Working with the SLPs!!! Rahhh!!!

I am going way out of order with this blog, but I'm so excited to share with y'all the things that I've been experiencing at my pasantia. For those of you who don't know, I chose to take this trip rather than go to Spain because of the opportunity to have an internship in a hospital with a speech language pathologist. I'm so excited that this week I finally had the opportunity to work with speech pathologists at Hospital Garrahan.
       Monday morning was my first day working with the fonoaudiologa. I had stayed up until midnight the night before working on a presentation and  when I woke up at the crack of dawn, I was tired out of my mind. But the excitement overwhelmed the exhaustion. Dr. Bes had given me a hand written slip that told me where I needed to go, but I didn't understand some of the symbols so I got lost. I had to ask three people before I finally figured out where I needed to be (their accents where really hard to understand). LOL! When I finally found the speech clinic I was introduced to Alicia, the fonoaudiologa (I'm gonna refer to her as an slp  from here out because that's easier to type) that I would be working with, an slp resident, and two other slps that I cannot remember their names. Alicia explained to me that at Hospital Garrahan the speech clinic is located in the psychology clinic. In the office next door there was an office that has child psychologists that specialized in maturation. Children that come through this office are often sent to the speech clinic to evaluate their speech. Hospital Garrahan is different from other hospitals in that the slps here only make evaluations and reevaluations and direct children to other hospitals for treatment. Many of the patients have speech problems as a result of grave diseases and disorders. As a result, most patients come to the hospital from far away provinces. So it only makes sense that slps here perform evaluations and send children to hospitals that are closer to home for therapy.
           We started off our day reading patient histories. There were five patient histories that we read. The majority of the children were on the autism scale and had both receptive and expressive speech problems as a result. Alicia read really slow and clearly so I understood the majority of what she was talking about. However, I think she thought I couldn't understand because she kept asking me if I knew what she was talking about. I started asking questions that I knew that answers to just to show her that I was following along with her. Alicia and I would be working with one patient that was five years old.His mother was an immigrant from Russia and the boy had speech delays in both Spanish and Russian. I knew this was going to be an interesting case. The little boy walked in with his mother and adorable baby brother, who looked to be about 1 year old. His mother had a slight Russian accent (which made it interesting to hear her speak Spanish). Alicia's eval was very similar to those performed in the United States. She had the little boy use blocks to mimic tasks that she was doing with the blocks then she had him identify and name pictures in a book. It was extremely sad to see the delays that the little boy had. What made it even sadder was that the little boy was five years old and this was his first time receiving a speech evaluation (autism is usually diagnosed by age three). He couldn't label the majority of the pictures that the slp showed him and he couldn't mimic many of the tasks that she was performing. In addition, you could tell that there was no discipline in the house because the little boy was doing things intentionally to get the attention of the slp while she was talking to his mother (this is a behavioral problem, not associated with autism). What made things worse was that the mother could not understand the majority of what the speech therapist was telling her and did not seem to be proactive about finding help for her son. This was a very sad evaluation to observe.
         I was very surprised that I spent four hours with the slp on Monday and only observed one eval. In the hospitals in the US where I've observed, I would usually see 6-8 sessions in the span of four hours. Nevertheless, it was awesome to get to observe an slp in a different country.
        Wednesday, I met with another slp that works with Alicia. We started off our day just as Alicia and I did. We read through patient histories together. Wednesday was particularly hard to focus, because this slp spoke extremely fast and was hard to understand. I had a paper due Wednesday afternoon so I was running on 4 hours of sleep. Needless to say it was a struggle to concentrate. Luckily one of the slps made coffee for us which was just enough to keep me through the day. We had a reevaluation with a boy that was 12 years old. Because he had been born severely premature, he had many delays and complications which were still causing problems to this day. He had received speech therapy in the past and the slp was reevaluating his speech to see what had changed since his initial evaluation. Unfortunately not much had changed. It was extremely hard to understand the boy. Although his reception was excellent, he mumbled and his speech was slurred and "muddy" sounding. In addition, he had trouble pronouncing his rs, ts, and cs. When the speech therapist asked his mother if he was still receiving treatment, she said that he was but it was hard on the family because they had to drive an hour each way to take him to see the speech therapist. However, he goes to an excellent school for those who are handicapped. The school has a farm and a garden and teaches the students how to tend crops and take care of farm animals. The boy had expressed a large interest in gardening and his school was preparing him for a related career. Learning about this school was interesting as this special treatment is usually written into the curriculum in special education programs in the public school system in the US. The slp and mother decided that because the boy's speech was not improving and he was doing so well in school, it was not worth it to continue with speech therapy. Although it was sad that the boy could not improve his speech he was very fortunate to have such a great education that would help to compensate for his lack of speech.
        After that reeval I was able to sit in on 1/2 of a reevaluation with another boy who was about 5 or 6. I was not able to read this little boy's history so I'm not exactly sure what was wrong, but I knew that during his initial evaluation his speech was horrible and his reception level was very low. As the slp performed his reeval he was doing much better. He was able to identify 90% of the pictures that she showed him and his speech was pretty clear. I was really happy that I was able to see two patients today!
        Wednesday afternoon I received an e-mail from Dr. Bes asking me to call a lady by the name of Margot. He told me that Thursday morning I would be working with the plastic surgeons who perform cleft palate corrective surgery. Thursday morning I was in the hospital with a room full of surgeons waiting to meet  Margot. When Margot arrived we headed to the conference room with the surgeons, who discussed the surgeries that had been performed last week...a girl who had been scratched by her dog that needed corrective surgery on her eyelid, another girl with melanoma that had covered her entire right cheek and nose (they removed the entire portion covering her cheek), and several patients who had had cleft palates. The surgeons provided corrective criticism for each surgery and discussed what needed to be improved.  Next we went to a cafe and had cafe con leche with the doctors. Then we headed back down to Margot's office. Margot explained to me that she was a speech pathologist that specialized in swallowing therapy and therapy associated with cleft palates. I've been told on numerous occasions by slps in the US that if I wanted to be competitive in the job market, this is where I needed to specialize. I could barely contain my excitement to be working with her. Margot worked alongside an odontologo (a dentist) and evaluated the speech/swallowing of those patients who had received surgery.
         The first patient that we met with was a 13 year old girl who was born with a cleft palate and received her surgery at the age of 3 years old. She had NEVER received any form of speech therapy after her surgery. This was unbelievable as children with cleft palates have to learn how to swallow correctly and speak correctly after their surgery. I cannot imagine this little girl trying to learn the ropes on her own. The girls speech impediments were very obvious. She had problems pronouncing dentals (words that your tongue has to touch the roof of your mouth (ex: "t") or between your teeth) and nasals [words that the air comes through your nose to pronounce(n, m etc) ]. To make things worse she seemed to have some sort of psychological delays. When the slp asked her if she had hearing problems the little girl said yes and pointed to her left ear and mom said no and said sometimes she gets water in her ear when she bathes (which could mean a middle ear infection that can cause deafness). Just like the little boy with autism, the mother didn't seem to be too invested in the health of her daughter. Finally the slp asked the little girl to open her mouth so I could see what a palate looks like after surgery. Normal palates are rigid and curved. This little girls palate came to a point like a tee and her teeth were misaligned. It was very interesting to see.
            The next patient was a little 2 year old boy that had received his treatment a year ago. He was your typical terrible 2 year old. When I said "hola" to him he growled at me. lol! Then every time the speech therapist asked him to talk he said no (you can tell he just learned this word) and screamed bloody murder when she tried to show me his palate. He put on an oscar winning performance when the slp pulled out a tongue depressor...all screams and no tears. Next, we worked with a 16 year old girl that had just received her surgery last year. This really put things into perspective for me. In the US, children are born everyday with cleft palates, but they have their surgery right after their born and speech therapists work with their mothers in the NIC-U. Thus, most children in the US don't have to experience the complications and social stigmas associated with cleft lips/palates. We are truly lucky here. This girl needed one more corrective surgery for aesthetic reasons only (one nostril and 1/2 of her lip was limper than the other). Margot showed me where the girl had received prostetic teeth and gums to help compensate for her cleft. The most amazing part of the day was when a woman walked in with her baby that was 13 days old. The baby was born with a cleft palate and needed corrective surgery. Margot and I watched as the odontologo fitted the baby with a mold. The mold would then be analyzed and altered so that a prosthetic could be made and the baby could have her surgery. This was really amazing to watch. The baby was fussing away but her parents where so calm and loving. She was amazing able to use a bottle (this is often really hard for babies with cleft palates and dangerous, because their nasal cavity is not protected and they can easily get respiratory infections from the milk.). I wish that I could see her progress after the surgery. Finally we met with a lady who had a baby that was 8 months. He was born with a severed uvula (the flap that prevents food from entering your respiratory system and air from entering your digestive system) and was extremely underweight because of it. However, he had received surgery and was now gaining a healthy amount of weight. Wednesday was by far my most exciting day at the hospital. I am so fortunate for receiving this opportunity to have an internship in a foreign country & it's gonna be so sad to have to leave this amazing country.

Ciao for now!

Jackie