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

Welcome to SLP Overseas

Welcome to SLP Overseas, a site dedicated to linking the world of speech, language, and swallowing therapy.

As a current international Master’s student in the field, I aim to bring awareness to prospective and current students as well as professionals on the opportunities available in the field on a global scale.

This site will allow students to discover Bachelor’s and Master’s programs around the world that will provide them with an opportunity to learn from international educators and build a network overseas. Additional opportunities available to students also include overseas clinical placements and volunteer work which will allow students to develop their skills alongside professionals in developing countries.

The site also provides information on how to work abroad as a professional. Both paid positions and volunteer opportunities are provided for qualified clinicians to take advantage of around the world in both developed and developing countries.

As an American studying in the UK, I have had the unique opportunity to learn from professionals with different views and approaches to intervention. This has allowed me to open my  mind to the different possibilities within the field and has encouraged my desire to expand my career within the international community. The experience has also helped me to realize the need to bring awareness of the field to areas of the world that would benefit greatly from speech, language, and swallowing services, but do not have the knowledge nor the means to implement intervention.

I hope that this site will encourage individuals to take the time to understand the importance of international speech and language therapy. I hope it will encourage students and professionals from around the world to learn from each other and work together to improve the effectiveness of therapy and the quality of our client’s lives on a global scale.

This site is far from finished but it is the beginning of something positive and it is full of potential. Check back regularly as I plan to post new pages focused on international conferences, research in developing countries, stories from inspirational students and professionals, and much more! I also plan to keep up to date on blog posts featuring my experience as an international Master’s student and the undertaking of my Master’s research project soon to commence this winter!

To learn more about me and my academic and professional pursuits, read My Story. Please contact me with any questions, feedback, or information you would like displayed on my site.

Speechie Love,

Kristin AmRhein
MSc Speech and Language Therapy
City University London