Speech and Language Pathology

Ghana 2010

Collaboration between

Teachers College Columbia University and

Howard University

Speech Language Pathology Master’s Programs

December 31, 2009 to January 15, 2010

 Catherine Crowley, Director     Miriam Baigorri, Clinical Director

Dr. Kay Payne, Howard Professor     Eliza Thompson, Clinical Supervisor

Students:

Blanca Armilla,  Imari Brown,

Lauren Bryant, Ferlyne Gesse,

Brittany Goodman, Lissette Gonzalez,

Llee Hardy, Maria Hinkson,

Francesca Lormeus, Dorothy Nolan, Valencia Perry, Lauren Powell,

Courtney Wilkes. 

The Ghana Program is designed to facilitate development of the knowledge, skills, and ethical awareness necessary to practice speech language pathology in our increasingly diverse world. Students gain firsthand knowledge on the impact of language and culture on speech and language services through the academic seminar and their clinical experiences in Ghana. The goal is to develop speech language pathologists whose practice in the U.S. will be informed and enriched by the Ghana experience.

ENT PATIENTS

 During the first week, we worked in Accra at Korle Bu Hospital with ENT patients referred to us by  Dr. Emmanuel Kitcher and Albert Osei-Bagyina SLP.We saw children with language delays and a number of patients with hearing losses. We also worked with a several adults who stutter and several patients with aphasia. We treated a number of patients diagnosed with vocal nodules. Most of these voice patients work in the market and/or lead prayer services at their churches. We attended a number of church services and saw amazing services, but also saw how many people were abusing their voices.

When the medical school heard that we were there, they sent medical students to observe our work. The medical students had not worked with speech language pathologists before and initially we sensed that they thought their time could be better spent elsewhere. But as the medical students watched us work with the patients, they became more and more interested. In the end they all stayed beyond their allotted time asking questions and even jumping in to interpret. 

 CLEFT PALATE TEAMS

 We were able to work with the two cleft palate teams in Ghana.—Dr. Peter Donkor’s team at Komfo Anokye Hospital of KNUST in Kumasi and Drs. Paintsil’s team at Korle Bu Hospital at the University of Ghana at Legon in Accra. Both teams had their clinics while we were in Ghana and the teams graciously incorporated us fully into the clinics. The doctors made sure that each of our students saw the cleft or fistula or cranio-facial defect with every patient. We were also invited to give lectures on the role of the SLP on the cleft palate team to the team members and nursing and medical students in one university hospital and to a large group of medical students in the other.

One highlight was assessing and providing counseling to the patients and their families before the cleft palate and craniofacial clinic started at Komfo Anokye Hospital. We met with each of the 28 patients and their families and gave them guidance on how to stimulate language and speech based on whether the cleft was pre- or post-repair and whether there were feeding issues. We demonstrated our individualized recommendations for what the parents could do at home with each patient. Then the parents had to model the interventions and show that they could carry out the recommendations at home. A number of our students had experience using Linder’s transdisciplinary play-based assessment model so they also assessed cognitive and motor development.

 It was thrilling to see our students participate as part of the cleft palate team. They  provided the speech and language report for each patient, responded to questions, and make important recommendations in speech, language, feeding and cognition and motor development.

We were very impressed by the work of both the Korle Bu Hospital and Komfo Anokye Hospital cleft palate and craniofacial teams.  Both perform about 75 to 80 surgeries a year. They have funding to support the surgeries for all their patients including those not covered under Ghana's national health insurance.

BRINGING AAC INTO THE CLASSROOM AND COMMUNITY

We continued our work in the unit school in the Effiduasi Methodist School. It is one of 25 "unit schools" established nationwide for students with autism and developmental delays--called "mental handicaps" here. These schools are different from anything else we have found in Ghana. We had found that students with autism and developmental delays are generally educated in segregated schools and institutions, or even kept at home without an education. Unit schools are much more in line with integrated services as they unit schools are "units": of usually 2 or 3 self-contained classrooms in general education schools. While the classrooms are separate the students with developmental delays are integrated in that they attend the same school as the typically developing students.  

When we arrived at the Effiduasi school this year, the parents told us that they wanted their children to be able to go to the market for them. We knew we had to use AAC with them. Last year we made communication board with pictures of  the market food. This year we realized what was missing. The students needed a "shopping list" with the items and a way to communicate “how much”.  

We began making shopping cards. Everyone was involved and we worked late into the night making several sets. We “laminated” the cards with clear packing tape. We drew a picture of the item on the left side, and wrote the word in Twi on the top right and under that at 75% size and in a different color we wrote the English name. On the bottom we wrote the amounts.

On the way to school the next day, we stopped at the market and bought the items so we could train the students before making the market trip. We did that in the classroom. Then when the understood and the teachers understood, we all got on the bus with parents, teachers, our students, the unit school students, and headed to the market.

At the market, the students were able to use the cards to buy the items the family needed. The parents were so very proud that their children could take that responsibility. The students themselves seemed so happy that they make significant contributions to their family and participate in the market—which is the center of the community.  The market women were surprised and happy and worked with the students to facilitate the sale. The market women were saying, “Look what these students can do!” and “Be more patient. They can do it.” It was an amazing experience for everyone.

We felt that we had made a real difference by changing perceptions in the market on what these students with disabilities could do. We later learned that the following week the community information center invited Belinda for the first time to give a talk on Disabilities. As a result of this work, Belinda has been invited to attend the International Society of Assistive and Augmentative Communication (ISAAC) in Barcelona July 2010. She is also applying for a seven month teacher-in-residence program in the United States to further develop her AAC skills so that she can return to Ghana to share that information. 

CULTURAL AND LINGUISTIC KNOWLEDGE AND SKILLS

Crucial to the Ghana program is an academic seminar whereby the group reads articles and discusses those articles in light of their experiences. The seminar classes allow us to put the work we are doing in perspective and be conscious of what we are learning and gaining from the experiences.

We visited our friend Emmanuel Ofosu Yeboah again. Emmanuel is an extraordinary man. He was the subject of the Oprah Winfrey-narrated documentary "Emmanuel's Gift" about Emmanuel's life having been born with a physical disability. He has worked to raise awareness in and respect for Ghanaian people with physical disabilities. He has collaborated with  the Challenged Athlete Foundation and Jim MacClaren. Now his work is to raise money to build a school for  students with disabilities in his home of Korfuridua. This year we met his wife and two children. We all went to see land he has been given to build the school. Emmanuel is planning to cycle across the United States in 2010 to raise money for the school and some of us plan to join him for the New York leg of the journey.

This year we had a number of guest speakers who discussed their work with us. Nana Akua Owusu,a Ghanaian speech language therapist trained in the UK, spent time with us talking about her work. She and an audiologist have established the first center in Accra where people can come for speech and hearing services.

We also visited Clement Ntim the head teacher at another unit school, this one in Nkawkaw. Clement trained with Belinda under Dr. Adrian Kniel at the University of Education at Winneba. He talked about his work and how he and the other teachers work to meet the needs of their students.

We visited several of the slave castles. This year there was a new plaque in the Cape Coast Castle honoring the visit in July 2009 of President Obama and Michelle Obama to the castle. Even after several visits to these slave castles, they remain a profoundly moving, and disturbing, experience. 

We were welcomed into a number of church services. The Paramount Chief of

one region personally welcomed us to the church. We also attended a wedding and danced and made offerings. Throughout Ghana we were made to feel welcome and appreciated. 

Our last day in Ghana was our media day. We were interviewed by a Ghanaian television station on our work. Cate met with Mr. Hendrickson. Deputy Director of the Department of Special Education in the Ministry of Education, and Mr. Otaa the Director of Education for the Mentally Handicapped. We have established a collaboration to expand the funding for the unit schools. We were also cast as the audience in a Ghanaian movie starring Mr. Beautiful, a famous Ghanaian comedian. The movie director and  crew filmed all the students in reaction shots and promised to send us copies of the film when it is ready.

We have already begun to make plans for our 2011 trip to Ghana. 

Many thanks to our colleagues in Ghana for welcoming us and including us in their work.