivers a well-integrated service. The organization operates with a small paid staff and large number of committed professional volunteers representing dentistry, genetics, paediatrics, social work and surgery.

The clinic’s volunteer Speech Language Pathologist, Dr. Fatima Dantas coordinates the clinical schedule for the students. She also provides clinical teaching in conjunction with other Armonizar Inter-Professional Team members and UWO Clinical Faculty.

What are we doing?

An important pre-departure dynamic of the SIA program rests in the collection of donations to be collected and transported by the students. Students are encouraged to reserve half of their 100lb. luggage allowance for donations. Students were motivated and determined to collect a variety of resources as suggested by Armonizar. We were able to collect toys, Spanish children’s books, medical and dental supplies, hearing aids, Spanish speech and language assessment and treatment materials and specialized feeding equipment.

Students were selected for the placement in January 2009. This allowed them to coordinate the drive for donations and to participate in a variety of preparatory teaching clinics. These 6 teaching clinics focused on:
1. developing knowledge and understanding of the philosophy of SIA and Armonizar (conducted by SIA)
2. establishing roles, determining the responsibilities and expectations of all parties, and discussing the supervisory process
3. ensuring logistical preparation including scheduling, waivers, health requirements, contact information, donations etc.
4. developing in-service materials - literacy, early language development, feeding/swallowing
5. investigating Spanish phonology and specific sound production differences
6. teaching specific to Cleft Lip and Palate assessment and management (resonance, co-articulation, compensatory articulation, fistulas)

Student clinical activities will include:
- provision of daily therapy (in Spanish) to 6 children and their families
- provision of Spanish in-services to families – information regarding specialized feeding strategies, feeding , early language development and early literacy development – all services not currently provided by the clinic
- participation in the professional consultations provided to children and families, including otolaryngology, dentistry, genetics, surgery, social work and paediatrics

Student cultural opportunities include:
- a trip to Machu Picchu
- Lima city tour
- traditional music and dance exhibitions
- market
- salsa lessons

Other student opportunities:
- daily evaluation meetings will offer students the opportunity to envision the connection between their career goals and social justice in an international context

Planning for the Future

This year we are investigating a clinical component that we hope will be worthy of expansion into an additional clinical placement experience in 2010. UWO-Clinical Faculty, Taslim Moosa, will be conducting a needs survey at a school for students with multiple physical and developmental delays. The need for support regarding augmentative and alternative communication, safe feeding and swallowing procedures and literacy development will be explored. Additionally the School for the Deaf in Cuzco will also be visited.

Broadening their Horizons

Additionally, The School of Communication Science and Disorders has three students participating in the general Solidarity in Action trip alongside students from other Canadian University programs. Two students are representing The School of Communication Sciences and Disorders Audiology program and one is representing the Speech Language Pathology program.