Cambodia Project: Week 5&6– 12th-24th October

Last week was Pchum Ben, a Cambodian holiday celebrating ancestors. We had the whole week off of work so we escaped to Koh Rong Samloem island for a mini getaway!

This past week we were back at work!

Tuesday was Lauren’s birthday and our sweet speech adviser, Samnang, took us for a birthday lunch! After lunch, we went back to Children’s Surgical Center where we spent the afternoon working with Samnang and providing speech therapy to the twins we saw before Pchum Ben. During the session, Lauren and I modeled activities to Samnang which were used to develop the twins’ ability to hear the correct production of sounds they have difficulty with as well as activities used to help them produce the sounds correctly. By the end of both sessions, Samnang was facilitating the activities by himself and said he felt confident to take the lead with some of the activities during next week’s session. Two other children came in for a speech assessment that afternoon. One girl who came in only had a cleft lip, yet was making very nasal sounds. We found this odd because typically when a child only has a cleft lip repair their speech is not affected unless they have other difficulties unrelated to the cleft. We decided to take a look in her mouth to check for anything out of the ordinary with her oral structure that may be causing the nasal speech and we made a possible discovery of a submucous cleft palate! A submucous cleft is one that cannot easily be seen as there is no obvious hole since the cleft is covered by the lining of the roof of the mouth. As doctors here do not typically identify and treat submucous cleft, the girl will come back in December when specialists from Europe are here and will help us to further identify the presence of the cleft and determine if surgery is appropriate.

submucous

Picture of a typical submucous cleft palate. We think the girl we saw had similar translucent lines running along the midline of the palate.

At Military Hospital, we saw a 5-year-old boy for his first speech therapy session. As we still do not have a speech adviser to train in this setting yet, a medical student served as our translator and we spent the session modelling simple therapy techniques to mom so that she could continue practicing the sounds at home with him. Seeing as they had to travel 3 hours for the session, we provided as many resources as possible for her to take home including leaflets on speech in cleft palate and ways in which to elicit speech sounds. Mom also agreed to come in for another session in November so we hope to see some progress with the young boy and train mom a bit more so that she becomes more comfortable and confident working with her son at home.

Friday was again another holiday so we didn’t go into the clinic at National Pediatric Hospital. However, Saturday was an exciting day spent at Khmer Soviet Friendship Hospital working alongside a huge multi-disciplinary team (MDT) of nurses, dentists, doctors and surgeons for the Smile Cambodia mission. The 5-day mission is spent providing free operations primarily to cleft patients and burn victims. Saturday was a pre-op assessment day in which the MDT worked together to determine who was appropriate for surgery and what type of operation would be performed. Our role was to confirm whether or not surgery would benefit the cleft clients’ speech. In some cases, we had the opportunity to recommend secondary palate repair for some clients whose speech did not improve following their first surgery and discussed with the surgeon the need for a second surgery to further improve palate function.

Our work station at Khmer Soviet Friendship Hospital for the Smile Cambodia mission.

Our work station at Khmer Soviet Friendship Hospital for the Smile Cambodia mission.

In addition to recommending clients for surgery, we provided advice to parents and the client about cleft lip and palate and the impact that surgery would potentially have on the client’s speech and feeding skills. We plan to go in on Monday for day 3 of the mission to follow-up with those clients who had surgery and answer any other questions the family may have in addition to providing leaflets on post-op care with feeding and ways to promote proper speech once the lip and/or palate has healed. On Wednesday we will attend a dinner banquet with all of the volunteers from the mission and have been told there may be an appearance by the son of Cambodia’s Prime Minister!

We look forward to telling you more about the mission in our next blog post as well as our group education sessions in speech and language therapy which will begin this Friday!

To read more about the experiences of past participants in the Cambodia project or to find out more about cleft lip and palate, check out the Cleft Lip and Palate Association (CLAPA) web site!

Your cleft team,

Kristin and Lauren

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