Day 13 Student reflections

From Emily:
Well the time has officially come that we are done with our program in the various clinics/locations that we have been at for the past two weeks. And boy have these 2 weeks flown by!! In a little over 24 hours we will board the plane back to the US and although we will go back to our daily routines,  I know that we will all carry the memories and knowledge from this trip with us forever.
Today we ended our trip at Beit Cure Hospital. It was a slower day, as they try to move as many patients as possible out of the ward by Friday. ENT and Audiology were also pretty slow. This gave us some freedom to go to different areas that we may have missed or just wanted to see again. For me, the great clinical experience that I have been receiving while in Zambia didn’t stop just because of a slower day. I did tympanograms on patients of a wide range of ages, found hearing thresholds, and sat in on some hearing aid consultations. I even got to make some ear mold impressions….something that even grad students don’t get to do right off the bat at home!
We ended the day after lunch (that of course included nshima!) with a powwow session of us students, the professors, Mr. Mwamba, Evelyn, Charity,  Precious, Lars, Patson, and Chisomo. I got some amazing insight from that meeting that I will remember forever. Basically, what the ENT/audiology department,  Cure, and Zambia as a whole need is KNOWLEDGE. And they need us, who have visited their country, to be ambassadors. Many people may think of Africa as a poverty-stricken, AIDS infected area where people wander around with no shoes. But that is not the case. What these people need isn’t a donation of clothing. They need knowledge. They need people who can train others to do basics like hearing screenings, so that even very rural areas can have access to hearing healthcare. And they admit that it won’t happen overnight, it is a multi-step process but with help, it can be done.
Knowing that we are leaving tomorrow is just sad! I’ve had the most amazing experiences here. I’ve done things that I never thought I would get to do as an undergrad such as earmolds, and I’ve done things I never thought I would do, period (zip lining, anyone?). It’s hard to put into words what this trip has meant to me, but I know that I will always rememeber my experiences here and who knows, maybe I will come back some time down the road!
From Megan:
This morning everyone joined the sleep club before beginning our last day of clinic work.  We were even more refreshed with the surprise of a new toaster at breakfast.  Ending where we began, Emmie, reliable as ever, drove us to Beit Cure Hospital where we were given our assignments for the day.  I was put in the ENT clinic which was really exciting for me because that has been some of my favorite type of work this trip.  Mel and I joined Evelyn in checking the ears of various Zambians.  We saw a multitude of issues including: otitis media, otosclerosis, fungus, and plenty of wax.  I learned about the difference between sucking the wax out verses syringing it out with water.  Evelyn and another clinic worker, Precious, even let me help with some of the removal.  As an incoming sophomore, this sort of experience is amazing and not practiced at my level in the states.After a couple of hours of working with the nurses, Dr. Uta arrived and asked Mel and me if we’d like to sit in her office while she consulted with her patients.  She didn’t need to ask twice as Mel and I jumped up for the opportunity.  Dr. Uta was wonderful at explaining the conditions of her patients and often let Mel and I look in their ears ourselves.  I found it really neat that a couple of these patients were people we had just seen at Evelyn’s desk, so we were able to witness the follow up.  The time came to switch out and I worked with Evelyn a bit more before going to lunch.The group congregated in the grassy area outside the kitchen as we enjoyed one of our last meals of nshima.  Kale, beans, and beef were also served for those who wanted it.  Once we had our fill, it was time for a meeting with Mr. Mwamba and some of the other staff in the ENT clinic.  We finally learned about Mr. Mwamba’s story of coming to the states to play tennis and ending up in audiology.  We learned about new programs that are in the works and hoping to help the children with hearing loss in Zambia.  Plenty of other great information was given.  I think the take home message was brought up at the end: what we can do to help. The problem is not money, it is education and the cultural ostracization of those with disabilities. People, including myself before going on this trip, often have an idealized image of an Africa with breathtaking rolling plains, the big 5 stomping around the savanah, and villages of bone-thin children staring at each other with deep, mournful eyes.  That is not necessarily realistic; there are cities here within the plains,  we did not even see all of the big 5, and there plenty of affluent people here.  Zambia, and even Africa, does not just need money.  The best way to help is through education and the sharing of knowledge.  What Zambia does with it is up to them; it is not up to the West to decide. The best we can do is to stay positive and innovative.

I have learned more on this trip than I ever even imagined I would.  It was almost one year ago that I was the over-eager, incoming freshman (I hadn’t even lived on campus yet) emailing Dr. Krishnan with questions about the trip and if I could go.  All I wanted was to learn some more about the SLHS program and Africa.  Again, I am amazed at how much more than that I have been blessed with.  We had to say goodbye to the Beit Cure staff at the end of our meeting.  It started to dawn on me how much I will miss this special place thousands of miles away from my home.  The support I have received from the team and the Zambian people touches me, and I find myself thoroughly grateful. Zikomo (thank you) to all those who made this trip so wonderful and even possible! Tonight at the farewell dinner, instead of saying goodbye, I will say “until next time.”

Advertisements

Day 13: The Last Program day at Beit Cure Hospital

Today was our last working day in Zambia. First bad news of the day: we had no hot water in our shower; good news though was that we had plenty of cold water! More good news – there was a brand new toaster at breakfast 🙂

Shiny new foster! The little things that make a difference! :)

Shiny new toaster! The little things that make a difference! 🙂

Emmie arrived promptly at 8:30 and after our last morning group picture we were off to Beit Cure Hospital for our final working day!

Final group picture on a work day

Final group picture on a work day

Today, I helped students get started in Hearing Aids, Jenn stayed in Audiology. I watched the ENT nurses for a short time and then today was my day to wander around the stations. First I went to physiotherapy, but they did not have any patients, so I went to the children’s ward, and spent time with several kids (names omitted):

  • A – a cheerful kid, not quite 2 years old with a great smile who has had surgery for club foot and was recovering
  • N: a tiny little thing, though her chart said she was 2, a double amputee at the thighs, because she was born without the lower leg bones (tibias). I hope and pray that she gets her prosthetic legs and makes good progress
  • K: another delightful and cheerful 2 year old with a large bandage covering his head – post surgery for a “pre-auricular sinus” which is a malformation at birth and which had been severely infected also. He was eating his morning porridge, but yesterday afternoon I had seen him playing in the ward with a ball
  • D: a 17 year old Grade 9 student who was enjoying working on a puzzle brought to him by one of our students
  • B: a 6 year old who was coloring with Jill and is also post-surgery for a problem with his right knee

All these children and their families in the large ward together, with people walking in and out including visitors such as ourselves and yet they are so patient, understanding, willing to talk despite their troubles. We take so much for granted in our comfortable lives and good medical care available to us in the US, while these precious children often travel long distances causing much hardship to their families to get to this hospital for their surgical procedures….

From the ward I went to the kitchen. The kitchen staff including Elijah, Kelvin and Mbita were all extremely friendly and welcoming. A few students joined me in a bit and we did various tasks including cleaning the sinks…

Cleaning the kitchen sink

Cleaning the kitchen sink

drying dishes and silverware, stirring the large vat of nshima,

Stirring nshima

Stirring nshima

All cooked!

All cooked!

clearing out their stock room and learning things such as how to scoop out the nshima into the football shape (sadly I did not get the hang of doing this well), and the typical way to eat nshima by hand.

Eating nshima by hand

Eating nshima by hand

Through all this we also chatted with the staff and learned about their families. It was a wonderful experience.

The kitchen crew (Elijah missing)

The kitchen crew (Elijah missing)

At Beit Cure the food in this kitchen is prepared for all patients and staff, and everyone eats the same food, from the upper administrators to the patients in the wards. We served everyone food at the kitchen window and finally ate our lunch.

Serving the meal

Serving the meal

My meal (chips brought from our stash of snacks!)

My meal (chips brought from our stash of snacks!)

At lunch I was fortunate to meet Beit Cure’s neurosurgeon Dr. Kachinga Sichizya, one of only 2 neurosurgeons in Zambia, and one of the few Zambian physicians in the country. It was an honor to meet him and have a chance to chat for a few minutes.

The other excitement around lunchtime was that I finally saw Chisomo – it was like meeting a long lost friend because after she hosted us during our trip to Zambia last summer, we have been e-mailing, but over the past two weeks, she had been out of town. It was great to see her and hear about what she is up to these days!

After lunch, we had a final wrap-up meeting with the Audiology and ENT staff including Alfred, Charity, Evelyn, and Patson, and also Lars, our friend who introduced us to the hospital on our very first day here last week. Alfred shared some information about the challenges faced by children with hearing loss in Zambia, and possible steps to improve audiology services in the nation. Final thoughts in terms of what we can do after we return to the US included being good ambassadors for Zambia, or even Africa in general by raising awareness and trying to erase the stereotypical images of Africa seen in western countries; and doing whatever we can to increase knowledge and innovation rather than just offering financial assistance…

After the final wrap-up meeting with Beit Cure Audiology and ENT staff

After the final wrap-up meeting with Beit Cure Audiology and ENT staff

After a short break back at the lodge, it was time for our farewell dinner at the Plates Restaurant and Wine Bar ( http://plateszambia.com ). This was a really nice restaurant and we took this opportunity to sincerely thank all of our community partners in Zambia including those who did not attend. The past two weeks have been a fantastic experience for all of us. We have all learned so much and words cannot express my feelings or describe how thankful I am to all of you. We thank all of you from the bottom of our hearts – you are a truly remarkable and inspiring group of people and we hope to continue and sustain this program and return to your wonderful country Zambia…

  • Alfred Mwamba, Dr. Uta Froeschl, Charity, Evelyn, Patson, Chisomo and Lars from Beit Cure Hospital
  • The staff and students at Munali High School
  • Dr. Kankasa, Alice and Pezo from the Pediatric Center of Excellence
  • Dr. Matafwali and the Special Education Student Association officers, especially Changwe Chibuye
  • Beth Bailey and Eric and Holly Nelson from Special Hope Network
  • Pastor John and the teachers and students at the deaf Bible Baptist Church
  • Mr. Katongo, the head teacher and staff and students at Kizito School
  • Sr. Marjorie and the staff and students at Cheshire Homes
  • Emmie Mwanje our constant companion these past two weeks who drove us wherever we wanted to go
  • Maggy Younger from cmc global who made all our travel arrangements for the trip
  • The faculty, staff and students of the SLHS department at Purdue University, including our Head Keith Kluender and Dean Chris Ladisch and Dr. Cai
  • And finally last, but certainly not the least the 12 students who participated in this inaugural program

This program could not have happened with out all of your valuable contributions.

Day 12 Student reflection

From Anyea:

At this point in our trip I am amazed at the amount of life lessons, experiences and information I gain from each individual I meet. Today I had the opportunity to spend the morning in the children’s ward at Beit Cure Hospital. In the ward the range of children vary widely in age, diagnosis and disability. I honestly did not know where to begin when I walked into the ward. I began to scan the room looking for any children who were not busy eating breakfast, changing clothes or spending time with their caregivers. I wanted to be very careful to not disturb but simply help where I was needed. As I looked around, I came across a young boy who looked quite sad and as I got closer I could see a single tear coming down his cheek. I quietly walked over and said hello to a nice woman who was sitting next to the child knitting and asked how she was doing. I continued to ask about the child, his name, why he was sad, etc. and I wanted to know if it was okay to play with him. She happily agreed and I quickly reached for my bubbles and began to blow! As soon as he saw the bubbles his frown immediately changed into a smile and that alone was enough to make my entire day at Beit Cure Hospital worthwhile. I continued to blow bubbles and take turns with him and he was soon out of his funk. As I continued to play I learned that he was sad because he was scheduled to have surgery on his leg this morning and because of the surgery was not able to eat. I made it my goal to keep him as happy as possible up until that time. We sat and chatted about everything from legos, to siblings and even talked about Dora the Explorer! As he continued to color, I even had the opportunity to talk to his grandmother about many interesting topics like religion, our families and she even shared a personal recipe with me which I am so excited to try when I get home. I spent the entire morning with him and his grandmother and right before lunch he was called to the theatre to begin his procedure.

After lunch was yet another wonderful opportunity, I spent the afternoon in the ENT department observing Dr. Uta with her patients. Of all the patient’s the most interesting patient arrived just before we were scheduled to leave Beit Cure. He was from Somalia and was born with a cleft lip and palate. Dr. Uta informed me that he suffered from one of the most severe cleft palates she has ever seen but at some time his cleft lip was repaired. The patient’s hearing was also impaired along with unclear speech. He had previously visited Beit Cure and was informed that he had fluid in his middle ear and today he had returned to have tubes placed in his ears to help clear the middle ear. Dr. Uta placed a local anesthetic in his ear and allowed the anesthetic to do its job. She then called the patient back into her office and performed her procedure of placing tubes in the patient’s ear. Through each step she clearly explained what she was doing and why as well as showing me through her microscope. I was absolutely amazed at the precision and timeliness of the procedure.

As you can see, from this trip each day and even each hour we have had the opportunity to gain clinical experience as well as life experience like simply spending time with a family in need. Each experience has contributed in different ways and has provided me with an unexplainable feeling of gratitude for the wonderful staff members of each organization as well as a special thanks to Dr. Simpson and Dr. Krishnan who have made this opportunity possible. Through this program I am learning skills and lessons that simply cannot be taught sitting in a traditional classroom. P.S. my friend from the ward this morning is doing just fine and the man from Somalia experienced an improvement in hearing and better understanding of speech immediately after the procedure!

Day 12: Beit Cure Hospital

Today we spent the day at Beit Cure Hospital. We started our program there and we are ending it there, as we will be there for our last working day tomorrow also.

We assigned students to rotations in Audiology, ENT, the children’s ward and physiotherapy. I was in Audiology and because Alfred, the audiologist at the hospital was ill he ended up leaving us in charge and we tested 17 patients in the morning clinic! It was busy and kept us hopping, but the students did well and it was clear to see that they have learned a lot in terms of basic testing skills over the past 2 weeks! We saw lots of patients (both children and adults) with eardrum perforations after chronic ear infections, some post-op, and one little girl who had lost all her hearing after meningitis about 3 years ago.

Hearing testing - teamwork

Hearing testing – teamwork

Other students enjoyed observing the two ENT nurses Evelyn and Charity: they got to see patients with chronic ear infections, eardrum perforations, and fungal ear infections. Still others checked hearing aids and also took apart some hearing aids, spent time with children in the wards, in physiotherapy and in the kitchen helping with preparations for lunch (nshima, beans and kale).

We stopped for lunch at about 1:00 and had a nice lunch out in the open. Then it was back to the clinics at 2:00. I saw three more patients in the afternoon, and then wandered a little – first to the laundry to see Jessica ironing and Jill folding laundry, and then to the wards where students were playing with children.

Ironing layndry

Ironing laundry

And folding it....

And folding it….

We wrapped up around 4:00pm and returned to the lodge. Before we left for dinner we decided to take a group picture of all of us wearing our chitenges that we got from our Zambian buddies yesterday…

Group wearing our chitenges

Group wearing our chitenges

Once again we went to the Arcades for dinner – most of us ate at the Mint Café, which is quite good and has a lot of vegetarian choices. Then it was back to the lodge for the nightly de-briefing in the presidential suite. Today’s discussions:

  • They enjoyed spending time in the wards with the kids; one student spent a long time with a child and his grandmother and was given a gift by the grandmother – a chitenge!
  • They found the ENT rotation to be really interesting – especially as they were allowed to look in ears and see the disorders
  • Two students got to observe an in-office myringotomy and tubes on an adult: this involves putting a local anesthetic in the ear, then making a small incision in the eardrum and inserting a tube in the eardrum. This adult patient had a large unrepaired cleft palate, and has to wait yet another year before specialists will be visiting Beit Cure and he may be finally able to have the cleft repaired!
  • They commented on how undergraduate students in the US do not really get any clinical experiences, and it is very different in other countries (as we have discussed here on a couple of other occasions), where they get some experiences and in fact in many other countries the model is to have an undergraduate degree that allows one to do clinical practice. In fact the clinical experiences in Audiology this week have made one student consider the AuD (she came in thinking she was going to do speech pathology)
  • Despite the transportation problems that we have heard about, they were impressed at the return rate of patients who kept follow-up appointments
  • They were allowed to look at patient files and found it interesting to read the doctor’s notes in the files about each patient some of which were quite personal
  • They commented on how patient “comfort” did not appear to be the first priority; rather the focus was more on the treatment with little explanation to the patients, and a very different kind of patient interaction
  • They noticed that most of the children sat still and were very cooperative for the procedures
  • They noticed that people still use malaria medication is ototoxic (despite the WHO recommendations to use alternate medications)
  • They also noticed patient comments that they used their “old” gentamicin drops that had been previously dispensed, rather than getting new medication. We discussed the overuse of these drops to treat ear infections, that then may end up causing hearing loss
  • They commented on the use of English words in Nyanja conversations – we have to investigate whether they are interspersing English words or whether Nyanja which is considered a mixture of languages actually includes some English words

Tomorrow will be our last working day – and it is with mixed emotions that I write this. Yes, I am happy to be going home, and yet, these experiences in Zambia will be pulling me back I am sure….

Day 11: Cheshire Homes and UNZA student cultural exchange

Today was our day at Cheshire Homes, a non-profit organization that works wirh children with physical disabilities. We left the lodge at 8:30am after eating bread (no toaster), and unfortunately the watermelon that we cut looked red and good but was mushy and spoiled 🙂 – so we started with a slight disappointment at breakfast.

We got to Kabulonga quickly and Sr. Marjorie was in her office. She was so sweet and greeted Jenn and me like old friends! She had arranged for all the children to be in the physiotherapy wing for us and had a sign on the door about our visit and asking anyone in need to be there for the free screening!

Sign on door about our visit!

Sign on door about our visit!

She also offered her office to do the hearing screenings and asked if that was quiet enough! This was the quietest room we have had by far during our entire stay in Zambia!! We asked to meet the students and staff to introduce ourselves – so we all crowded into one of the physiotherapy rooms and introduced ourselves. There were 4 special education teachers, and there are 4 nuns at the convent (one being Sr. Ornela the physician at UTH) there as well as several novices. I counted about 30 children seated on the floor. And then – what a surprise we had! At a small cue from Sr. Marjorie, the children all broke into a welcome song for us! They sounded great and it was such a wonderful welcome for us!

We then set up for the screenings in Sr. Marjorie’s office, which was quite a distance from the physiotherapy room. We decided to take the kids there two by two and Jenn and I started with the first two. So – the kids scooted out of the room, pointed at the wheelchair which was theirs, hopped into the chairs and we wheeled them to the office. It was a very bumpy ride over rocks and such but the kids seemed used to it. So for the entire morning, student pairs and I walked back and forth between the office and physiotherapy room taking kids two by two, some in wheelchairs, some mobile on their own. We completed 17 screenings – because the transport between the rooms was slow going.

Teaching a child to respond

Teaching a child to respond

In the mean time the other students were in groups doing other activities. Some were in the physiotherapy rooms playing with the kids, others were holding a sign language class for staff and students, and some were also involved in a music activity.

Music activity!

Music activity!

We stopped for lunch at about noon and saw all the kids transported to the lunch area; we had our lunch as a picnic on the well-kept lawn.

Lunch on the lawn

Lunch on the lawn

After lunch we decided to add another screening station in the physiotherapy room in order to be more efficient. So I was in there after lunch and saw how rambunctious the kids were – despite their limitations in mobility, the little boys were roughhousing each other and having a grand time! During the afternoon screenings I heard more songs from the kids – they do really sound very good! I learned that they have practice daily and sing at the Saturday mass every week! The students again participated in screenings as well as activities with the kids and also observed a little physiotherapy. In all we screened 39 children by 3:45 pm, and it was once again a very good experience and show of teamwork and flexibility. Although we had expected to see children with physical disabilities, we were surprised to also see children with cognitive delays. Yet, all were screened appropriately  and as the day went on the students got more and more comfortable interacting with the children.

More hearing screening

More hearing screening

At the end of the day the kids also sang us a “thank you” song – it was very touching and humbling to have spent a day with these brave children and the wonderful people who work with them everyday to improve their lives!

Some of the group in the physiotherapy room

Some of the group in the physiotherapy room

Team Zambia with Sr. Marjorie

Team Zambia with Sr. Marjorie

After a brief rest at the lodge we went to the Manda Hill Mall to meet our UNZA student buddies – this time we had set a meeting location and did not miss each other thankfully! So 12 Purdue students and 12 UNZA students sat at the Pizza Inn and ate pizza and appeared to have a great time getting to know each other better! Jenn and I had our third dinner at the place called “Curry in a Hurry” and then went for our final grocery shopping during this trip!

When it was time to leave at 8pm, the students clearly did not want to and then another wonderful surprise! The UNZA students had brought each of us a local Zambian chitenge! We all wore our chitenges and some of the guys were showing the girls how to wear it – it was wonderful to see the students from two different continents getting along so well!

Chitenges as gifts from our Zambian friends!

Chitenges as gifts from our Zambian friends!

On the way back to the lodge, the bus was at its noisiest level ever with all the students excitedly talking about the evening with their Zambian buddies!

Tonight’s de-briefing session included as always many thoughtful comments from the students. For me this has been one of the best components of the program – to listen to the students reflect after each day, to hear their insightful comments, and to really see how this program appears to have opened their eyes has been so rewarding. Tonight’s discussion included:

  • It was not an easy day today, but it was really fun!
  • They enjoyed the personal time with the kids for the whole day
  • They enjoyed the different activities throughout the day
  • Again, they had a great deal of difficulty understanding some of the kids, but today they said they tried to use context cues to figure out what was said, or tried to get the child to point to what they were saying if they did not understand
  • They noted that despite some of the severe physical disabilities, many of the kids were not cognitively impaired; therefore it was important not to assume that the children could not understand them
  • They described how they were able to talk to a 17-year old girl as they would to any teenager: about music, boys etc.
  • They commented on how there were a range of kids today: from kids with normal intelligence and severe physical disabilities to those with both physical and intellectual disabilities, and admired the people (teachers and others) who work with these children daily
  • They acknowledged that at times it was overwhelming because it was difficult to know how to keep working with the kids for an extended period of time
  • They saw that because the kids were at very different levels intellectually it was difficult to have activities appropriate for all of them; although as the day wore on and they got to know the kids they were better able to select more appropriate activities
  • They appreciated words that one of the sisters (a physiotherapist) said: that each kid has a disability, but each also has a special talent even if it is something as simple as a great smile
  • They commented on the advantages of the environment where the kids were with other kids with similar disabilities and had a community and that they seemed to motivate each other
  • They commented on how the kids helped each other! We saw kids who were somewhat mobile, pushing others in wheelchairs, using the wheelchair pretty much as a walker for themselves while pushing their buddy along
Child pushing buddy in wheelchair

Child pushing buddy in wheelchair

  • They also learned from the physiotherapists not to help the kids too much because these activities help the kids not only improve their physical abilities but also their independence
  • They commented on some of the songs the children sang and how they were about self esteem
  • They discussed how frustrating it must be for some of the non-verbal kids who understood them but could not communicate and how may benefit from simple communication boards – and maybe we should bring some such boards or help Cheshire Homes make personalized communication boards for the kids who need them
  • They said they were able to be more assertive with the kids (after yesterday’s chaotic day where they had to control kids!)

Regarding the UNZA student meeting they enjoyed learning about the cultural differences

  • Before a wedding, brides may have their mothers choose ladies to teach them how to be a wife
  • Men pay the bride’s family for their wife; if there is a divorce, they have to pay the money back
  • Child marriages still occur
  • Men often marry women 10 years younger than them
  • At funerals, all the furniture is moved out of the house; the men sit outside while the women sit inside
  • There are no nursing homes because families take care of the elders
  • Most Zambians know several languages (we discussed how this is typical in many parts of the world and the US is somewhat unique in being such a strong single language country)

Final important thoughts included that poverty in Zambia is at a very different level than poverty in the US, that all Americans should see life in another country such as Zambia, and that although there is poverty in Zambia they are rich in many other aspects.

Another productive day in which we all learned a lot!

Student reflections

Day 10 student reflections:

From Kelsey:

This morning we visited Kizito School. This was our first school we have visited with what you would call typically developing children since we have been in Zambia. We had another early start and loaded the busses at 7:45 AM to head to Kizito. As soon as we arrived we began to clear out two of the classrooms where we would do the hearing screenings. Across the lawn the Beit Cure truck was parked with desks set up outside where our team would do the routine otoscope check on every child before the came to get there hearing screened.

Every day so far has been so unpredictable and wonderful, today was no different. This morning shortly after we arrived to the school the children broke for their 15 minute break in between classes. Half of our team was outside by the Beit Cure truck and the other half was setting up inside the classroom. Those of us inside the classroom looked up, and literally within seconds there was a huge swarm of students, possibly even around 200 surrounding the truck and the rest of our team. This would be a sure sign that today could be one of the most challenging days yet.

Some of the challenges that we faced today were the age of the children (first grade), the language barrier between us and the students, the environment, and the pure confusion and intimidation that the children seemed to get from all of us. Working with 140 first graders is probably going to be difficultly wherever you go but at Kizito only few of the children could understand English which made it very difficult to try and explain the task at hand. A great trick that I learned right of the bat from Kate was to turn the hearing screening into a game to keep the child involved. Kate quickly came up with the idea to teach the child that every time they heard the “beep, beep, beep!” they were instructed to give one of us a high five. After taking the time to condition each child so they understood the concept of the “game” we were successfully able to screen the entire first grade.

Another huge challenge that we faced was the environment where we had our screenings. It was nearly impossible to screen the children in a quiet environment. There were students everywhere outside. They were constantly peering in the windows of the classrooms, many which did not have glass over them. There was several distractions and lots of noise but overall I was very proud of our team for working so successfully and efficiently in the environment we were in.

Every day that we have had in Zambia has been so different from the next. Today may have been the most challenging, but I can say I believe I learned the most. I learned that patience is key, especially working with younger kids. Creativity is crucial, you must be on your toes so you are able to keep the child you are working with involved and attentive. And finally I am continuously reminded how rewarding it is once you have been able to get through to a child and see them light up when they realize they have successfully conquered their hearing screening or test.

From Mel:

This is a mixed reflection on events from the past week as a whole, rather than one on a specific day.

I never thought I’d be on the other side of an otoscope. Growing up with a severe-to-profound hearing loss (ototoxic drug, age 2; my audiogram plummets into no-response territory around 1kHz) I was always the kid in the booth raising my hand, the one pulled out of class for speech therapy, the one peppering the audiologist with questions and getting in trouble for disassembling my hearing aids with eyeglass screwdrivers (it turns out first-graders aren’t supposed to adjust their own hearing aids, but nobody had told me that). 2 decades later, I’m an engineering grad student, the sole non-SLHS team member in Zambia, surrounded by 13 speech-and-hearing folks whom I can pepper with questions for two weeks. Somewhere, my tiny-child self is grinning like a maniac.

Except right now I’m staring at a variant on my tiny-child self. A 5-year-old is sitting on her mother’s lap, demanding in a nasal bellow that I blow more bubbles for her; I can’t lipread any consonants in her speech. Most of the other children in the pediatric HIV center have passed, but this time the OAE screen is blinking that the girl’s cochlea isn’t responding properly; she’s failed the hearing screening. I listen as Dr. Krishnan and the other students briefly counsel the mother about following up with the local audiologist (the only one in Zambia). I wonder what the mom is thinking. The door clicks shut. “That’s how old I was when they found out,” I tell my classmates as we prep the probe tips and elephant puppet for the next kid. “That’s what my speech sounded like when I was in kindergarten.” Later, on a sunset walk, Dr. Krishnan will tell me that telling the parents is the hardest part, that they cushion the blow by spacing the tests a week or so apart to “get more detail” and to “check again,” so that there’s time for the realization to sink in and they can start to address the big unknown: what’s going to happen to my child? The ADA doesn’t exist in Zambia.

Another day. We’re at a deaf school, one of only 4 in the entire country. Students swarm through the courtyard, the little ones signing wildly, sloppily, semi-grammatically, thwacking shoulders and waving hands to get each other’s attention. They see me and break into a flurry of questions: DEAF-YOU? HEARING-AIDS, DEAF-PEOPLE-IN-AMERICA? BUT-YOU-SPEAK! And then a sign, a tapping of the nose with a hooked finger, that I don’t recognize. It’s our second visit to a deaf school, so I’m used to the irony of being our primary interpreter (it turns out that ignoring one’s interpreter from 2nd through 8th grades still leaves you with a reasonable ability to communicate in sign). I ask one of the teachers (many are deaf as well) what the mystery word means. “White-person. They never see deaf white person before.” I see the kids miming kung-fu moves – I’m also the only Asian for miles around – and laugh: “I’ve never been called a white person before.”

One teacher and I get into an extended conversation – Zambian sign is close enough to American that our rapid fingerspelling can bridge the occasional gap – and as we speed up (HOW-STUDENTS-BECOME-DEAF? MANY GET-SICK, MEDICINE DESTROY HEARING. AH, ME TOO, BEFORE-WHEN SMALL CHILD, 2 YEARS OLD IN AMERICA) I stop simcomming, I’m just signing, and my classmates are blinking at us in incomprehension. The teacher is asking me questions, amazement on his face. You’re in college? — No, I finished, now I’m getting my engineering PhD.  — They allow you into college? Deaf people in America go to college? — Yes, there are even Deaf colleges where the classes are all sign language, no interpreters. I’m sorry my signing is poor, I studied in hearing schools… — How? Amazing, to see deaf person doing PhD, someday they open brain to find out how you did this, that deaf person can go to university, we are so happy to see you, to see it is possible for deaf person to do this…

Small bits of smouldering lava are crumbling inside my chest, frustration at the great unfairness of the world. Thank God my parents immigrated to America, and for a thousand other tiny coincidences that allowed me to become who I’ve become. If the best education and career I could aspire to had been the things I’ve seen in Zambia for deaf folks, I’m pretty sure I would have been a high school dropout; why waste effort trying when the highest you can go isn’t very far off the ground at all?

I abruptly realize my classmates have no idea what we’re saying, and attempt to translate; they’ve been great about relaying things to me on noisy bus rides, in thick crowds, when I’ve turned around and don’t realize someone is speaking, etc., so I’m trying to return the favor. I relay the signed conversations in our evening debrief meetings: kids arguing, teasing, joking – for the first time in my life, I’m the only one who overhears (er, oversees?) and understands these side conversations, instead of being the only one who doesn’t. Some side conversations are just kids being silly (“They’re going to stick injections in our butt!” “You’re a big crybaby!”) but others are more sobering: after getting thresholds for a high school girl, I signed to her that her hearing was better than mine. YES, BUT YOU IN AMERICA, she replied. I NEED SIT IN THIS CLASSROOM, TOO FAR-AWAY TO HEAR. I looked at the metal roof and concrete walls, which turned the place into an echo chamber, and couldn’t reply; I’d recently whispered to the professors that the lighting was too dim to lipread, that the noise was painful, and that I was going to take my hearing aids off and go outside and sign with the students because at least there I could communicate. If some of these kids got hearing aids, I told them, they would have an awful time with the acoustics; turn the lights up, get some books or fabric in there to muffle the din, or nobody will wear them.

It’s these kinds of things, I think, that have been my contributions to the team; I’m less clumsy with an otoscope now and can operate an audiometer at lightning speed, but still ask basic questions nonstop. (What are inner hair cells? So the auditory nerve is embedded in the basilar membrane? No? Oh. What’s a morpheme?) But I’m also the first non-hearing classmate most of the Purdue students have had, and I tell them about that: how my hearing aids can’t noise-cancel the crowd at the mall, how I’d thought I wasn’t understanding the first graders we were testing because I couldn’t hear (it turns out that they actually weren’t speaking English), how the tiny visual cues (shoulder shrugs, eye glances, finger twitches) made it easy to cheat on audiograms, how the ADA doesn’t magically make all jobs equal-access, how people still speak to you as if you were mentally challenged when they see your hearing aids or hear your voice. Why I sometimes just don’t care about trying to listen because it takes too much effort. Why I’d shunned assistive services from high school all the way through college (“…you may not believe me here, but it was easier to go without them.”) I’m a stickler for lipreading during meetings: use a talking stick, one person at a time, face me, face me, FACE ME.

It’s been good to get their questions too, because I take so many of my coping skills for granted. How do I pass my classes? (I read extra textbooks during lecture time.) How did I learn to speak German? (Books and a very patient German grad student who coached the inaudible consonants into my muscle memory.) Why did I like getting pulled out for speech therapy as a kid? (I couldn’t understand group conversations in the classroom, so quiet 1-on-1 time with the therapist was often the most adult conversation I had in school that week.) I apologize to them on behalf of all the future difficult kids they’ll ever work with (“we’ll think of you when we get those kids, Mel”). I ask them to please, please explain things to their patients, feed their curiosity, push them towards possibilities they may not have considered. I don’t have the emotional endurance to be a clinician, but they do – I watch them work patiently with these kids day after day – and I’m glad we’ve got these sorts of people going into the profession.

Oh. And on the engineering side, I’ve now got sketches for portable audiometers and VRA setups and other things that would make good projects for EPICS teams… but that’s another story for another time – perhaps next year.

Day 10: Kizito School and Kalimba Farms and Reptile Park

Day 10 in Zambia – the running group did their run and after another breakfast of toast (and bread for some because the toaster stopped working), but also watermelon and bananas, we departed for Beit Cure Hospital at 7:45am. We reached there on time, this time without forgetting any adapters or other supplies fortunately! We had to wait there for a while, until Alfred and others came.

Once again we were going to a school – this time a regular primary school called Kizoto School and we were going to screen hearing of all the first graders at the school. The ENT truck came along with both the nurses (Evelyn and Charity) and also Patson, the audiology tech, and they examined all the children’s ears.

Once again we also passed through some rough neighborhoods getting to the school, although the school building and grounds looked good.

Garbage heap close to school

Garbage heap close to school

The school building and grounds

The school building and grounds

We met Mr. Katongo, the head teacher and he welcomed us and arranged for us to have two rooms for the hearing screenings.

Team Zambia and Mr. Katongo

Team Zambia and Mr. Katongo

We had some initial difficulties setting up the equipment because the rooms had no power sources! So Patson had to go buy some batteries to use the battery powered audiometers – we eventually did get set up with 4 screening stations. The chaos started pretty soon thereafter! I believe the kids had a 15 minute recess and all of a sudden there were literally hundreds of children swarming around us and around the ENT truck – so much so that Evelyn took out a broom and shooed them away saying they had to step back! Fortunately a teacher asked the kids to form a line so all the first graders got in line and the rest of the kids gradually returned to class.

At the screening rooms we also had kids peering into the windows and lots of groups of children talking and had to shush them and try to send them away. At first we did this politely, but then we too started being more forceful asking them to leave or go back to class, trying to desperately make the screening environment quieter so we could test the children! One staff member Timoth helped us the most by shooing the kids away from the screening rooms and trying to keep the area quiet.

Timoth - our helper in trying to keep the kids quiet and get some order

Timoth – our helper in trying to keep the kids quiet and get some order

In addition to these challenges, we were also taken by surprise that the children did not speak English, as we were not expecting that. Once again our student team did a great job overall – adapting to the situation, doing whatever it took to get the job done. For example Jill and Nicole kept the kids waiting in line to be screened entertained with “Simon says” even though most of the kids did not understand the game; Many students rose to the task of trying to keep the area quiet and under control and became more assertive. In the end we screened 142 children and finished around 12:30pm or so. The students were exhausted from their efforts and the chaos at this school!

Jordan and Mel screening a child

Jordan and Mel screening a child

However, since we had an unexpectedly short day, we decided to take a short rest and then went to visit Kalimba Farms and Reptile Park. This turned out to be another nice little park near Lusaka – although we had to drive for about 12 km on a bumpy dirt road and keep the windows of the bus closed to avoid the clouds of dust.

Dust cloud on bumpy unpaved road

Dust cloud on bumpy unpaved road

We had a guide who gave us a tour of the park and we saw lots of snakes and crocodiles ranging from small ones to huge ones that were 60 years old and weighed 3 tonnes!

Guide with little croc

Guide with little croc

Medium sized croc

Medium sized croc

HUGEcroc!

HUGE croc!

At the end of the tour we also got to hold an African python if we wanted! Mel was the bravest and wrapped the whole snake around her and also held its head. Others were not as brave!

Mel with the python!

The "not so brave" :)

The “not so brave” 🙂

There was also a trampoline and miniature golf, which we enjoyed for a little while.

Trampoline!

Trampoline!

And miniature golf!

And miniature golf!

Then it was on to Manda Hill Mall for dinner. Jenn and I invited our driver Emmie to join us and he did! We had a very pleasant time chatting with him and learning more about his family and school in Zambia. His oldest daughter is in 11th grade and wants to be an economist and is doing well in school.

Emmie and me

Emmie and me

At our de-briefing this evening we had a great discussion and the students had some good insights about today’s experiences at the school:

  • They said that even though we finished early today, it was more exhausting and has been their most challenging day so far
  • They felt the language barrier with the kids today was more than at the schools for the Deaf, because there they were able to use gestures better, and found this frustrating
  • They commented on how difficult it was to condition the kids to do the hearing screening task and how they had to be more creative in their ways to get the kids to do the task
  • They commented on how many of the kids just had blank stares; but they did also see how once the kids understood the task many did well
  • They discussed clinical decision making – and how undergraduate students were getting to experience and participate in more advanced graduate level skills
  • They discussed how they became more assertive with controlling the kids to reduce the chaos
  • They discussed how the swarming of the kids was overwhelming, and how “micro breaks” may be helpful as needed
  • They again discussed cultural differences: how the pace of work here is different (slower) than the US; how the kids were likely overwhelmed and maybe intimidated by the large group of “muzungus” (white people) that came to their school
  • They appreciated some of the older kids (9th graders) who were prefects, who helped try to keep the kids organized
  • They commented on how rewarding it is to work with kids, even though it is often difficult
  • They also realized that sometimes you may do everything possible and not be able to test a child and that is OK – it is not you but the child in some cases
  • They also had some great suggestions on how to make this experience better
    • Keep this experience but not have it be the first thing students do in future years
    • Brief the school ahead of time about what we are going to be doing
    • Introduce our group to students and staff and explain what we are going to be doing
    • Learn phrases in the local language
    • Have a translator / staff member in each room
    • Start off on a better more organized fashion (because once we started with chaos it was difficult to recover from it)
    • Prepare more for this day (which was difficult this time around because this is the first time we are doing this)
    • Discuss the normal school schedule with the head teacher so we know about recess or breaks when all students are going to be out of their classes

All in all a challenging day but with a lot to be learned from it!

Student reflection from Kate:

Today was yet another interesting day here in Zambia.  I went into the day thnking, we’re just doing screenings on first graders? not a problem after visiting two schools for the deaf but boy was I wrong.  Our visit started off with the Beit Cure truck being swarmed by children and the chaotic theme continued throughout our time there.  Although testing the kids had its challenges I’m not too surprised considering their age as young kids can be challenging to work with but the types of challenges were different than what I expected.  What surprised me most was the difficulty we had with communication.  This was so surprising because going into today I assumed this school would be the easiest to test because they could hear and I thought they could speak English, compared to the other two schools that basically just used sign language.  Even though our environment was not ideal because of the open/broken windows  that let sound into our testing rooms I’m impressed each time we make these situations work.  Whether its turning the screening into a fun game or chasing other noisy students away from where we were testing the group is continuing to show flexibility which has been key on this trip.

Previous Older Entries