All aboard! The bus breaking barriers to care in Ghana
In the Eastern region of Ghana, a bus pulls up outside the Gyankama primary school. The outside of the bus is covered with photos of Operation Smile patients. Familiar faces like Ramata, Idrissah and Hannah adorn all sides of it, beaming with their new smiles after surgery.
It’s immediately clear this is not just any bus – but it’s not just a mobile advert for the life-changing surgery we see in those photos either. On board is a team of speech therapists bringing vital support to patients in some of Ghana’s most remote regions.
With many patients living in remote areas without the means to travel long distances, Ghana’s speech therapy programme has gone mobile to solve the problem. The team of specialists hits the road in a specially adapted bus to bring vital support to more people who need it.
Bringing care closer
With around half of children born with a cleft palate needing help with their speech, this mobile speech therapy clinic is a vital addition to Operation Smile’s work in Ghana, where many patients are scattered in remote areas without the means to travel long distances to their nearest clinic or hospital.
Palate surgery significantly reduces the need for speech therapy, but many children will need ongoing support with their speech even after their palate is repaired. Mobile clinics like this one help ensure patients don’t miss out the extra support they need to be able to communicate clearly and confidently, something most of us take for granted.
In Ghana, the speech programme has already helped more than 1,500 patients. That’s 1,500 children and young adults who may otherwise have missed out on this important follow-up care.
We talked to Operation Smile Ghana’s Speech Programme Coordinator Kwaku Bekoe Obuobisah to find out more about the programme and how this new mobile service is benefitting patients all over the country.
Photo – Lorenzo Monacelli
The mobile speech clinic is breaking barriers to care. It couldn’t have come at a better time. Because of the caseload in Ghana, when you take the statistics, out of 10 cases, you will have one of them suffering from a communication disorder, and they are sparsely scattered. This mobile clinic goes into some of these remote areas and then with support from our speech therapists and then the Ghana Health Service, we are able to partner with these hospitals and provide care to these patients.” Kwaku explains: “The programme provides complementary care to our patients. Also it goes beyond speech to even include their communication disorders, the way they behave, and even hearing aspects as well.”
Kwaku Bekoe Obuobisah, Speech Programme Coordinator, Operation Smile Ghana
Photo – Lorenzo Monacelli
Kwaku is proud that the mobile clinic does not only benefit Operation Smile patients, it brings care and support to any patients struggling with speech or communication issues that the team meets along the way.
The mobile clinic is the first of its kind, but it is not a standalone service. It’s part of the wider speech programme in Ghana which has already established two speech therapy clinics in the country. We ask Kwaku to tell us more:
“Firstly, before the speech programme, we did not have speech and language therapy clinics within the Ghana Health Service. Thankfully, we’ve now been able to establish two of those clinics, one in the eastern region and one in the northern region. Currently together, over 1,500 patients have benefited from the establishment of these clinics. That is an achievement. The question is, where would these patients have been if not for the establishment of these clinics?” The beauty of the new mobile service is that it bridges the gap between the two existing clinics and expands the reach of the team into more remote areas. It’s also big enough inside to have two compartments, with a flexible layout so that it can be changed to suit different needs.
Challenging superstition
The speech therapy programme is also working to reduce the harmful stigma that surrounds speech and communication disorders in many communities. The programme has already trained 50 volunteers to challenge misconceptions and superstition about children with cleft or speech problems. Kwaku explains:
“In some of our communities, for example, if a child is two years old and that child is not talking, there is a misconception about what exactly is wrong with this child. Some people think the child came into this world with a bad omen. Now, these volunteers are out there explaining to caregivers that it is not a bad omen, but that there is help.”
Kwaku explains that after the initial relief for parents when they find there is help at last for their child, comes the reality of discovering that there is no ‘quick fix’ and that it takes time for their child to learn to speak. Sometimes up to a year, and that news can be hard to come to terms with for some parents. But the rewards are worth waiting for, and preferable to the isolation children face when they are unable to communicate and make friends. “It will take time for a child to learn that full functional speech and be able to break out of his or her shell and even play with their peers. For example, a child who is four years old and is unable to talk, will not even feel confident to play with their peers. Most of the time they are found playing by themselves. The speech therapists are on board to explain to their caregivers and even teachers that in the past where you end up punishing a child for isolating himself because he is unable to express himself, this is not the time. There is a change, and the solution to that is speech and language therapy. Although it is new in Ghana, it is an area that is growing, it is developing.” He says.
Photo – Lorenzo Monacelli
New ‘speech surgery’ ensures comprehensive care
Speech surgery is an important addition to the speech programme in Ghana. After palate repair surgery, some children develop small holes or ‘fistulas’ in their palate which may not be discovered until they start trying to make certain sounds during speech therapy. This comprehensive approach to care sees speech therapists working with surgeons to identify children that will benefit from further surgery to improve their speech. Operation Smile Ghana is also training local surgeons and their supporting medical teams in this new type of speech surgery. “We currently have five surgeons who are currently undergoing training. Not only are they helping with the speech surgeries, but also building the local capacity of these surgeons here in Ghana. In addition to the speech surgeries, it’s a whole array of care. We have nurses, anesthesiologists, biomeds, and speech and language therapists. Even now, audiologists are coming in, but that is also a new area that Operation Smile will look into in the future. It then means that, for example, if an anesthesiologist is working and is more familiar with the normal cleft surgeries, now there is speech surgery, which is new. Obviously, the care that you will provide to a normal patient with a cleft that is undergoing normal surgery is different from the anesthesiology dosage that you will give to a patient that is undergoing speech surgery.”
Kwaku tells us about a patient we already know and love, a young girl called Shine. Shine was born with a cleft lip and palate, both of which were repaired by Operation Smile. But, it was during her speech therapy assessment that the team realised she would need further surgery to repair a fistula in her palate that was causing her to still have issues with speech:
“I met Shine in Koforidua Eastern Region when she came for her initial assessment. It was discovered that she needed a revision. With support from the Korle-Bu Teaching Hospital, that revision was done for her. She followed up with a therapy at the Eastern Regional Hospital, and she’s been discharged by the speech therapist because according to her, she has attained what is known as functional speech. All the sounds that were made that required omission and substitution have all been repaired due to the speech surgery and subsequent therapy.
“I think that is a plus for Operation Smile because without this program, yes, the surgery would have been done, but then the therapy, which is also a key component, would have been missing. I think that is a success story for us and that we should all share as an organisation and as a project.”
Photo: Lorenzo Monacelli