Day 16-January 15, 2014

We began our final day at the Komfo Anokye Teaching Hospital in

Kumasi. As we walked inside, we were greeted by children and adults of

all ages who had come to see the talented Kumasi Cleft Palate Team for

pre and post-surgical consultation. The faces of tiny babies as young as

two- months stared back at us from colorful cocoons on their mothers' backs as we smiled and stroked their beautiful faces. Once in the clinic, we assessed the speech and language of children with repaired and non-repaired cleft lips and/or palates and provided recommendations. However, the highlight of the morning was the time we spent demonstrating safe feeding techniques to mothers of babies with non-repaired cleft palates.

While many of the mothers had figured out how to best feed their babies with cleft palates, some of the little ones were undernourished. An opening between the mouth and the nose makes it easy to swallow excess air. These babies also have difficulty creating enough suction to latch on to a nipple and lose nourishment through nasal regurgitation. We taught the mothers to hold their babies in an upright position, to burp them frequently and to keep them in an upright position for twenty to thirty minutes post feeding. The mothers caught on quickly to the feeding strategies, which were accompanied by beautifully drawn handouts illustrated by Tina. It was amazing to see the changes in both the mothers and the babies after a successful feeding and bonding session. One particularly tiny baby who began the session with a glazed-over look transformed into an alert little boy who gazed curiously at the faces around him. In addition to watching a mother learn how to successfully feed her child, it was incredible to witness the look of relief and thankfulness in the eyes of a mother after one compassionate smile or gentle touch of her child.

After a beautiful morning of therapy, we grabbed a quick local lunch before we returned to the hospital for a meeting with the world class Kumasi Cleft Palate Team. Dr. Peter Donkor, Head of the Cleft Palate Team and Dr. Solomon Obiri Yeboah, Specialist Oral and Maxillofacial Surgeon, were gracious enough to share their experiences performing cleft lip and palate surgeries in Ghana. Dr. Solomon explained that he had become the sponsor of a child whose cleft lip he had repaired. Not only does Dr. Solomon provide financial support to the child, but also includes the boy and mother in celebrations and gatherings as part of the family. For Dr. Donkor and Dr. Solomon, performing a cleft lip and/or palate surgery is only the first step of a life-long investment into the long-term investment into the well-being of these children.

We concluded an eventful day with a final shopping spree at the Kumasi Cultural Center for last-minute elephant paintings, beaded jewelry and other goodies. After packing our bags for the 7-hour morning bus ride to Accra we had our final class where George Odoi re-counted the past few weeks with a near-perfect memory. The night ended with a cheerful round of charades!

-Jenna

Day 15- January 14th, 2014

Today we spent the morning at Effiduase School, a unit school in which Belinda works. TC has been working with Belinda, a teacher of students with disabilities, for the past 7 years. Her class was comprised of 45 students ranging from age 3 to 22, all with a range of disabilities. We were all beaming as we walked into Belinda's classroom. All of the supplies that TC has donated over the years were seen throughout the classroom and was being utilized! The opportunity that we were given to co-teach with Belinda was an invigorating experience--the students remained engaged throughout the lessons, and were excited to learn. We were all in awe of Belinda's expertise as a teacher.  

 We also went to the local market with the students. There, they showed us how they use their AAC market cards to buy goods. It was amazing to see the market women recognize and engage with the students in an extremely friendly manner. 

After we left Effiduase, we added to our cultural experience by watching traditional kente cloth weaving, natural ink extraction, and wood carving. We also stumbled a upon a traditional Muslim funeral which we couldn't pass up. Funerals in Ghana tend to be a large celebration open to the public, and an all day event! We were warmly welcomed and included, and we were even asked to dance a traditional Ashanti dance in front of the everyone there.

Later in the evening, Belinda came and spoke to our class about the challenges she has faced while pursuing a career in special education in Ghana, and the process of starting a unit school in this community. Belinda's dedication to her students and to the field of special education has improved the the lives of  many despite the prevalent cultural taboos that still exist in Ghana.

---Katie

Day 14-January 13, 2014

We awoke bright and early this morning to our beautiful new digs in Kumasi. After breakfast, we boarded the bus to start our day at Komfo Anoyke hospital. It was a busy morning of introductions, and more assessments similar to those at Korle Bu. We saw kids with hearing loss, cerebral palsy, Waardenburg syndrome, and stuttering. For most of us, it was our first exposure to Waardenburg syndrome, which served as a particularly interesting case to assess and analyze.

Once our work at the hospital was complete, we grabbed a quick lunch to fuel ourselves for more market shopping. In the very back of the market was a painter who had no functional use of his arms and had to use his mouth to paint. He demonstrated his talent to us as we flipped through and purchased his pieces. Needless to say, they were all unbelievably stunning. However, that wasn't the only craft shop that stood out to most of us. There was a father and son who owned a woodworking shop with gorgeous handcrafted pieces. They even went so far as to carve it in front of you to make sure it's exactly what you want.

The night ended with a class discussion about the work we are doing and suggestions for next years trips.  

-Jenn

Special Post- Faruk's family

We all expected a simple happy story when we arrived in Larabanga to meet Faruk and his family. However, we witnessed the social and financial impact that cleft lip and palate has on families in developing nations all over the world. Faruk's father rejected him and his mother shortly after he his birth. The father, his family, and many members of the Larabanga community labeled Faruk and his mother as cursed.  Although the community gradually started to accept Faruk and his mother after the repair, they still were living off alms.

And then we heard Cynthia's story. Cynthia is Faruk's older sister, and she was living with her father's family in Damango.  However, her father disowned her after she brought water to Faruk and their mother when he was getting his surgery in July of this year.  Her voice broke and she fought back tears as she recanted her story, and spoke about her determination to take care of her mother and brother if she had the chance to finish school. Our hearts ached as we listened to this young girl's plea. 

The group decided to collect money to finance Cynthia through the remainder of her junior year; to help sustain Faruk and his mother; and to provide capital for the mother to start a business. We were happy to help this family temporarily; however, Cynthia still has to finish school.  We set up a committee to raise funds for this family, so please keep an eye up for future updates.

Day 13-January 12, 2014

On Sunday morning, we went back to Larabanga to see Faruk and his family.  We were excited to tell them that we had raised enough money to finance Cynthia's schooling for the next year so she could go back to her old school in Damango.  This school is much better than the one in her village and would give her a better chance at getting into a government high school.  We brought Cynthia to Damango with us where we were able to speak with the headmaster of her school and inquire about her returning to the school.  The headmaster gave his assent for her to start classes again so we happily began helping Cynthia buy supplies and material for a new uniform so she would be ready.  Since Cynthia would not be able to travel from her village to the school every day, we helped set up room and board with a family member who lives in Damango.  We also visited the Catholic Church where some of the women played traditional music for us and Cynthia was reunited with her school friends.  It was incredibly emotional and we are hopeful she will keep in touch by using her new cell phone.

After Larabanga, it was back on the bus for another "African massage" and many, many hours traveling south to Kumasi where we will be working for the next three days.  To pass the long hours, we laid down some tracks for the TC beats.  Get excited to hear them at home!

-Galadriel

Day 12-January 11, 2014

Today we drove from Tamale to Mole on the bus while enjoying an "African massage" from the unpaved, bumpy roads. Along the way we stopped to see a traditional village. The village consisted of several families living in mud huts. Unlike cities such as Accra where it's more common to have fewer children, men in this area would have multiple wives, and up to 20 children.  We met the elders of the village, and were introduced to a chief from the surrounding village who's daughter had a physical disability. The chief explained that the family treats the child just like all their other children,  and Jenna spoke on behalf of the group to agree with this approach, and to share how we try to accept such children in the US.

After this beautiful exchange, we made our way to Larabanga to visit Faruk and his mother. We were so excited to see how Faruk's surgery had gone. Faruk was a baby that the previous TC group encountered in May when they heard of a baby that was born with a cleft lip, and the rejection from the community forced the mother to keep him indoors since his birth.  The group pooled money together to help fund his surgery.  We were all so happy to see that Faruk's surgery had gone well! However, we quickly realized that this family still faced so many challenges. Since this story deserves its own posting, we will leave the details out for now. The group left the family with a promise to return the next day with a plan to help them.

The village interpreter lead the group to the oldest mosque in subsaharan Africa. It was fascinating to see the construction of the structure, and how there were multiple entrances for different groups (men, older women post menopause, the Imam).

We ended our day with a safari at Mole National Park.  The park rangers told us that we would be really lucky to see one elephant considering the time of our arrival. We climbed up on the roof of jeeps and prepared ourselves for a thrilling and dusty ride.  We were extremely lucky, and saw baboons, warthogs, bushbucks---as well as over ten elephants!!!

--Marissa

Day 10-January 9, 2014

Today was our final day at Korle Bu Teaching Hospital. We spent the morning providing outpatient speech and language therapy to patients who ranged in age and diagnosis, from adult stroke patients to young children with hearing loss, and everything in between! We are grateful to have had the opportunity to work with and learn from the Speech and Language Therapy team at Korle Bu, especially Dr. Albert Osei-Bagyina (the first Speech Language Therapist in Ghana), Josephine, Nana Akua, and Clement.

After thanking the Korle Bu SLT team for their clinical support, translating services, and cultural insight, we headed over to the Cleft Palate Clinic in the Korle Bu Reconstructive Plastic Surgery Centre. We saw over a dozen children with repaired and non-repaired cleft lips and/or palates. We made recommendations (for speech therapy, surgery, or other services) based on our parent interviews, speech and language assessments and an examination of each child's speech mechanism.

One 9-year old boy we saw was particularly interesting. He had multiple surgeries to repair his cleft lip, palate and fistula; however, the fistula had re-opened, resulting in hypernasal speech. The boy told us he was afraid to undergo further surgery, but after our SLP students counseled him on the importance of repairing his fistula (an opening along the stitched seam in the repaired palate), he agreed to have his fistula repaired. Yay!

Next, we presented our findings to the Cleft Palate Team. The team included surgeons, audiologists, Ear Nose and Throat (ENT) doctors, dentists, orthodontists, and medical doctors. Together, we met with each patient and his/her family to discuss the patient's condition and make recommendations for future care. It was a privilege to collaborate with such a remarkable and compassionate group of healthcare providers.

Before saying farewell to Korle Bu, we visited the boy whose cleft palate repair surgery we observed yesterday. He looked happy and well :) We are hopeful for a smooth recovery.

Tonight, we went to dinner in Osu (a neighborhood in Accra) - "Little London" - at Oxford Mall. We toasted to a successful few days! We're going to bed early tonight to catch a 6:00am flight to Tamale!

-Amanda and Jenna

Day 11-January 10, 2014

Our day started dark and early at around 4am. We headed to the airport at Accra to catch our flight to Tamale. When we arrived we were all pleasantly surprised that we had escaped the humidity that we had been growing accustomed to in Accra. Unlike other regions we have visited on the trip so far, Tamale is more like what we expected Ghana to be like. We saw dry desert lands with scarce vegetation. According to George, it is common to see wild life in this more northern region of Ghana.

Our day in Tamale began by meeting one of the teachers we met at the professional development retreat  in Sunyani. She took us to her special education school. Upon arrival we were graciously welcomed by the students. They crowded around us with their beautiful smiles and shook our hands to introduce themselves. We learned from the school's headmistress that the students ranged from ages 5 to 28 years old. During our visit we had the pleasure of interacting with many of the students. One student in particular truly touched our hearts. Her name is Marta and she is about 10 years old. She walked through the tour of the school with us and went out of her way to find a couple of seats for us to sit in. Though we were moved by the students' hospitality and kindness, it was an emotional  experience to see how little resources the school had to work with. It was a lesson to not take the resources we have in the US for our students for granted.

We then visited a unit school nearby. Our goal at this school was to encourage integration between the students in general education and special education. We worked with one 8 year old student named Mageed in the unit school  who was reported to have a severe stutter. Not only were strategies provided to the student, the teacher also played an integral part in the therapy session to ensure sustainability of treatment after we leave. The student's success during the small amount of time we spent with him and the apparent joy that it brought him inspired us to invite him and his family to dinner at our hotel to continue therapy and to educate his parents on the various techniques that were introduced to him. Our hope is that through our time working in the unit school, students in the general education as well as teachers of the school will notice the incredible potential that these students possess.

After dinner,  we were joined by Mageed and his family as well as Fati, her 14 year old son, and husband. With Mageed and his family we worked on strategies introduced to him at school and ways to involve his parents in encouraging these new techniques. Fati's 14 year old son, Muiz, had a cleft palate repaired at 8 months of age, but still experiences challenges with his speech. The students and supervisors found that with a second surgery this boy will have fantastic articulation. A great way to end the day!!

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Day 9-January 8, 2014

Today was an exciting day! We headed to Korle Bu Hospital bright and early and immediately started seeing patients. We saw many new and some old faces as some of our previous patients came back for a second or even third day of therapy. Throughout the day we continued to work with patients with autism, language delay, articulation disorder, hearing impairments, vocal fold paresis, and patients who have suffered from a stroke.

We were then whisked away to go see a cleft palate surgery in small groups!  Dr. Ampomah, head of ENT at Korle Bu Hospital, warmly welcomed us into his operating room and we stood elbow to elbow with him as he operated! During the surgery, Dr. Ampomah made sure to explain the process and his every step. We eagerly looked on and excitedly recognized various structures and anatomy of the mouth. This was a once in a life time opportunity that we will always remember!

After our busy day at Korle Bu hospital we headed to a local Ghanaian market in Accra to do some shopping. It was a shopping experience unlike any other. There were small huts grouped together selling beautiful hand made shirts, jewelry, instruments, wooden carvings, shoes, paintings and so much more. We had to put on our toughest skins to bargain with seasoned merchants to get the best rates! On our way back to the hotel we all took turns sharing our stories about the best bargains. Our winners? Melissa for buying a painting worth 400 cedi for an amazing price of 200 cedi and Shannon and Jenn for haggling the price of hand made shoes from 120 cedis for 3 to 70 cedis for 3!

We ended the day with a talk from the famous Albert, one of the amazing SLT's we work with in Ghana, and his son Pius. Albert shared his story about becoming a speech language therapist, while Pius discussed both the challenges and rewards of being a doctor in Ghana. Afterwards, we reviewed cleft palate to prepare for our exciting day at the cleft palate conference tomorrow!

- Eleni and Allison 

Day 8- January 7, 2014

Oh hello there! Today was another busy, but amazing, day filled with many, many, exciting patient assessment and treatment sessions. We continued our therapeutic strategies with patients who had returned from yesterday and developed new strategies and assessment tools for the unique cases we saw. One case worth mentioning was an adolescent patient with an unilateral vocal fold paresis who had immediate success utilizing the various techniques we taught him!

While the groups continued to evaluate and treat patients, Dr. Crowley and 2 students attended the opening of the Stroke Unit at Korle Bu. They were included in the meeting to introduce themselves and provide any useful information to the intramural team. They also were able to view the renovated building (which looks amazing!) that began in 2009.

After we completed the sessions, we went to the Dean's House for lunch accompanied by HALF of the SLPs in Ghana (Albert, Clement, Josephine, and Nana). Clement and Josephine revealed their experiences of becoming SLPs, while studying in the UK and returning back home to Ghana. And by the way, did I mention they had DELICIOUS food and FRESH pineapple and mango drinks??

Then it was off to the Accra Market, where we all bought elegant kente and batik fabric, which would later be given to the local seamstress to make CUSTOM Ghanaian clothing! On the way home from the market, the lovely George discussed the flag's colors and their significance: green (the land and its vegetation); yellow (the gold); red (the blood of the forefathers); and black (signifies Ghanian wishes to become the "star" of Africa, and has ties to being the first sub-saharan African nation to gain independence). We also took a quick bus tour to view the national stadium and the Unknown Soldier memorial.

And now it is time for BED!

Peace, Love, and Sleep,

Melissa (and Henry)

Day 7 - January 6th, 2014

Mache! This morning we left Sunyani for Accra to visit and work in the largest hospital in all of Ghana. The flight was short, less than an hour, but we were served snacks and drinks. What a treat! After landing in Accra we immediately boarded the bus and headed straight to the only mall in Ghana to refresh our snack supply. We headed to Korle Bu Teaching Hospital to provide speech and language therapy to both adults and children.

Upon arrival we were introduced to the famous Albert, one of 9 speech language therapists in Ghana. We also met Clement and Josephine, two SLTs who are starting the first masters program for SLT at the University of Ghana. We split up into three groups of five students and began providing therapy. We were all nervous, but excited to begin applying our knowledge and thinking on our feet. We saw a variety of patients with varying disorders such as autism, Down syndrome, aphasia, cerebral palsy, and speech disorders. Each student was given a different role during the evaluation and we all worked together to create functional goals and techniques that would benefit each patient. We taught these techniques to the patients and caregivers so they could practice at home.

Providing therapy today was a challenging but rewarding experience! We are beginning to realize how much we have already grown and will continue to grow as clinicians throughout this trip. After leaving the hospital we had an amazing Ghanaian meal at our hotel. We all ate many helpings of chicken, fish, plantains, pasta with steamed veggies, rice and beans, and watermelon. It was delicious! We also met briefly to discuss all the patients seen, their progress, and what lays in store for us tomorrow.  

Day 6 - January 5, 2014

Today was the third and final day of our 3-day Professional Development Retreat. All teachers who attended the retreat received a certificate and a bag of materials/supplies donated by us TC students and our friends and families. From the teacher surveys, we were all excited to find that most teachers found all of our talks and activities over the weekend to be tremendously helpful and beneficial to their students! Many teachers were eager to make AAC market cards, name tags for students, communication passports, and community request cards, and all were even more eager to implement the materials in the classrooms. All of us were truly grateful to have had this wonderful learning and sharing experience with the brilliant teachers who care so deeply for their students.

After the retreat ended, we were invited by a Sunyani unit school teacher to visit two of his students and their families. Both students and their families had tremendous stories to share about the skills acquired at the unit school. The parents explained how both students experienced substantial growth; one father proudly told us about how his son can now independently perform activities of daily living and small errands.

Tomorrow morning, we embark on a journey back to Accra, where we will be working with speech language therapists and doctors at the Korle Bu Teaching Hospital in assessment and treatment of children and adults with speech and language difficulties. 

Day 5-January 4, 2014

Today was a day of true collaboration! The second day of the professional development retreat was an exciting day of sharing, teaching and learning from each other. The retreat covered many Augmentative and Alternative Communication approaches that will be beneficial for many of the teachers and professionals in Ghana. It was amazing how much we as students also learned from the teachers and how much they learned from each other.

Many AAC approaches were reviewed from previous years including the AAC Market Cards, Narrative Social Stories, and Community Passports. A few new approaches were also introduced: the Five-Finger Story Retell, Talking Mats, and Joint Action Routines. The special education teachers made fabulous, passionate presentations! Teachers shared how they use AAC approaches in their classroom, as well as their challenges.

One of the teachers, Mary Osei, talked about how one of her students went missing after taking the wrong way home. Fortunately, the student had a Communication Passport that denoted emergency information. The student had limited speech, so this was particularly useful.  Many teachers also shared how they were implementing vocational training. Students who may have been previously labeled as incapable were making holiday cards, paper beads, and even fashionable bags.

We also presented on various strategies such as how to incorporate the use of a daily schedule and calendar within the morning routine in the classroom. It was awesome to hear how teachers have been using these in their classrooms. Some added physical movements to their "Days of the Week" song and displayed their own hand drawn daily schedules!

"Make and Take" allowed us to work directly with the teachers in creating the actual approaches for them to take back to their classrooms.   We worked side by side in brainstorming ideas and bringing them to life. We made sure all of our materials would be replicable.  Each teacher also went home with an "AAC Approaches Booklet" that highlighted every approach to be covered throughout the weekend to reference once they leave.

Before dinner and the evening program, a few of us and one of the clinical supervisors completed an assessment and provided strategies for one of the teachers who stammered (stuttered). Earlier in the day, he asked a question during the presentation of "What is Speech Therapy" about treatment for those who stammer because he has had dysfluent speech since he was a child. We asked him assessment questions and developed strategies based on his responses. He started using these strategies and experienced more fluent and clearer speech almost immediately.  In less than 30 minutes we had helped someone who had negative feelings about his speech. The smile on his face is unforgettable.

The evening program including African drumming and dancing by a local, professional troupe. The audience was encouraged to join in.   We ended the night with students, teachers, professionals all on our feet.

- El'licia 

Day 4- Jan 3, 2014

Akwaaba! Long time no talk! Today we bid farewell to Cape Coast and headed towards Sunyani for our Professional Development Retreat this weekend.  We ate breakfast by the water and then loaded up the bus and were on our way for our 6 hour trip!

Along the way we made a few stops.  As we were driving along we spotted some coffins on the side of the road and had to make a stop.  Sounds bizarre right?! Well not in Ghana! In Ghana funerals are a celebration and the coffins reflect that! For example, if a man spends his life as a priest he may be buried in a coffin that is shaped as a bible, or if he spends his life as a farmer he may be buried in a coffin that looks like a piece of corn.  We were able to see a few examples of these coffins and it really was a cool insight into the Ghanaian culture.

Next, we stopped at Ancestral River Park where the slaves took their last bath before they were moved to the slave forts and then later sold.  It was so moving to see this place that has now become a museum.  

Ice Breaker Activity- Five Finger Story Retell

Our 6 hour bus ride became 10 due to traffic.  Finally, we arrived at the hotel where we will be having the Professional Development Retreat and were met by about 60 special education teachers who had traveled hours from all over Ghana to spend the weekend with us.  We kicked off the weekend with an ice breaker to get to know each other- so much fun was had by all! 

EVERYONE is doing well (hi mom) and we are having the BEST time! We hope you are all enjoying the snow... it's 90 degrees and sunny here! : )

-Rebecca!!

Day 3 Cape Coast 1/2/2014

Today began with a traditional ceremony, "Eldina Brunya" which is unique to Elmina and occurs on the first Thursday in January every year.  The ceremony is held to remember their ancestors who have since passed on.  This is also the day they consider to be Christmas.  We were fortunate enough to be warmly welcomed into a local family's home to experience and participate in their remembrance and celebration.  The ceremony included blessings of both family and ourselves, reading of the deceased ancestors, sharing of libations, songs, and dancing.

After the ceremony, we headed to Mary Osei's unit school to see how she and her staff implemented the AAC strategies that were introduced during last year's professional development.  Needless to say, the results were impressive.  Schedules and calendars were being used in every classroom.  When they needed additional pocket calendars, they decided to make their own!  We were all blown away by their innovations and creativity.  Anthony showed us examples of the children's communication books and passports and explained how the children used them.  Next, Mary described the goals for the vocational classroom which focuses on teaching the students how to make bags from kente and batik fabrics which are sold in local markets.

Our next stop included a canopy walkway through Kakum National Park.  The walkways were suspended 150 meters above the ground.  We were assured that they could hold up to 2 elephants!  We ended the day with discussion and preparation for the upcoming professional development weekend which begins tomorrow.

Jenn and Shannon

 Afishapa!  We spent the first day of 2014 visiting two different slave forts that were active during the transatlantic slave trade; Elmina and Cape Coast.  This was a powerful experience for all of us as we were reminded of this sad chapter of human history as we walked through the dark dungeons and punishment cells.  We walked away from this experience with the main message "May humanity never again perpetrate such injustice against humanity" (as stated on plaques hung in both forts).

While driving to dinner we noticed a beach party.  We couldn't help but ask to pull over so we could join in the New Year's festivities.  We were immediately drawn to a drum and dance circle where Miki jumped right in with the rest of us soon following.  The next half hour were spent dancing the afternoon away.  After we worked up an appetite, we went to dinner by the water where we engaged in a debriefing on our trip and personal experiences so far.  Much of the discussion centered around the sustainability and functionality of our work in Ghana.  Dr. Crowley also reiterated the importance of not misrepresenting the country and population by conducting our work and portrayal of the country without preconceived notions.

Day 1 El Mina 12/31/2013

After the 10 hr transatlantic flight and a 4 hour bus ride, we arrived at our hotel (Bridge House Hotel) in El Mina. Our guide, George Odoi, welcomed us warmly and explained the various Ghanian cultural and social customs to us passionately.  Along the way, Dr. Crowley spotted a celebration on the side of the road. A young man finished his apprenticeship and was being congratulated with family and friends throwing baby powder on him. We couldn't resist, and decided to jump in! After enjoying an outdoor dinner, we are enjoying a quick break before we head out for New Year's celebrations.

To celebrate New Years, George took us to a local church.  It was a very passionate and spiritual service.  For most of us, it was an eye opening experience of the importance of religion in Ghana.  At the end, the pastor acknowledged our group and Dr. Crowley spoke about our purpose for the trip.  We danced our way out of the church and into a new year!

Miki & Shannon