Cambodia Project: Week 3–28th September

Lauren and I had a good but busy second week in all of our settings!

Children’s Surgical Center: On Tuesday, we went into Children’s Surgical Center to support our speech adviser, Samnang, in carrying out assessments with three different clients. We saw one child who had had a Cleft lip and palate repair and two non-cleft clients. Samnang did a great job carrying out the case histories and assessments and made appropriate decisions for each client. One of the non-cleft client’s was a 16-year-old who travelled from a province several hours away and presented with a learning disability. The session was very eye opening and difficult to see firsthand the lack of awareness and education around learning disabilities and communication disorders in Cambodia. To see a teenage girl in our clinic 16 years too late, knowing the impact and difference early intervention could have had on her life since childhood was a tough reality to come face to face with. Samnang shed some light on the situation explaining that many families in Cambodia who have children with special needs accept that their child will be ‘different’ and are often told by doctors from the start that there is nothing that can be done to help their children. As the Cleft settings only work with children who present with Cleft lip or palate, Samnang made the appropriate referral for this girl and another boy who we suspected may have Autism to CCAMH, another setting which two other girls on our team work at and provide input on communication delay and disorders.

Military Hospital: On Wednesday, we returned to Military Hospital where unfortunately we were told no one had yet agreed to work with us as a speech adviser. Fortunately, another doctor at the hospital was able to serve as our translator during the assessment session with a boy we had seen the week before for a surgery consultation with Dr. Nous Sarom. Lauren and I carried out our first proper assessment in which we performed an Oral Motor Examination to check that the boy’s oral structures presented normally followed by a Khmer version of the Cleft speech assessment to determine what sort of speech difficulties he had. We found that his speech was quite hypernasal in which he turned sounds like /p/ into /m/. We suggested he would be a great candidate for therapy once we have a speech adviser; however, mum said the family live four hours away and it is quite difficult to travel so long on a weekly basis. Mum agreed to carry-out some speech exercises with her son at home and to come in for another session in 3 weeks at which time we would observe the progress he made and provide more resources for her to take home.

Smile Cambodia (Khmer Soviet Friendship Hospital): Lauren and I had our first day at Khmer Soviet where we met Dr. Theavy and staff of Smile Cambodia (originally Operation Smile). They told us about the monthly missions at the hospital in which a team based locally or from another country comes for a week to perform a mass amount of Cleft lip and palate surgeries. Our role during the missions will be to provide general speech and language advice for parents prior to their child’s surgery. We are also hoping that during quiet, non-mission weeks we will be able to see past patients who had a successful surgery in a previous mission and are able to attend some therapy sessions at Khmer Soviet. Like Military Hospital though, we are still in need of a speech adviser who we can train to provide this service. Dr. Nous Sarom expressed a keen interest in building a speech program at the hospital so we are hopeful that we will find a few dedicated speech advisers to help us make the service more sustainable.

National Pediatric Hospital: The Friday morning clinic was as busy as ever with 10 clients seen within 3 hours. The youngest client was just a few weeks old and the oldest client was 25! Our speech adviser, Chanthy, was extremely helpful in providing advice to parents with us. Throughout the morning, we were faced with some challenging situations. One mother came in with her daughter who presented with Cleft lip and palate as well as Down’s syndrome. Once again, it was hard to realize the lack of awareness around learning disability and the stigma which surrounds it. However, mum was keen to understand ways in which to support her daughter and we spent quite some time providing education and strategies to support her daughter at home. Though the family lives quite far away, mum agreed to attend an appointment at CCAMH where they would be better equipped to further assess her daughter’s needs and provide additional advice. Lauren and I also found it challenging to provide advice for the 25-year-old woman who came in looking for help with her speech. As she was not able to have her Cleft lip and palate surgery until her 20s, she had mislearned how to produce speech sounds through her nose rather than her mouth. We provided as much feedback and self-practice as possible, but again she lived hours away from Phnom Penh where there is no one to provide speech and language services. After clinic, we spent an hour with Chanthy and Dr. Sophen, a general practitioner, training them in the basics of speech, language and communication. This was the first of 10 training sessions we will have with Chanthy and Dr. Sophen as they are keen to support children with speech and language difficulties in their practice as a nurse and doctor. The training session went really well and we are looking forward to working with them for the next 9 weeks!

Lauren, Chanthy and clients at NPH's Cleft clinic

Lauren, Chanthy and clients at NPH’s Cleft clinic

This past week definitely had its fair share of challenges. We are beginning to realize just how much need there is for awareness and education on learning disabilities and communication disorders and the lack of support services available throughout Cambodia. However, we are glad to be working with individuals who are passionate about gaining knowledge and spreading awareness about such issues and the benefits of speech and language therapy!

Your Cleft team,

Kristin and Lauren

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