Cusco 5-day summary

March 2 - Chicago to Mexico City. 11:20pm flight to Lima, Peru, was canceled. Stuck in Mexico for 24 hrs.

March 3 - Fun sightseeing Mexico City. Caught next 11:20pm flight to Lima.

March 4 - Lima into Cusco 9:15am. Very quick tour of Camino Nuevo's campus (but no school in session yet), quick lunch with Director of Manos Unidas, who suggested I take the next couple days to adjust to the high altitude, culture, language, and jetlag. So I napped till evening's dinner party with said Director and her friends.

March 5 - Walked around San Blas area of Cusco and took a "city tour" of 5 archeological sites.

March 6 - With Director & her friends to Pisaq's Carnival festival, during which children enjoy throwing water balloons, dumping buckets of water, and squirting water guns and spraying foam on people... Loved it!

March 7 - FINALLY spent the day meeting staff and students at Camino Nuevo! First day of school back from break; Came home more fulfilled and excited than 3 days of being a tourist. This will definitely be a primary destination for professional therapist volunteers. They are receptive to outside assistance, have a vast list of needs, and have plenty of work for any therapist. I still would love to get trained Spanish interpreters for therapists involved!!!!

Today I only spent assisting in 3 classrooms. In one class, the teacher was feeding a child with severe cerebral palsy when I came in. His head was rolled to the side and he was tied to a wooden upright chair so he wouldn't fall over. She reported that he doesn't chew and drools a lot. Boy am I glad (or, boy are they lucky) that I've got a dysphagia background. I taught the teacher how to support his head and body upright (since his wheelchair is too heavy to bring from home, apparently), use a smaller spoon with a soft tip, mash/puree all food, present only a half teaspoon amount, have him help hold the spoon and watch it approach his own mouth, and activate his lips to clear the bolus rather than bite on the spoon... And lo and behold, he chewed and swallowed and minimized drool almost to none, and feeding was a happy experience now he gets to participate. I also taught the teacher how to clean his mouth after each meal (which is extremely important since all his teeth looked like cavities, his gums were 100% inflamed as well as his cheeks... You betcha I said he HAS to be seen by a dentist ASAP), and how to give him drinks (using a sippy cup instead of from an open cup)

In another classroom with children with autism and down's syndrome, things were ... out of hand. Kids (about 6-7 years old) were putting blocks and toys in their mouths, one kid kept grabbing and pulling and trying to bite another kid's hair, another pulled his pants down to indicate he needed the toilet, another freaked out (tears, screaming, jumping, pulling others' hair and clothes) for no apparent reason and couldn't be calmed... There's a lot of work to be done... And finally I observed the afternoon class with the young adults, and helped a bit there too (though it was very calm in comparison hehe)

The plan now is that Tuesday I'll observe and help the rest of the classes.
Wednesday I'll actually go out into the rural villages to see how ThWB therapists can support families in the homes and communities.
Thursday afternoon I'll host a workshop for the teachers on communication and the many ways to use toys to teach different lessons (esp. regarding expressive/receptive language).
Friday I suppose I'll wrap things up in the classes, and in the evening I'll take a train up to Machu Picchu to spend the night.
Saturday Machu Picchu and then return in the evening.
Sunday all day outdoor rock climbing!
Monday fly back to Chicago via Lima and Mexico City again...
Tuesday finally arrive home.

I do have a lot of pictures, but as I am quite exhausted and slightly overwhelmed tonight, I'll post them another day. Buenas noches!

Mzungu in the Orphanage!

Saturday, June 28th

At Dago, my hosts suggested I go to the orphanage around 2pm to do something with local kids. As per African Standard Time, they sent me at 4:30pm. When I arrived, there were about 14 children waiting for me.

By 6pm, there were 42 kids... and growing.

Apparently they had heard a mzungu was around and kept trickling in, even as we left the building.

My Dago host, Mr. Odoyo, suggested I make crafts with the kids like the other volunteers have done in the past, but I insisted on using books somehow (even though I had no clear plan except winging it SLP-style!). Mr. Odoyo also said not to go alone to see the kids, because "they are too much to handle without help." Susan came with me, and I'm so glad she did because she helped with translating back and forth between Luo and English whenever we didn't understand each others' accents.

They started off like the kids I came across last year, pushing & shoving, loud & rowdy, and extremely eager to touch/grab any part of the mzungu and her belongings. But after my experience at Kamiak High School, I gained some guts and disciplining strategies (thanks to some great special education teachers there!!). So even as the crowd swelled, I actually had control of the room using my ONE book, which held everyone captivated because... well it's a book. Something new.

(I took this video after I released the book.
They were all fighting over The Three Little Pigs until they noticed I was recording.
This is also a glimpse at how the kids were before I got stern, and before the crowed tripled in size.)

We went through a couple books that night. I kneeled on the table and read a page or two for them at a time, then asked a comprehension question. They were very simple picture books, and my questions were extremely basic (e.g., "What is the boy doing?"). I also found a pack of math flashcards and did that with them as well (I know, once a nerd, always a nerd. Everything's gotta be educational with me! But they apparently enjoyed it!).

The kids initially all raised their hands and shouted "Me! Me! Me! Me!" even though none of them knew the answer or even understood the question. They just wanted the stickers I was giving as rewards. I didn't want to run out of stickers before I got to Sirua Aulo Academy (where I was headed the next day), so I changed the reward to getting their picture taken. At this point, Susan sat behind me and was in control of my camera.

These boys each earned their picture taken several times, and eventually started posing for them in their own ways. So cute.

Afterward, I taught them Simon Says, which took a while with lots of examples and Susan translating for me. But when they cottoned on finally, I let an older student take over and I was able to sit back, enjoy the game, and rest my voice.

<--"Simon says, 'Stick your tongue out!'"

"Simon says, 'Pat your head and rub your tummy!'" -->






By dinner time, we had to stop. Mrs. Odoyo, who entered during the last hour, told the children to sing something for their guest. Here's what they came up with:

And finally, I suggested they gather in front of the orphanage for a group photo. This one is our "silly poses" picture. I love that they always show off their stickers (Thanks again to the MSD SLP who donated them!).

Name: Nathan Parningo

Chronological Age: 7
Grade: Introductory (i.e., Kindergarten)
School: Sirua Aulo Academy
Vision Screening: Appears to be WFL
Hearing Screening: Appears to be WFL
Evaluation Date: July 5, 2008
Evaluation Location: Transmara District
Examiner: Linda, M.A., CCC-SLP, through Emmanuel as our Swahili/English translator

Reason for Referral: Nathan was brought to the school at my request to meet all children in the area with disabilities.

Educational History: Nathan attended nursery school with his twin brother, but was refused entry into the next and consecutive classes. His brother is now in Class 2 (i.e., 2nd grade) in a public school, while Nathan has been forced to stay at home for the past 3 years.

Medical History: Nathan presents as a healthy boy with a normal birth and developmental history.

Interview: They say he has a "heavy tongue" and that he "doesn't talk." However, further questioning revealed that he does speak, but it is not often and inaudible. I did not hear his voice in my short period with him. Mom reported that he can follow directions and if he wants something he can do it himself. Her biggest concern is that he has not gone to school.

I was not able to do a complete oral-motor examination with him; he did not imitate or follow directions much, though Emmanuel stated that he "understands everything." My clinical judgment is that he is selectively mute, and his segregation from his brother and peers has not helped his emotional-behavioral development. The tongue thing? Habit. He was able to close his mouth sufficiently, and I see no other reasons for him to maintain that open mouth posture. (Check sinuses? Darn, I didn't think of that! But I didn't see or hear about respiratory problems to indicate it)

In any case, Nathan's situation drives me crazy! He would do perfectly fine in school alongside his brother! In fact, we incorporated Nathan into the Intro class right away, and during break time he played soccer along with the other boys his age just fine! He didn't verbalize then either, but the boys allowed him to kick the ball and participate. He could catch up to his brother in no time, at least to Class 1, with tutoring and the higher quality education Emmanuel's school is providing.

For a tax-deductible Dollar A Day, you can help Nathaen get quality education, food, clothing, and in the near future, shelter, for A YEAR. $365 is a fraction of what you spend on coffee every year. Please help to ease the burden for this one family, and let this child realize his full potential. Contact me at autosmiler at gmail dot com and/or donate through the Village Volunteers website.

Name: Naeku Nkilasi

Chronological Age: 10
Grade: Nursery
School: Sirua Aulo Academy
Vision Screening: Appears to be WFL
Hearing Screening: Appears to be WFL
Evaluation Date: July 5, 2008
Evaluation Location: Transmara District
Examiner: Linda, M.A., CCC-SLP, through Emmanuel as our Swahili/English translator

Reason for Referral: Naeku was brought to the school at my request to meet all children in the area with disabilities.

Educational History: Naeku has not attended school. No public school will accept her (even if they could accommodate her), and family cannot afford to send Naeku to a private school, though there are none in the area anyway.

Medical History: Born normal but had delayed milestones such that by two years of age they "realized something was wrong." As she grew up, she has had epileptic seizures lasting a couple minutes each, with up to 4 month breaks in between. Fortunately, she has not had one in the past three years. Naeku has a mental age of approximately four years old. Receptive language appears to be a relative strength, as she speaks about 10 Swahili words.

Interview: Mom reported that her biggest concern is that Naeku has not gone to school. She can wash dishes, sweep, wash clothes, and bathe herself.

Naeku is a very sweet kid. Although she was fearful of me as a mzungu, she clinged to Emmanuel right away, who is a stranger to her, and seemed to really enjoy socializing despite being kept at home for her entire life.

Here I do a simple oral-motor evaluation with her, which not only reveals any potential structural or coordination deficits but also gives a sense of her stimulability and expressive/receptive language skills.

And since I didn't feel like captioning this, here are a couple notes:
"Mzuri sana" means "very good" in Swahili.
"Asante sana" means "thank you very much" for those people-in-a-cave who haven't seen "The Lion King"

I suggested that Naeku and the other child with a disability (who will be profiled in my next post) start school in October when I return so that I can try to get them sponsored and come back to train the staff on how to accommodate them. But Emmanuel accepted them immediately into Sirua Aulo Academy, saying he's sure I could find them sponsors.

If you are touched by Naeku as I am, and want to sponsor her education, feeding, clothing, and in the future, her sheltering as well (when the dormitories are built) for an entire year, please contact me at autosmiler at gmail dot com. It is only $365 [a dollar a day!] to support her for an entire year. And don't forget, donations made through Village Volunteers are tax-deductible.

For the Nkilasi family, Emmanuel, and myself... Asante Sana.

Name: Jacqueline Achieng

Chronological Age: 12
Grade: none
School: none
Vision Screening: Unable to complete
Hearing Screening: Unable to complete
Evaluation Date: June 24, 2008
Evaluation Location: Dago Village
Examiner: Linda, M.A., CCC-SLP, through Edwin as our Luo/English translator

Reason for Referral: Jackie was referred for intervention due to significant concerns regarding her health, development, and cognitive status affecting the family's daily living and survival.

Educational History: Jackie has not attended school. Public schools cannot accommodate her needs. She is unable to walk to school or be unsupervised.

Medical History: Hospitalized for severe malaria at age 3 and has had epileptic seizures ever since. Mom reports doctor recommended she eats several small meals instead of 3 normal ones in order to decrease her chances of choking on reflux or vomit during an attack.

Family History: Jackie has 7 siblings and lives with her mom in a small mud hut in Dago village. Jackie's father has other wives and rarely visits this home. They suspect it is because of the disabilities in the family: Jackie's 10-year-old sister, Rose, is developmentally delayed.

Interview: Mom reported that Jackie zones out particularly when the moon is in its ascending phase for 5 days, and when it's in the descending phase for 5 days (so, a total of 10 days). Her seizures last an average of 30 minutes, and there are times when she stares off into space.
Mom reported that she constantly falls, resulting in scars on the back of her head. Mom says she "can't think straight" so she does everything for her (feed, bathe, etc.). I noticed she drools as well. During my visit, the moon was not in the right phase for me to see her in her more 'active' state, during which she can help with simple chores, talk, and feed herself.

On an average day, Mom must get up very early to make breakfast for her 8 children. This involves gathering firewood, getting water from the river, and preparing all food from scratch. She also does the laundry for all the kids, and by 10-10:30am she has to make another meal for Jackie before her other children return for lunch.

Around 4pm, Mom makes another meal for Jackie, and later makes dinner for everyone before bedtime. Dishes, farming, cleaning, and other chores are done somewhere along the way. Jackie has a habit of wandering around in addition to falling during seizures, so she has to be constantly supervised.

Mom's biggest concern, beyond her worsening state, is Jackie's inability to bathe herself. Jackie likes to follow her sisters to the river and tries to even copy washing panties, but she is ineffective and wastes their soap and takes up a lot of Mom's time.

Caregiver Education: I educated Mom about epilepsy, grand mal seizures, how it affects her growth and learning, and the different treatment options available to help her function normally. Having only cursory knowledge of epilepsy disorders, I couldn't do much else. I explained again my background in rehabilitation, and the training I can provide after the seizures are controlled. I had to emphasize that only through medical intervention like medication, which can be a long, complicated process to find the effective dosages, can she be able to function and learn.

However, I was determined to do SOMETHING to help while I was there. I returned the day after with some felt and a headscarf I bought in Kericho last year. At least to prevent more major scars from falls, she can wear a wrap like other women do, yet hide the extra padding underneath. Mom liked this a lot.



Next, at my request to observe the bathing process, Mom set up a little area out back with a tub of water and a wall of leaves. Mom said when she's not in her dazed period, she can do almost everything herself except bathe herself. The best way I thought I could help was to see what the problems were in person. Over the next half hour or more, I observed how Jackie bathed and how Mom interacted with her throughout the process, then taught Mom about teaching techniques, and finally spent time practicing with Jackie. I tried to give just some basic ideas like keeping to a routine, giving hand-over-hand help with verbal cues, and keeping her instructions short/simple. The best I could do then was leave her with some notes using donated paper and markers (Thanks again, folks!).


I wish you could each see the pained expression on Mom's face as she talked about her children, her sense of helplessness, her fear for their future. She was desperate for help. No, she IS STILL desperate for help. She's already doing everything she can for Jacqueline and her family, but has nowhere to turn. Mom is also a devote Christian, and said that she "trusts in God because He made her, and will do anything for her to improve her life".

Before I left her home for the last time, I committed myself to helping her and her family. First thing's first, Jacqueline needs medical attention. Edwin is still helping me figure out the costs and logistics of transportation to/from the hospital, potential medical fees, etc. so that I can have a ballpark figure to target when fundraising. Meanwhile, I think I can now start the process of creating awareness, arousing sympathy and requesting help.

To donate by check, please make checks payable to Village Volunteers and note the purpose in the memo line ("Jackie Achieng of Dago"). Checks should be mailed to:

Village Volunteers
5100 S. Dawson St., Suite 202
Seattle, WA 98118
USA

You can also make a donation online. Village Volunteers uses PayPal to securely process all online donations.

Or, if you would like to wire a donation to Village Volunteers, please email Florinda Peralta at florinda@villagevolunteers.org for our account information.