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Dominican Republic Study Abroad Trip - Spring 2012

The following entries are descriptions of this year's trip. Days 1 and 5 were spent in travel.  These entries include perspectives from both Audiology and Speech-Language Pathology students

Day 1 - Speech Perspective by Rebecca Rogers

We finally made it to Santo Domingo!  We did not arrive at the Foundation for Peace house until 1:00 am, and we are all exhausted from a full day of travel.  We left Memphis at 11:30 am and flew in a tiny plane that left Kelly and I gripping our armrests a few times.  We made it safely to Miami, where we had a layover.  Our connecting flight ended up being an hour and a half delayed, so we all got dinner in the airport and did a lot of sitting around in Gate 6.  I was relieved when we finally got to the Dominican Republic, but I am also really anxious.  Despite everyone reassuring me otherwise, I am terrified of contracting a contagious disease, especially from mosquitoes (They love me, and if there is one within a 10-mile radius, it WILL find me).  But, I am loaded up with vaccines, malaria pills, and bug spray, so I am ready to go!  Despite my anxieties, I am very excited to experience Dominican culture, serve and bond with all of the children we encounter, and hopefully learn a lot and grow as a person along the way.  I am grateful for the opportunity to push my limits and expand the first world “box” that I live in at home.  So, with that in mind…Bring it on, DR!

Day 2 - Speech Perspective by Charlie Bird

When we were at CAES on Monday, Marilyn and I walked over to one of the classrooms that were in session. The teacher introduced us and the students asked us a few questions. Although I did not have a tremendous of knowledge of sign language, being in the sign language class came in handy and I remembered enough to answer basic questions using sign. The coolest part of it, however, was when the teacher asked the deaf children to give me a sign for my name. This is customary in deaf culture. Each child gave a slightly different and unique version of my sign name but the "h" sign made across the nose (apparently my nose is my unique characteristic) was a shared feature. It made me laugh. Overall, it was enjoyable interacting with those children as well as those with whom we did hearing screenings. It may have been a long day, but it was definitely a fulfilling day.

Day 2 - Audiology Perspective by Caleb McNiece

Despite arriving well after midnight local time due to a delay in Miami, we all were able to get a decent night's sleep. The morning began with a delicious breakfast prepared by the staff at Foundation for Peace. The overwhelming favorite aspect was the fresh sliced pineapple, cantaloupe and papaya paired with fresh squeezed guava juice.

We departed the foundation house around 8:30 on the hour drive to San Pedro. Talk about a beautiful drive. After leaving Santo Domingo, we were driving eastbound along the southern coast with waves crashing on the rocks. Arriving in San Pedro, one definitely senses the smaller town atmosphere. One of the first sights to great us was a burro hitched to a 2-wheeled cart.

CAES (Central Auditivo Experimental del Sordo) sits on the edge of town. The compound is at least 2 acres in size. Having only seen a few pictures, it was an incredible moment to see this place where we would spend the next 8 hours serving the students and the community. CAES has several buildings across the compound, not only educating students who are deaf, but also offering a traditional private school and a technical school for young adults.

After meeting Jose, the magnanimous founder of CAES and a few other staff, we set up shop in one of the classroom buildings, taking over 3 semi-separated classrooms in which to hold our clinic. The first was set as an intake from which some basic information and case history. Adjacent was our testing room: otoscopy, tympanometry, OAE screenings, and audiometry. The final room was set up for ear molds and hearing aid fittings. Mabel, one the school administrators had a list of students who had not previously received a hearing aid for us to assess and hopefully fit.

Rachel and Elizabeth were handling hearing aids and ear molds. Carla was set to be in charge of testing assisted by Sara, one of the speech pathology students. I was in charge of otoscopy and assisting the speech pathology students with tympanometry and OAEs. Finally, we were ready to begin.

As we began testing, it was a rather interesting seeing the development of a rhythm, working collaboratively with our classmates to assess and fit the children. The children were truly the bright spot of the day. So many were smiling and happy to see us, signing about getting hearing aids. Unfortunately, my signing is much less refined than Spanish (which was very useful in speaking with some of the mothers and the CAES staff), but several of the other students were more proficient signers, especially useful when communicating test instructions to a profoundly hearing impaired child wearing insert earphones and supra-aural earmuffs for noise attenuation.
I also must add that the children at CAES were a joy to work with. I have never seen so many children compliant for otoscopy and immittance testing in one place.

As we began dispensing the hearing aids, the joy on the faces as the students began to hear the world around them and excitedly sign with their friends. The heart wrenching moments came with several of the children we tested who would either not receive benefit from a hearing aid or who would receive benefit but we had already run out of hearing aids. We were still continuing to test because in April, a benefactor by the name of Ray is planning on bringing nearly 300 hearing aids down to San Pedro. Thankfully we were able to tell those we could not, that there would be another opportunity in the very near future to receive hearing aids.

Another fantastic aspect of our work today was the opportunity to restore function to several non-working hearing aids and replace several damaged and broken ear molds, thereby increasing the impact of our outreach.

A professor from the local university's medical school brought a group of students in his epidemiology and preventative medicine class to see our work at CAES today. He has great optimism for working collaboratively with the University of Memphis in the future. One of the end goals would be collaborative research into the high incidence of hearing impairment within the San Pedro community.

The most touching moment for me today was my interaction with Karen. Karen was a beautiful little 2 year old, brought to the clinic by her mother, a local physician practicing family medicine. Karen was diagnosed at 8 months with auditory neuropathy/dysnchrony disorder, based on an absent ABR response and present OAEs. The ABR was recently confirmed again, reinforcing the earlier diagnosis. Our opportunity today was to fit Karen with 2 hearing aids programmed for a moderate loss, as is common practice in children with neuropathy/dysynchrony disorders to determine if any benefit is present or if there is the need for a cochlear implant consultation.

I have had several pediatric clinical placements throughout my time in graduate school and I thoroughly enjoyed them. I do find myself lacking in confidence when it comes to otoscopy and ear impressions of littler children. I can't explain it, I just feel that I am afraid of not knowing my own strength and hurting them, hence I have struggled with being timid around the smaller children throughout my previous clinical experience. For some reason, be it the adrenaline of a non-stop clinic all day today or finally just telling myself to take charge, I was able to do otoscopy and make two ear molds for precious Karen. I mean they weren't the prettiest ear molds in the world, but for being my second set of ear molds ever, I was pretty darn proud of myself.   I also truly enjoyed counseling with Karen's mother. All by myself. In Spanish. Throughout the day, more and more of the language came back. The ear is still a bit rusty, but it has already improved with only 24 hours in the country. Karen also showed some improved response to sounds with the hearing aids on. I know that we have turned her old auditory world upside down, making everything new again, but I pray that she will see benefit from the hearing aids as she grows. (Just a little hint, Lifesavers can be a clinician's best friend while making ear molds on a little child, at least in Karen's case.)

I can only hope to continue to be involved with CAES and the University's trip down to La Republica Domincana in the future. There is truly a need for services that not everyone can afford. Hearing and education for those with hearing loss may seem to be such a small detail, but it can truly have an impact on their lives. Tomorrow, we are off to Casa de Luz, an orphanage for children with disabilities. I will now be working under the direction of our speech pathology students and am excited for this new opportunity.

Buenas noches!

Day 3 - Speech Perspective

Today was again a very busy day! We had an excellent breakfast- oatmeal, bread, pineapple, papaya, fresh fruit juice, and Dominican coffee. After we ate, we travelled to Casa de la Luz, an orphanage for children with disabilities (mainly cerebral palsy), and arrived there around 10 am. We had a tour of the facility, which is pretty big, but not yet completed. Casa de la Luz received most of their funding from a group that had an onsite doctor and physical therapist, but pulled out of the facility once the earthquake in Haiti occurred. Therefore, some of the facility (2nd floor, dining room, playground, and therapy room) were not completed. You were able to tell that a physical therapist had been to the facility because they had a lot of wheelchairs, but they were not correctly fitted for each child.

After the tour, we got right to work gathering information and screening each child. Speech, language, and feeding was assessed by the speech students. There was a wide range of speech production- some of the children had excellent speech and conversational skills, some were able to imitate some sounds, and some able to make vegetative sounds. We found a few of the children that we thought would benefit from a communication board and were able to train her some. There was also one child we would like to assess with the PLS when we return on Thursday.

Feeding was one of the most interesting things we saw today, and there is definitely a lot that can be worked on in this area! These children were being fed by their caregivers with very large spoonfuls of food without much time between swallows. We also noticed poor posturing and wet, gurgly sounding lungs of the children. The feeding at this location was very different than anything back in the States. Today, we were very successful in obtaining information on how they children are being fed. We will be returning Thursday to educate the staff at Casa de la Luz on possible suggestions and recommendations to feed the children in a healthier way.

Overall, it was a very busy but fun day! The staff was so grateful to have us. It was an extremely positive and loving environment and the people who work at Casa de la Luz have huge hearts. They are willing to do whatever they are able to do for these children. We are all very excited to return on Thursday!

Day 3 - Audiology Perspective by Carla Killins

I'm typically shy when it comes to new experiences, usually the one who fades to the back of the crowd until I'm comfortable.  That was my plan today, to stand back, observe the children, then slowly get my feet wet.  I had  no idea what to expect.  All I knew was that we were going to an orphanage for children with special needs.  Since I've never been to an orphanage, the only thing I could picture was a sad, dark place with helpless children; the image most children's books and movies portray.  That image was quickly erased when I was approached by a little girl who, as I thought, was coming to whisper something in my ear.  Instead she took my glasses off of my face and ran outside and around the building.  Chasing a little girl was definitely NOT a part of my plans, but it was definitely a bright start to a bright day at the house of light (Casa de Luz).  The directors of this bright green building in the middle of the country shared how their journey through life and faith in Christ led them to opening this orphanage.  We toured the facility, met the children and workers, then began testing.  Instead of "slowly getting my feet wet," I dove head first into cerumen management (my favorite facet of audiology).  The image of sad, "helpless children" was replaced by children who were full of life, eager to interact with us in any way they could.  Lydia, the "glasses kidnapper" made sure she kept us entertained and occupied throughout the day.  Mary Elizabeth, the sassy little girl on the scooter, taught me a little Español after she scowled at me for not already knowing the language.  Emilio made sure I kept my promise to push him up and down the halls.  Ruth greeted me with a smile, before man-handling me into whatever she wanted me to do.  Although I left encouraged about my technical skills as an soon-to-be audiologist, I was reminded to leave my expectations at the door and open myself up to new, bright opportunities.     

Day 4 – Audiology Perspective by Elizabeth Meenen

I've just know realized that every day we've been here I've said that it has been the best day yet, but each day keeps surpassing the previous in new ways.  While the activities of the day were exceptionally important, I do not want to forget to talk about the phenomenal food we've had today - so that is where we'll begin.  Our cook at the Foundation for Peace house is Mary Sosa.  The foundation is assisting her with paying for cooking classes so that she can achieve her dream of creating a cookbook and she repays the foundation with the incredible creations she makes in the kitchen.  Kristin told us this morning that Mary feels she has been called to serve God by feeding His missionaries here at the foundation.   Breakfast was apple crepes with fresh papaya and pineapple, juice and coffee.  Every component was fresh, unique, and delicious.  For dinner, Mary prepared roasted pork, guayabas (pigeon peas) in coconut sauce over rice, and eggplant rolls stuffed with a shrimp mixture.  I was so in love with the eggplant rolls (which my Mom will never believe because I've always turned my nose up at eggplant) that I sat with Mary after dinner and had her explain the recipe to me so I can try and recreate it.  I'm optimistic I can do it, but I have a hunch Mary's passion for cooking is one ingredient I'll always be lacking.  

Our activities of the day were split into two parts.  In the morning we visited the Associacion Dominicana de Rehabilitacion (ADR).  This facility was in the center of Santo Domingo and took us all by surprise.  Rehabilitation can be such a broad term, but this facility is truly comprehensive and forward thinking.  Later in the morning we met the President of the Board of Directors, who informed us that she began the facility 48 years ago with a donation from the Archbishop himself after her son was stricken with polio and she realized she had to travel to the United States to obtain therapy for him.  She told us the facility was modeled after one Theodore Roosevelt contributed to because she trusted his ideas since he was in a wheelchair himself.  The facility has areas for occupational therapy, physical therapy, prosthetics, speech therapy, audiology, psychology, early intervention, special education, technical training, and probably more that I've forgotten.  The classrooms for special education were immaculate, organized, and heart-warming with ages from preschool through adult's technical training.  Their prosthetics lab was incredible and it was so neat to see the pride in the work of the workers who made the custom shoes.  The exciting part for me was that they had a sound booth and an audiometer-the first we've seen or heard of in the country.  The director of the speech and audiology department described to us that this is the department with the greatest need.  They have an audiologist who evaluates patients one morning per week, but they need someone much more often.  Also, in the DR the cost of hearing aids is cost prohibitive to the vast majority of those who need them.  They have 7 trained speech pathologists that have gone on to train other specialists to do speech therapy as well and yet still they are at capacity for therapy clients.  However, the training program in the DR closed about 7 years ago and now no educational program exists for speech pathology.  After a tour, we met with the Executive Director in the boardroom.  It was such an honor to have him agree to meet with us on such short notice and to be so warmly welcomed.  Their international programs representative spoke with us as well, and we later found out that he is a retired professor of genetics from Texas A&M and continues to volunteer his time at ADR because he feels it is so important.  ADR is a non-profit and privately funded outpatient facility that receives minimal government subsidies and most of the funding comes from Rotary/Lion's Clubs or donations.  No one is turned away because they cannot pay.  The more I think about it, the more impressed I am with the facility (and their 25 satellite facilities across the country).  The philosophy of the Director was that rehabilitation is about the whole person, not just fixing their arm/leg/speech, but helping them to achieve their full potential in their own life.  So, it was a fantastic experience and it seems that I have found a fantastic place where I can spend a month or so before my externship begins this July.  I am hopeful that I will be able to borrow some equipment from MSHC, gather hearing aids/supplies from donators, and return to the DR to help as many people as I can (and make proud my first/best supervisor Brisy Northrup).  After I leave, we may also have a speech student come down in August for her CFY as well.  It looks like the beginning of a fantastic collaboration between the two groups.  

So, following that, we had a leisurely and delicious lunch in the city center and then saw some of the more famous sights of Santo Domingo.  It was beautiful, steeped in culture, and so old (the one building was from 1505).  My mind kept wandering back to the logistics of moving to the DR and both Kelly and I kept talking about it all afternoon.  We did some shopping in the mercado and it was fun to haggle and buy some treasures to take home.  Overall, it was a fantastic day and has given me so much to think about and plan.

Day 5 – Speech Perspective by Sara Jordan

Today we went back to Casa de Luz (House of Light) for a second day.  Both audiology and speech had prepared and organized for the day to get as much accomplished as possible—all the kids and staff complete audiological evaluations, complete language testing on two children, feeding assessments and recommendations on all children and some fun language rich activities. As soon as we entered the building we went to work to win a friendly bet on which team would finish first! Audiology began by doing hearing testing on the rest of the staff that hadn’t been completed on Tuesday and speech began by finishing feeding/swallowing assessments and complete language testing. Next, both teams—audiology and speech—got to help feed the children, test out some of our recommendations and give the workers a break. What a change of perspective for all of us. We realized how difficult and time consuming the task of feeding all of these children was. After an hour, we all had little accomplished as far as feeding the children a complete meal! We realized why the staff feeds the children in the way that they do because it’s so time consuming and challenging. We made some positioning adjustments, introduced smaller spoons, and made changes to the consistency of the food but the children still struggled due to their disabilities and limited tongue, lip and jaw movement. Due to our slow progress and because our own lunch was getting cold, we were told to let the true professionals—the caregivers—take over! We had a wonderful lunch prepared by the staff of chicken, rice, beans, salad and plantains but everyone only took a long enough break to eat because everyone wanted to win the bet and be productive as possible! Everyone took time throughout the day to spend time coloring, painting, and playing with the kids. The kids have stolen our hearts. They are so resilient, so happy even with such a difficult and limited life. We have a lot to learn from these children and they are an inspiration to all of us! We want the best for each of these children. For them to reach their full potentials and rise above the adversity and limitations of their disabilities.  We were excited to find that the two children with which, we did complete language testing were within normal limits. They only struggled with pre-academic skills such as counting, identifying colors and reading to which they have had little to no exposure. The idea of teaching a few of the children at the orphanage to read and count was discussed and a typical child at the orphanage who currently attends school was identified as the perfect teacher! Exciting possibilities for the children to learn who may never get a chance to go to school themselves due to their disabilities. Then, we held a meeting with the staff to discuss some recommendations for feeding to make it more efficient and safe for the children and to praise their excellent and hard work in caring for these children. The staff was very receptive to the suggestions we gave and willing to try them out and incorporate them as best they can into the daily routine including: upright positioning during feeding, breaks and pauses to wait for food or liquid to clear before introducing more into the oral cavity, replacing bottles with sippy cups for some children to make them more self-sufficient and less reliant on the caregivers, and a better, more manageable consistency of food for all the children. Finally, we ended our work at Casa de Luz by presenting Lucas and Tempura, the owners, with a financial gift to pay for a maternity leave salary for one staff member and to pay for repairs to their transportation. The joy and relief on their faces was a wonderful sight and left us wanting and wishing we could provide even more. Such as small amount of money in the United States, goes a long way in the Dominican Republic. We then had the sad task of saying goodbye to the kids but instead we chose to say, “See you later,” because most of us will definitely be coming back. The bus needed a little extra push from the boys to get started but then we were off to celebrate the week with dinner on the beach! Part of us felt guilty for eating a nice meal on the beach when we know what large financial needs of CAES, Casa de Luz and the majority of the Dominican people. Dinner was enjoyed by all and was such a wonderful end to an incredible trip! Now to get everything packed up and get to bed before the bus picks us up at 4 am (2 am in Memphis) to start our journey home.

Day 5 – Audiology Perspective by Rachel Elkins

Today was exciting yet bittersweet as we headed to Casa de Luz for the second and final time. When we arrived, we set up our equipment and picked up where we left off. The audiology group began doing hearing tests for the employees and other Foundation for Peace staff. Caleb was given the task to complete and update the medical files of the children with new pictures and information. He is always our reliable technical guru! While the audiology ladies completed testing of the staff, I took pictures of the speech students as they worked on an art project with the children. Marilyn had purchased different colored finger paints and posters to create two posters with the children’s handprints or footprints. Several of the kids seemed to really enjoy this project.

Following this, we all began testing where we had left off. Audiology had completed testing on the girls on Tuesday, so we began with the rambunctious boys today! A few were perfect participants with huge smiles and patience as we peered in and tugged at their ears to complete otoscopy, OAEs, and tympanometry. I must say, otoscopy has never been as interesting or difficult as it has been here. We discovered several stenotic ear canals, unknown forms of debris, external otitis, and other random shapes and colors of cerumen…all of which required a second look from our expert JPT! Unfortunately all of this extra bending over was no easy task for her with her sore back (sorry Dr. Taylor)! Because many of the children had cerebral palsy with spastic muscle contractions and uncontrollable body movements, it would often take three or more people just to perform otoscopy safely and other measures reliably. We quickly developed an efficient team dynamic.

Near the end of our testing, lunchtime for the children rolled around. We all stopped what we were doing to help the staff feed the kids. Elizabeth and I worked with Luís David. He was a bed-ridden little boy who suffered from spastic cerebral palsy it seemed. At a much younger age, he had been caught in a house fire and still bore the scars from that on his face and right arm. I held him in a sitting position while Elizabeth worked diligently to feed him using the techniques we had been taught by the speech students and Marilyn.  It was a very slow and exhausting process that gave us a small taste of what the staff must deal with every day. In the middle of lunchtime, a large nursing group from New Jersey (also on a school trip through the Foundation for Peace) arrived at Casa de Luz for a short visit. It was a bit overwhelming for this large group, dressed in beach attire, to swarm in with their cameras and many questions. This was also a small taste of how the staff and children must feel on occasion—like specimens under a microscope for observation— when groups come in to view their organization. However, the nurses were quick to jump in and help with feeding. Since this was the group’s cultural day, they seemed to leave as quickly as they arrived.

After we had a delicious lunch ourselves, we worked to finish up our final assessments and paperwork. Marilyn and speech students spoke with the staff about the numerous donated supplies and food items and how each might be utilized. During this time, the audiology students did our best to keep an eye on the children and take a few of them on trips outside in their chairs since the weather was so nice. It was a fun time but sad since we knew we would be leaving them soon. After the meeting with the staff, our entire group met with Lucas, the supervisor of Casa de Luz, and his wife to present the earnings from this year’s Silent Auction. Lucas and Casa de Luz were currently facing the hardships of financing an employee on maternity leave and recent car trouble that prevented travel to and from the house. We also discussed donating an amount of money to an emergency fund for Casa de Luz under the discretion of Kristin, our Foundation for Peace director.

We soon packed our supplies and said our goodbyes to Casa de Luz. We headed out on a long bus ride to dinner on the beach at sunset. While this was a remarkable scene, the true beauty came as we watched the full moon rise over the palm trees and ocean. It was the perfect ending to a perfect trip. Several of our cameras tried to capture the scene. All in all, the pictures cannot do justice to the overall experience we had throughout the week and the lessons we have come away with. As I said before, the day was filled with the bittersweet feeling of being excited to soon be seeing our loved ones again, but also sad to be leaving behind so many wonderful people with numerous opportunities to provide our support.

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