Cambodia Project Weeks 10-12: 16th November-4th December

It’s been awhile since our last post! During week 10, many of the surgeons and speech advisers from our settings attended a cleft lip and palate conference in Thailand and during week 11, Cambodia celebrated Water Festival so our clinics were closed. Though these two weeks were quite slow with work, things picked up in week 12 and we were as busy as ever!

On Monday, we spent our admin day visiting the other settings where our other colleagues involved in the project work. First, we checked out the Rabbit School where Sam and Shona work. The Rabbit School is a school for children with special needs including Autism spectrum disorder, Down’s syndrome, and learning disability. Following this visit, we went to the Children’s Centre for Adolescent and Mental Health (CCAMH) where Kim works. This centre focuses largely on multi-disciplinary care for children with Autism. It was great to visit this setting as Lauren and I often refer non-cleft clients seen at the clinic for suspected Autism and learning disabilities to CCAMH. The opportunity to visit the other settings gave us the full picture of the positive impact we are making to spread support and awareness for several areas of SLT in Cambodia!

On Tuesday, we spent a full day at Children’s Surgical Centre with our speech adviser, Samnang. Samnang did a great job following through on his promise to book in a substantial amount of clients. The day was non-stop with the twin boys being seen for a therapy session in the morning and three assessment and advice sessions with cleft clients in the afternoon. Additionally, we invited a speech adviser in training from Khmer Soviet Friendship Hospital to begin her training that afternoon. As Samnang now has 8 years of experience as a speech adviser with our project, we thought this would give him the opportunity to share his knowledge and develop skills in others to become speech advisers. It worked out perfectly since we have just recently secured a speech adviser at Khmer Soviet but are near the end of our 3 months here. It was great to watch Samnang work with the clients and train the speech adviser at the same time. He seemed very confident and was excited to be the teacher rather than the student. We even got to watch him use his ENT skills when he carried out a nasendoscopy on one cleft client who expressed concerns of difficulty breathing. After watching Samnang in action, we are confident that he will be able to train the new speech adviser independently after we have left.

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Samnang in action taking a case history.

 

On Wednesday, we supported Alin in the morning clinic at National Paediatric Hospital. Now that Alin is back from Taiwan, she is providing SLT services to non-cleft clients on Wednesdays in addition to the Friday cleft clinics. As Alin is keen to become a qualified SLT, we think this is an excellent opportunity for her to broaden her skills in the field beyond cleft lip and palate. Though the clinic is meant to be primarily for non-cleft cases, we still saw quite a few cleft kiddies! But that’s OK because the important thing is that the clients are aware SLT services are available! Since the bulk of Alin’s experience is with speech and feeding advice for cleft clients, we have started developing her skills in assessment and advice for language delay and disorder. In doing so, we worked with Alin to create a basic language assessment known as the Derbyshire Language Scheme which assesses a child’s ability to understand directions at different levels of complexity.

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Alin training a cleft client on how to practice using oral sounds with the use of a tube. When producing oral sounds into the tube, the client should be able to feel the air reach ear. If the air doesn’t reach the ear, this is a sign that the client is using nasal sounds rather than oral sounds. This is an effective tool for providing feedback to the client.

 

As time was limited on Wednesday, we met with Alin again on Thursday morning and we completed the language assessment together. She offered great ideas and grasped the concept of the assessment quite quickly! We plan to do a role play this week with the assessment so that she can learn how to administer it and feel competent doing so. During our Thursday meeting, we also helped Alin to create a budget for her cleft services. The organisation which sponsored Alin to go to Taiwan has agreed to provide Alin with some funding in order to set-up a 5-day clinic at NPH for cleft clients. She will continue to provide SLT services on Wednesday and Friday, and on the other days she will take on her doctor role in providing care and management to the cleft clients. We are very excited that Alin will have some funding to build up the SLT services at NPH and look forward to seeing the developments of the clinic!

On Friday, we went back to NPH for the morning clinic. It was a pretty crazy morning because our other speech adviser, Chanthy, and Dr. Vanna were absent leaving just Alin, Lauren and me to see over 20 clients in the space of 3 hours. But Alin handled it like a pro and we managed to see all of the clients! That afternoon, the three of us met with Betsy, a visiting Speech and Language Therapist from the USA. She comes to Phnom Penh for about 9 weeks at a time every few months to provide SLT input for the adult population. Betsy is one of the only SLTs providing support for adults with communication and swallowing disorders in Cambodia so her work is very important! She spends most of her time training physical therapists in communication strategies for stroke clients and trains surgeons and doctors in FEES, Fiberoptic Endoscopic Evaluation of Swallowing. This January, she will hold a 4-week training course in this procedure to advance the skills of surgeons and doctors here in order to become competent with the use of this assessment tool in order to evaluate swallowing difficulties in adult clients. Even more exciting, Susan Langmore, the inventor of FEES, will provide this training with Betsy and offer her expertise in the field to further support services in Cambodia! Very exciting stuff! We were glad Alin had the opportunity to meet with another SLT who works with a different population outside of cleft so that she could begin expanding her professional network!

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A very busy day in the cleft clinic with Alin!

 

Our second to last week in Cambodia sure was full-on and eventful! We are hoping our last week here will be as well. We can’t believe we will be leaving Cambodia in just a few days. It is crazy to think how fast time flew by! We are so thankful to have had the opportunity to develop our field in a country where it is essentially non-existent and hope to be back one day soon!

To read more about the adventures of past volunteer SLTs and learn more about cleft lip and palate, visit the Cleft Lip and Palate Association’s (CLAPA) web site!

Stay tuned for our final post coming soon!

Your cleft team,

Kristin and Lauren

 

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