Our day started in the neurology department with Cheri doing an oral motor and speech-language evaluation with a stroke patient. The hospital staff was very involved in the evaluation and showed enthusiasm with what they learned about adult evaluation yesterday.
Following the neurology department, Carmen taught the staff about behavior modification techniques. The child-raising culture here is quite different, and behavior modification is like a new idea. In order for us to keep our sanity for the next 3 days, we realized not only did we need to teach behavior modification, but the staff need to implement it immediately. Ha! There was a moment when the penny reinforcement boards were brought out, where pure pandemonium broke out when the therapists were so excited to see American coins. The translator said, "It's Lincoln," and we all applauded.
The Boardmaker program was brought out, but a slight glitch was observed. The program requested was for a Mac, which is what the hospital staff has, but the program received was for Windows, which the hospital does not have. Bummer! But, everything that Boardmaker can do was reviewed and demonstrated with picture cards, schedules, and picture boards printed from the program and brought here. Upon returning home, the program will be exchanged and sent back to Amanda.
In the afternoon, we saw 2 beautiful American children, and we were pumped to get to speak ENGLISH with them!!! And once again, it was culturally appropriate for Carmen to touch little kid heads (it's not ok in this culture). They were so fun. Carmen gave articulation tips, and both kids caught on very quickly.
The final teach for the day was on speech-language checklist evaluations. When talking about the oral motor part of the checklist addressing drooling; suddenly, one of the staff members threw her hands over her face with a sigh of despair, gasped, and whispered, "Sometimes at night I drool when I'm sleeping." What she was asking was, "Do I need speech therapy????" Hahahaha! Good times in speech training!
We hit the ground running introducing speech-language therapy to the hospital staff. We first evaluated and gave recommendations to two little sweeties in an ex-pat family who moved to the area a few weeks early just to meet with us. Then Carmen did a teaching session on intro to speech-language therapy, defining articulation and receptive and expressive language. Speech development and articulation therapy tips were introduced. The staff was super receptive and enjoyed playing with speech sounds. They took lots of notes on this new area to begin in their therapy repertoire.
Following the first teaching session, another little kiddo came in for an evaluation. Recommendations were given to his mother and grandmother, and they repeatedly thanked the therapists. It was heart-warming to give them concrete things to work on at home that they never realized they could do. They were encouraged.
Cheri then evaluated an older stroke patient with hospital staff observing the eval. He was a super sweet little man and gave such good effort for tasks that were very difficult for him. It was exciting to hear him say words with sounds the staff had not previously observed him using. The hospital therapists were very involved, and tried many of the oral motor evaluation tasks themselves while looking in the big mirror. It was lots of fun!
The day ended with Cheri teaching the oral motor and communication evaluations for adults that had just been demonstrated.
We got up this morning and headed to the streets to hail a cab to Amanda's home independently..... We actually got there on the first attempt! On our walk to church we got to experience the joy of the Chinese open air morning market. It was slightly larger than the one in Fayetteville. There was anything and everything you could imagine, and even a few things you couldn't imagine!!!
We had a refreshing service with a group of people from a variety of countries including the US, Australia and India, before heading out to ANOTHER lunch. This time it was with some of the directors of the hospital. They wanted to treat us to a western meal, but still ordered around 10 different platters of food and insisted that we try everything!!! They were very friendly and enjoyed sharing cultural stories from their past and asking us questions about our lives in America.
After lunch, we visited a few more homes. The first was a family from New Zealand who are fostering a child from a local orphanage with spina bifida. WE. FELL. IN. LOVE. He had only been in their home a couple of months and was super happy and full of life! He has undergone several surgeries. One to correct his myelomeningeocele and 2 others for his hip and foot. He had received AFOs, HKFOs, HKFOs with a TLSO attached, and a stander from a recent trip to Hong Kong. We made some recommendations and the family was very thankful that we came.
Next, we visited friends of Amanda's whose son needed a speech eval. The made us dinner and we visited about living in China before Carmen got busy! She made some recommendations and may see him later next week at the hospital. Enjoy the pics!!!
Saturday morning we met the staff at the hospital and began unloading all the goodies we brought for them since this would be Macey and Julie's last day at the hospital. They were beyond excited to see and learn about each item and immediately got to playing, examining, and organizing them!
Soon after, our first patient arrived and the staff got to witness Macey working her casting magic. They were thrilled, the kid, not so much... We therapists were searching for snacks and iPads to take the child's attention off casting, but apparently this is not how they do it in China. We also saw a few other kiddos from earlier in the week and introduced them to fitting a child to a wheelchair. Once again the staff was enthralled, the kid, not so much. The male staff was mesmerized by the tools. We may just have to ship them some allen wrenches when we get home.
We had one last lunch with our new friends complete with 20+ dishes. Someone even went to another restaurant on the way, and brought us dumplings to the restaurant! We presented them with their gifts and said some kind words about each of them. They are each very special to us!
After lunch we regrouped for a trip to the countryside for a home health visit. We were to see a child who hadn't been out of bed in 10 years due to multiple fractures in both femurs and tibias, that were repaired via placement of intrameddullary nails. We weren't sure what to expect, but were amazed by this child and his family. After one visit to the hospital for an OT/PT evaluation where he stood for the first time and was given a home program, he was walking up to 25 feet with a home-made walker. His family had also constructed push up bars and a bolster from items found within their community. We were welcomed with a full meal and 2 treasure tea which was all delicious! The mother informed us that she is known for her cooking and her children only eat food she makes! We all left feeling very inspired by this family and their dedication to this wonderful little boy.
We were spent at the end of the day. Amanda's friend, who is from Texas, made us an American dinner of bar-b-que with homemade chocolate chip cookies. What a wonderful way to end the day!!!!
Looking back on everything we did today, we feel a mixture of amazement and exhaustion. We started the day by meeting with one of the hospital directors who welcomed us repeatedly and wanted to know if we liked the hospital cafeteria food. Ha! (We actually really like the hospital cafeteria food - it's much more like the "Chinese" food we're used to at home than the more authentic food in restaurants here.)
After that meeting, we headed to the neurology department of the hospital, where we saw inpatient and outpatient adults. Cheri and Carmen made the rounds doing swallowing/speech evals while Julie and Macey worked their magic in the PT/OT area. Next came Macey's teaching on AFO's. 5 or 6 outpatients were seen in the therapy clinic with a "triage-like" atmosphere, AKA minimally controlled chaos. Following lunch, more AFO and kinesiotaping were demonstrated/practiced. The male staff members were a bit apprehensive about removing shirts for demonstrating/practicing taping techniques, but after much encouragement, they complied with lots of giggling all around. Another triage clinic of chaos followed taping fun, and we then ended the day with Macey teaching NICU and infant massage. Yesterday was Julie's marathon teaching day, and today was Macey's marathon.
Amanda's staff of therapists are not currently being utilized in the NICU; however, it just happened to work out that our translator is the chief midwife in the hospital and has access to the NICU. She was very excited about the information that Macey presented and can't wait to set up a meeting to discuss involving therapy staff in NICU operations.
We had dinner with Amanda and her staff of therapists at a local hu-hot-style restaurant. Macey and Carmen might have gotten dishes that set their mouths on fire, finding out AFTER tasting that one of the spices used in the dish was nicknamed 9-volt because biting into it would be the equivalent of licking a 9-volt battery. Relationships with the staff were strengthened, and many laughs were had about cultural differences in everything from work settings to personal relationships to life ideals.
We hit the ground running this morning and didn't look up until 6:30 pm this evening! Several of the kiddos we were supposed to have seen earlier in the week came today, plus the ones already planned for. Between patients, Julie and Macey educated the awesome, awesome staff on constraint induced treatment, kinesotaping, and assessments.
The staff here is young and hungry for knowledge. They caught on so fast and had great insight and questions! They had fun trying out the techniques on each other. During the afternoon appointments several staff members utilized treatment strategies learned earlier in the day and were impressed with the results they saw with the children!
We ended the day with dinner with Amanda. She is such an inspiration doing this work day in and day out in a foreign land!
Now to bed, so we will have the energy for day 2! Enjoy the pictures!