Creative Healing An SLP practicing in Nepal tackles language barriers and resource limits, but relishes the universal rewards of helping people in need. World Beat
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World Beat  |   October 01, 2015
Creative Healing
Author Notes
  • Sarah Riggsbee, MS, CCC-SLP, is a speech-language pathologist at United Mission Hospital in Tansen, Nepal. She is an affiliate of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders (Dysphagia); and 17, Global Issues in Communication Sciences and Related Disorders. riggsbee.sarah@gmail.com
    Sarah Riggsbee, MS, CCC-SLP, is a speech-language pathologist at United Mission Hospital in Tansen, Nepal. She is an affiliate of ASHA Special Interest Groups 13, Swallowing and Swallowing Disorders (Dysphagia); and 17, Global Issues in Communication Sciences and Related Disorders. riggsbee.sarah@gmail.com×
Article Information
International & Global / World Beat
World Beat   |   October 01, 2015
Creative Healing
The ASHA Leader, October 2015, Vol. 20, 40-41. doi:10.1044/leader.WB.20102015.40
The ASHA Leader, October 2015, Vol. 20, 40-41. doi:10.1044/leader.WB.20102015.40
I used to recommend an altered diet for a patient and expect it to magically show up, prepackaged and standard.
But that was two years ago when I worked at a large hospital in South Carolina. After eight years practicing in U.S. nursing homes, hospitals and clinics, I now serve in a rural hospital in Tansen, Nepal. These days, my expectations—and life in general—are very different.
At United Mission Hospital Tansen, where my husband (a family physician) also works, the challenges of practicing speech-language pathology can be overwhelming some days. The best estimate is that, among staff at my hospital, I am one of five speech-language pathologists in the entire country, along with one of only four occupational therapists (OTs) and five of the 500 or so physical therapists.
I am still learning Nepali, which happens to have aspirated and non-aspirated consonants, along with a slew of nasal sounds. As I try to pick up on the nuances of aphasia and apraxia, I often rely on my Nepali colleagues to translate. I am learning the Nepali equivalents of purees and thickened liquids, which requires a lot of creativity for people who eat rice, lentils and curried vegetables twice a day, every day. With no equipment available here for objective measures, I’ve also learned to rely solely on my clinical swallow evaluation to make diet recommendations.
Although our area wasn’t directly affected by the destructive earthquakes in April, my patients speak of them constantly, rapidly expanding my vocabulary regarding “earthquakes” (not to mention “anxiety”), I keep reminding myself that the words for “chicken” and “dog” are remarkably similar in my accented Nepali, so they are never good stimuli for me to use. Automatic naming tasks are hard until you can say the days of the week and count smoothly. Bottles are generally not used here, so I have to be creative in teaching parents to feed older infants.
Battling stigma
I am learning the culture and stigma surrounding disability here, and the custom of hiding away a child with a disorder because the child can be considered “bad karma.” I am learning that follow-up and outpatient services are rare when patients have to walk for hours from their village, then ride a bus for a day, to reach the hospital.
I am learning that the fee for speech-language treatment that I see as nominal may be a day’s wage here (even though our mission-hospital fees are lower than those of private hospitals and we also offer a medical-assistance fund), so I better make my treatment count.
We have quite a few mothers who bring in children with seizure disorders and cerebral palsy (CP). Many babies are born in homes or village health posts that lack medical resources, so when birth asphyxia occurs, it often results in neurological damage.
One mother had traversed Nepal and India seeking services for her 3-year-old daughter with CP. Working with our OT, I taught the child some basic sign language and provided a picture communication board so she could share her wants and needs. Now she no longer had to cry to get attention; she was able to sign.
One day, as we worked with this girl and another child with CP, the two mothers compared treatment plans and felt a connection over knowing what it’s like to have a child with a disability.
Cleft palates are also considered bad karma. Caregivers usually feed these infants by spoon, and they end up malnourished. Since I’ve been here, I’ve shown four or five mothers how to use a squeeze bottle to feed their babies with cleft palate. I showed them pictures of U.S. children born with a cleft and reassured them that clefts happen worldwide. When I tell mothers and fathers that it was not their fault, they often seem visibly relieved and become advocates for their children. One mother beamed with pride as she told me she self-expressed breast milk and bottle-fed her baby by herself.
Finding rewards
The rewards of practicing here are enormous. It is so satisfying to see a baby born at 30 weeks survive, thrive and go home fully breastfeeding at 36 weeks with a proud mother. So satisfying to have a patient who had a stroke go home without a nasogastric tube after a week of swallowing exercises. So satisfying to share a cup of tea with the family of a patient with a hypoxic brain injury. So satisfying to see the excitement on the face of a young woman who is deaf when I recommended she get a cellphone and use texting to connect with loved ones.
The similarities around the world are evident. Colleagues I relied on in the U.S. for help are still there, just an email away. Families and patients still need a clear reason for modifications if there is to be any carryover. The diseases and conditions we treat are enough to break your heart. And it is still necessary to find the right words to speak about dying with dignity when treatment is no longer beneficial.
Perhaps most important—language barriers aside—laughter, compassion and creativity go a long way in establishing trust and helping people heal.
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October 2015
Volume 20, Issue 10