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Bolivia 2009

 Bolivia 2009
Program in Speech Language Pathology
Teachers College Columbia University
Catherine Crowley, MA, CCC-SLP, JD, Director
crowley@tc.columbia.edu
Miriam Baigorri, MS, CCC-SLP, Clinical Director

 
The Bolivia Project is a combination of an academic seminar and a clinical practicum experience. Currently it is only open to matriculated students in the master’s program in Communication Sciences and Disorders at Teachers College Columbia University. The seminar focuses on cultural, linguistic, educational, and political issues that affect services for Bolivians with disabilities. Students are placed at one of three practicum sites. They provide speech and language services there under the supervision of ASHA-certified speech language pathologists. Students also prepare workshops on disabilities for teachers, medical staff, and parents focused on how to enhance communication skills. During the 4 weeks of providing services in Bolivia, students acquired between 40 and 60 clinical hours.

2009 is our fourth year going to Bolivia and providing services to people with communication disabilities. Our three main practicum sites remained the same as last year: Camino de Sordos, a school for the deaf; CEREFE, a medical center and school for students with disabilities in El Alto that has been offering services for over 20 years; and Hospital de Niños, a national pediatric hospital.
 
Sustainability:
We are always working to make our work sustainable and we are very gratified when we see it happen. At CEREFE two of the classrooms still used the songs that 2008 TC students created when they were there. We built on those songs and added more. They also continued to incorporate the books and literacy-based language tasks that the TC students integrated into the classrooms in prior years. 
 
This year at CEREFE and Camino every class did plays and sometimes musicals based on books. Some of the books were adapted. For example, Caps for Sale became Mandarins for Sale because we noticed that mandarins were the principle produce in the market right outside of CEREFE. In this Bolivian version the seller imitated the hypernasal sing-songy way the women sell their goods in the market, and included some hard-bargaining Bolivian style.
 
At Camino de Sordos we continue to provide aural habilitation in real time via skype over the interent from our clinic in New York to the school in La Paz three mornings a week. Camino students who received hearing aids last year have had an entire year of aural habilitation therapy. Their parents and the teachers have been present during the sessions and have learned by participating and engaging the children in front of the computer screen in La Paz. 
         
 The Spanish Language Component:
This year 11 of the TC students arrived in La Paz 7 days early for intensive Spanish classes at Instituto Exclusivo. Classes met for 4 hours per day and students were in groups of two and three. This was the second year that the intensive Spanish component was offered to the non-native speakers of Spanish in response to suggestions from the students in prior years.

Th
e Charlas (Workshops):

This year we offered a full day of talks at CEREFE focused on skills within a variety of topics: Down syndrome, hearing impairments and deafness, cerebral palsy, autism, and language delays in young children. The day was well publicized beforehand; 35 teachers from eight different schools and centers for the disabled attended. One teacher came from Cochabamba, over eight hours away.     
At Camino we gave a talk on the use of hearing aids and how to stimulate language development in the deaf at Camino de Sordos. The parents and teachers learned how to maintain the hearing aids, and ensure that the battery is working and the ear mold continues to fit.                                   
 
 
Another opportunity for charlas presented itself at an orphanage in La Paz. We had been working with three babies under 12 months at the hospital who were admitted for reflux, aspiration pneumonia, and bronchitis. When they were discharged they were sent to their home—the Virgin de Fatima orphanage in Obrajes. We contacted the director and offered to do some training on feeding and language stimulation. The charlas at the orphanage were interactive and experiential, and even though half of the audience had just spent 24 hours working, they were extremely interested and had many questions..  As a follow-up to the charlas, a number of us returned to work with the caregivers during feeding showing what could be done for those children who were most “at risk.” With so many extra, and experienced, pairs of hands to feed her 15 toddlers, one caregiver exclaimed, “It must be my birthday!”  We donated a number of books before we left and the director asked us to promise to return for more training next year.
 
 
Hearing aids and aural habilitation:   
  
 With Melissa Inniss on board we added an audiological experience in the afternoons. Her work was again funded by the Downey Family Foundation. Through Melissa’s efforts, all the students at Camino have at least one hearing aid. They each also have custom made ear molds. While at Camino, we did telepractice in reverse checking out the quality of the sound in La Paz with Elise Wagner, Assistant Clinic Director, on the other end in our speech and hearing clinic at Teachers College.
 
Through the continuing generosity of the companies who have donated the hearing aids, four children at CEREFE received hearing aids for the first time. Few if any of the students at CEREFE have ever had hearing aids. So the work must begin to establish the knowledge base in that school and community on the importance of hearing aids, and how to keep them running. Dr. Ricardo Quiroga is quite interested and indicated that the fonoaudiologist at CEREFE might work on this project with us.

 
Impact of Bolivian politics on education and people with disabilities: 

 1)  In June 2009 President Evo Morales instituted a program whereby families with children with disabilities could register and receive a financial stipend. With this incentive, families brought their children to centers like CEREFE who had never been in school. We worked with two extraordinary cases. One 13 year old girl arrived at school for the first time. For the first few days she did not seem to see anyone but just sat with a fearful and bewildered expression. She had no means of communication--not even by facial expressions or gestures. Two of the students started working with her. In the few short weeks we were there, the girl began to smile and laugh and request bubbles from a drawn colored picture. She began to request more pattycake by putting her hands on the students’ hands to make them move in a “pattycake way” and even began to request hugs by gently placing her hands on a student’s  elbows and moving her body ever so slightly forward. The other case was an 11 year old with dwarfism. He had never been to school but had taught himself to write his name but did not know how to teach himself to read. He was clearly at least of normal intelligence and maturity, but because of his size disability he had never been taken to school. The offer of the stipend changed that. 
 
 
2) The Ministry of Education has determined that within four years all students wh disabilities be integrated into general education classrooms. Michael, one of the students from Camino, was attending a general education school in the afternoon and Camino in the morning. On our way to visit the school and observe him in the class we learned that the teacher did not know that Michael was deaf for the first 5 months he was in her class. We arrived to find Michael lost in a class of about 35 other students. The teacher was alone, with no special education support or training. It was impossible to imagine any child having academic or social success in this model of inclusion.
 
3) In an effort to reach out to people with disabilities CEREFE has a pilot program where a team of professionals goes out into unserved communities. The team visits people who cannot leave their homes due to incapacitating disabilities. We visited three such homes and each of us felt so grateful for what is available in the United States. One 17 year old girl had some serious swallowing and communication problems. We were asked to evaluate her communication and swallowing skills and prepare a written report with recommendations. We have since learned that they are implementing all our recommendations.
 
 Excursions:
 
 This year the students also had the opportunity to participate in several cultural excursions.
 
We met renowned the renowned Aymaran indigenous artist Eusebio Choque. He invited us to his studio in his home with beautiful views of all of La Paz. Eusebio had just returned from a trip to the United States. His work is of indigenous people primarily from the Potosi region. He paints them without faces but focuses on the textiles that the people wear to have them come to life. 
 
One was a weekend trip to Lake Titicaca, the lake that borders Bolivia and Peru. There we visited Copacabana, La Isla de Luna and Isla del Sol. A highlight of our stay at Isla del Sol was a visit from a yatiri, (translated as shaman in English), who performed a sacred ceremony with us. He made a sacrifice on our behalf to the Pachamama (Mother Earth), wishing us each individually health and good fortune in life and incorporating elements of Christian prayer. Yatiris are well-respected spiritual authorities in the Aymara culture, and it was incredible to have the opportunity to participate in a sacred ceremony with this yatiri.       
                                  
Another excursion that several of the students participated in was a trip to Sucre, a colonial city in south-central Bolivia, and Potosi, the highest city in the world and a mining city that used to be a great source of wealth for the Spanish empire. We visited the mining mountain “Cerro Rico” and witnessed an extraordinary festival held once per year in June: The festival of the llama sacrifice. The llama sacrifice is offered to Pachamama, Mother Earth, to ask for protection over the workers who work in danger in the mines.

 
We spent the entire day at Cerro Rico with a special family featured in the award-winning documentary The Devil’s Miner (2005). We found Bernadino, Basilio, Vanessa, and their mother, who all still live in the same house as in the film. They provided us with a tour of the mine and shared their festivities around the llama sacrifice with us. We interviewed the two boys, Bernadino (now 16) and Basilio (now 19) about how their lives have changed since the 2005 film. We learned a lot from our conversations with them and have remained in touch.



Teachers College Bolivia 2009
Director: Catherine Crowley Clinical  Director, Miriam Baigorri
 
CEREFE: Miriam Baigorri, Supervisor.  Students: Noor Al Radi, Alana Bibergal, Ashley Ganin, Yael Herzskopf-Oreamuno, Jessica Lew, Christine Mullaney.
Camino: Melissa Inniss, Supervisor. Students: Sheeva Abolhassani, Llee Hardy, Jessica Salas, Sarah Schuman.
Hospital de Ninos: Pamela Andres, Supervisor.  Students: Blanca Armilla, Ashley Khwaja, Jayne Miranda, Tamara Naparstek, Sara Schwarzwalder, and Caitlin Ruderman (honorary).