Belmopan and the Jungle (Day 6)

Today, the Therapy Abroad team made a trip into Belmopan, the capital of Belize. Our first stop was a visit to Helping Hands, an educational resource center created by Miss Emily to support the learning needs of Belizean students. During the visit, she told us about the challenges students of all ages face to receive a good education in Belize. She shared with us that many students in Belize do not continue on to high school and some even discontinue their education after elementary school. Several cultural and economic factors influence this decision and Miss Emily’s mission is to provide free educational support at Helping Hands. Furthermore, she aims to unlock the learning potential of all students she works with by improving their literacy skills and encouraging them to think about their future selves and what they aspire to be when they grow up in the hopes that they will continue to seek out a good education as they get older.

As a proud Garifuna woman, Miss Emily shared about the origins of her people and their presence in Belize then sang a song in the Garifuna language. After bringing tears to our eyes with her passion for education and her culture, she took us to meet the children who were attending the summer tutoring program she set up for those who were identified as falling behind in school. The Therapy Abroad students and staff broke into small groups with the kids based on their age and academic levels. We spent the next hour or so getting to know our kiddos and eliciting language opportunities through the interests of each individual child. We met kids who love singing, pretending, writing and drawing. We met young students who aspire to become teachers and the older students shared their dreams of becoming a lawyer in the future to support their families. Two things all of these children had in common—enthusiasm to learn and lots of love to give!

In the afternoon, we took a trip to a local market where we explored the fruits and goods, ate some local grub, and took a much needed coffee break!

Dinner at Jungle Creek

After some afternoon R&R, we headed to Jungle Creek for a dinner with Pathlight, an organization who’s mission is to ensure that secondary education is made accessible to all children in Belize. As previously mentioned, many children do not go on to continue their high school education because unlike elementary years, high school is not free and many families cannot afford to send their children to school. As a result, Pathlight setup a program called Sponsorship+ which allows individuals to sponsor a child by providing monthly financial support to cover fees such as tuition, transportation, school supplies, tutoring and so on. To fully sponsor a child costs $200/month.

Pathlight also provides teacher training to local teachers to build on their own education and teaching strategies. This July, Pathlight will hold their annual Teacher Training Conference and Therapy Abroad’s SLPs and Behavior Therapist will attend to provide education and training in these specialties.

During our dinner we had the opportunity to meet 3 Pathlight students who are being sponsored by the Therapy Abroad team!

That wraps up week 1! Time for some weekend fun exploring Mayan ruins, cave tubing and ziplining!

Kristin AmRhein, M.S. CCC-SLP
Team Leader
Therapy Abroad

Therapy Abroad–Welcome to Belize (Week 1: 7/1-7/7)

The students and staff of Therapy Abroad, a program designed to provide students and professionals with opportunities to develop speech and language therapy overseas, launched its first student program in Belize this week! As an avid blogger and the Team Leader of the undergraduate students participating in the program, I am thrilled to share about our experiences thus far and those to come this summer!

We arrived early Sunday morning after our red eye flight from Los Angeles. Despite the exhaustion (and unBelizable heat), the students and staff were eager to explore our home for the next two weeks, Monkey Bay. We kicked off our trip with a trek through the Pine Savannah!

Our first real day of work began at the Inspiration Center, the only clinic in all of Belize to provide speech and language therapy. The students and staff of Therapy Abroad will support the Inspiration Center throughout the summer by carrying out evaluations and a group therapy program we have dubbed ‘Communication Camp’.

The students spent the day planning all the activities that will be carried out during Communication Camp and prepped LOTS of resources for our pirate themed camp which will run for 6 days over the 2-week period!

On our way to the Inspiration Center

DAY 3-5
Time to play with our Pirate Campers!

Communication Camp is based on Titan Tykes, a group therapy program developed by Dr. Kris Brock from CSU, Fullerton who is also working with Therapy Abroad in Belize to provide a well-rounded experience for the SLP students and campers. The language enrichment program consists of 7 stations—Fine Motor, Storytime, Basic Concepts, Behavior Regulation, Gross Motor, Snack (a station added to support those picky eaters!) and Pretend Play. With the support of licensed SLPs, the undergrads have had an unique opportunity to plan activities for the stations and lead the campers in each as they grow to become more confident communicators!

In addition to providing therapy, we supported the head SLP at Inspiration Center (and only therapist in all of Belize) with her backlog of evaluations. While some students and SLPs stayed at the clinic to carry-out these evals, a small group of students went with myself and Chad, the Program Director of Therapy Abroad, on home visits to both evaluate the children being seen and support the caregivers with communication and feeding strategies. We worked alongside the Inspiration Center’s social worker who regularly sees clients in the community to support their needs; however, as her educational background is not in speech and language pathology, this gave us an opportunity to provide training and model strategies that can be implemented during her visits following the departure of Therapy Abroad’s students and staff.

Fun Times
Therapy Abroad isn’t all about work. We like to have some fun too!

It’s only Day 5 and already so much has happened! It is the end of our first big work week and the students and staff worked so hard to make the first ever Communication Camp in Belize come to life! I feel like a proud mama as the Team Leader of these intelligent and creative women who surpass the expectations of undergraduates in our field. I look forward to seeing what ideas they bring to the table for next week’s camp. But until then, it’s time to see some more of Belize and embrace the culture!

Next up— A visit to local schools and Pathlight (more on them later) on Friday followed by an adventurous weekend of Cave Tubing and Ziplining! Stay tuned….

And follow us on instagram @therapyabroad

Kristin AmRhein, M.S. CCC-SLP
Team Leader
Therapy Abroad

Cambodia Project- The FINAL Week

So we’ve done it! We’ve worked out in Phnom Penh for 12 weeks now (3 months!) and this week was our last. The final hurrah.

Monday and Thursday, our admin days this week were spent report-writing for each of the settings and drawing our work to a close. It is really difficult to summarise our work into a few pages of a report but we tried! Although we both love the hands on Speech and Language Therapy work, we know that it is important to keep good records so that these can be passed on to the next cohort of Speech and Language Therapists who go to Cambodia. Hopefully our work can continue where we left off.

On Tuesday we went to say goodbye to our Speech Advisor Samnang and our Speech Advisor in-training Srey Lak at Children’s Surgical Centre. It is great that Samnang has someone to pass on his skills too – the further we spread the word about Speech and Language Therapy, the better. Srey Lak will shadow and learn from Samnang on Tuesday afternoons until she feels confident enough to work on her own at Khmer Soviet Friendship Hospital. She is a trained midwife and full of enthusiasm for her new role. It is such good news as well that these two hospitals are willing to learn from each other and communicate as this was unheard of a few years ago. We had a second session with a boy we saw a few weeks ago with lots of sound substitutions in his speech making it difficult for him to be understood. We did some further assessment and with Samnang we decided on sounds to target with him in therapy. He has agreed to come regularly for therapy which is another success story! The twins were ill today but we also saw Samnang give advice to the parents of several young patients in the wards about post-op care and feeding. Samnang is using his leaflets wisely and we gave him more copies to start giving out. We ate lunch with Samnang as a special goodbye and also said goodbye to other staff we know at the hospital.

On Wednesday we saw Dr Alin at the National Paediatric Hospital (NPH) to help with her non-cleft caseload. Inevitably there were some cleft cases but this always tends to be the case. There were a few cases we referred to CCAMH (Centre for Child and Adolescent Mental Health) and a few that Dr Alin would like to see for therapy in her clinic. This week we saw the new clinic room being decorated along the corridor. This is exciting and the future at NPH for cleft and non-cleft patients alike looks very bright!

A little girl who loved playing to the crowd at NPH clinic

Friday brought us back to NPH for the final time and with it, so many babies! We saw Chanthy again, our Speech Advisor who works with Dr Alin now at the Friday clinics. She is hoping to stay working on Fridays until she has her baby next year and she is so confident now at giving advice for feeding and speech difficulties. This week we worked with Chanthy to train her in using the KASS (Khmer Assessment of Speech Sounds) which helps us to decide which speech sounds a child struggles with and which to target in therapy. She found it difficult to listen for the sounds at first but it takes practice. We found this one of the most difficult things to learn when we didn’t really know the language! The assessment involves asking the child to name pictures and writing down how they say them. As we have used this assessment a lot, we now know lots of weird and wonderful Khmer words such as ‘grapes’ (‘dom-be-an-buy-chew’) and ‘hammer’ (‘nya-new-ah’). It was great working with Dr Alin as well and she saw the young lady we brought in for a second opinion about her secondary palate surgery from another hospital. She now has to decide whether to have the surgery or not. A whirlwind day as always.

Chanthy, our Speech Advisor, giving early speech advice to a mum of a baby with cleft lip and palate.

It is so sad to write this final blog post and even sadder to leave everyone in Phnom Penh who continue to work tirelessly for children with Cleft Lip and Palate. We look forward to returning to Cambodia in the future and using our new found skills in jobs in the UK or USA.

Kristin, Samnang, Dr Alin, Chanthy and Lauren meet at NPH for one final goodbye


Goodbye and Good Luck! (‘Nee-hi’ and ‘Samnang la-or’)

Your cleft team signing off,

Lauren and Kristin

You can find all of our blog posts on CLAPA’s new web site too!


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.

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.

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!

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


SLT job posting in Cambodia and visa info!

Indigo International in Cambodia is currently looking for a speech therapist to join their team. Indigo is a multidisciplinary clinic based in Phnom Penh working with adults, children and families from a range of backgrounds, both expat and local, and with a wide range of difficulties.

You would join a team of psychologists, speech therapists and occupational therapists picking up an existing caseload from a therapist who is leaving. The work is paid sessionally so this would mean that you would be able to start with a good sized caseload and income. Sessional work also means that you are in charge of the hours you work and the size of caseload you would like to take on. The role can be very flexible and there is high demand so scope to develop any special interests as appropriate.

The start date is for January 2016 and applications will stay open for the next two weeks (until Sunday, November 29th). You will hear back soon after the application closing date.

To apply, please send a CV and cover letter to angela@indigo-international.organd Please send further questions or informal inquiries to, though please note Paula will be out of town from 23rd-29th due to a national holiday.


Some useful info for working in Cambodia:

Visa requirements and cost:

You are required to purchase a 30-day visa when entering Cambodia. There are two visas available–the tourist visa ($30) or the ordinary visa ($35) both good for 30 days, both single entry visas. If planning to work in Cambodia, get the ordinary visa as this one can be extended for as long as you like.

To renew your visa, go to a local travel agency (we went to the Air Asia office). There are several options for visa renewal and prices vary based on where you go:

1-month extension– $50

3-month extension-$80 (we went with this option for our extra 2 months in Cambodia as it worked out to be cheaper than getting two 1-month extensions.

6 and 12-month extensions also available (do not recall exact prices but was $100+). The 6 and 12-month visa extension options provide multiple entry into Cambodia whereas the 1 and 3-month extensions are single-entry visas. So if you plan to work in Cambodia for a long time and travel around Asia, go with the 6 or 1-month extension as it will be a cheaper and more relaxed option.

DON’T FORGET PASSPORT PHOTOS! You will need these for the arrival and renewal visas!

Useful site for living in Cambodia–

Good luck!

Cambodia Project Week 9: 9th -13th November

So it has been another busy week! We can’t quite believe it is Week 9 already.

On Monday we had a meeting with our Khmer friend Thyda, who works in an International school, to discuss raising awareness of Speech and Language Therapy in her school. We will be preparing a presentation for parents and teachers in English and then Thyda will hopefully be our interpreter on the day. This is an exciting prospect as we are always looking to get the word out about Speech and Language Therapy and how it can help children and adults, not just those with cleft. We also had another meeting with a representative from Smile Train who are an organisation helping to fund cleft surgeries in countries all over the world, including Cambodia. We wanted to try and get funding for a Speech Adviser in some of our other cleft settings so we chatted to him over dinner, along with Dr Nous Sarom, a surgeon from Military Hospital. We are finding it difficult to work at Military Hospital at the moment due to the lack of a consistent Speech Adviser. We hope to get someone to train in the next few weeks so that they feel confident working independently when we leave. This is still up in the air at the moment so we will keep you updated. They did however say that they are happy to get the Smile Train feeding video we found translated into Khmer, so this is small step forward! We hope to get one of our Speech Advisers to provide the voiceover.

On Tuesday morning we visited All Ears Cambodia, an NGO which provides free hearing tests and ear care to people in Phnom Penh. As children with Cleft Lip and Palate very often have associated hearing difficulties, this was a great chance to see where we are referring our patients. We met with Ned, a British audiologist who is head of the training at All Ears. Every two years they take on 10 new Khmer trainee audiologists and help them gain a new profession. We were very impressed by the set-up and we hope to the see the same sort of training for Speech and Language Therapists in Cambodia one day. The afternoon brought us CSC and time with our Speech Adviser Samnang. Unfortunately there were no patients for us to see and this is happening quite regularly so we had a chat with him about how we could organise the way he sees patients. Tim Pring, who started the City-Cambodia Project, came out with us to CSC and wanted to speak to Dr Jim, the founder of the hospital. We had a meeting with them all and we gave Samnang a target of finding at least 10 cleft patients for us to see in our last two weeks at the hospital! (Samnang is at a cleft conference next week and it is Water Festival the week afterwards, so time is running out!)

Wednesday morning was the first Non-Cleft clinic at NPH with Dr Alin. She is growing more and more confident in her skills and is already calling herself a Speech Therapist after her 3 months training in Taiwan. Although she is brilliant at providing speech and feeding advice for cleft clients, she hasn’t had much experience in providing language advice or therapy for children without cleft. The normal protocol would be to refer these on but now she wants expand her skills which is great. We saw about 5 children and informally trained Dr Alin on some basic language assessment. We think it is a great idea to separate the cleft and non-cleft but it is just a matter of making this clear to the patients, who seem to turn up whenever they like!

On Thursday afternoon we went to see Samnang again but unfortunately he was ill. We saw the twins again and gave advice for a little girl who had just had her palate operation. The twins have obviously been practicing a lot, as despite not coming to therapy for the last two weeks, they have improved a lot. This was great news as often parents come to us for a quick fix for their child’s speech, but this Mum seems very motivated and makes sure her children do their homework! Ramaniya, an eye doctor came to help us when giving advice and therapy, as we needed someone to translate for us. We still haven’t learnt much Khmer apart from numbers one to five, ‘mouth’ and ‘nose’! Although it was helpful to have a translator, it is even better when Samnang is here because he can improve his skills as a speech adviser and translate for us at the same time.

A little girl from the NPH Cleft Clinic playing with our new assessment toys!
A little girl from the NPH Cleft Clinic playing with our new assessment toys!

Friday was a busy day like always and we saw about 20 patients between us at the National Paediatric Hospital. It was great to work with Dr. Alin again because we don’t have much time left with her. We also saw the patient’s quicker than usual because we could split up and give advice; one of us working with Chanthy and one working with Dr Alin. Maybe Dr Alin could use her skills to train Chanthy in the future but we will see how this goes. NPH is so busy and it would be great to see the other hospitals having a clinic like this – an aim for future City-Cambodia Cleft teams I think! In the afternoon we saw Chanthy, Dr Alin and all the staff at One-to-One again to give training. This time it was about assessing children’s speech and language and we tested everyone’s discrimination of speech sounds, with mixed results! We have one more training session to do next week and then it is Water Festival and everyone in Phnom Penh has a week off.

We’re 9 weeks in with 4 more to go! To learn more about cleft lip and palate, check out the web site of the Cleft Lip and Palate Association (CLAPA) 

Your cleft team,

Lauren and Kristin

Cambodia Project—Week 8: 2nd-6th November

This past week brought some exciting new developments!

Monday was no ordinary admin day. In search for a video on feeding babies with cleft lip and palate to add to our Friday presentation, we found a great animated video created by Smile Train, an NGO we later found out supports funding for cleft surgeries at some of our hospital settings. We are keen to make a feeding video as well but in Khmer. So we emailed Smile Train for permission to create a Khmer voice-over for the original copy and they agreed! Even more exciting– Today (Monday, 9th November), we have a meeting with Smile Train as they are interested in supporting funding for SLT in Cambodia! We are eager to hear what they have to say and how we can work together to continue raising awareness for SLT while we are here. Follow this link to watch the video we hope to create a Khmer version of!

On Tuesday, we saw Samnang at Children’s Surgical Centre. The twins weren’t able to make it to the therapy session again, but we saw two new cleft kiddies for a speech assessment. This gave us an opportunity to focus on Samnang’s clinical skills for carrying out assessments. He’s already great at asking the right questions for a case history and has quite good instincts in terms of appropriate decision-making, but we wanted to teach him the importance of introducing the session and informing clients of exactly why they are at the clinic and what will occur. A lot of people don’t understand the purpose of speech and language therapy here so it’s our goal to emphasize the importance of what we are doing for their children. We also built up his skills in assessing speech sounds by teaching him the importance of testing for stimulability of a sound on its own if the child is not able to produce it in a word during assessment as this informs the approach we will take in therapy. He proved to be a very receptive and quick learner, and by the time the second child came in for assessment, he was independently introducing the session and feeding back to us the specific difficulties the child had with production of the sounds. Overall, he has been a great guy to work with—though we still struggle to get him to use his email!!

On Wednesday, we went into Military Hospital to see the 5-year-old boy we first met when we arrived in Cambodia. Mom travelled far from Kampot province to have his hearing checked at All Ears followed by a second therapy session with us. We were happy to see good results from his audiology appointment reporting normal hearing. We were concerned he may have hearing difficulties because in our last session he was having difficulty distinguishing sounds. These good results meant that we could continue on with therapy that day. This time around, he did much better receptively discriminating the difference in sounds so we could move on to working on his production of them! In this session, a big focus was to train mom up in the facilitation of both the listening and production activities of his target sounds. Mom was an excellent student and we all had a lot of fun watching the boy crash toy cars towards the sound he heard when getting it correct. By the end of the session, mom felt confident enough to use the advice and skills she had learned in order to apply them independently to work with her son at home and said she wouldn’t need to come for another session. We were glad that she was happy with the tools we gave her to help her son at home as it was difficult for her to make the trip out to Phnom Penh so often.

Lauren and I with mom and the 5-year-old boy we have been working with at Military Hospital.
Lauren and I with mom and the 5-year-old boy we have been working with at Military Hospital.

The Friday clinic at National Pediatric Hospital was quite a whirlwind this past week! We saw many more children with language difficulties and had a few extra people in the room than usual. Alin, who is a doctor but has worked as a speech adviser with our project in past years, had returned from her 3-month SLT course in Taiwan and was back at the clinic seeing patients that day as well as Dr. Vanna, our speech adviser Chanthy, and Lauren and I. So needless to say, it was a full house with lots of kiddies running around. Our supervisors from City University who oversee the project came near the end of clinic and we all had a chance to properly meet Alin and discuss her experience in Taiwan. She was very enthusiastic about the wealth of information she had gained in the 3 months and expressed interest in being a fully certified SLT in Cambodia—Very exciting considering the role of SLT is virtually non-existent out here! Chanthy also expressed how much she has loved learning about SLT and how she would very much like to carry-on working as a speech adviser when we leave—so we have two very keen people who will hopefully build on their SLT skills together and continue providing services after we go!

Our supervisors gave us some great tips as to how Lauren and I should continue training Chanthy and Alin and what our next steps should be in promoting the development of SLT. They also attended our training later that day at One-to-One. We were happy to see that everyone from last week was back to learn more and even more pleased to see a few new faces. For last week’s training, we taught about feeding in CLP and syndromes associated with CLP. Training is a brand new experience for Lauren and I, and it was a bit intimidating but also encouraging to have a supervisor there who had taught us in uni lectures and was now watching us teach!

Well a new week has begun and we are looking forward to what’s to come. Hoping to have more exciting news to report next week!

Learn more about past adventures from the City Cambodia team and more about cleft lip and palate on the Cleft Lip and Palate Association’s (CLAPA) web site!

Your Cleft team,

Kristin and Lauren

Cambodia Project– Week 7: 26th-30th October

So it has been a different but exciting week this week.

On Monday we went to Khmer Soviet Friendship hospital for Day 3 of the Smile Cambodia mission. Our first job was to get a document translated into Khmer about how to care for children after cleft lip and palate operations and how to feed them. We thought this was very important as sometimes cleft repairs can get infected and break down if they aren’t looked after properly, leading to poor speech and feeding outcomes and the need for further surgery. We also were able to have a quick look at some surgery going on for a cleft lip in the operating theatres. They managed to get over 50 operations done during the mission over 3 days, so as you can imagine it was very busy! Another way we helped was by playing with children waiting to go in for operations and provide a speech development video in Khmer for their parents to watch. Although this isn’t an ideal time to give out information to parents, some of the families have travelled a long way to Phnom Penh for the mission and we would not be able to reach them otherwise.

On Tuesday we visited Samnang at CSC again and while we waited for the twins to arrive, Kristin and I talked Samnang through the planned activities and the rationale behind them. The twins didn’t turn up in the end but it is just one of those things! Their mother was ill and couldn’t bring them in but hopefully we will continue therapy with them next week. While we had some spare time, we thought it would be a good idea to do some training with Samnang about different speech activities and help him to plan a presentation he will hopefully give to an MDT meeting about ADHD.

We didn’t go to Military hospital on Wednesday as Dr Nous Sarom was working with the Smile Cambodia mission so we used this as our admin day instead of Monday. In the evening we went to the closing ceremony for the Smile Cambodia mission and the son of the Prime Minister made a speech. This is the closest we have come to meeting a Cambodian celebrity! All volunteers received certificates thanking them for their support with the mission. It was really nice to see some of the volunteers we met on Saturday and Monday and thank them again for their help with translating for us.

Kristin and I with some volunteers at the Smile Cambodia Closing Ceremony

Friday was a very busy day at National Paediatric Hospital and One-2-One. We took another UK Speech and Language Therapist with us, Sam, who normally works in schools but wanted to find out more about cleft. We saw around 15 children from 8.30 until 12 and the time flew past! As well as the cleft cases we saw one child with possible hearing difficulties or language delay and another child with possible learning difficulties and referred them to either All Ears Audiology service, CCAMH (Child and Adolescent Mental Health Services) or both. I think we both really enjoy Fridays because it is so fast-paced and also involves on-the-job training for Chanthy our speech adviser, so there is lots to think about! In the afternoon, we went with Chanthy to One-2-One, an NGO which trains medical professionals from Cambodia to work in the communities and slums. Here we are planning to do some training on four Friday afternoons, all about the importance of Speech and Language Therapy in cleft lip and palate and other related conditions.

The first of our four sessions was about introducing Speech and Language Therapy and why it is important and providing information about the anatomy of speech and particularly the types of speech difficulties people with cleft lip and palate have. It was very rewarding and everyone really got involved in our silly activities! We hope that raising awareness of speech, language, communication and swallowing difficulties among Khmer health professionals such as doctors and nurses, will raise the profile of Speech and Language Therapy in Cambodia.

So that was Week 7 and it has been a whirlwind! We hope you have enjoyed reading about our work with the City-Cambodia Project so far.

You can also follow our adventures and learn more about cleft lip and palate on the Cleft Lip and Palate Association’s (CLAPA) web site.

Your cleft team,

Lauren and Kristin

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.

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

Cambodia Project: Week 4- 4th October

Written by the lovely Lauren Cooper:

On Tuesday we went back to the Children’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 boys’ 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 doctor’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 wouldn’t let us look in his mouth, despite Kristin’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!

Lip taping is commonly used in Cambodia as a way of encouraging the tissue either side of a cleft lip closer together before surgery.
Lip taping is commonly used in Cambodia as a way of encouraging the tissue either side of a cleft lip closer together before surgery.

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 doesn’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’s crocodile puppet named Cambi proved very popular at the clinic!
Kristin’s crocodile puppet named Cambi proved very popular at the clinic!

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