An American SLP in Honduras

Disclaimer: This post is a little speech pathology-y. I know it’s not the most interesting to all of you, but it’s my job here on the Ranch, and a huge reason why I chose to volunteer with NPH. Besides, I just love what I do, and want to talk about it.

After two weeks of orientation in early July, it was already time to start working. The school year runs from February – November here, so I started in the middle of the academic year, which was an unforeseen challenge. While I had the schedule of the previous SLP to use, I also wanted to meet the kids and see if there were others who could benefit from therapy. I decided to spend my first weeks organizing my room, observing classes, and evaluating kids. I soon discovered that as I continued to seek out kids for therapy, I continued to find kids for therapy, with a limited amount of slots in my schedule. I have struggled a lot with numbers, because there simply are too many kids on the Ranch who I would like to work with. I have made small groups and work with as many kids as possible, but with 300+ kiddos here, I just can’t do it. We talked about using our “clinical judgment” all the time in grad school, and for the first time, I'm working on my own, and I suddenly have to critically think and apply my clinical judgment in a way I never have had to before.  

Although I’m not sure I have yet to experience a “typical” anything here on the Ranch, here’s what a typical work week looks like:

On Mondays I go to Casa Angeles, which as I shared before, is a home in Tegus for children with severe disabilities and/or medical needs. My therapy is very play-based, to work on engaging the kids and trying to work on goals as simple as joint attention, or being able to appropriately play with a toy. I found creating appropriate, reasonable goals for this population to be challenging, because I needed to have a realistic sense of their current communication, and what I can work towards this year. I also help with feeding during snack and lunch. In the future, I would like to do a charla, or chat about feeding and swallowing safety to share what I know with the tías who work in Casa Angeles. 

One week at Casa Angeles, I got to observe hipoterapia, which some of the kids receive once a week. I had never seen anything like this before, and really enjoyed it! It was amazing to see the reactions and changes in the kids when it was their turn to ride. I would love to go again sometime this year.

Tuesday through Friday, I stay on the Ranch. In addition to spending time at the school, I spend mornings in Casa Suyapa working with the Chiquitos in their Montessori classroom, visiting the abuelo home Casa Eva, working in talleres, or the junior high, as well as the hogar San Juan de la Salle, where I work with two boys with autism. I have a huge variety on my caseload, which forces me to think about a ton of different goals and therapy techniques. I’m so grateful to be able to work with such a range of ages and diagnoses, because it will hopefully help me find a job back in the States. Plus, it just makes work more interesting and fun.

My very own classroom! 

My makeshift "reading corner." The kids aren't used to sitting at a table and working, so they often opt to do therapy here. As long as they are engaged and focused, I'm happy to let them choose where they want to sit. 

The library in Casa Suyapa, where I work with the Chiquitos one-on-one. It's not my official classroom, but I love working in here too!

The younger kids love therapy, because it means individual attention and the possibility of earning a sticker. Although I sometimes need to remind the kids to focus, they typically work hard and enjoy their time with me. When I walk to the younger grades, I’m often greeted by a swarm of kids asking, “¿Cuándo me toca la terapia?” or “when is it my turn for therapy?!” Although I can’t usually work with every kid who asks for a turn, it’s so nice to know that the kids don’t dread working with me.

I scooped up one of the Chiquitos for a quick hug while working at the school. He's actually a twin, and they are both doing great in therapy. Doesn't he have the sweetest little face?

Taking a picture at the end of a productive session. 

All of the little ones love this little plastic duck I found in a bag of old toys. Here, my little friend is reading a story to the duck while we practice using complete sentences and expand her vocabulary. 

She loves to back herself into my lap (quite forcefully, actually,) and start reading to herself. Notice anything about the book? I snapped this right before turning the book right side up.

Unfortunately, I am not greeted as warmly when I go to talleres, or the junior high to give therapy to a few kids. I am often given an eye roll, and was once told that death sounds more fun than therapy. I have always felt more comfortable working with younger kids, so I was a little hesitant to start working in talleres. But, I also know that these girls can greatly benefit from therapy, so I continue to try every week to make therapy motivating and fun.

In an effort to make the older girls comfortable with me, I took our first couple sessions to play “get to know you” games to give them time to adjust to a new therapist, while I sneakily listened to their speech and language while we played. I brought two games to give the girls a chance to select whichever game they preferred. Both girls chose Sorry. As I played with the particularly reluctant girl, I drew 3 Sorry cards in a row, which as all you Sorry players know, means that I can replace her piece on the game board, giving me the lead. She was too old for me to “change the rules” and do something different as I may have done with a younger kid. So I found myself completely dominating the game, when for the first time in my life, my competitive self actually wanted to lose to give her confidence and more comfort with me. Despite my Sorry plan backfiring, we have slowly made progress over the past couple months. Although I'm never greeted with a hug as I am with the Chiquitos, I am happy to spend time and work with the older girls, and I would like to think their time with me isn't too horrible, either. 

This is my first time really being “on my own” as a SLP. Although I slowly was given more freedom as an intern, I always had a supervisor to ask questions or give me feedback. Now, I’m in a different country completely on my own. I have spent a lot of my time explaining what exactly a speech-language pathologist is, and what our scope of practice includes. While I love talking about my work, it is sometimes tricky to explain everything we can do in Spanish, but it gets easier every time. The school is run very different than a school in the States, and I have deliberately tried to keep some of my "American SLP" habits, because I think it will make me a stronger therapist in Honduras. 

I have moments where I question myself and wonder how on earth I am allowed to just treat kids. I’ve studied and worked towards being a SLP for six years, and now I’m given the freedom and trust to apply what I’ve learned. It’s scary at times, but also so rewarding. I'm so thankful for my professors, supervisors, and friends who share goal and activity ideas via email and Skype, and the constant reassurance, trust, and gratitude of the tías and teachers here. Here's to 9 more months of plastic toy ducks, stickers, and (hopefully) losing more games of Sorry.