Written by the lovely Lauren Cooper:
On Tuesday we went back to the Childrenâ€™s Surgical Centre and saw Samnang our speech advisor carry out a session with twin 11 year old boys, both with cleft lip and palate. One had bilateral cleft lip and palate and one had unilateral cleft lip and palate and they were both very co-operative during assessment. We used the KASS (Khmer Assessment of Speech Sounds) to assess the boysâ€™ speech sounds in Khmer (the language used in Cambodia). This was interesting as it helped us to see the difficulties each boy was having and helped us to plan therapy for when we next see them. Samnang identified target sounds for the boys to work on as homework appropriately. One of our goals is that with support and training, Samnang will feel confident in using session plans to help him plan therapy. We ended the day providing training for Samnang in ADHD, which he requested at the start of our visit. He will then hopefully feel more confident in giving a presentation on this subject at the doctorâ€™s morning meeting in 2 weeks time. Good luck Samnang!
On Wednesday we spent the morning in Military hospital and had a session with a 3 year old boy who has not been seen for therapy before. He was quite stubborn and wouldnâ€™t let us look in his mouth, despite Kristinâ€™s crocodile puppet demonstrating what to do! We did however gain a detailed case history from his mother, which is what we often do with younger children and often we can get an idea of how a child communicates just from observing them during the appointment. We also had a session with a 5 year old boy who really needs more surgery for a fistula to help his speech. Fistulas (holes) in the roof of the mouth mean that air can escape through the nose, even when you are trying to make air come through the mouth. This means that Speech and Language Therapy is not appropriate for him until after he has had this operation. We organised for his operation to happen in 3 weeks time, but still we have to wait around 3 months after the operation before we can see him for therapy. We will be back in England but hopefully there will be a trained speech advisor around by then who can see him.
Thursday was spent in talks with Dr Theavy about possibly hiring a speech advisor! Making a paid position for a speech advisor would really encourage the Speech and Language Therapy profession in Cambodia. At the moment there are no Khmer Speech and Language Therapists and speech advisors are generally volunteers. However we are not getting too excited as he still has to talk to the board of directors at Khmer Soviet Friendship Hospital about it and persuade them that it is a good idea!
On Friday we attended the Cleft Clinic at National Paediatric Hospital with Chanthy, our speech advisor and Dr Vanna. After the clinic today Chanthy, Kristin and I all agreed that we were feeling more confident in giving the advice for children with cleft in terms of speech and feeding. This is really great and we hope that Chanthy will be giving advice independently in the coming weeks. We saw a 15 year old boy today with cleft lip and alveolus and we are pleased to say no concerns with his speech. This is often the case with this type of cleft because it doesnâ€™t affect the hard and soft palate. Children with cleft palate often have nasal speech and other speech errors as there is no separation between their mouth and nose. Again we had training after lunch with Chanthy and Dr Sophen, this time on the anatomy of speech and the types of cleft. This was a slightly harder presentation than the last one as it involves a lot of terminology but they coped really well! Possible Speech and Language Therapists of the future!
Kristin and I had a really positive experience this week and we are looking forward to a week off next week for Pchumben (a festival celebrating ancestors) where we hopefully delve into some more Cambodian culture.
Your Cleft team,
Lauren and Kristin