Tag Archives: Speech Pathology Group

Bhutan Summary from SPG Clinic Director, Lisa Cameron

“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.”  ImageImage


The Only SLP in the Country Left “Months Ago…”

Hello All,

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


Autism in Tuzla Day 2

I am writing this blog on Tuesday night, Bosnian time. It is the end of day 2 out of a two week experience. SPG: CSI has come to Tuzla to accomplish 3 specific goals:

1) Co-host a 5-day seminar presenting evidence-based treatment and diagnosis information about the autism spectrum disorders

2) Meet with 10 families in their homes, determine the goals for their child, model treatment interventions and leave the family with programs that can be followed in years to come

3) Open the second classroom in Bosnia for preschool children that incorporates effective interventions for children with ASD. This classroom is intended to be used as a training center for university students and professionals from throughout northern Bosnia.

SPG:CSI intends to meet the goals by having a multidisciplinary team of 11 people from all over the US and Australia present imperative information to professionals and parents in a vaiety of formats.

For those of you who have been supporting SPG:CSI, these goals are not news to you. We have been in the process and planning stages for over one year. So let me, as the President of CSI and the fortunate team leader for these amazing professionals, tell you what has happened in only a very short time.

I met the team upon their arrival in Zagreb, and we began the journey to Tuzla together. As expected, people were tired and hungry, but they came with smiles and full of hope. We arrived on Saturday night. The hotel we are staying in is in a perfect location- close to the classroom and close to downtown restaurants. We share our grievances about the lack of hot water, the intermittent internet access, and cramped quarters, but we do so with a light heart. We know why we are here, and our purpose is greater and will give us more than what these acommodations can weigh us down.

Day 1: We began the day with little sleep. The night before we all laid in bed quietly, silently, while our minds raced about what was to come in the next two weeks. Would we have enough to give to the parents and children in Bosnia? Were we qualified enough to be here, to present such vital information, to work with children with such extreme needs? Would we be able to meet the needs? We are only ordinary people, with ordinary lives in the U.S., but somehow here it seems we need to be more! Do we have what they need?

At 8am we left our hotel to begin our various jobs. Some people left in small teams, paired with University students, to make home visits. There are three teams seeing a total of 10 families, for three visits each. On day one the goal is to identify the needs of the families, the goals for their children, and begin to implement effective intervention to help the families meet these goals. Most of the children are over age 10 years, and their goals include potty training, using a spoon to feed themselves, or learning to say their first words. Fortunately, we have a team of behavior analysts, speech therapists, psychologists, and sensory-based professionals ready to tackle any goals that the parents may want.

For the Family intervention team, their first day was filled with emotion. By the end of their first visit, all of their initial trepidations were gone. The families in Bosnia are incredibly receptive to learning new ways to teach their children, and are grateful to have us in their home. We are equally grateful that they allow us to share in their journey of autism.

Personally, my highlight of day one was when I got back to the hotel at the end of day one and I spoke with one of the professionals who had been to see a family in the home. He and the University students were talking about how exciting it was to go in the homes, to meet the kids and to begin intense training on essential skills. Then I hear Eduardo say, “Anna, we need to buy a toilet.”

??? What? We need to buy a toilet? Why?? Eduardo begins to tell the story of a 17 year old boy who lives in a home where the toilet is located outside the main home, and is what we consider a “turkish toilet”. Essentially, it is a hole in the floor. The child can go “#1” in this toilet, but he does not have the core body strength to hold himself upright to go “#2# in the turkish toilet. The family has chosen potty training as their number one goal. If the child can be fully independent in toileting, then the mother and father will be free to run daily errands and other essential tasks, and the 17 year old will not have to wear a diaper.

Currently, the mother waits at school during the hours her child is there in order to help her son go to the toilet. The school will not help the family potty train this young boy, and when considering his future, it is very bleak. There is no family freedom, and this child will never be fully independent unless he learns to go to the toilet alone.

So when Eduardo says to me that we need to buy a toilet, I was aghast! A toilet is not in our budget. A toilet is not something we have considered as a goal. A toilet is not anything I have ever had to consider as part of my profession! But nonetheless, if we buy a western toilet, the child will certainly learn to use the bathroom independently. So as a team, we began the 2 day search for a western toilet installation for this family. I will let Eduardo and the rest of the team explain the rest of the toilet story. For now, I can tell you that we have a temporary fix and tomorrow the potty training begins in earnest.

Day 1 continued: For those of us on the Seminar team, we began our day with excitement and fear. At 9am we had a press conference in which 3 TV stations and 4 radio stations were present. In addition, we were placed directly in front of the Vice President of Bosnia and her cabinet, as well as the Minister of Education, the Minister of Social Politics and Labor, and representatives from every level of government in Bosnia. We had coffee together, we smiled and shook hands in front of the audience, and we did our very best to represent SPG:CSI and all the people affected by autism.

At 9:30 am, the seminar began. We met people who came from Serbia, Montenegro, Croatia, and other ex-Yugoslav countries for our presentations. Even though they traveled far and wide, some people in the audience initially looked at us with hesitation and mistrust. Our panel of experts knew the information we were giving was the most up to date and reliable information in the field of autism, so we began the seminar with confidence. In the first few presentations there were very few questions, which indicated that people were not ready to connect with us. Day one went by without a problem, but we all left feeling like we needed to somehow break through the barriers that separated us.

Day 2:

Home visits continued. The search for the toilet continued. The suitcases that carried the toys and materials were emptied, the toys were out on the shelves, and the name tags were placed. The classroom needed only a few more hours of work before it was really ready for children to come. We have until next Monday. Stay tuned.

The seminar was incredibly successful.There was standing room only. We had double the attendees that were expected. As a matter of fact, at lunch we ran out of food because so many people came that were not expected. We must have gotten through to them on day one more than we knew.  Over 90% of the audience had made a connection with the speakers by the end of day one. When I told the “Welcome to Holland” story (feel free to Google this), there were tears in the eyes of many people, mostly parents. Maybe this is when they began to trust us. When Dr. Jackson presented part one of ABA, the professionals applauded and gave her high-fives. Tomorrow can only bring more successes!

Day 2 continued:

Home visits were emotional today. One particular child, who has been the focus of many professionals, has an intense preoccupation with cutting paper or cloth. She does not know how to use scissors and so she uses knives. Although she is an adolescent and almost fully grown in the physical sense, the problem with her using knives is that she is self-injurious and has had instances of aggression towards her family. If she has learned to hurt herself or others for attention, or to get what she wants, what could happen when she learns the full power of a knife?

The family was sure that removing her knives would result in a full out battle that would result in her screaming or hurting herself. When we asked if we could try to teach her new skills and get the knives away, the family stated that they did not think it would be successful but that we were welcome to try. Everyone stood back and held their breath. In a matter of a few minutes, our team was able to remove the knives from her and teach her how to use scissors. By the next visit, the child and the family should be safe and blunt-tip scissors will be the child’s new best-friend.

It is the small successes here that matter. It is when we connect with the people and hear their stories that we feel we are part of a larger, global family. It is then that we know we have a responsibility to give something back to the world in need.

Our team has shared their fears, their hopes, and their joys. We have cried together (and its only Tuesday!!!), we have laughed together, and we continue to learn from each other. Day 3 promises to be even better.

I cant wait for you to hear all that is happy and joyful, sad and scary, and all that is SPG:CSI in Tuzla 2010!!!

Good night!

The Final Countdown to Tuzla 2010

With only a few days to go before we kick off the 2010 Bosnia Autism Project, I wanted to give our supporters some very exciting updates!

The volunteer team arrives Saturday afternoon in Zagreb and then will travel by bus, finally arriving in Tuzla on Saturday night. SPG: CSI team 2010 has spent the last year preparing for the next two weeks. We have 11 professionals coming from all across the US and Australia ready to put in action all they have dreamed about until now. Even though they will arrive exhausted from the journey, I have no doubt the excitement of finally being able to meet the children and families will be energizing!

Regarding the seminar we are co-hosting with the University of Tuzla, which is called  “Autism: Our Reality”, we will be speaking on topics related to the treatment and diagnosis of Autism Spectrum Disorders (ASD) for the first 5 days. We were expecting to train 100 people each day, but yesterday I heard that we have more than 140 who would like to come on day one alone. Standing room only- I am so happy people are so interested! HOORAY!!!

While we have the seminar team speaking at the Hotel Tuzla, the Family Intervention team will be making home visits to families and children in the community. We are scheduled to work with 10 families in one week, with teams of professionals and University students seeing each family 3 times. The Family Intervention team has established goals individualized to each family, and at the end of their visits they will have provided each family with a home education, communication, and/ or behavior plan.

After we finish the first week of the theoretical training and home visits, we will begin practical training in the new Tuzla Kindergarten for children with ASD. We will have nine students in attendance from the local community, and we will provide intense training to 18 professionals and University students who will come from all parts of Bosnia. The long-term purpose of this classroom is for it to serve as a training center for other professionals in the future, and provide a place for University students studying speech-language pathology and special education to receive hands-on training prior to graduation.

Wonderful news for those of you who have been following our progress: The classroom is ready! The furniture has been assembled, the walls have fresh paint and the grass has been cut…it is just waiting for students to make it complete. Even the neighbors are now asking when the children will arrive!

We are looking forward to June 21st which is the first day of the seminar and home visits, and June 28th which is the first day of the classroom practical training.

Follow our blog to receive new updates and see pictures of SPG:CSI in action in 2010!

Tuzla Classroom and Training Center

Wonderful news! The classroom and training center has been identified and the Bosnia team has received official approval that we can use the space for one year! Professor Amela took some pictures from her cell phone and sent them to us. I love what she said, “I can see the castle it will be…”

It is quite a bit larger than the space we had in Sarajevo. This Kindergarten is currently empty and we have total use of the entire space, including the classrooms, kitchen, bathroom, dining space, etc. I will have more details of the space when I go to Bosnia in April. Stay tuned!

Sarajevo Classroom Update

After some delay, the classroom in Sarajevo has officially opened!

SPG: CSI wishes the students, families and professionals luck in their first few weeks as they get reacquainted with each other and get back in the “school” mindset. While there were only two students in the first week of school (they are expecting four students in the weeks to come), we have been told it was challenging to design goals for students, find effective ways to take data and create a workable schedule.

Our hearts are with Admira, Selma, Natasa and Dzevida- you are all excellent teachers and professionals and the students will learn so much from you! Thank you for your dedication 🙂 The good news is that the first few days and weeks are the hardest, and after that you will find your routine and the kids will come to look forward to learning with you. Please send us pictures soon!!!

On another note, we have word that another classroom may be opening at Mjedenice, a school in Sarajevo for children with special needs. Hooray!!! Amila, you truly have become quite the ambassador for evidence-based practice 🙂

Way to go Sarajevo!!!

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