Tag Archives: SPG

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

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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