Cambodia Exploratory Trip 2008
Karen Froud and Cate Crowley visited
Karen Froud is an assistant professor in the Speech-Language Pathology and Neuroscience & Education programs at Teachers College,
Karen has a long-standing association with
Karen and Cate were accompanied on the trip by Sam Froud, Karen's 9-year-old son, who became the designated trip photographer -- a role he carried out with patience and finesse.
After long journeys via (for Karen and Sam)
On leaving the Bayon, we stopped in at a couple of the large Buddhist roadside temples which are currently active in the area. The official religion of
AHC was the first of the organizations we'd scheduled to meet. The hospital is supported by Friends Without A Border, an NGO operating out of
Dr Housworth explained that the hospital each year receives many volunteers, and surgical missions, and that there's a difficult balance to be maintained in terms of deriving the greatest benefits for the people served by the hospital while minimizing the inevitable drains on hospital human resources incurred by training and supervising volunteers. Bill invited us back to AHC to meet with the Medical Director, Dr Ngoun Chanpheaktra, and one of the senior pediatricians, Dr Varun Kumar. On this second visit, Varun was kind enough to provide a whirlwind tour of the AHC facility, which includes state-of-the-art operating rooms and intensive care units, as well as a nutrition program, a model farm where visiting families are taught how to raise beneficial crops for their families, a dental clinic, and the services of a play/art therapist.
Varun and Pheaktra discussed with Cate and Karen the possibility of piloting a visit from a small group of TC students, with supervision to be provided by Cate, Karen and other clinical supervisors, and we're in the process of working out details of when this can happen, and what form such a program could take. The pilot visit would provide us with even more concrete information about the best and most beneficial (for students and for the local community) ways to structure a clinical experience in this environment. One identified need was for AHC professionals to receive training in SLP-related issues so that the work could continue even when the students and professors from TC are not around; we also discussed possibilities for tele-practice as an additional means of addressing the sustainability question.
Dr Housworth at AHC had mentioned HI as an organization we should try to connect with, and we were very glad we followed his advice. The offices at HI are a mix of administrative, workshop, accommodation, education and rehabilitation facilities. The organization was initially established to provide prostheses and rehab services for people who have lost limbs in landmine-related incidents, but the work has extended to provide remediation of "clubfoot", provision of special seating and mobility aids for physically handicapped individuals, and physiotherapy and other support for those with cerebral palsy. We met with Mr. Sok Sophorn, the manager of the Siem Reap outpost of HI, and his very able assistant manager. Karen and Cate told them about the plans for SLP provision and training, and were pleasantly surprised to discover that a recent survey commissioned by Handicap International out of Singapore, had designated speech-language pathology as an area of need in Cambodia which Handicap International were keen to address. HI were therefore very willing to consider ways to work with us.
A large part of HI's work in Siem Reap involves bringing children with cerebral palsy, and their families, to the center for a week at a time, and providing a kind of "workshop" approach to alleviate physical and cognitive difficulties. Currently their interventions are limited to some wheelchair and seating provision, with some physiotherapy and sometimes the services of a play therapist. During one of our visits to HI, we met a 2-year-old boy with CP accompanied by his mother. Due to hypotonicity affecting his trunk, the little boy sat hunched over, with his gaze permanently fixed on the floor. By showing the mother to hold his head, and change his posture, and by providing some stimulating materials (an Elmo book!), we were very quickly able to engage the little boy's attention -- within a few minutes he was reaching out to turn the pages by himself. The mother and phsyiotherapist we worked with were delighted, as were we, to see just how quickly some simple-to-demonstrate intervention techniques can make a real difference. We're hoping that we can participate as service providers and trainers in one of HI's cerebral palsy workshops.
We traveled by boat to
Our work in
The CCPCR is a residential and vocational center for girls and young women who have been removed from abusive or dangerous situations at home. We arrived on a morning when the road outside the center was being dug up for new drainage ditches, so we had a hilarious journey through mud and puddles to get to the front gate. Once we arrived, we were led upstairs to see the morning dance class; the girls were dancing beautifully in traditional Cambodian style (above). After dance class we had an art class, led by Ann, and Karen and Cate joined in so that each of us worked with two or three girls. The task set by Ann was to make an abstract design using three fish shapes, three circles and three triangles; we used the opportunity to get help with counting in Khmer, and made the girls laugh at our efforts. At first it was difficult for the girls to get started, because they were concerned to try and make exact copies of the original design shown as an example. But once we got going, they all managed to come up with a unique fishy design. Ann helped everyone write their names on the designs, in English and Khmer, and one of Karen's new friends added the words "I love you" and insisted on making us a gift of her design. Cate led an "English lesson" based on Eric Carle's book "I can do it!" -- and in true Cate style soon had everyone on their feet pretending to be elephants and crocodiles, and giggling together. Then we all met the puppies that were recently born at the Center - everyone got a turn at holding them.
Some of the young women at CCPCR are talented artists, and they make beautiful paper mosaics - see some work in progress below. One way you can support the Center is buying these mosaics - please email us if you'd like more information.
It's a real testament to the strength of these young women, and to the importance of the amazing work undertaken by Ann and Alex, that despite the terrible experiences they've been through, we all felt so uplifted by spending this brief time with them. Family Care
Phnom Penh Pediatric Hospital
Ann Soldner had arranged for us to visit Dr Chour y Meng, the medical director at
Cate's expertise in SLP intervention with cleft lip and palate post-repair came in very useful, as we were able to talk with parents and extended family members of children with recent repairs. We met Farid and his family -- Farid was due to have his repair the day after our visit, and was a very engaged (and engaging) baby who was delighted to try to imitate Cate's bilabial "noises". Farid's mother and aunt were with us, and quickly picked up on this activity for Farid; with the help of Dr Vanna's medical social worker, we were able to explain that this simple activity after his surgery would help Farid to start making those "front" sounds which can be very difficult for children who are born with craniofacial abnormalities. Cate and Karen will be providing some non-verbal information (pictures, cartoons) for Dr Vanna's patients to take home with them after surgery, in the hopes that a few such simple activities could help to minimize later speech disturbances.
While we expected to find children needing speech and language services, we found one thing that was completely unexpected - a very lonesome EEG machine! Dr Vanna also showed us the operating facilities at the hospital, and then took us to the emergency room, where Karen was delighted to find a 36-channel EEG setup for monitoring brain activity. The system had been generously donated from
Dr Mok Theavy of Operation Smile works out of the
Krousar Thmey ("New Family") School for the Deaf
Krousar Thmey, like Family Care
Where do we go from here?
There is much that we can do and many children who need our services. Most of the places we visited have a number of children with a variety of communication disorders that we could help. We also have identified particular disabilities that we could target, such as children with repaired cleft palates after they have recovered from their initial surgery to close the palate, and children with cerebral palsy who lack effective communication systems. All of the places we visited seemed like fertile ground for providing quality clinical training for our graduate students.
Perhaps what we found most remarkable about many of the Cambodians we met is their thirst for our expertise. As we played with the children post-cleft repair in
We'll use this webpage to publicize our ideas and plans for a speech-language pathology training experience in
Thanks Sam for the photos. Sam is available to hire for photojournalism assignments of all kinds, in all locations around the world; please contact his mother for details..