Speech and Language Pathology

  Each year the students of Teachers College provide services to students at CEREFE. In an effort to create sustainability, most choose to work with CEREFE students who have received therapy services from TC students in previous years. Some of the AAC materials need to be recreated or reinstituted as a means of communication for these students but each year the awareness of AAC and what it provides increases. This year we provided a full day conference on AAC that was well attended by teachers and parents. With funding from the Central Coast Children's Foundation and the Wycote Foundation, we were able to provide all attendees with a large variety of materials that they could use in the classrooms and at home. In addition we incorporated a workshop in which teachers created laminated nametags for each of their students; activity choices;  and a schedule for the classroom. After the workshop the TC students worked with the teachers to implement the use of these materials to develop literacy and organize the classroom curriculum. One of the most exciting moments was at the end of the presentation when all of the teachers wanted copies of the powerpoint to refer to in their work. The major shift this year was in significantly increased collaboration with the teachers in the classroom involving the curriculum.

In addition to the conference and collaboration with the teachers, we provided direct speech and language therapy. Andrea Arce Henry joined us this year as supervisor of the CEREFE site. Together with the TC students, she developed individual goals for the CEREFE students. As with the other years, we brought many books and educational materials which we used in the classrooms. With these materials the teachers acquired skills in how to use them to develop language-based curriculum goals. One example was the continued expansion of creating plays based on Spanish picture books that we brought. The picture above right is of the "cast party" after the "Three Billygoats Gruff" play with the discarded goat horns on the table and so much joy shared by the CEREFE students, their teacher, and the Teachers College Students who worked with them.

The work in Camino continued to focus on ensuring that all the students have first-quality hearing aids with custom molds and working batteries. Dr. Melissa Inniss brought enough hearing aids donated by The Hal-Hen Company and Widex so that every Camino student has at least one hearing aid. The students worked on aural habilitation that was a continuation and expansion of the aural habilitation services had been provided via the internet from the Teachers College SLP clinic in New York to Camino in Bolivia. The telepractice had been suspended for a time before we arrived this year and the first thing one of the students asked us was why we had stopped the telepractice. We continue to work with the teachers to incorporate aural habilitation goals and Spanish language goals in the classrooms.

HOSPITAL DE NINOS: A national pediatric hospital
This year Dawn Levy Gold joined us as clinical supervisor of the hospital. There we worked with outpatients in the physical therapy rooms and with some in-patients in neurology, gastroenterology, and pulmonology. The mothers of children with disabilities know when our group is coming and begin asking the physical therapists and doctors exactly what day we arrive. Parents come from long distances with their children to receive speech and language therapy. An important part of each therapy session is the parent training that we provide through modeling and giving the parents the opportunity to act as interventionist. In addition we provided a workshop for parents on how to stimulate language development for children with disabilities.

 The Story of Alan: Miracles do happen

In the last few days of our trip, we had one of those extraordinary experiences that often happen in these trips is taking place. The workers in El Rey Palacio, the hotel where we are staying, learned about our work over the time we were there. We learned from them that one of the cooks in the kitchen here has two sons ages 10 and 7, and that the 7 year old is a child with a disability. The boys' mother passed away from tuberculosis (something that virtually never happens in the US but is far too common here) 4 years ago. The father works 6 days a week often from 5 am to 3 pm or 10 am to 11 pm. He does not have a support system to care for the boys so they are in the home by themselves. When Alan, the 7 year old, was born there were problems at birth. The father told us that because of this Alan cannot walk well and he only says 3 words. Because there are so few schools for children with disabilities in Bolivia and there is no such thing and educational rights for these children, the father did what many Bolivian parents of children with disabilities do; when his 10 year old son goes to school, he turns on the TV and locks the door and Alan is left home alone every school day.

We saw Alan for an evaluation. He was clearly a boy who has had very little stimulation and it was true that he has only 3 words--mama (for females in his life), papa, and Alje (for his brother Alejandro). He communicates primarily though gestures--gesturing to his mouth for food or drink, pointing to his pants for the bathroom--a few very basic gestures. But what we saw was a boy who could learn quickly. Within a couple of tries he was using the sign for "give me" and saying the words as best as he could. He learned a routine of what he had to do to get spoonfuls of yogurt. Within just a few minutes he had learned a handful of signs and was saying the words as best as he could. We then gave him some crayons and paper. The Eric Carle book, "The Very Busy Spider" happened to be out on the table near the paper. Alan drew the spider in detail with both body parts and all 8 legs, and drew the web around the spider. It had great detail and was at least age appropriate. 

We noticed that Alan did have trouble walking but it was easy to identify that he had mild to moderate cerebral palsy. This affected all his gross motor movements including walking and running. His fine motor movements were within normal limits which allowed him to draw the spider and web so well.

His performance during the evaluation told us that he was cognitively intact and very teachable. The question remained why had he not learned to speak? We could understand why he had not developed gestural system--because he was mostly at home alone and when he and his brother were together they probably interacted with little need for even gestures.

Although Alan was interested in and responsive to everything during the evaluation, we saw that he did not respond to someone calling his name when he was not looking unless the person yelled fairly loudly. We figured there was probably a hearing loss and Dr. Melissa Inniss evaluated him and confirmed that he has a moderately severe sloping to profound sensory neural hearing loss.

While normally that is bad news, in Alan's case, it is good news. First, Melissa will get a donation for Alan of a quality hearing aid. The second news is that with that hearing loss he can go to Camino--the school for the deaf. Over the last few years, with the hearing aids, a group of about 8 Camino students have enough hearing to learn both verbal Spanish and sign language. Alan will join that group.

The truth is that if Alan were in the U.S., he would have had his hearing loss identified close to birth. He would have had hearing aids or even a cochlear implant and likely be in a general education school. That will not happen for Alan in Bolivia. But he will be in probably the best school for the deaf in Bolivia, with caring, good, committed teachers; and with other students who can learn both sign and Spanish. He will also likely learn verbal Spanish and be able to talk with his family and friends.

On our last day in Bolivia, Melissa Inniss fitted Alan with a brand new Widex hearing aid. Alan heard his father speak to him for the first time. It was so moving. He definitely needs aural habilitation. On this trip 5 children got hearing aids who had never had them before. It is one of those miracle moments when a child can hear for the first time.

Bolivia's diversity and beauty

This year we returned to Isla del Sol and Lake Titicaca. Some of us returned to Sucre and Potosi and spent time with Basilio from the 2005 documentary The Devil's Miners. Basilio is finishing a degree in tourism while Bernadino is serving his year of military service. Others went to Rurrenbaque in the Amazon basin.

This year we also met with Roberto Mamani Mamani at a special private session arranged for us by the Museum of Contemporary Art in La Paz. Mamani Mamani is Aymaran and the most well known and well respected painter in Bolivia today. Mamani Mamani's inspiration comes from the Aymaran religion, mythology, and cultural practices.

We spent a morning with Jean Friedman-Rudovsky a journalist for Time magazine. Jean spoke with us about the political climate in Bolivia and the evolving politics under President Evo Morales.

The future

Our work can continue at CEREFE, Camino, and Hospital de Ninos through the generous support of the President, Dean, and Provost at Teachers College. In addition, the Downey Family Foundation has been providing support for our work at Camino including the ongoing telepractice. The Wycote Foundation this year provided direct financial support for our students making it the international trips to both Bolivia and Ghana financially affordable to many more of our students.

We have found that our students benefit greatly from having the experience of learning in a completely different cultural and linguistic environment. When they return to work in New York throughout the United States, they bring a different perspective about diversity. When ASHA came for the 2009 re-accredidation visit, the ASHA site visitors identified the Bolivia and Ghana programs and the bilingual/bicultural program in the speech language pathology program as the most outstanding facet of the program. When the site visitors contacted alums of the program for their input, many indicated that they continued to be influenced by what they learned during those programs. One alum stated that the program in Bolivia was "the greatest positive influence in her personal and professional life thus far."

With continued support, we can continue to offer this program to our speech language pathology masters' students. In this way, we can continue to ensure that they graduate with a deeper understanding of nature of diversity and how that can enhance the quality of services they provide. 

Continued thanks to Caitlin Jane Ruderman and Andrea Villazon, the inspirations for the Bolivia Program