Project Harar, in collaboration with Transforming Faces, has been at the start of speech therapy consultations in Ethiopia. This is a new and exciting development in Ethiopia contributing to Comprehensive Cleft Care.

In 2019, the very first cohort of Speech and Language pathologist professionals were trained and graduated in Ethiopia to provide speech and language therapy as a result of The Toronto Addis Ababa Academic Collaboration (TAAAC). Natnael, a Project Harar team member, graduated from this scheme in 2019 and is our charity’s designated speech and language therapist. He is now training medical health workers to support the delivery of Speech Therapy with Project Harar. This training consists of theory and practical classes, as well as assessment periods and on-the-field training supervised by Natnael.

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Training of health workers:

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There is a particular process for training medical health workers. Otherwise known as community-based health workers, the health workers are being trained to become community-based model speech therapists.

A typical structure of training sessions, these are separated into theory (2 weeks) and practical (1 week) lessons. The theory lessons are formatted like a lecture class, they last 15 days and taught by Natnael (speech and language therapist); this covers all that will be assessed in the practical. It covers the activities they will do, plus information on nutritional support and feeding counseling that they can provide to parents if needed. There is also a refresher training given quarterly to the health workers for 1 week after the pratcial and theory lessons. 

 During the core training module, various different topics  are included such as:

 

•       Anatomy & Physiology
•       Why is Speech Therapy important?
•       Embryological Development
•       How speech sounds are made
•       Oral Examination
•       Speech Sound Assessment
•       Addressing Nasal Emissions
•       Strategies for Eliminating Glottal Stops
•       Strategies to Eliminate Pharyngeal Fricatives, Pharyngeal Stops, Mid-Dorsum Palatal Stops, and Nasal Rustles
•       Feeding a Baby with a Cleft lip and /or palate
•       Why Non-Speech Oral Motor Exercises Do Not work
•       Practical Practice with patients at Yekatit 12 Hospital Medical College

  

Natnael frequently supervises and assesses the training to see the improvement in the technical capacity of the health workers and the child's speech.

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The contents of a Speech and Language therapy session:

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A typical speech therapy session with Project Harar begins as tailored to the child rather than on the basis of a strict curriculum. Training for the medical health workers during sessions last for however long it takes depending on the child’s progress.

The sessions always begin by assessing the sound 'eorr' of the child of Amharic/Oromffa vowels and sounds. They may train the muscle around the mouth to say these vowels, and the health worker will work with the child to improve sound

The session after this  begins to focus on phrases and sentences, this is where the health worker will use tools such as a booklet with Amharic/Oromo phrases in the International Phonetic Alphabet and accompanying pictures to train the child to recognize the vowels in the words and reference an image for support. The parents are always in the sessions with the child and are trained themselves by health extension workers to carry on these activities at home – it is vital that the work continues so the child can adjust their speech more securely.

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Project Harar's designated Speech and Language Therapist Natnael is pictured during a speech therapy session with the child and parent, as well as an assisting health worker.

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  The other activities include:

• Pre and post-surgery speech assessment and feeding counseling for all cleft lip and palate patients
• Post-surgery speech therapy sessions
• More detailed feeding counseling & techniques

Our communications intern Sharon had the opportunity to be present in the speech and language therapy sessions. We interviewed her to ask about the importance and necessity of these sessions for the child after surgery, Sharon begins by saying, “The speech therapy has been helping a lot of children in so many ways. The first thing is that even after surgery there are a lot of difficulties for the babies, they have the growing urgency to speak freely, but this is often not that clear with cleft lip and palate surgery still. Speech therapy is important to help the people communicate more clearly, for them to be confident and for other people to hear clearly the words and understand what they mean.”

"After their surgery, it is more important to keep up with the speech therapy because that how children become more assured, it helps in so many ways. They will sound more confident, I have seen a lot of children who received  speech therapy and those who didn’t and what I see is that the children that had speech therapy were more confident."

The age range of the students in these sessions can range from up to 3 years old and above. The regions the children are typically from are the Oromia region, Harari region, and Dire Dawe region. We plan to expand these sessions into other regions in the future.

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Techniques and skills taught to the families: 

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Sharon, our communications intern, talks about activities that are encouraged for the families of children who had undergone surgical treatment. These are organised by our Speech and Language therapist Natnael and taught to parents and family by the health extension workers.

“In the first place they (speech therapists) will be showing them (families) what kind of sounds they have to make, there is a book that shows the sounds, also their parents can help them do this as a short-term solution."

This book is utilised by the health workers in speech therapy sessions and uses phonetic spelling, for parents and speech therapists to help a young child to practice pronunciation of vowels post-surgery.

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A health worker training with Project Harar is pictured using Articulation Test Book during a speech and language therapy session, with the parent in attendance.

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“It helps both the patients and the families because after surgery to be able to communicate like that freely makes the patients and families happier because psychologically they will be affected if they can not communicate how they wanted so the family will be affected because the children cannot communicate freely. Even for the children to go to school it’s difficult because they cannot ask what they want and even communicate with their own families so it helps for both families and patients.”

We are steadily expanding our outreach in Ethiopia to provide more Speech Therapy sessions to  children who have received cleft lip and palate surgery and treatment. /

It was warming to see the children happy like that, to see them communicate more heartily and be more confident. For me in that speech therapy training there was so much to learn for me to know you can help a lot of children even if you are not a speech therapist, for example, if you can see the sounds they have to make on youtube. i would also like to help these children communicate more freely so it changed my mind on speech therapy. - Sharon, our communications intern.

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You can find other articles written on Speech Therapy in the links below:

Speech and Language Therapy

Adapting our community-based speech therapy programme in Oromia

Kumaaol receives speech therapy after surgery 

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Help Project Harar continue to provide vital services to families so they can access cleft lip and palate treatment. It costs £150 to provide access to treatment for one child.

That's £150 to change someone's whole world 🌎