Thanks for attending our presentation today. For those of you who did not get a handout please follow this link to our power point.
Anna, Leah, and Raquel
“I made it back to the US on December 15th after 22 hours in flight. Jet lag and the holidays followed quickly! My colleagues, (known affectionately as Dr. Brad and Dr. Kie by the Bhutanese) were able to stay on another week or two after my departure. We will be meeting up January 16th to reflect on “lessons learned” and plans for the future.
The most lasting legacy of this trip for me was an appreciation for all that we have here in the US (and may take for granted). This includes a variety of materials we use as speech therapists, but also basic requirements of a therapeutic-learning environment, e.g. adequate heating, lighting, a workable table/chair set-up for adult-child interaction, and reduced distractions/interruptions when trying to assess children and counsel parents. I also appreciated having taken Maret Wilson’s seminar on “Culturally and Linguistically Diverse Populations” right before I left, which prepared me for working with interpreters and how to use more alternative assessment methods. There are approximately 12 different languages spoken in Bhutan given its isolated, mountainous topography. Most children before the age of five speak one of these twelve “mother tongues”. Upon entrance into “PP” (the equivalent of kindergarten or the first year of school), children learn both the national language (Dzongka) and English. Most typically developing children are thus trilingual by the age of 7 years and most professionals whom I worked alongside spoke several languages, including Nepali, Hindi, English and at least 3-4 Bhutanese languages.
The country is considered “developing” and they have many world-wide agencies helping them in areas of health, education, economic growth, and environmental and cultural preservation. One of the more active agencies includes UNICEF which is involved in establishing early intervention centers. During our stay we met with UNICEF staff, and Dr. Berman toured one such center. Future efforts to bring speech therapy to the country will likely involve collaboration with such agencies and with the Ministry of Education, which together can plan and deliver service across the many different regions of Bhutan.
My role this year was more of information gathering and to expose Bhutanese professionals to our field of speech therapy. In addition to presenting to about 75 people over a three-day conference (many of whom had to ride buses for 2-3 days to get to our location), my team was observed and videotaped by teachers, para-educators, and hospital staff during consultations at the country’s only developmental clinic and at a newly formed agency supporting parents of children with special needs: Ability Bhutan Society. We also met Ministers of Health, Education, and even the current queen of Bhutan. Future efforts will likely include fund-raising in 2013 and a return trip in 2014. Given many children whom I assessed were severely impaired communicators with neurologically-based problems or syndromes, future efforts will need to specifically address alternative-augmentative communication, and parent education with respect to realistic goals of intervention.”
Today I delivered the last of three presentations to 70 professionals from Bhutan. Most were “Physiotechs” or Physical Therapists, Special Educators, and a few Ministers and hospital doctors (pediatrics, psychiatry). Many people commented afterward how much they appreciated the videotapes of clinic clients in therapy sessions, so thanks to SPG clinic staff and clients’ families who contributed to these efforts. We asked the audience about what they learned which was most surprising, and some of the comments were that they didn’t realize that therapy with children would be play-based and that parent training would be so important. Dr Berman and I also role played administering the PLS, with Dr. Berman taking the role of a “difficult to test, three-year-old child with ADHD and language issues,” with the audience clearly enjoying his antics and my efforts to contain him and get him to cooperate.
The visit to the local hospital was an eye-opener. I spoke with Dr. Philip, a US pediatrician on a two year contract, and he has as many as 28 patients with acute illness whom he cares for on a daily basis. He is on a rotating weekly on-call status 24/7, so in emergencies, has to get to the hospital at any given hour. His rounds are pretty much non-stop, 9am-3pm. Given the terrain is so mountainous and thus it is difficult to travel to the capital city’s hospital, most kids are in severe distress when they arrive.
I also met the hospital’s only audiologist. He was trained in India and has both speech and audiology degrees, but he described minimal duties as a speech pathologist. Once diagnosed with hearing impairment, children do have access to some hearing aids. There are no children fitted with cochlear implants at this time (in fact, he laughed when I asked this question)! He did have access to a sound-proof booth, also had an “audio tech assistant”, and told me his training in India took 5 years to complete. Next door to his suite was an office titled “speech therapist” but there was no one there providing ANY speech therapy given the country’s one and only therapist left several months ago.
Next week we will be doing multidisciplinary consults at the hospital Monday-Thursday. We will also be meeting with our sponsors, Ability Bhutan Society, to discuss ways in which we could be most helpful in future efforts. Finally, we will be touring the capital city’s Special Education School, and meeting with the Director there, Madam Chimi. We will also tour the school for the deaf in Paro. There are currently efforts with Unicef spear-heading efforts to provide Early Intervention Centers in key areas of the country. Dr. Berman and his wife, Shiva, are trying to ascertain how future missions could help support these efforts with respect to fund-raising efforts back at home in the US.
Tomorrow will conclude our trainings with Dr Brad Berman and Dr. Kie Johnson discussing more on assessment methods for neuropsychological and overall developmental issues.
More later! Lisa
Here is a picture taken in Paro, Bhutan (not far from the little airport).
On December 2nd Lisa arrived in the capital city of Bhutan, which is much more populated, about 80,000 people, but the landscape is still pretty spectacular. On Saturday, Dec 2nd there was an all day marathon with Ability Bhutan Society’s community events honoring people with special needs. There was something like the Special Olympics with disabled kids participating in races and such, and the Queen of Bhutan actually attended and gave out trophies to the kids. Very sweet. She then stopped by our tent and shook our hands which was quite a moment.
The afternoon ended with a forum/discussion of issues facing kids with special needs, with about ten community leaders presenting on various obstacles. They have a lot to tackle as just their infrastructure is so challenging for people with physical disabilities. There was also a lot of discussion about their special education system, practical issues of inclusion vs. special schools, how to get the government ministries more involved, etc. Dr. Berman presented on how the US has tried to tackle issues with various laws, e.g. American with Disabilities Act, IDEA and Free and Appropriate Public Education, IEPs/504s, importance of early intervention, etc.
On Dec 3rd, Lisa visited the hospital with Kie Johnson while Dr. Berman toured an early intervention center in another town.
Today, Dec 4th the team starts their presentations! We wish them the best of luck!
Well I made it to Bhutan this morning. It was smart to spend a few days in Bangkok to adjust to the 15 hour time difference and I feel pretty good. The flight from Bangkok to Bhutan stopped in Dhaka, India near Bangladesh and it looked pretty bleak out there (a lot of impoverished houses and dry, arid land). Fortunately we just remained on the plane for about 30 minutes and then flew on to Paro, Bhutan. As we descended we could see Mt. Everest and the Himalayan mountains to our left, pretty spectacular. The plane had to zigzag in a steep descent into a narrow valley which was a bit scary. We met our guide, Tshering, who drove us to a nearby hotel where we will stay for two nights. We will then move on to Thimphu, the capital city, once Brad Berman and Kie Johnson arrive on Sunday. The weather here is clear and chilly, and is supposed to get down to freezing at night. As I am writing this there are a few people engaging in an archery contest outside my window, their national sport, with a lot of good cheer and hooting and hollering. A herd of 11 wild horses and a few yak also just went by!
Once I get to Thimphu on Monday, we will take part in a Resource Fair for People with Disabilities and tour the hospital. Tuesday we will meet with various people from Ability Bhutan Society and finish preparations for our three-day training.
I will send you guys some more updates as events unfold. Hope all is well back at home! Lisa
Our time together in Bosnia is coming to an end, and the farewells have begun. Looking back, this has been a life changing two weeks for everyone. We’ve laughed, we’ve cried, and we’ve grown stronger as a team and individuals.
Tonight we had our going away dinner in Luckavac with the teams from Zenica and Luckavac. Everyone has been so welcoming and such wonderful hosts. We are all so grateful for the hard work and preparation that went into preparing our team’s arrival! Thank you everyone!!
Even though we will be dispersing across the U.S. upon our return, this trip has permanently joined us. We will think back on the memories we’ve created and smile. Yes, we introduced new ideas to the different schools and centers here on Bosnia, but we have also learned new techniques and ideas from our experience. It just shows that you can never stop learning.
Again, another huge thank you to everyone who made this trip possible!