By: Jann Morehouse
In October of 2010, I was invited to go to Jamaica as part of a “therapy missions team”. At the time, I gave it very little thought; it was a nice idea, but ME doing speech therapy in another country? Living in unknown accommodations? Eating unfamiliar food? Probably not, and I put the thought away.
But the idea kept coming back up, when one therapist or another would say, “I’ll go if some of you others are going.” Yeah, I thought, that is easy for you to say, you are an occupational (OT) or physical (PT) therapist, you know about positioning, and orthotics and weight-bearing. That stuff is universal. What am I going to do as a speech therapist in a foreign country? Well, the answer came back – you could do feeding therapy, sign language, language development. Oh yeah, guess I could do that. Well, I will pray about it, I said. Well, that took care of that. God provided me with a sense that there was some benefit to my going to Jamaica as part of a team. And on December 4, 2010, I made the commitment to the trip. After several months of preparation and a few team meetings and not a little angst on my part, we left for Montego Bay on April 2, 2011 at 6 am.
Here are a few of my thoughts and experiences from that trip.
Just a few words about the “missions team”. The idea of a therapy team to Jamaica was one which our group’s leader, Marty Walker conceived after several previous trips to Jamaica. There is very little “therapy” available on the island of Jamaica, even in the hospitals in Montego Bay and Kingston. There is a clinic in Montego Bay that offers physical therapy one day per month for who ever can get to the clinic. But they have never had an occupational therapist (OT) or a speech therapist. Even if services were available in Kingston, that is a four hour drive one way for the residents on the other side of the island and most of the people don’t have cars or don’t have money to spend on transportation. Our “therapy team” consisted of four therapists (one physical therapist, one occupational therapist, one occupational therapist assistant, one speech therapist), and a nurse. In addition, we had two other women go with us to help with moving people through the clinic, etc. and three men (one, the husband of the OT, and two college age men) who went to help with cement work at a school building.
The goal of the trip was to provide as many children as possible with a therapy session and offer materials, equipment, and suggestions to parents or teachers on how to help the child function better in their daily life. We knew that one visit would not make a significant difference in a child’s situation but if we could provide some suggestions, maybe their life might be improved. We were scheduled to provide therapy for three days (Mon – Wed) at the clinic in Montego Bay, a training session for some of the parish workers who learn their job with on the job experiences and occasional workshops. Thursday was to be the day to visit two orphanages in Jamaica and Friday was a “fun” day. As it turned out we were able to provide therapy on Thursday morning at the house where we stayed, for four children whose mothers had heard we were there as therapists but they couldn’t get to the clinic by 4 pm on Wednesday. While there we also planned to work as much as possible with Sashika who is the 7 year old daughter of the minister who was hosting us.
SATURDAY APRIL 2, 2011
Arrived in Montego Bay at noon, by 2 pm we were at the beach to enjoy a nice lunch, a swim, and glass bottom boat ride until 5 pm when we left to drive to our “home” for the week.
“Home” was a private residence where two young women lived. They would allow us to live there for the week and would cook our meals. Shawna and Janet and Bibby (Shawna’s sister) welcomed us graciously and fed us wonderfully for the week. “HOME” was in the town of Ramble, 15 miles from Montego Bay. Although only 15 miles, it took 45 minutes or more to drive the narrow road up the mountain. It was barely wide enough for two cars (one in each direction) not to mention the people who walked on the side of the road. The trip was often slowed down by the sugar cane trucks that were overloaded and drove slower to avoid tipping over, something that was a daily occurrence.
After arriving at the house and eating dinner, we tried to unpack our therapy supplies to be more “organized”.
Bedtime came early as we were all exhausted from waking up at 3 am to catch the plane at 6 am.
SUNDAY APRIL 3, 2011
We were picked up by Pastor Kingsley Smith and taken to his church for Sunday School and the worship service. After church we had a delicious fried chicken lunch with his family (wife Symone and four children) at the parsonage. We spent some time that afternoon working with Sashika. The primary focus was on fixing the stander and walker that they had but could not put together so Sashika could use them. After Sunday's supper of cake (a traditional Sunday supper in Jamaica) we retired early to be ready for our first day at the clinic.
MONDAY APRIL 4, 2011
Our work at the clinic was scheduled to begin at 10 am each morning. Our goal was to arrive by 9 am on the first day to set up and organize the therapy services. Unfortunately, “Jamaica time” interfered and for reasons outside of our control we did not leave our “home” until almost 10 am. Therefore we arrived approximately one hour after we were scheduled to start. Children and their parents had already been waiting for more than an hour, so we hurriedly set up in the two clinic rooms and in the outer waiting area and began to see children. We worked frantically that day seeing a total of 16 children by 4:30 pm. Some of the children received all three therapies, some only one or two therapies, depending on the need. Most of the children needed to be seen by at least two therapists. It was hot, confusing, and overwhelming at times. Some of the children were so developmentally disabled that without specialized equipment and on-going bi-weekly therapy there was not much else to offer. Other children were provided with orthotics to help with walking, hand splints to help with fine motor skills, feeding suggestions, and sign language or picture communication tools.
After all of the children and parents had gone, the physical therapist noticed a stander under a pile of boxes in the office. She asked about it and learned that the staff did not know how to set it up or use it. It was decided that first thing in the morning, the stander would be set up so that children who would benefit from it, would be able to use it during the clinic, and in the future.
Going home exhausted, overwhelmed and yet somewhat exhilarated we ate dinner, worked with Sashika and went to bed.
TUESDAY APRIL 5, 2011
We arrived at the clinic at approximately 9:45 am. Although some families were there and waiting (they come early – when they can get a ride) we took a few minutes to try to plan the therapy – we would provide service as a team for thirty minutes to decrease the amount of time it takes to gather information, etc. That plan lasted only a few minutes as I saw children for speech while the OT and PT set up the stander. As the morning progressed, the pace became very hectic once again but each child was given at least thirty minutes of therapy and was able to be seen by each therapist if necessary. We saw some very tough kids that day. Some that stick in my memory are two 10 year old twin girls who were very busy. They had characteristics of autism, they would not engage in any activity with an adult or each other and just ran around outside. Without special educational services it was very difficult to offer suggestions that would be effective. The stander was used for several of the children that day and one of the boys was able to demonstrate the ability to use picture communication cards to facilitate communication with his parents.
After a brief stop by the beach to put our feet in the water, we went home to dinner and to work with Sashika.
WEDNESDAY APRIL 6, 2011
We arrived at the clinic shortly after 10 am. We set right to work, but the pace seemed a little slower at first. Then it picked up and we worked frantically until 4 pm. The initial plan was to finish at 1 pm and then provide a 1 ½ hour training session to the workers who see children in the schools. But new children arrived whose parent had heard about the therapy services. After an hour of answering some of the worker’s questions we were ready to leave the clinic.
It had not been a perfectly organized therapy clinic, but we provided therapy for a total of 53 children over the course of three days which translates to 106 – 159 therapy sessions. Almost all of the children saw at least two therapists during their visit to the clinic.
THURSDAY APRIL 7, 2011
We didn’t really know when to expect the four children we were to see at the house. “In the morning” was all we knew. We were up and just finishing breakfast when the first little boy arrived. As we began to work with him as a group, the second child arrived and within a few minutes the other two were there.
The two success stories of that morning were four year old Dante and 13 year old Shauntala.
Dante, a four year old twin crawls because he is unable to walk. He does not speak and makes only a few occasional sounds. His mother thinks he may be deaf and is trying to have him evaluated so he can go to the deaf school on the island. Dante responded to noises and verbal directions and during my brief time with Dante he was able to imitate a few simple signs to indicate that he wanted something. His mom had not tried to teach him sign language as she thought he would learn that at the Deaf school. She had tears in her eyes as she saw her young son communicate with me using some simple signs. She left that day with several pages of signs to use and suggestions for increasing his use of sounds.
Shauntala is a 13 year old girl who lost her left arm at the elbow at age three. At that time her father passed away and she lost her ability to walk and talk. When she arrived at our house in a taxi with her mother and aunt, her mother got her out of the taxi and carried this 13 year child up the stairs on her back. That is how Shauntala gets around, on her mother’s back. Once upstairs, it was demonstrated that with maximum support on each side Shauntala could shuffle her feet to walk but her feet and ankles were not strong enough to support her. During her session with the OT and PT, the therapists asked about the possibility of a wheelchair for transportation. Symone said she thought there was an old one at their church but she didn’t know if it was broken. Two people jumped in the van to go and get the wheelchair. Harry, the husband of the OT, was able to put it together, it fit Shauntala perfectly! She was also fitted with a pair of orthotics to help stabilize her ankles. But her shoes were not the right kind to use with the orthotics for walking. After discussing the possibility of getting new shoes with Shauntala’s mother and aunt and learning that they had no resources for shoes, Jody gave Shauntala her hiking sandals. They fit Shauntala and provided the traction necessary to help her use the orthotics to learn to walk. When it was my turn to see Shauntala, I was not sure how I would be able to help. But I learned that she had full use of her right arm and was cognitively able to respond to requests to point to pictures appropriately. I gave her mother a set of picture communication cards with some suggestions on how to use them to give her daughter a means of communication besides just shaking her head no.
SUMMARY
Over the course of three and one half days we saw 57 children. Although not everyone received something that made a significant difference in their lives, several did.
Children will now have access to the stander in the clinic office for once a week treatment.
Three children were measured for wheelchairs and the chairs were ordered.
One child received a wheelchair.
Five children received a pair of orthotics.
Several children received hand splints to facilitate fine motor control.
Several children and their parents were taught sign language to facilitate communication and stimulate speech.
Three children received picture communication sets to facilitate communication in the absence of verbal skills.
The Jamaican workers received some training on the benefits of sign language and working with children individually and in a fun way.
