Soi Dog Foundation: Jackson & Mitchell

Trying to be lazy no more, we have upped the homeschooling to all morning and have begun volunteering a couple of times per week at the Soi Dog Foundation. They are a wonderful organization that cares for the 20,000 stray dogs here on the island of Phuket. Probably the most important thing they do is spay and neuter all these homeless dogs, as well feed them, clean them and house them until they are restored to health. They welcome volunteers of all ages, so it is a perfect fit for us and our dog-loving boys. You can read more about the great work they do by clicking on the link above.

Here's some more details from Mitchell and Jackson. . .

Mitchell: We heard about a foundation called "Soi Dogs" here in Phuket, which means "street dog" in English. They rescue stray dogs there, and they give them a home and take them off the streets. They also let people come and walk dogs, so the dogs get a chance to run. around and socialize. We came one day, and Jackson and I got to walk dogs. I picked a nice golden dog named Tesco, because she was found in the parking lot of the Tesco Lotus supermarket. She has a big scar around her mouth, because she had a bad owner who wanted to starve her, so he tied a wire around her mouth so she couldn't eat or drink. Jackson picked a white dog named Shirley. We walked them to the end of the street and back. Since. it was very hot outside, we couldn't walk very far without getting very hot quickly.

For that day, we only walked those two dogs. But the next time we came, we walked Shirley and Tesco, with another dog that had bad fur who looked like he wanted to walk, so we took him too. After we took them, we brought them back and took another group of three dogs for a walk. This time, Jackson took a big brown and white colored dog, I took a big black dog, and Dad took a big German Shepherd-looking dog. Mom didn't walk a dog because she carried all the supplies and water bottles. The dogs were really big and hard to control, but they were nice dogs. After that, we went back home and are looking forward to going again. I like Soi Dogs because I think it is a good foundation and it was fun to get to walk dogs.

Jackson: We found out about Soi Dog Foundation, where they keep stray dogs and sometimes cats from the street. They take care of them and you can play with them. We became volunteers and we go two times a week to walk, brush, and play with the dogs. We took a dog named Shirley and a dog named Tesco each time and some more dogs. It's fun doing it.

Jackson has a special fondness for this fluffy white dog named Shirley:
Brushing Shirley:

Mitchell taking Tesco for a walk:

We all have a soft spot for Tesco - explained later:

Soi Dog Shelter, there are a couple of these kennel areas on the grounds:

Impossibly clean kennels at the shelter - dog waste is scooped up regularly and the floors are hosed clean several times in a day. I think we've stayed in dirtier hotels, believe it or not:

The founders had areas of shade constructed within the kennels; they have thought of everything for these dogs:

Time to give some other dogs a turn for a walk and a brushing:

Beautiful Tesco - notice the scar across her snout. . .

Tesco's scar - someone wrapped a wire around her jaw which prevented her from eating, drinking, or barking. She was found emaciated in the Tesco Food Store parking lot and brought to the Soi Dog Shelter. We will all miss her when it's time to go.

Kwaheri Kijabe

Today is our last day in Kijabe, Kenya. Three weeks have come and gone quickly and tomorrow a company called Safe Ride Safaris will pick us up for a four-day safari in Lake Nakura and the Masai Mara. People at Bethany Kids and the AIC hospitals have been thanking me for coming and introducing speech-language therapy here, but honestly I feel as though I have learned more from being here than anyone else. In the photos immediately above and below, mamas and their babies are returning home after successful cleft lip surgery. They will return next year, when the babies are bigger and stronger, to tackle the closure of their palates.

I have met some amazing people. Below is a photo of Mercy (chaplain at Bethany Kids) and Ann (new speech therapy assistant at Bethany Kids). Ann is also Mercy's daughter. We were treated to a delicious Kenyan meal at their home last night. Mercy has told me now that I have "given birth" to speech therapy here, I have to keep feeding it, it's "my baby". Mercy has this hypnotic way of speaking that I could listen to for hours - a very wise woman. I feel a big responsibility on my shoulders to ensure that this new position and speech therapy service really work out here. To all my SLP friends back home, I'm gonna need your help!!

Here is my class. . . (L-R) Elizabeth, Carol, Joyce, Michael and Ann. A mixture of OTs, PTs and other support staff. Peter and Stanley were missing this day (both PTs). We spent a total of about 20 hours together, with me doing powerpoint presentations and leading discussions on the topics of cleft palate speech therapy, cerebral palsy, hydrocephalus and spina bifida, Down syndrome and autism. I tried to hit on all the patient populations they work with here. We accomplished alot together, including translating handouts for parents on ways to stimulate speech-language development now that their child's cleft lip / palate has been repaired, as well as creating our own photo articulation test using all Kiswahili words!

Below is a photo of Ann, myself and a young lady named Francesca. Francesca is a child mentor at the hospital. She runs a playroom for the kids in addition to counseling the moms and providing support. She is truly a wonderful person who has had a very difficult life but has an unbelievable strength. I should really do a whole blog post on her life story. Just briefly, she was a patient at Bethany Kids as a young person (like many of the staff here actually) and lost her leg to spina bifida. Despite her own health issues, all the patients draw strength from her!

And here is Elvis! I know one is not supposed to have "favourites" but I can't help it. I really warmed to this little guy. He came from far away with his mom because, even though he had previously had his cleft palate repaired, he was having serious speech problems. In fact, when we assessed him, I realized I had never heard such a severe case of VPI in my career. That is, his soft palate (even though repaired) was just too short to do the job of closing off his nasal cavity from his oral cavity and his speech was excessively nasal. He had also developed all sorts of compensatory misarticulations such as trying to valve at the level of his glottis (vocal cords).

I have peered into the mouths of hundreds, if not thousands, of children in my job back home. It's part of doing a thorough speech assessment. But I have never seen such a deep pharynx - it was like looking into a cave. I asked the ENT surgeons if he could be considered a candidate for secondary surgery and they agreed. Elvis got a phayngeal flap and I was so happy for him. I also went in with Ann to watch the procedure - a great learning experience for both of us.

Here is Ann in her scrubes, getting ready to watch the surgery on Elvis.

A close-up of little Elvis. . . the surgery involves excising a piece of tissue from the posterior phayngeal wall and attaching it to the soft palate to bridge the gap. I went to see him several times after the surgery but could not get him to speak. I was anxious to hear if his hypernasality had been corrected or at least, decreased. However, Elvis was just too sore and groggy to speak and then was discharged two days later because the bed was needed. Hopefully, Ann will see him to follow-up at one of the mobile clinics the hospital organizes in his area.

Dr. Dan and Dr. Lousie (both from Canada) performing a cleft lip / palate repair. Dr. Dan has been here for years and Dr. Louise was doing a short-term mission.

Two of the most disturbing and challenging cases she had were two eight-year-old boys, both from Mogadishu who were caught in crossfire and received terrible gunshot traumas to the face. Dr. Louise performed major reconstructive surgery to their little faces but obviously they are severely disfigured for life.

Ann and I were asked to see them for speech afterwards. I cannot put their photos on this blog as it is very upsetting to see. One boy lost one eye, has no nose left, no upper lip, no maxilla and no alveolar ridge. Amazingly, his speech is understandable because his tongue was not damaged. He makes lip sounds such as. p, b,. and. m. by closing his bottom lip against where his upper lip would have been. He has, in the short time since injured, developed all kinds of ways to compensate for missing oral structures and when I watched him and his mother interacting, I could tell there are very few instances of communication breakdown between them.

Here is one of my favourite signs so far. It says "Only God Knows Butchery". Kind of gives new meaning to the term "mystery meat". . .

Ann and I, along with David the adminstrator of Bethany Kids Africa, did a day-long trip to. Joytown Primary School for Children with Physical Disabilities. in Thika, Kenya. I later wrote a short proposal for funds for a speech therapist. Most of the kids have severely disordered speech, secondary to cerebral plasy. It was a hard day for me, because there is just so much need there it almost overwhelmed me. But the fact that such a school exists, with staff dedicated to working with these kids, is encouraging.

Below is a photo of Frances, a little guy with hydrocephalus and spina bifida and a great sense of humour.

Hereis another little boy who could really use a picture communication book. He is nonverbal because of cerebral palsy.

Some of the kindergarten students. . . they later sang to me without any prompting. Of course I was delighted!

Driving back from Thika, beautiful tea farms everywhere. All Kenyans love their chai time, but it's their coffee that I love the most.

Baboons are a regular sighting on the front lawn of where we're staying. The babies hitch a ride on their mamas' backs.

Ted took a great shot of Mt. Longonot at evening from the front veranda of our place here.

Jackson and his adorable friend, Terryanne. Somehow they managed to communicate and play together and have lots of fun, despite the language barrier. I have never seen Terryanne without a huge smile on her face.

Many mornings, while I was at the hospital, Ted took the boys to the library at Rift Valley Academy (boarding school here) to do their work in a conducive environment. It's a huge campus with every amenity. I imagine some people choose to be missionaries here just to get their kids in such a great school.

Just one of the gyms at Rift Valley Academy. There are gyms, soccer fields, racquetball courts, tennis courts, basketball courts, a pottery studio, music roms, art studios, two libraries, a chapel, a huge cafeteria, the list goes on. . .

So tomorrow we head out on safari! On Mt. Longonot, we saw two cape buffaloes come stampeding the hill. On the way back from visiting Longiro, we saw zebras. And on the way back from Thika, we saw an elephant. So I kind of feel like I'm on safari already but looking forward to more animal sightings. Kwa heri for now!

News from Kijabe

Sasa from Kijabe!

Finally, we have found a place to access the Internet. Right now I'm in the town of Naivasha, near Kijabe. Usually Kijabe has Internet but it hasn't been working since we've been here (about one week now).

Slowly, slowly (pole, pole), I’m learning a little Kiswahili and Sheng to help me interact with patients and staff at the hospital. Actually not so much to converse with the staff, as they all speak very good English. Sheng is a sort of patois – a slang-like dialect that is a mixture of English and Kiswahili, with a few other languages borrowed from as well. It’s mostly spoken by the younger people here and, from what I can discern, the young people speak it to each other to keep their parents from knowing what they’re talking about. Sasa is a greeting, kind of like hey, how’s it goin’? It has been a bit of a surprise to us how widely spoken English is here, especially in Nairobi. English and Kiswahili are both official languages of Kenya. There are a multitude of tribal languages also, but Kiswahili seems to be the unifying language of both Kenya and Tanzania.

So we have been here in Kijabe for almost one week. It’s been very busy for me, volunteering as SLP at the AIC Hospital, but maybe a bit boring for Ted and the boys. We haven’t been able to post any updates on this blog, as connection to the Internet is very sporadic here. As they say here, TIA (this is Africa!)

We will be in Kijabe until the end of November. The first two weeks, I am part of a Smile Train ENT team that is here from the US. In this first week, the two ENT surgeons, along with one ENT resident and one plastic surgeon from Montreal, have repaired close to 60 cleft lip and palates. Also on this team are a nurse-anesthetist, two other nurses, and a family practitioner. These people are all in and out of the operating rooms so I don’t see a lot of them during the day. My role is a bit different. I have been asked to devote a good chunk of time to training a speech-language pathology assistant. She was hired just prior to my arrival. Her name is Ann and she is a lovely person. She is a Kenyan who speaks four languages (English, Kiswahili, Turkana and her native language, Kikuyu). She also has an undergraduate university degree in medical sciences. I think this is such a brilliant idea – truly sustainable in the sense that who better to deliver basic speech therapy than someone from the same cultural and language background. I hope we can cover lots of ground so she feels equipped for her new role. The third week it will be just Ann and me seeing patients (mostly children) together, as the ENT team will have left.

My assignment was pretty open-ended so to feel more organized and less anxious, I set up a schedule for myself. We have a teaching time the first and last hour of each work-day and the time in between, we see patients together, doing speech screenings, hearing screenings, dispensing solar-powered hearing aids, and demonstration speech therapy for the parents (usually moms). Ann is also helping to translate a couple of speech-language handouts for families into Kiswahili. After the first day, I was asked if the rehab staffs from the two local hospitals here could sit on the teaching sessions, so now I have a little “class” of 6 people (Ann plus three occupational therapists, one physiotherapist, and one support staff person). We meet in the small hospital library and I am so thankful that I have this laptop with me, with all my powerpoints and video clips loaded. Otherwise I would be creating a curriculum completely from scratch.

As for Ted, Mitchell and Jackson, they spend the mornings doing home-schooling, relaxing here in the house where the hospital has put us up (no TV once again), and in the afternoons they might go exploring a bit. Kijabe is very small. It’s a mission station. Most people here are working for one of the two hospitals, the Bible College, or the boarding school for missionary children. The patients come from all the outlying villages and they typically speak no English. One highlight for the boys has been the baboons that run around the front lawn. It sounds cute but they are actually quite dangerous. We’ve heard that the baboons have cornered, killed and eaten large dogs right here in Kijabe. The view from this house is amazing as well – a clear view of a volcanic mountain called Mt. Longonot.

Ted is also helping one of the doctors (the one from Kingston that facilitated us coming here) to construct some type of cistern to capture rainwater, as there are often drought-like conditions and a serious shortage of water.

I’ll try to post some more updates from Kijabe, if we can get through to the Internet from time to time. We have many great photos of Kijabe and kids who have had successful cleft lip/palate surgery at the hospital, but unfortunately none are loading right now. The Internet is just way too slow. I'll try again later . . . kwa heri (good-bye)!

Update from DJ and What's Next

Just before we left Ottawa, my friend Darlene gave me her fleece jacket to take on this trip - heretofore known as DJ (Darlene's Jacket). I promised to send updates once in awhile but I've been a bit negligent with that. Truth is, until this past month of October, DJ basically just hung around (on a hook that is) waiting for the weather to chill.

I remember we actually went swimming on Sept. 30th at Narbonne-plage. Unbelievably, my mom reported snow in Saskatoon not long after! In early October, the weather here started to turn and DJ has been at my side (actually on my back) ever since. DJ would like everyone to know how exciting her life has been this part month . . . galavanting all over Carcassonne with Arms Akimbo, checking out the paleolithic cave paintings at Grotte de Niaux, browsing the early-morning market in nearby Revel, or even just strolling around St. Papoul. The mornings here are especially chilly right now and DJ is the first thing I grab to throw on over my PJ's before I stumble downstairs to put some coffee on. One of my favourite activities that I will miss is walking along the Canal du Midi all the way from St. Martin Lalande to Castelnaudary (takes about 60-70 minutes). Right now the fall colours are spectacular. I could not do that these days without DJ!

Who needs a coat like this when I have DJ? Please note, I have had my hair cut since this photo!

But alas, DJ may have to hang around unused again for awhile, now that we are preparing to head to Africa. Here's what is coming next for us:

-depart St. Papoul and drive to Paris this Sunday
-fly to Nairobi, Kenya via Zurich (just one night in Zurich)
-arrive in Nairobi on Tues., Nov. 3rd

One of my dreams is coming true! I will get to participate on a cleft palate mission in Kijabe, Kenya for 3 weeks in November. It's a long story how this came to be. Here's the condensed version. I had credentialled as a volunteer with Operation Smile and applied to several of their missions. However, I never "got the call" (at least not yet anyway - there is still Vietnam and Cambodia ahead). I decided to contact Smile Train, an organization with a similar mission of repairing cleft lip/ palate in developing countries. One key difference with Smile Train is you more or less set up your own mission and they provide support. They give you a stipend for certain expenses and put you in touch with their medical partners around the world.

One of the names on the list jumped out at me - Dr. Dan Poenaru in Kijabe. He is from Kingston and he and his family had visited our church back in Ottawa a couple of years ago. Just before we left Ottawa, I had coffee with a wonderful woman named Zeta from my church. She had encouraged me to contact Dr. Dan when we got to Africa and to be sure to visit Kijabe if we could. Dr. Dan has been a pediatric surgeon at the AIC Hospital and the adjoining Bethany Relief and Rehab wing in Kijabe for about 6 or 7 years, I think. And there was his name, at the top of the list given to me by Smile Train. Coincidence?? After contacting him, things just really fell into place. We will be in Kijabe until Nov. 28th. They are hiring a local Kenyan women who has shown some potential to be a "speech assistant". In addition to assisting with a visiting cleft palate team of ENTs and plastic surgeons from Canada and the US for the first two weeks, she will be shadowing me and I will spend the third week intensively training her to carry on basic speech therapy after I leave.

After Kijabe, it will be safari time (Rift Valley Lakes plus Masai Mara) and then off to Tanzania. Our plans for Tanzania are not completely firm yet although we know we will spend 2 weeks in Longido helping Corey Wright from Sauti Moja. The plan is to build and paint bunk-beds for their Child-Mother project. Ted will be our lead man with that project! We hope to visit the famous Ngorongoro Crater and Zanzibar as well.

I've been doing a bit of research on the Swahili language. (Here's an aside - ever wonder what the difference between Kiswahili and Swahili is? Now I know. Kiswahili is the language for most of East Africa while Swahili refers to the culture as a whole including the language. So to say someone speaks Kiswahili or Swahili is really the same thing). Another thing I learned is that Kijabe means "place of the wind" in Kiswahili, not surprising given that it sits along the Rift Valley escarpment at an elevation of over 7000 feet. I mention this because maybe - just maybe - DJ will see some action in Kijabe after all . . .

A good news post

There is also good news. I will save the best for last.

The tiles have arrived! Phoning twice a day for a solid week clearly paid off. Squeaky wheel and all that.

Our new stove arrived! The first night I baked a casserole in it and the oven got so incredibly hot that I almost singed my eyebrows off when I reached in to remove it. I had become used to a lukewarm oven and forgot what heat feels like. So what I'm trying to say is I no longer feel like sticking my head in an oven, ha, ha.

I have a powerful new laptop! I purchased a new laptop through my employer's purchase program, so I got a bit of a deal. Now we need to get busy and load the various software we'll need for home-schooling.

And now for something quite exciting . . . I got to observe a cleft lip repair at the Children's Hospital of Eastern Ontario (CHEO)! Dr. Duncan, a well-respected pediatric plastic surgeon, graciously agreed to let me watch the two-hour surgery. There is a fabulous nurse, Sue Hunt, who is the backbone of the Cleft Palate Team at CHEO, and she got me into the OR. They gave me scrubs to put on and a mask (which I put on backwards, I felt lik a dork when one of the nurses had to fix it). The morning of the surgery I was up by 5:30am to get to the hospital very early as they start right away. Dr. Duncan even brought in one of her massive textbooks to show me the procedure she was using. It was fascinating. She narrated everything she was doing and why, so I certainly learned a great deal. I wanted to see this as I hope to volunteer with Operation Smile in either Africa or South-East Asia during our year away.

I have to say I found it tiring to stand in one spot for two hours and I was not even doing anything with my hands. I don't think I could ever be a surgeon. I also could not really differentiate what I was seeing. For example, the surgeon would point out the obicularis oris muscle that she was attaching but it looked nothing like pictures of muscle fibers in an anatomy book. The little baby was 3 months old, a very gorgeous chunky little fellow. I met his parents and you could feel how concerned they were about everything. The lip surgery went well and he will probably have his cleft palate repaired around age one year. It's hard to imagine that in many developing countries these kids grow up into adults (well, the lucky ones actually do get to grow up) with these gaping clefts unrepaired.

One amazing coincidence occurred in the Operating Room. The anesthetist actually knows my sister Lori - they went to med school together in Saskatchewan. I forget exactly how we figured this out. I think someone mentioned Sask., so I mentioned I grew up there which led the ansthetist to comment she went to med school there, to which I added "so did my sister", etc. etc. Lori, if you're reading this, Dr. Marion Gould says hi!



I also spent some time observing in the various Cleft Palate Clinics, including speech pathology of course (thank you Sussie!) as well as the dental clinic, ENT and audiology. Thanks CHEO for some great PD!

One Smile at a Time

One goal I have for myself in our year away is to take part in an Operation Smile medical mission. Operation Smile is a private, not-for-profit medical services organization that travels to developing countries to repair cleft lips, cleft palates, and other childhood facial deformities. I first heard of this organization years ago as a speech pathology student in Toronto. It always seemed like it would be an exciting and rewarding volunteer experience. Next year, if everything lines up as I'm hoping, this dream could become a reality.

Operation Smile was founded by Dr. Bill Magee, a plastic surgeon, and his wife, Kathy, a nurse and clinical social worker. In 1982, the Magees traveled to the Philippines with a group of medical volunteers to assess and surgically repair children's cleft lips and cleft palates. They encountered far more children suffering from facial deformities than were equipped to deal with on that trip. They were forced to turn many children away but rather than succomb to discouragement, they took stock of the enormity of the need and founded Operation Smile.

Cleft lip or cleft palates occur in approximately one out of every 700 live births. In the western world, corrective surgery would occur within months of that infant's life. But in developing countries, these children can live for years - sometimes even into adulthood - with unrepaired clefts. The consequences to their ability to eat and to speak are obviously very signficant. In some cultures, these kids will be hidden away by their families because of rejection by their villages due to a lack of understanding of the condition.

Since 1982, more than 120,000 children have been treated by thousands of volunteers in Central and South America, Africa, Middle East, Eastern Europe and Asia and thousands of healthcare professionals have been trained globally. According to their website, Operation Smile now have a presence in 51 countries. Operation Smile builds in sustainability and capacity-building by coming alongside professionals in these developing countries and offering education and training. Mission-based education ranges from full-scale medical conferences to informal workshops on a specific skill or technique.

Each medical mission is compised of a team that includes a plastic surgeon, anesthesiologist, pediatrician, pediatric intensivist, biomedical technician, speech pathologist, child life specialist, dentist and nursing staff. Each medical volunteer has to be credentialed by Operation Smile. I began this process last year and am happy to report that I have now been approved and am offically in their database as a credentialed SLP. . . aka future volunteer. The process involved a lengthy application listing courses and training in cleft palate/craniofacial anomalies, letters of reference, copies of degrees, proof of certification and licensure, and an up-to-date CV. A couple of months later I got the good news!

And so now I keep checking back to their mission schedule, waiting to see which countries are being scheduled in our timeframe of August 2009 to August 2010. Of the countries we have in our own itinerary, there are several that overlap with previous Operation Smile missions. They include in Africa the countries of Kenya, Tanzania, South Africa (and more recently Lesotho) and in South-East Asia the countries of Cambodia, Laos, Thailand and Vietnam. Keep your fingers crossed that a mission will be scheduled in one of these countries that matches up with our flight path.

An international mission is usually a few weeks in length. About 300-500 children receive full medical evaluations and 100-150 children are surgically treated. Each year Operation Smile organizes about 25 international missions. I don't really know if Ted and the boys would be allowed to be on-site during that time. I hope so and I'm sure, at a minimum, it could be helpful to have extra hands available particularly during the intial screening period when hundreds of families are waiting in line to be seen. Also, the Child Life Specialist typically needs volunteers to play with the children who are waiting for their surgery and so this might be another opportunity for the boys, under Ted's supervision.

I would invite you to check out their website - the videos and mission reports are especially moving. For example, view the one below. I get goosebumps - so anxious for this time to come.