Where: Nairobi, Kenya When: For 1 week in April, August and November Who: For children with repaired cleft palates who reside in Kenya or can get themselves to Kenya. Smile Train in partnership with our clinic- HearSay & Read Clinic makes the free cleft speech therapy camps possible. Last week, we concluded a FREE week-long cleft speech therapy camp, sponsored by Smile Train, in partnership with our speech therapy clinic, HearSay and Read Clinic. The camp is 1 of 3 week-long camps we offer typically in April, August and November, to coincide with Kenya school holidays This has been our 4th camp, having started in April 2018 and our next camp will be in August 2019. This camp sees approximately 20 children with repaired cleft palates attend an all- expenses paid, 5 days of intensive speech therapy within the environs of Nairobi, Kenya. The mood at the camp is usually a relaxed and energised one with parents getting much needed R & R time as we offer intensive, but fun speech therapy to their children. During this camp, a CURE staff expressed an interest in writing a piece about the camp (read about it here), which made me reflect a little more about the cleft speech therapy camp. We have conducted the last 4 camps at CURE Hospital, Kijabe, one of Smile Train’s partners in Kenya. CURE Hospital is able to provide our cleft speech camp families with accommodation and meals at a nearby hostel.

During the day, we use a quiet hall within the CURE compound and in the evening, the families retire to a nearby hostel. For me, this camp reflects service to Kenyans, but it is a lot more than that.

What the Free Speech Therapy Camp Represents

When my staff and I were asked what it is we liked about the camp, many responses flowed effortlessly from our mouths;

1. The impact in these children’s (and young people’s) lives
2. The restoration of hope to the dreams and aspirations these parents had for their children
3. The restoration of what is possible if parents believed in their child’s capability to improve their speech skills
4. Watching the determination in these children’s eyes
5. The quick progress made and sometimes immediate difference to their speech and confidence after this burst of progress
6. Watching how completely relaxed not just the children, but the parents are in each other’s company- no judgements; no questions to answer about why their child’s speech sounds different or why their child has a scar
7. And the warm hugs, squeals and smiles all around
8. The stories- sometimes heart-breaking, but the realisation that some of these stories can now be re-written because of this opportunity to alter outcomes

The atmosphere during the camps is usually uplifting. We get to give out stickers, play with bubbles, hand out colouring pages and generally be these children’s allies and teachers for a whole week.

Who Sponsors the Camp?

These FREE cleft speech therapy camps are made possible through Smile Train’s funding.

“Smile Train is an international children’s charity with a sustainable approach to a single, solvable problem: cleft lip and palate.” https://www.smiletrain.org/our-cause

Smile Train fund-raises to support the various programs, all related to cleft lip and palate. They offer much needed surgeries to children and adults born with cleft lip and/or palates and for a long time, they mostly specialised in providing surgeries. In the last decade, Smile Train’s scope of operation has widened to include;

• Speech Therapy
• Dental and Orthodontics
• Nursing Care
• Nutrition

All of the programs Smile Train supports are completely free.

What is a Cleft Lip and Palate?

A cleft lip and palate is an orofacial  malformation that occurs when certain structures on the baby’s face (upper lip) or mouth (roof of mouth- soft/hard palate) do not completely join therefore leaving a split or a gap

Complete cleft occurring on single side of the face http://columbiasurgery.org/conditions-and-treatments/cleft-lip-and-palate

Incomplete cleft occurring on single side of the face http://columbiasurgery.org/conditions-and-treatments/cleft-lip-and-palate

Complete cleft occurring on both sides of the face http://columbiasurgery.org/conditions-and-treatments/cleft-lip-and-palate

According to research, the likelihood of a child born with cleft lip and/or palate is higher in the Asian population and least likely in the African population. An estimated 1 in 500 births of children of Asian descent are born with cleft lip and/palate; 1 in 700 births (caucasian) and 1 in 1,200 births of children of African descent are born with cleft lip/palate. https://www.smiletrain.org/our-cause/what-is-cleft

Causes of Cleft Lip and Palate

There is not a single 1 cause for cleft lip and palate. Many researchers agree that indeed the causes are many. Genes play a role in many of the cleft lip and palate cases, but from my experience in running cleft speech therapy sessions in Kenya, many of the children I have evaluated or offered speech therapy sessions to did not have any other family member afflicted with the same condition with the exception of twins. Other causes of cleft lip and palate include environmental factors such as a pregnant mother’s exposure to infection, maternal illness, drug (prescribed or illicit), alcohol use or lack of vitamin B (folic acid). During foetal development, the lip develops between the 4th and 7th weeks of pregnancy while the palate (roof of the mouth) develops between the 6th and 9th weeks of pregnancy. https://www.cdc.gov/ncbddd/birthdefects/cleftlip.html By the 9th week of pregnancy, the foetus’ lip and palate development is usually complete. If a child was born with a cleft lip or palate, it would have already formed before the end of the first trimester.

Smile Train Model

Smile Train started its operations in 1999 and currently operates in over 85 countries around the world.

It is the world’s leading cleft charity and since its inception, Smile Train has helped over 1,000,000 cleft surgeries across the globe. https://www.smiletrain.org/about/faq

The model Smile Train operates under is essentially a sustainable one, that looks to increase local capacity unlike other charities or missions, which provide surgeries through say, surgical tours. A surgical tour would be one where an organisation organises or facilitates the travel of a surgical and allied team to places where patients cleft lip and/palate patients would await a camp-like intervention, but the team would leave immediately after not to return until the next camp or never. You know the Chinese proverb,

“Give a man a fish, and you feed him for a day; teach a man to fish, and you feed him for a lifetime.”

…is a way of describing how Smile Train works. Smile Train focuses on building capacity in the regions they work in. This capacity-building is in the form of training programs for surgeons and other medical professionals and provision of equipment to make surgical and related procedures possible. As 1 of handful of speech therapists in Kenya, I have myself had to devise sustainable solutions to providing speech therapy services to more children and adults as well as building more awareness. This blog is one such sustainable solution for creating awareness and increasing the knowledge base in the speech therapy field as well as what is available, e.g. free cleft speech therapy camp made possible through organisations such as Smile Train.

How I have benefited from Smile Train’s Model

Through Smile Train’s model, myself as well as the 100s of children who have accessed the free speech therapy services through my clinic, have benefited directly. I have attended many Smile Train- sponsored training initiatives aimed at up-skilling me on cleft-related speech therapy practices. Most people imagine that all speech therapists can practice in the varied scope that exists under speech therapy. Most speech therapists, as I have explained to many, have specialised in a few areas- it’s like how doctors who practice general medicine can be termed more generalists whereas a paediatrician has chosen to specialise in children. Click What Does a Speech Therapist do? to learn more about the various speech therapy specialisations. Depending on a speech therapist’s areas of interest or the focus area of the training program they underwent in college, a speech therapist can be better skilled in certain speech therapy areas of practice. Before the training I underwent courtesy of Smile Train, cleft speech therapy, which is such a specialised area of speech therapy, wasn’t something I felt very comfortable with.

Not every trained speech therapist is capable of delivering evidence-based cleft speech therapy. Lorna Muthamia-Ochido

I deeply appreciate the many training opportunities I have been fortunate to attend because of Smile Train. And what I have liked the most about the training programs through Smile Train is, like I mentioned, the fact that they have all been aimed at equipping me as well as all those who have attended with skills that increase my capacity to be self-reliant in the provision of cleft speech therapy.

Training Opportunities

The first training I attended was back in January 2015, in Addis Ababa, Ethiopia. This was a 1- week training program that was conducted by Dr Catherine Crowley, a professor of practice of the bilingual/multicultural SLP program focus at Teachers College Columbia University in New York.

Smile Train was able to arrange with Dr. Crowley, a lecturer who has done a considerable amount of work in the field of cleft speech therapy to offer this training. The following year (2016), Smile Train sponsored the same group of speech therapists and paraprofessionals from around Africa to a subsequent training with Dr. Crowley, but this time in Kumasi, Ghana. In 2017, Smile Train sponsored a select few of the speech therapists that had attended both of the previous 2 years’ training, to a special Training-of-the-Trainer training opportunity that would see these few speech therapists continue the training program acquired through Dr. Crowley throughout the continent. After undergoing many cleft related training opportunities, I have been able to facilitate training to other speech therapists and paraprofessionals in Eastern Africa through Smile Train initiatives. I have also participated as well as presented at 2 Smile Train sponsored symposiums held here in Nairobi, Kenya (2018) and more recently, in Bukavu, in the Democratic Republic of Congo (2019).

All these opportunities to collaborate with other professionals involved in providing cutting-edge surgical treatment and overall comprehensive care to persons born with cleft lip or palate, have been so worthwhile and reflective of the commitment that Smile Train has towards improving the lives of children born with cleft lip and/ palate.

With Smile Train shining the light on cleft lip and palate, I cannot help but feel a deep sense of gratitude for Smile Train’s unrelenting efforts at this single focus of cleft care in the African continent as well as the rest of the globe. But… I cannot help but imagine how different the speech therapy field would be if there was another player as mighty as Smile Train interested in improving the outcomes of children afflicted by other communication disorders. When I’ve circulated flyers about the free speech therapy services we provide in partnership with Smile Train, I’ve often felt a tinge of guilt that we are not able to provide free speech therapy for children presenting with other communication difficulties, who may not be in a position to access speech therapy. We run 2 free speech therapy programs;

1. Weekly speech therapy sessions at our clinic in Nairobi; and
2. 3 week-long camps in April, August and November (dates to be advised)

Final Word

What Smile Train has been able to achieve through its dedicated effort is an inspiration that non-governmental sector can be involved and succeed at providing solutions to some of the continent’s problems. It only takes the vision of someone such as Charles Wang (one of the 2 founders of Smile Train), keen to question and change the status quo and whose entire drive is centred on sustainability, capacity-building and service to people. I am truly inspired to, in my little way, be the change I want to see. In Kenya. In Africa. In the world. I am inspired by the enormous expertise that exists in our continent that foreign missions not focused on local capacity-building, neglect to tap into. It is a shame that in Africa, the term, ‘expat’ seems to only be reserved to foreigners when we the dwellers of this continent have unique perspectives, which when applied to whatever field, can radically and positively alter outcomes for those we serve. I have been left with little doubt that Africans are capable of solving our own problems if we’re involved. There is too much good faith. If you know someone with a cleft lip and/ or palate, please get in touch with our clinic through the contacts on here.