Speech and Language Pathology

Ghana 2009

Fifteen graduate students and three clinical supervisors from the graduate program in speech language pathology at Teachers College Columbia University made the trip to Ghana. At hospitals andschools, the Teachers College group worked with the parents, teachers, and medical staff. The model they followed was to identify the person's communication challenges and then develop recommendations that the family and teaching or medical staff could implement.They could return for additional therapy sessions where the recommendations could be modified if needed.The TC group benefited greatly in many ways including learning how to work with interpreters and deepening their sensitivities to and skills in working with people from diverse cultures.

Clinical Experiences:

Komfo Anokye Hospital, Kumasi.Komfo Anokye Hospital we worked with Dr. Peter Donkor Maxillo Facial Surgeon and Mr. Albert Osei-Bagyina Speech Language Pathologist.Peter and Albert had arranged for approximately 20 post-surgical patients with cleft palate to come for speech and language therapy. Albert served as interpreter and guided the TC group in how to make recommendations that would be most effective from a cultural and linguistic perspective. In addition, Peter invited all of us to participate in the hospital's cleft palate team's cranio-facial clinic. Peter was extremely generous and explained each of the 20 cases and made sure that we all could see exactly what was going on with each patient.

In the fours days at Komfo Anokye Hospital, the students saw and worked with approximately 40 patients with cranio-facial disorders. Two of the babies who were brought to the cranio facial clinic were only 24 hours old. One very motivated woman who hadher first surgery to repair her cleft palate at 18 and had had five additional surgeries,came each day and made great progress.

Garden City School, Kumasi. At Garden City School the TC students provided speech and language services to students with developmental disabilities. The students were accompanied to school by their families. The teachers acted as interpreters in a collaborative approach to meeting the communication needs.

The Unit School at Effiduasi Methodist School. The Unit School's main teacher is Belinda Bukari with Eric, Geoffrey, and Adelaide completing the able teaching staff. The students ranged in age from seven to fifteen with disabilities ranging from mild to severe. In addition to providing speech and language services, the TC group worked with the teachers to incorporate the books and educational games they had brought and donated to the school.

When asked what the parents wanted for their children, most said that they wanted their children to be more independent, especially to be able to walk to the local market and to buy and sell items there. This was not possible for many of the students who could not speak and the TC group introduced AAC to these families. We created materials that reflected what they needed to communicate in the market, such as hand-drawn picture boards with symbols for water, plantains, fufu, money denominations, and other market-centered items. After seeing how effective these boards were, the families seemed very open to using them with their children.

The last day in each of the schools turned into celebrations full of dancing and singing. We were presented with gifts of bracelets, waist beads, and large bags of oranges. We in turn gave each teacher a certificate of appreciation for volunteering their time to work as interpreters and cultural informants for the students and their families so the Teachers College group could provide effective and sustainable services.

Korle Bu Hospital, Accra. Dr. Emmanuel Kitcher Department Chair of ENT and Albert Osei-Bagyina organized a number of patients for the TC group to see. These patients ranged from very young children with delayed language development, to patients with hearing loss, to older patients with aphasia and traumatic brain injury.Here again, the TC group identified the communication challenge of the patients and developed recommendations that the families could implement. Albert continued to provide interpreting and cultural insights for us and was joined in this by the ENT nurses and administrators.

Each day, Emmanuel arranged for a snack for the TC group. On the last day, Emmanuel, Albert, and all the nurses who worked with us prepared a closing ceremony where they thanked us for our work. We responded with our thanks and gave them Columbia University baseball caps.

The Seminar:

We met as a group eight times at night to discuss the readings in our coursepack and to connect our experiences to the readings. We were treated to three guest speakers: Belinda Burkari from the Effiduasi School, Reverend Monsignor George Kwame Kumi, the Vicar General of the Catholic Diocese of Sunyani, and Emmanuel Ofosu Yeboah of the movie Emmanuel's Gift.

Belinda Burkari the founder and head teacher of the Effiduasi unit school joined us with her husband and two children. Belinda said that when she decided to open the school, friends and acquaintances thought she was crazy.When she was pregnant with her second child, many people told her and her husband that her baby would be born with the same disabilities her students have--that her baby would "catch" their disabilities. Belinda and her husband described the parade of people that went through their houseonce the baby was born to see for themselves that her baby was born without any disability. Belinda's committmentto provide educational opportunities to children with disabilities in Ghana,when so little is available and so little understood,was extraordinary to witness.

Monsignor George is a family friend of Molly Singleton. He described the historical structure of the villages where each village had its own governing system with a chief and his"royal family" along with a fetish priest, the religious leader of the village. Many Ghanaians practice both Christianity and the traditional religions--attending church and paying respects to the fetish priest. Monsignor George was very supportive of our work in Ghana and said that little is know about disabilities in Ghana, and even less about speech language pathology. He described our work there as "a candle in the night."

Earlier in the trip we had watched the movie Emmanuel's Gift narrated by Oprah Winfrey about Emmanuel Ofosu Yeboah. Emmanuel was born with a deformed leg and Ghanaians with physical deformities were expected to become beggars. Emmanuel's mother died when he was young but gave Emmanuel the confidence to believe he could do more than that. His story is simply remarkable and meeting him was a gift for all of us. We hope to accompany Emmanuel for the New York leg of his dream to cycle across the United States in 2010 to raise awareness and funds for people with disabilities in Ghana.

Experiencing the cultural diversity of Ghana:

A dance troupe performed for us and then taught us some West African dances.

The visit to the dungeons of slave castles of St. Georges and Cape Coast evoked a terrible time in human history and many of us retreated into our own thoughts.

In Kumasi market, the biggest outdoor market in West Africa, we bought beautiful West African fabric and beads.

People were celebrating the results of the Ghanaian election with music and dancing. We danced with them through the narrow walkways that threaded the market.

We visited a fishing village and walked on a rope bridge over the jungle canopy.

We saw and were invited to participate in a wedding, a funeral, a baby's naming ceremony.

At Larabanga we visited the oldest mosque in sub-Saharan Africa, paid our respects to the Iman, and watched and danced in a ceremony to end the village's annual fire festival with men playing drums and other percussion instruments while the women--dressed in their finest clothes--danced in a circle.

We visited Ntoso, a village known for its adinkra dye stamp cloth.On walking safaris and in canoe trips we encountered an elephant, hippos, baboons, warthogs, and African antelope.

We visited a monkey sanctuary in a forest where the monkeys were revered by the nearby village as fetishes for the gods of the traditional religion.

The most important contribution we can make in Ghana isto work with our Ghanaian colleagues in Ghana to establish the first speech language pathology (SLP) program there. We have been invited to collaborate on this venture with Dr. Peter Donkor Provost at KNUST; Dr. Emmanuel Kitcher, Chair of ENT at U. of Ghana; Professor E.K. Wiredu, Dean of the Department of Pathology at the University of Ghana Medical School, Mr. B-Keseku Afari Danso, Registrar of the U. of Ghana School of Allied Health Sciences; and Mr. Albert Osei-Bagyina Speech Language Pathologist.

In addition to the Ghanaian professionals, Karen Wyles, an Australian-trained SLP moved to Ghana with her family in January 2009. They plan to be in Ghana for several years and Karen is very keen on working to establish an SLP program in Ghana. Karen has lived in Mali and most recently in Zambia where she was in the initial process of establishing an SLP program there. She brings extensive experience as an SLP both in Australia and more recently in Africa.

There is much in place and this will be a Ghanaian program. Our input will be simply to fill some academic and clinical holes untilGhanaiandevelop the expertise to take over our roles. Ghana already has quality programs in place that can provide some of the academic coursework needed for a SLP masters program, including the already-established linguistics and medical programs at KNUST and University of Ghana. Other necessary coursework can be covered in the audiology program at University of Ghana that is beginning in September 2009. Coursework in special education is available at the University of Winneba or by bringing in graduates of the U. of Winneba who can teach the SLP students about disability issues in the classroom such as Ms. Belinda Burkari.

For the past several years Professor Wiredu of the University of Ghana has supported three Ghanaians who are in a masters program of speech language therapy in London. Those three people are expected to come back to Ghana and join the faculty.

The issue from this end is how to bring the SLP coursework toGhana. There seem to be three ways to approach delivering the Coursework: 1) Via the internet such as through teleconferencing or asynchronic video streaming; 2) By having the faculty go to Ghana for weeks at a time to teach courses; or 3) A hybrid model in which all or parts of courses arevia internet/teleconferecing or on ground teaching.

In addition to the coursework, the SLP students will need to acquire 400 clinical hours during the master's program. It may be possible to recruit experienced SLPs from overseas to volunteer to provide supervision. This supervision could be done via the internet, through a review of a student's journal entries about the experience, by direct supervision by experienced speech language pathologists. Here again, we can implement a hybrid model that might depend on the skills of an individual student.
We have developed a draft syllabus for the speech language pathology program that is being reviewed by our Ghanaian colleagues.

 

                  

  Special thanks Alejandro BenChimol, photographer!