Bringing Smiles to Children: An SLP in Egypt Last year nearly 40 medical and non-medical Operation Smile volunteers from Egypt, Colombia, Honduras, Jordan, Oman, the Philippines, United Kingdom, and United States traveled to Qena (Egypt) General Hospital. From Nov. 9–18, 2006, they provided free medical evaluations to 329 children and young adults with facial deformities and performing 108 ... World Beat
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World Beat  |   March 01, 2007
Bringing Smiles to Children: An SLP in Egypt
Author Notes
  • Cathy Pearse Snyders, is an SLP at the Children’s Hospital of The King’s Daughters in Norfolk, VA. Contact her at snyders21@cox.net.
    Cathy Pearse Snyders, is an SLP at the Children’s Hospital of The King’s Daughters in Norfolk, VA. Contact her at snyders21@cox.net.×
Article Information
Cultural & Linguistic Diversity / International & Global / World Beat
World Beat   |   March 01, 2007
Bringing Smiles to Children: An SLP in Egypt
The ASHA Leader, March 2007, Vol. 12, 10-11. doi:10.1044/leader.WB.12042007.10
The ASHA Leader, March 2007, Vol. 12, 10-11. doi:10.1044/leader.WB.12042007.10
  • Graphic Jump LocationImage Not Available

  • Cathy Snyders works with a young patient and his family in her treatment area.
  • Photo credit: photo courtesy of Cathy Snyders
Last year nearly 40 medical and non-medical Operation Smile volunteers from Egypt, Colombia, Honduras, Jordan, Oman, the Philippines, United Kingdom, and United States traveled to Qena (Egypt) General Hospital. From Nov. 9–18, 2006, they provided free medical evaluations to 329 children and young adults with facial deformities and performing 108 free reconstructive surgeries. This worldwide children’s medical charity is dedicated to helping improve the health and lives of children and young adults born with facial deformities. Cathy Snyders has participated in five missions to Brazil (she speaks Portuguese), one to Morocco, and one to Kenya, for which she learned Swahili phonetics. She will take part in her ninth mission, to China, in November.
I am the speech-language pathologist for Operation Smile’s mission in Qena, Egypt. This is Operation Smile’s first medical mission to Egypt, my eighth Smile mission to a developing country. I have spent months trying to learn Arabic phonology—enough to conduct assessments to determine the effects of a cranio-facial deformity on a child’s speech.
  • Graphic Jump LocationImage Not Available

  • Cathy Pearse Snyders’ bubbles delight Operation Smile families.

  • Photo credit: photo by Jeff Zelvansky

Screening
As the screening day begins, 15-year-old Islam stands quietly, his body pressed against the fence. His dark eyes peer over the restraining bar, the metal hiding his mouth. As I watch, he moves slightly and slowly reveals his facial crater, teeth protruding as if a small bomb had exploded in his mouth.
He stares at me with a crooked smile as he enters my screening area—after he has seen the plastic surgeons, anesthesiologists, pediatricians, and dentists. “Kayf halak (How are you)?” I ask. His face lights up—he understands my poorly accented Arabic. As we end our screening session, I say I will see him soon. “Insha Allah (God willing),” he replies, his hands in a prayer pose. In Egypt, it’s not considered a right or even a privilege to have this basic surgery; it happens only “insha Allah (if God wills).” [The word insha Allah is the same in both cases, meaning “God willing” or “if God wills,” depending on where or how it is used.]
As my screening week continues, more than 230 children come through my speech station in just two days.
Surgery Week
Islam is waiting in pre-op and I can see the fear in his face. I learn he has five brothers—one born with this same deformity died during surgery years ago. Islam breathes deeply and I give him a thumbs-up as he disappears into the surgical suite, trying bravely to show his family he is not afraid. Traditional Muslims will make a “haj” (pilgrimage) to Mecca during their lifetimes; Islam’s “haj” to a normal life is about to begin.
I leave Islam and go to my treatment “room,” just about three square feet in a corner near the entrance to the operating room. Having taped my education materials to the walls, I spread a sheet on the floor and sit down. Mothers and children come and balance on their haunches with great flexibility. I was designated four translators, but because their abilities are limited, I rely on my pictures and words written in Arabic. I thought the written words would suffice, but then discover that most of the mothers cannot read. Illiteracy exceeds 65% among women, and hovers about 50% in men. Since we are primarily seeing Egyptians who are poor, my pictures—American hieroglyphics—serve as the best form of communication.
Ahmed, a 14-year-old teen with brown, curly hair, sits in the pre-surgical area with me. His bilateral cleft lip causes his broken smile to be stretched up to his nose, making a pronounced “M” where his upper lip should be. He constantly covers his mouth with his hand, as if coughing. I try to get him to lower his hand so I can watch him form his bilabial sounds—m, p, b. He is reluctant, so instead I show him pictures of children before and after surgery. His eyes scan the photos and he forms a jagged smile and slowly lowers his hand. I show him how, after surgery, he will be able to form those sounds. He grabs my mirror and uses his fingers to push his residual lip pieces together, trying to form his own smile. He stares at the “after” picture, running his thumb over the photo, then places his finger to his mouth as if performing his own surgery.
For the rest of the day I do palate treatment, primarily using pictures. I show the children and their family members the Arabic letters and sounds and have them practice exercises to aid their speech. We use speech tubes, mirrors, and small toys. During other trips I have handed out written exercises, and often have had someone in-country whom I can train to carry out what we have begun. But here, most patients and parents must commit the sounds and advice to memory because they cannot read.
Islam sits quietly in his post-op room despite the loud bustle around him, and glances at his reflection in the mirror his nurse holds to his mouth. He seems as amazed that he is alive and okay (“tamem”) as at the medical miracle that has transformed his lips, teeth, and frenulum—not the same fate as his brother’s several years ago.
Treatment
I return to my treatment area, squeezed against the wall, and sit on the dirty sheet, wincing as a cockroach crawls across the floor. I am providing feeding services for babies too small for surgery, and working with families of several children who had disorders we could not treat, either for lack of time or because their conditions—mental retardation, autism, cerebral palsy, hearing loss, stuttering or other speech disorders—did not warrant surgery. Time permitting, I meet with the families and counsel them.
My next challenge is trying to engage young Sawa to speak so I can learn why her parents say she has a speech problem—she sounds great to me! “She cannot say the ‘k’ sound,” they say—but I know I heard her make his lingual-velar sound just perfectly! “But she just said ‘k,’” I argue. “No!” the mother and interpreters say, “she said ‘k,’ not ‘K’!!!”
I sigh in frustration. There are several “k” sounds in Arabic—a lingual velar and pharyngeal (almost like the sound in “Bach”), and then a uvular “q” I cannot truly describe—sounds that American English speakers cannot discriminate and form. The mother spends the next 15 minutes teaching me how to say the pharyngeal or uvular “K” sound.
Recovery
I then go to the recovery room, where nurse Carrie holds 6-year-old Mohammed who just had palate surgery. I give him fluids orally with a syringe, trying to keep him hydrated. As I feed him, I hear the drone of many languages. Mehrdad, a pediatric intensive care specialist, is stomping on another cockroach—he curses at it in English and Arabic. Mohammed, an Egyptian plastic surgeon, speaks Arabic with a plastic surgeon from Oman. They switch to English to speak with a nurse from Australia, who then speaks to me in British-accented English. I greet Liliana, a plastic surgeon from Colombia, in Spanish and she discusses a patient with her colleague Juan, who is from Honduras. Rodeio, an anesthesiologist from the Philippines, speaks with James, another surgeon, in Tagalog.
This day has been chaotic in the rush to finish the last operations and screenings—in little more than four days we have screened 329 patients and performed 108 surgeries. I think about the lives we have touched, the looks of relief on the faces of those old enough to understand the ridicule and feel the shame, and the expressions on the faces of parents whose children’s new smiles will change their families’ lives.
Sitting with my Operation Smile teammates and our Egyptian counterparts, we have all come to the conclusion that animosity among our nations is very unwise. Medical diplomacy serves as an incredible peacemaker, as we manifest compassion and humanity in our work. I am astonished at how alike—at least in our hearts—we are.
Operation Smile Marks 24th Year

Operation Smile, a worldwide charity dedicated to helping improve the health and lives of children and young adults, is celebrating its 25th anniversary this year. Volunteers have provided medical treatment to more than 100,000 patients around the world; last year more than 9,334 received free surgeries.

Based in Norfolk, VA, Operation Smile has a global volunteer network of thousands of credentialed plastic surgeons, nurses, anesthesiologists, dentists, pediatricians, SLPs, child life specialists, and biomedical technicians. It sends international teams of medical volunteers on two-week medical missions to 25 partner countries, airlifting volunteers and donated medical supplies to hospitals in Africa, Asia, Eastern Europe, Latin America, and the Middle East.

To volunteer with Operation Smile, visit www.operationsmile.org or call 888-OPSMILE.

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March 2007
Volume 12, Issue 4