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 paula@indigo-international.org. Please send further questions or informal inquiries to paula@indigo-international.org, though please note Paula will be out of town from 23rd-29th due to a national holiday.

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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– http://www.movetocambodia.com/

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.

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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.

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

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

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

Cambodia Project: Weeks 1 and 2

Our first blog post, written by Lauren, will soon be published on the official website of The Cleft Lip and Palate Association (CLAPA). To read about past experiences of the City Cambodia cleft team, check out CLAPA’s blog page where you will soon be able to view our weekly posts! For now, enjoy a sneak peak of our adventures in Cambodia thus far….

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Hello! We are Lauren and Kristin, two recently qualified Speech and Language Therapists from City University London who have made the decision to fly to Cambodia for 3 months and work with children with cleft lip and palate in various hospitals around the city of Phnom Penh. This is part of the City-Cambodia project which is now in its’ 9th year! Please read our weekly blog to keep up to date with our work and adventures…

WEEK 1: 14th September 2015

So Kristin and I arrived in Phnom Penh on the Tuesday and we stayed in a hostel for a couple of days whilst we found our feet (and a place to live). We also had to get in touch with all the settings to tell them that we were here and ready to start!

The rest of the week was spent in anticipation; we were nervous and excited about starting in our settings. We had only just qualified and this is technically our first job! We also tried to get accustomed to the heat, humidity and hustle and bustle that is Phnom Penh.

WEEK 2: 21st September 2015

We managed to get a tuk-tuk to our first setting which will be visiting every Tuesday – the Childrens Surgical Centre. We got there for 8am and listened to the daily doctors meeting where various cases were presented and discussed. We were particularly interested in the case of an 8 year old girl with cleft lip and palate who was getting a bone graft later that day for the gap in her alveolus.

We met Samnang, the speech advisor for this setting, and Dr Jim, who runs the hospital and everyone was friendly and showed us around. Samnang showed us where his new speech room would be located and also introduced us to a very cute 4 month old who had recently had his cleft lip operation. We toured the rest of the hospital, ending with the staff canteen (extremely important)! We discussed with Samnang how we could help him and he said that he had been asked to present to the doctor’s meeting about ADHD, so this became one of our first aims.

Our next location was the Military Hospital, a large hospital with wide corridors which were easy to get lost in. Our contact here is Dr Nous Sarom, a plastic surgeon with an interest in cleft lip and palate. He welcomed us and gave us a quick tour, showed us the room we could use as our base for Speech and Language Therapy and invited us to watch his consultations that morning. One case was a 5 year old boy with nasal speech despite successful palate surgery (to be continued we think). Later on we watched Dr Sarom perform cleft lip surgery on a 3 month old boy. Thank goodness for air conditioning in the operating theatre! We hope to come to the Military Hospital next week and have someone to train as a speech advisor.

Thursday was a national holiday (Constitution Day), so we don’t get to meet our colleagues at Khmer Soviet Friendship Hospital until next week! Cambodia has a lot of holidays as we are quickly finding out.

On Friday we travelled to National Paediatric Hospital where we sat in on a doctor’s meeting, all in Khmer… Dr Vuthy introduced us to the staff and it was there that we met Dr Vanna, one of the lead surgeons for cleft lip and palate. We will be working with him at the hospital clinic, every Friday morning. Before our clinic started, the speech adviser, Chanthy (also a trained nurse), took us to meet the orthodontic team based at the hospital. They showed us some techniques they use to support feeding in unrepaired cleft lip and palate. We had a busy morning providing speech and feeding advice and carrying out quick assessments alongside the multi-disciplinary team. Some of the patients included a 16 day old baby all the way up to an 11 year old girl. We were thrown in at the deep end but it was very enjoyable.

Next week we are looking forward to becoming more familiar with our speech advisers and our settings, and settling into our life in Phnom Penh.

Your cleft team,

Lauren and Kristin

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Lauren (left) and Kristin (right) enjoying pad thai at the Phnom Penh night market!

SLT Cambodia Project 2015

In September 2015, Team Cambodia 2015 (in photo from left to right– Lauren, Sam, Shona, Zoe, Kim and Kristin) will be travelling to Phnom Penh, Cambodia, to volunteer for three months as Speech and Language Therapists (SLTs) on behalf of the City Cambodia Project. The City Cambodia Project is a charitable project that sends SLT graduates from City University out every year to provide SLT training and support to the people of Cambodia.

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Why are we doing it?
The recent history of Cambodia is well known; its recovery from those events is ongoing. Health care remains poor for most of the population and it is estimated that over 600,000 people in Cambodia are in need of Speech and Language Therapy (SLT) services. Though individual SLTs and organizations are working towards greater provision of services in Cambodia and other developing countries, the need remains overwhelming. There is no SLT training in Cambodia and awareness of the role it can play is lacking. Education for most of the population is rudimentary, but for those with disabilities it is largely non-existent. Due to cultural and religious differences, the attitudes towards disability in Cambodia are far worse than in the UK, where inclusion of children with disabilities has gradually been rising over the years. The Cambodia Project is now in its eighth year and has been influential in raising awareness of the need for SLT in Cambodia.

What will the work involve?
The 6 of us will be in pairs, spread across three different settings, involving travel to many different sites across Phnom Penh.

1) Cleft lip and palate setting

Kristin and Lauren will be working alongside a team of specialist medical professionals across four hospitals in Phnom Penh to provide specialist services to children with cleft lip and palate and their families. They will be seeing the children both before and after they have surgery and giving advice to parents through translators who we also train to carry on the work when we cannot be there. Operations in Cambodia are often later than would be the case in the UK and the children can have lasting speech problems and difficulties with feeding.

2) Orphanage and schools setting

Sam and Shona will be working with children with a wide range of disabilities in an international school, a special needs school and an orphanage. The work here is divided between helping individual children and training teachers, carers and parents and raising awareness of disability in general, and of children with communication difficulties. In the orphanage there is a major need for advice and support with caring for children with cerebral palsy and other physical/learning disabilities, whose problems with swallowing have led to severe malnutrition.

3) Mental Health hospital setting

Kim and Zoe will be based at the Child and Adolescent Mental Health Hospital in Phnom Penh which is an outpatient hospital for children with mental health difficulties and other disabilities from all over Cambodia. The work here will involve preparing and delivering training to parents and staff, modelling 1:1 assessment and therapy, creating specialised assessments and resources and working alongside a team of doctors, nurses, physiotherapists, specialist teachers and psychologists.

SO HOW CAN YOU HELP?

Funds from City University are limited. The money you help us raise as a team will go towards:

  • Specialised resources, including: feeding equipment, toys which facilitate communication, and other therapy materials
  • Travel to and from the sites we are working at
  • Accommodation and living expenses

** As UK-trained SLTs, the expertise we can bring to this impoverished country can make an invaluable difference. We would be delighted for any pennies you can spare to support us – however small. EVERY LITTLE BIT HELPS! Thank you 🙂 **

To donate, please follow this link to our JustGiving page

For more information about the work of Speech and Language Therapists generally, please see this fact sheet provided by the Royal College of SLTs

Thanks for your support,

The Cambodia Team

(This post was written in collaboration with Team Cambodia!)

Cleft Training Week– SLT Cambodia Prep

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Lauren and I will be in Cambodia with the rest of our speechie team providing services for children with cleft lip and palate in just two months!! In preparation for the three-month service trip, we are in Salisbury for a training week in cleft lip and palate!  Day 2 of training was spent in scrubs observing cleft surgeries! Happy to report our stomachs held up strong and we survived the day without tossing our cookies! #teamcleft