Surviving Marian Ridge - Week Three (23 April - 25 April 2013)

Tuesday (23 April 2013)

I arrived at Ridge Cafe to find the parking lot packed with high school kids, wandering aimlessly around and talking - not a typical scene in the morning. I soon discovered that the teachers are on strike, thus did not come to school. This has been an ongoing battle over the past few weeks and has slowly escalated, leaving parents frustrated while the students - in typical student manner - are taking the strike as a holiday. Coming out of the MCC, I clearly surprised one of the boys who were hanging around because he turned to his friends and half shouted "How! Mlungu!", clearly not expecting a white person to be walking around comfortably in Marian Ridge. I smiled and greeted them, asking how they were in isiZulu, which resulted in incredulous looks from all who stood nearby. I have to admit that I chuckled the whole way to Candy Floss Creche at their responses.

Picture courtesy of Katie aka The Audio in Africa

I had been prepared for how the creche operated as I heard many stories from my peers about the set-up but I didn't really know it was going to be as chaotic as it really was. The creche comprised of, what seemed like, millions of little kids packed into a church hall which is divided up into smaller open-planned classrooms by bookshelves and other furniture. The most obvious thing about Candy Floss is the noise. It would be impossible to screen inside the hall because of the noise, so we decided to screen outside where it was relatively quieter.
We had decided to try to screen in a production-line style with each member of our team doing a bit of the screener before sending the child to the next clinician, however we quickly discovered that this method wasn't working so we went back to the traditional way of screening one child per clinician at a time. It was quite interesting to see how the results varied between the children, although without knowing their backgrounds it would be impossible to gather a theory on why some performed so well while others were barely passing. When it was time to leave, we made the mistake of saying goodbye to all of the kids and within seconds we were being surrounded by little kids hugging our legs goodbye. It took us forever to disengage ourselves from the children and we all agreed afterwards that each time we leave in future, we shall do it covertly.

As the schools were all closed and there were no children hanging around the library, we were unable to do start the Literacy Program which we had planned. Instead, we decided to do some work on the many pamphlets and posters we need to start on. 

Wednesday (24 April 2013) 

I woke up excited for our the session we had planned for the Grade Rs at Marian Ridge Primary, and then I remembered the strike. Deciding to be pro-active, I called the school to find out if anything had changed. The woman who answered, who I can only assume was the secretary, told me not to even bother coming to the school because it will be locked. Having our plans ruined, we decided to do some more screening at Candy Floss Creche before we joined the OTs on home visits with Aunty Katie, a Community Healthcare Worker.

The first home took a while to walk to as it was on the edge of Marian Ridge, and we had to walk along a treacherously steep and slippery path to the house. We encountered a few dogs on the way which was rather sad because they were malnourished and obviously strays, in some ways a danger to the area with the increase in Rabies there has been over the past few months. When we arrived at the first house, we were greeted by the father of a 41 year old man with cognitive impairment and limited communication abilities. Between the OTs and ourselves, we decided that the client needed a full assessment so we plan to return. We went to two more homes, the residents of both being in their eighties. The last home we went to was the home of an 86 year old man who clearly had a hearing impairment, although at first he didn't want to admit that he couldn't always hear us. We spoke to him a bit about what happens to your hearing as you age and why you can hear some peoples' voices clearly but not others'. I must admit that it was great to see the lifestyle the community members lead, and it surprised me that the two elderly people were living on their own quite proficiently without the constant supervision of their families. In comparison, those who live in luxury seem to be frail and delicate.

From the home visits we went to do some stimulation training with the parents/teachers at the clinic while the OTs taught them how to make play dough. It was really nice because we got to put a lot of input into this one small activity and the two creche teachers who came along were enthusiastic about what they could do with the activity. We had a new member at the stroke group, the only guy amongst the sea of women (not including the lonely male OT who has probably been tortured to death by us females). Apparently, one of the ladies who is a regular at the stroke group invited him to come and join us. He seemed a little overwhelmed by the sheer exuberance of the other two ladies, but held his own in the activities. The OT who organized the session took the patients into the library, although two of the patients complained that they cannot read. Working with them in finding specific books made me realize that their inability to read is actually a perceptual problem. As usual, after the session we sat down with Chantelle to talk about the session.

Thursday (25 April 2013) 

After another eventful ride to Marian Ridge, in which we managed to cram two extra people over the seating capacity into the vehicle (all we were missing was a goat and it would have been a typical African Taxi experience) and the driver missed the turn-off to Khetiwe, we arrived at the clinic. Trying to get the parents who were sitting in the queue to talk to us or even acknowledge us seemed like mission impossible, and we didn't want to cause any trouble, so we abandoned mission impossible and went to Candy Floss to try and finish screening.

I think Thursdays are a free-for-all at the creche because withing a matter of minutes we had a sea of children surrounding us. Trying to get them to settle down and go back to where they were meant to be was a mission which rivaled the clinic, however with the help of some of the teachers the tide abated and we were able to settle down to do some work. We managed to screen all of the grade Rs except for those who were absent and we spent the remainder of the time expanding the vocabulary of the small group of kids who wanted to read the books. It was quite blatant that there was a contrast in the teachers. Some were extremely helpful and knew everything they could about the kids in their class, while others barely knew the kids names. Their attitudes towards the kids were also extremely different. Being someone diagnosed with A.D.D. and having being medicated since I was a child, I'm certain I wouldn't have responded well to a teacher who would rather shout and call you stupid than give you one-on-one attention to make sure that you get the best results that you can get. While I would love to run a workshop on the different learning disorders, I'm not certain that it would change that specific teacher's attitude toward her class. It was great to see the same teachers who came to the stimulation training on Wednesday do the activities that they were taught, so it was nice to know that at least some kids are benefiting from what we could show the teachers.

Overall, it has been an extremely improvised week, although a week in which we were able to go deeper into the community and learn even more about the members within it,

Surviving Marian Ridge - Week Two (16 April - 18 April 2013)

Week Two (16 April - 18 April 2013)

Tuesday (16 April 2013)

Once again, the Speech Language Pathology students found ourselves at Rainbow Crèche, although I think this time we were all a little bit more prepared. It had been decided that we would tackle Rainbow while the OTs would continue screening at Candy Floss as the OTs would be screening the children all at one time and it would be impractical for us speech students to interfere in any way, therefore putting a proverbial spanner in the works. We also couldn't abandon Rainbow completely as we had noticed that the children there were under-stimulated in terms of language and literacy.

We walked from Ridge Cafe to the crèche, the already boiling hot sun beating down on us at half past eight in the morning. We should have taken that as a sign of how hot the day was going to get. The children greeted us enthusiastically as they watched us walk down the steep embankment to the crèche, and I have to admit that it made me feel all warm and fuzzy on the inside. We set up in their large hall thinking that we could take on all of the Grade Rs at once, seeing as there were four of us there and that we could each take turns to lead the different activities we had planned. The sheer volume of children that were running around in combination with the extreme heat could have erupted into sheer disaster, but I do think we managed to remain in control most of the time. Needless to say, we now understand why the group had been split in two the last time we went there. After witnessing how one of the children were prone to pushing and hitting, we came up with an impromptu social story on why we shouldn't hit - which many of the children added to with their own pearls of knowledge including "only granny can hit because she's old and doesn't know that it's not nice". 

Seeing as the children were all so full of energy, we incorporated our aim of developing prepositions into an obstacle course which made them physically do an action which involved the preposition. Unfortunately, only one child could do the activity at a time and, as there were so many children, it became problematic as the ones who had already done the activity got bored really quickly. It was attempted to entertain them by singing songs and cheering on their friends, but that quickly wore off and we were back to trying to calm the chaos and help the others through the obstacle course as quickly as possible. I started to wish that I could split myself in two and that I had a Panado on hand. We did a few more activities, including reading a book which contained a bunch of verbs, before it was the children's lunch time and we had to get going. 

On the walk back up to Ridge Cafe we came across a group of adults sitting in the shade of one of the buildings and I was, once again, confronted with the reality of the unemployment problem in the area. We joined the OTs at the cafe who told us that they had arranged a meeting with the ladies from the Marian Ridge Coordinating Committee (MCC) for that afternoon. As one of our projects is to set up a Library Literacy program, we went to the library to see what resources they have and to ask the librarians' for any advice they could give us. I think this allowed them to be part of the project at some level, and it was clear that they were excited about the program. We were able to meet the ladies who were extremely involved in their community and it was inspiring to hear what they had to say. Jenny, one of the ladies who head up the MCC, was interested to hear what was happening with the projects we were starting to set up. She also provided some valuable information about the community and what projects were already running which had been set up by community members and the various churches and organizations which are involved in the community. One that I found particularly interesting was the phoneme awareness program which is being done with the students at the Primary school. Two of the ladies who are part of the MCC were trained to do extra training on phoneme-grapheme awareness and have seen vast improvements in the students, in particular those who are first language isiZulu speaking.


Wednesday (17 April 2013)

The Grade Rs at Marian Ridge Primary kept us laughing the whole morning with the funny things they said, proving once again how blatantly honest children are. We started off the morning with an OT exercise involving a relay race, and while we had tried to insert our speech aims into the activity they failed miserably as the children were so preoccupied with doing the physical acts that they were not even bothering to do the speech part of it. It seems that integrating the activities needs more careful consideration when it comes to planning those activities, although the situation would have been impossible to predict. We had planned to target /b/ and /c/ in terms of phoneme-grapheme awareness and phoneme awareness within words, so we got the children to sit at their desks and introduced the /b/ sound first, asking them to think of words which start with it. We then got them to trace the letter, using the dotted lines as a guide. Each table had a speechie helping out and one of the OTs stayed in the classroom while the others went to try and sort out the jungle gym which had just arrived. I sat between two tables at the back of the classroom and almost immediately I noticed that one of the children who I was helping out had difficulty with the tracing due to fine motor control. Luckily, we still had an OT with us so I was able to speak to her about what I had noticed and she was able to work with him directly. Speaking to the teacher afterwards, we were informed that he, along with another boy at his table, had difficulties in class. This made me wonder why they were placed at the back of the class as it was clear that they would need as much support as possible. After tracing, the children were shown cards of pictures with the /b/ at the beginning of the word as well as random cards which had no /b/ in them at all and the children were asked to clap whenever they heard the /b/. While some of them clearly understood what was expected and heard the /b/, I got the impression that some of the children were copying their friends or clapping just for the sake of clapping. From there, we did the same activities with /c/. After tea-break, we went to screen some more Grade 1s. This time, I screened three kids of which two were predominantly isiZulu and could only understand the bare minimum in English. I asked one of them how old he was and he replied with the area he lives in, however when I asked again in isiZulu (although rather broken isiZulu) he was able to tell me without a problem. Screening in isiZulu was a challenge, however we were lucky to have a translated screener which helped a lot (even though I had to say a few words in my head a few times before I could say it aloud). One thing I have learned about working in isiZulu is that no amount of lectures will ever prepare you for a conversation with an isiZulu person.

The stroke group was rather interesting and the two ladies who attended were able to provide us with lots of information about what living with a stroke is actually like. We played a memory game which one of the ladies was brilliant with but the other one had difficulty remembering more than four items for a period of more than a few minutes. We also spoke to them about their feelings and attitudes towards themselves as a result of the stroke. It was actually heartbreaking to hear just how their disability had knocked their self-esteem. They both mentioned that they feel useless, and that they would both love to go back to work but feel that they can't. The lady who had difficulty with the memory task told us about the business she had started from home, selling loose cigarettes. It is a new business, but I think that it will give her a confidence boost. After the session, we met with Chantal and spoke about what we had learned. I must admit that I feel that I didn't pick up on half of what the others picked up on, so I guess that's something I will have to work on.

Thursday (18 April 2013)

Having been split up, two speechies and two OTs arrived (with a rather lost bus driver) at St. Mary's Hospital, the venue of Khetiwe. I didn't really know what to expect other than the lady who runs it is a physiotherapist and that we would be seeing clients with Cerebral Palsy (CP). We spent the day counseling parents and seeing what information and help we could provide where we could. It felt a bit like a whirl-wind and the three and a half hours we spent there were beyond my wildest dreams. To be perfectly honest, I always dreaded working with CP and I was nervous about what we were going to find, but I found myself enjoying it. I think I learned more about CP in terms of what to aim for and where the possibilities and limitations lie than I expected to learn from the day. I guess the challenge now is to develop what we can to leave at the venue for parents. One of the biggest barriers I faced today was, once again, the language barrier and I found myself being forced to resort to asking another mother to translate for me whenever I couldn't put the point across in my broken isiZulu. Just one more example to add to my growing list of why I should push myself to learn and practice my isiZulu. This Thursday entry seems rather small, however my mind is swimming with thoughts of how to deal with drooling, feeding problems, advocating for AAC devices, how to make a "switch", what pamphlets need to be developed and who we can wrangle to translate them into isiZulu for us, and what Mitochondrial Myopathy is.

~ Kirsty Wheeler



Want to find more about the Audiology side of Africa? Meet my mate, Katie, who will show you just that.  

Surviving Marian Ridge - Week One (9 April - 11 April 2013)

Week One (9 April - 11 April 2013)

Tuesday (9 April 2013)

Armed with what knowledge we had gleaned from our last block (Severe Developmental Communication Disorders), the student Speech Therapy students descended on the bus stop, having no clue what to expect. I had all heard our peers talk about the CBR block and I'd read as much as I could about the community, but actually going into the setting is rather daunting. This block brings a range of firsts which I was excited about. It was the first time I had ever got to work with the OTs, the first time working in a low-income community and the first time I've had freedom to get involved and help set up projects that I'm passionate about. 

Just travelling through Marian Ridge, you can see that the community would benefit from whatever services we can provide. I had read that there was a lot of unemployment in the area, but I don't think I expected to see as many people walking around the community as I did. Arriving at Ridge Cafe, we were able to go through the handover file with the OTs and find out what had been done and what their plans were. We were later joined by Dr Flack who gave us a quick introduction and set out the basic plan for the week. Something I think the speechies all appreciated was that she explained how important the speechies contact hours were to the OTs, especially as the speechies didn't know that speechie and OT hours were calculated differently. I noticed throughout the week that this changed the OTs' attitude toward us and they have tried to help us by including us in the screening they were doing at the clinic. 

After Dr Flack left, the speechies went to introduce themselves to the principle, HOD and teacher of the grade Rs at Marian Ridge Primary School. The HOD, Mrs Zulu, seemed extremely interested in what our profession involved and we explained to her how speech therapy can help those children who have learning difficulties. We also explained the importance of early intervention for these children. We joined the OTs up at the clinic, which was packed with parents and little children. We introduced ourselves briefly to the staff and they gave us permission to use one of the empty rooms in the clinic to screen some of the children who were in the waiting room. As the room was far too small to accommodate all of us, we split into two with two OTs and Stella screening in the room and the rest of us screening outside on the corridor. Within a matter of minutes we had a few children join us, interested to see what we were doing. I managed to screen two children, a three year old and a seven year old. I think by screening the children while their parents were waiting in the queue for the clinic, we provided the children with something to do and therefore we held their attention much easier than what we would have done if they had been waiting in a queue to see us. The only disadvantage was that we were outside in a corridor where people walked passed frequently. Perhaps, next time we could find a better place to work. 

On the way back to Ridge Cafe, we met up with one of the women who were at the clinic. She was extremely interesting to talk to as she had recently moved back into the area after living in Gauteng for a few years. She explained how the area had changed and it was great to get a resident's perspective of what the community needs and where the problems lie. Many of the problems she raised included drug abuse, unemployment, teen pregnancy and domestic violence.

Wednesday (10 April 2013)

 After planning for the group therapy session with the grade Rs at Marian Ridge Primary the previous day, we were all much more prepared for what we were going to face. Unfortunately, the weather was our biggest enemy. We had planned to use as much movement as possible in the activities, but it was freezing cold and raining, and so we scaled our activities down to make them more "classroom friendly". 

We had planned and integrated our activities with the OTs so that in each activity the children were learning and using more than one skill. First, the OTs played "Simon Says" with the children, starting off at a basic instruction level with visual cues and then gradually minimizing the cues and increasing the complexity of the activity. It was clear that some of the children struggled further along in the activity, especially when there were no visual cues and there were two or more parts to the instruction. The activity may have worked better if there was more space and if the children were split into smaller groups (as was originally planned), however due to the weather this was impossible. From there, the OTs started the tabletop activity where the children were required to make pictures of themselves, cutting out a paper template and sticking it onto another piece of paper. Once again, space was an issue as the clinicians tried to fit between the children to help where needed. Once that was done, the speechies took over and got the clients to glue and stick parts of the face onto their paper template. These included eyes, a nose, a mouth and ears. The children were asked to point to where their eyes/nose/mouth/ears were and say what each part did, including verbs into the activity. As each speechie sat between two tables and helped and asked the children from both tables questions, each child got a chance to answer questions. I sat at the back of the class with the quieter children and noticed that they were more reluctant to answer questions than those at the front of the class. I was quite impressed with the resources available to the children in the class.

As it was pouring with rain and there was no electricity, the library, where the stroke group meet, was closed. Therefore, the stroke group had to be cancelled. The OTs called their supervisor and it was decided that they would go back to campus and that we would join them after we screened some of the children as I had taken my car to Marian Ridge. After break, the speechies went to screen a few of the grade 1s and speak to Mrs Zulu (HOD) and a few of the teachers about the Library Literacy Program which we were planning to set up. We had heard from the previous group of speechies that the program had once been running at the library, but the teachers were not happy with it as the materials used were not what were being used at the school. Therefore we wanted to try and get as much input as possible from the teachers as well as make them feel as if they are also involved in the project and not feel that we are trying to take over. Mrs Zulu and Mrs Van Wyk (a teacher) seemed enthusiastic about the project and shared some concerns about some of the children at the school. They mentioned that many of the students cannot speak English and that they are unsure what to do with them. We got the impression that they did not know how to educate these multilingual children and that they were seeing their inability to speak English competently as being a disorder. We managed to screen six children in the staff room which was a great venue in terms of it being warm and quiet. 

After we were finished, we made our way out of the community (with the help of my GPS which we would have never have managed to do without) and went back to campus for a tut with the OT supervisor, Cgantelle. 

Thursday (11 April 2013)

After an interesting bus-ride, during which the bus driver got lost and started to take us towards Kwa-Ndengezi, the speechies and audios (and one OT) were situated at Rainbow Crèche for the morning. It was an amazing venue to work in purely because of the space available to us. We had planned the previous day what we were going to do and had prepared to split up, aiming at expanding vocabulary (animals, colours, shapes and common items), following directions,  facilitating the use of prepositions (in and out, up and down) and understanding time concepts (before and after - fast and slow). The activities used included "Simon Says", standing inside and outside hoola hoops, book reading, singing songs, going up and down the rungs of the jungle gym, looking at pictures and explaining the vocabulary in it as well as finding the real item in the environment. It was good to work with the audios as they had experience in the venue and with the children. 

There were a few problems which we encountered during the morning. Firstly, we had chosen a book which we thought the children could handle, using the grade Rs from the previous day as a measure. It quickly became apparent that these children were on an entirely different level to those at Marian Ridge Primary, and therefore we had to downgrade the book we were using. Another difficulty was that many of the children could not speak English and there is no Zulu speaker in our entire group, thus when the children wanted to speak to us in Zulu we couldn't understand them and no teacher was available to translate. This has been a problem since the previous block as there is no speechie within the entire block who can speak Zulu fluently. While we try to speak Zulu to the best of our ability, the Zulu narratives, which the children were trying to express today, were impossible for us to understand and at one stage I had to ask one of the English-speaking children to tell me what one of her friends had said. While I understand that we need to develop our Zulu skills, perhaps in future the Zulu speakers could be shared out equally between the blocks. Another thing that could have been improved, and which has been raised in the afternoon tut, was that we should have made those who were more capable do more advanced things in the activities. I noticed that the children did not know the alphabet and were generally under stimulated in terms of developing early literacy skills. This will have to be worked on during the therapy sessions. 

On the way back up to the bus we encountered a few guys smoking weed. It struck me as being strange that they were so free and open with their drug use, showing how different their attitudes are about those issues. 

Overall, the week has been an eye opening experience where we've all been trying to find our feet in the community. I'm looking forward to seeing what progress can be made and if that progress will be as sustainable as what we aim for it to be. 

- Kirsty Wheeler