Through the Eyes of a Speech-Language Pathologist

I was originally inspired to go on this trip because I was told “people like you are needed”, meaning medical professionals, therapists, etc. I thought, “maybe I can make a difference with how the nannies interact with the children; maybe I can give them some education about children with special needs in general or about a specific child; maybe they will realize the potential of some of the children if I can teach them how to work with the children to encourage their communication, maybe I can teach them how to teach the children signs or even how to use a communication device. We’ll get iPads donated so that the kids who need them can use them to communicate” I came equipped with my iPad and ProLoQuo2Go software (which is a voice output communication app that a non-verbal child can use to communicate). I was ready to make a difference. Although deep down inside, I knew. I knew that God had a different plan for me on this trip. I mean, how was I supposed to teach communication in the presence of a huge communication barrier (ahem…I don’t speak Chinese and they don’t speak English!) But on the first day in the orphanage, while feeding some of the older kids who were non-verbal, I started teaching a few of the kids to sign “more”. One of the kids picked up on it immediately. I was so excited. Then, wham!, reality struck me down, as the nanny took the bowl of porridge out of my hands and motioned for me to move over so she could feed the child. Turns out I was going too slow. It then hit me that as I sat there taking my time feeding these kids, talking to them, and trying to teach them a way to communicate, that the nannies don’t have time to do that. Their goal during mealtime is to get these kids fed, as quickly as possible because there are many kids to be fed and a limited number of adults to feed them. There’s no time to slow down and wait for them to learn a communication skill. After the second day there, I realized that there weren't many opportunities for the kids to communicate anyway. They appeared to have pretty regimented schedule, including feeding and toileting. It appeared that they were fed two meals a day (at least that’s all we saw-lunch was around 10:30 and dinner around 4:30). They were served a ginormous bowl of porridge at each meal. As I watched them shovel one heaping spoonful of porridge after another into the kids’ mouths, I realized that the kids have no need to communicate that they want more. They get it, whether they want it or not, and when the bowl is empty, they are all done. And to communicate “all done”. Well, that did not appear to be an option either. They made those kids eat every last bite. Not in a mean way. It was necessary. They have to eat. And this was their opportunity. As for requesting favorite toys or other items, this wasn’t possible either. And the bathroom, they had no need to request this either. Their needs were met on a schedule and that’s all they knew. If they wanted to communicate something, I’m not sure they would be responded to anyway. Not because the nannies don’t care, but because they are understaffed and one person can only do so much. They may have wanted to communicate: “I’m wet.” or “I want to be picked up/held/rocked.” But even if they could say that, they most likely would not have gotten a response. It’s difficult to teach a child to communicate when there is no "reward". Why bother, right? By mid-week, I realized that I wasn’t going to be doing ANY actual speech related work. What the heck was I doing there then? I became frustrated, confused, discouraged (okay, maybe jetlag played a part in those emotions, too). Through prayer and tears (lots of tears), I started to rethink my purpose in being there (like it’s my place to figure it out, anyway, right?). I decided that maybe there was a family that could benefit from my observations, not just though a mommy’s eyes, but though a speech-language pathologists eyes—looking for those little things, the things that let you know that, Hey! This kid CAN do something. Despite all of his challenges, he has strengths! He has potential! When placed in a loving family, in an environment where his mind and body are stimulated, he can be taught to communicate (or even to walk)! So I observed. I played with the kids. I made mental notes about what they CAN do. And hopefully by sharing these little observations, a potential forever family can be reassured that while the child they are considering has many limitations, he also has much potential. While I didn’t get to do a lot related to my profession, I do know that God had a plan for me on this trip (more on that in a future blog post). I also have some thoughts about how I think I could be of more value (as a speech-language pathologist) if I go on another trip in the future, and how other medical professionals may be able to help when they go. 1.) One thing I noticed with the nannies was that while they were not lacking in love for the children, there was a definite lack of understanding—about disabilities in general, about what the children were capable of despite their diagnosis, about how to encourage independence, about how to stimulate the children’s development—social, cognitive, language, and motor. Most of the children we met have so much potential. They just need an environment that stimulates their minds and their bodies. Many of the children we met had some sort of special needs ranging from mild physical deformities to Down syndrome and cerebral palsy. The more “severe” of these children were not deemed “adoptable” so they were mostly ignored. I believe that all of the kids can thrive in the right environment and with the right parents. I wish I could have done more education with the staff. Although the conditions there are much different than the ones we live in. What’s realistic for us may not be realistic for them. I think it would be helpful to develop a handout with about five strategies for encouraging communication skills-something very basic and practical for their environment-that can be translated into Chinese for the nannies. Then, when I (or other SLPs) go in the future, they can review this with the nannies, with the help of the guide and model the strategies for them while working with the kids. I think this would be helpful. It would be awesome for other professionals to do this, as well, pertaining to their areas of expertise. I will say, I think you have to go first to really see what it’s like there in order to make it practical to their needs. 2.) Another thing I noticed was the lack of developmentally appropriate toys. There was only one room that actually had some great toys in it and not all of the kids even got to play in there. There were puzzles, cars, and books, and pretend play items like food and bowls and spoons in this room. However, the rooms where the kids were for most of the day had no toys. The therapy rooms had toys that were old and not developmentally appropriate for all of the kids. I think that when future teams go, it would be helpful for them to purchase toys that encourage development to take to the orphanage. And perhaps instead of just giving all of the toys to the director, we could actually take those toys into the rooms with the kids and model how to play with them and how to stimulate the children’s development. Based on what I saw, I think the following types of toys are needed: Cause and Effect Toys (ones that don’t require batteries) although, it would be great to have some that light up, make music, etc., too. - Jack-in-the-box - Ball and hammer - Push and spin toy - Pop-up toys - Visual Tracking ball tower-- - Push and go toys Wooden puzzles Rattles and teething rings Pacifiers Sorting and stacking toys: Stacking rings, Shape sorters 3.) While I made mental notes about what the kids that I played with CAN do, I think it would be even more helpful to WRITE IT DOWN! It would be helpful to know who is “paper-ready” and spend time with each of these kids. To actually write down notes about what each child CAN do to help a potential family understand the child a little bit more. So, again, while I didn’t get to do much related to being a SLP, I do think that I am off to a good start with how to better help in the future. Baby steps! And hopefully, if you are a medical professional and you are considering going on a mission trip with AWAA, you will find my experience helpful.