These are traditional Tet items for sale. They are everywhere. They adorn peoples homes during the Vietnamese New Year.
These are traditional Vietnamese statuary, Considered good luck and to bring the owner good luck.
These are golden Buddhas and a golden fish, which again are good luck items. Gold items ~ statuary, jewelry, banners ~ are 'gold' in Vietnam. Pun intended.
This is a pic I forgot to post earlier, but thought it appropriate now, as I am going to write about the past 2 days that Amy and I spent with a local pediatrician seeing 24 patients with autism, language delays, cognitive impairments and/or a combination of these 3 diagnoses.
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| This is Amy and me the moment we first arrived in HMCM (Saigon). 24 hours of travel at this point and ready to get started. We always take a pick upon our arrival and this one ranks fairly high in the 'we don't look too terrible' category. Ha. Amy and I first met, working together in Chicago at La Rabida Children's Hospital. We met in 2002 or so and first traveled together to Vietnam with Mission Peace (now IEP) in 2003. She's a great travel partner for me. She is a Speech-Language Pathologist and a Professor at Northwestern University in Evanston, Illinois and lives in Chicago. She works in the graduate Speech-Language Pathology program at Northwestern and not only teaches, but also supervises graduate students in their clinic on campus, seeing patients with Autism and other language and cognitive delays. |
We met him this trip and his (English) name is Nathan. He was super-great ~ quirky, quiet, artistic, but very helpful, as he was listening to music via ear bud in one ear, drawing these super-complex superheros and anime characters, and texting friends, but also listening to all of the conversation during the consultations we did with parents and offering Amy frequent translation and insight into what the parents were saying.
Dr. Lam placed a posting on a Vietnamese equivalent to Facebook (called Zalo), stating there would be an Autism expert (Amy) here in Can Tho for Thursday, January 2nd and Friday, January 3rd. Families then reached out to her to set-up an appointment. This posting, though, drew the attention of the local police and throughout our time with Dr. Lam, there was a presence, as she was being watched. Here in Vietnam, there are clear channels that have to be navigated to work in hospitals, permissions that need to be granted by not only hospital leadership, but also district/governmental leadership. When we worked with Dr. Lam in 2015, she didn't follow these channels and apparently got in some trouble for this, so this time, she, with the guidance and suggestion from Amy, connected with the surgeons we work with at the General Hospital to guide her through the process of getting approvals, etc. We, as a result, worked out of a room at the General Hospital, not Pediatric Hospital, but it was quite a to-do to get this done, it seemed.
So, when we began at 830a on Thursday, the 2nd, Dr. Lam informed Amy there were 14 patients to be seen that day and 14 to be seen on Friday. This is a very aggressive number of patients to see if 2 days. She had them scheduled every 30 minutes, but in the end, Amy spent at least 45 - 75 minutes with each family in consultation. I was there as her assistance, stepping in a few times to help with those kids who needed a little more input to their bodies (along with that which Amy so deftly provided) and to be Amy's photographer and videographer, as well as to create a little medical chart/information sheet for them all that she can take home for each patient.
We had quite a crew the first day in our room (again: air conditioned!! Such luxury!). This crew included Dr. Lam, the pediatrician, a new doctor from the children's hospital, which she was a Neonataologist, a high school teacher, an English teacher, a college student, the physiatrist (rehab doctor) from the General Hospital's Physiotherapy department (who I met on Tuesday), Nathan, Dr. Lam's son, me and Amy.
We loved this sign, which was above the door of our treatment space.
This was the sign on the door to our treatment space. We were seeing patients in the general hospital, at which no pediatric patients are seen, so Dr. Lam put up this sign so the families would know where to find us. It was very sweet.
This was the room's set-up. It was perfect and lovely. Dr. Lam purchased new toys for these evaluations, including balls, puzzles, a toy car, crayons/coloring book, a book, legos, and other things.
The Vietnamese version of "Rodi." Rodi is a blow-up horse that has been around for 30+ years in the US therapy world and we use it to work on balance, jumping/hopping while sitting on it and kids just love it.
Dr. Lam, following emails exchanged with Amy, created a check-list/information sheet for each child and on this included their age, communication history and then Amy spent time asking additional questions of the parents and/or caregivers (grandparents, aunts, uncles). As I said, all of these children had autism, language delays, cognitive impairments and/or a combination of these 3 diagnoses.
The children seen on day 1 were less severely impaired than the children we saw on day 2. All of the children were great and Dr. Lam did a very nice job of selecting good cases for Amy to consult on to help the parents and her to learn what to do with these children to improve their social-play skills, language skills and to just answer questions about autism and options. Here in Vietnam, there is 'regular' school and now, which are new, there are 2 'special' schools here in the Can Tho area. These 'special' schools require parents to pay to send their children there, but this is new since we were last here in in 2015. Then, there were no options for parents of children with any type of special needs. Now, we don't really know how these 'special' schools are set-up, but seems many of the children we saw this week attended daily for up to 2-4 hours per day with some of the time spent in groups and some of their time spent with a one-to-one teacher. We discussed, hopefully, next time we are here, that we would like to go to one of the 'special' schools, but aren't sure if that is possible. We'll see.
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| The crew! (L to R) The English teacher, the high school teacher, Nathan (Dr. Lam's son), the Neonatologist, and Bac Si (Dr.) Lam . |
Our first patient, a boy with an ADHD diagnosis. We saw both he and his brother. They were both prescribed heavy-duty sedative medications for their ADHD and so it gave opportunity to discuss the rationale for how medications are used in the US to treat this diagnosis. This child was sedated. Not good.
This kiddo was terrific. He has a diagnosis of Autism. He had the best laugh/giggle on the planet and worked really hard, engaging with Amy. His mother was very engaging too with him, as all the parents were.
This little guy came with his aunt to the session. He struggled mightily to engage with Amy, but throughout the session, he did pretty well. Amy spent a lot of each session teaching the parents/caregivers how to develop joint attention (playing with another person/adult), rather than playing alone (solitary) and how to integrate simple language development into their interactions with the children..
This little NY Yankee was not quite 3 years old and had limited language, as well as some signs of autism. He was moving about the room, roaming, for much of the session, but did engage with Amy and this his mother (with Amy's assistance to teach his mom).
This boy presented with a language delay. He was social and engaging, but was behind in his language development.
This little peanut was about 2 1/2 years old and spoke mainly English rather than Vietnamese. She has autism. Many of the children we saw are using English to label items, etc., rather than their families' language, because they are learning via TV, videos and/or YouTube. This is a concern, as they aren't developing language, rather just vocabulary, so it isn't functional for communication.
This little guy was around 5 years of age and has autism and cognitive impairments. He did not use any toys functionally, rather just 'collected' items (see the pile of letters from the floor mat) and really struggled to engage in any way. Amy was able to give his family simple ideas of ways to try to get some engagement, as a starting point.
Amy teaching Dr. Lam. She is an excellent teacher and clinician.
Amy's notes for Dr. Lam about the different diagnoses we were seeing over these 2 days and how they fit together and how to interpret severity of impairments based upon these diagnoses and the combinations therein.
This video is of Amy working with a boy with autism and trying to get him to engage in joint play with her. He keeps his hand over his eyes most of the time, as social engagement is very hard for him, but he does a good job playing with Amy. She uses these moments to teach the family how to engage with their children with autism for short periods of time to improve their joint attention/play and for assistance in the developmental of functional language. There is limited to no information available to parents here about how to work with their children with autism and there aren't therapy services, for the most part, for these children.
This video shows Amy working with another child with autism and she's using the inflated balloon to get his attention and counts (in Vietnamese ~ mo, hai, ba), waiting to let it go until the child looks at her face, indicating he wants her to let go of the balloon. His giggle is terrific.
This is a video of the little girl who mostly spoke English and liked to play independently, but not engage in play with others. Amy is using a turn-taking game (the puzzle) to work toward joint attention. Children cannot learn without engagement with others and development of joint attention is vital.
This little guy has autism and language delay. He could label everything in English, but communication was limited. I like his little jammies.
This little lady was about 2 1/2 years old and has autism. She held onto her large toy in her right hand then entire time, which is common. She exhibited limited communication skills and limited joint attention, so Amy is using bubbles to teach her mom how to increase these skills.
This is Amy's education sheet that she put together for Dr. Lam. This lays out treatment strategies that Dr. Lam can share with the families, as she was sending each an email after these sessions with Amy. This discusses increasing play skills, communications skills and how to provide these kids with the sensory and motor information their bodies need to stay focused and to improve their overall body control. We call these 'heavy work' activities, which require the child to use their whole body to move.
This little boy was very cold, because of the air conditioner, so that's why he's wearing his hoodie. He presented with overall cognitive delays, but can definitely learn and had such a nice bond with his dad.
This girl presented with her adopted mother. This is something we have never seen before in Vietnam. Her mother stated this girl, who was 8 years old, and her older sister, both present with autism, but we don't know much else. This girl has a lot of potential to learn, but is quite impaired at this time and there aren't, unfortunately, the supports in-place here to make those improvements, so hopefully her mom and family can try to help her.
Amy is trying to get her to engage in play, so her goal was for the girl to put the balls into the box, indicating she wanted to continue to play with Amy. Basic turn-taking play, but importantly, play with another person, rather than just by herself.
This is another little one with autism and language delay. Amy was using the bubbles to teach her mother how to do reciprocal play and to increase engagement.
Our day ended quite late on Friday evening, as there was a physician from the general hospital who asked us to see his son, who was 8 years old and presented with cognitive impairments. His parents were so terrific and at one point, his father, a physician, said, "We don't care if he's an engineer or doctor or singer, we just want him to be happy." Wow.
The final step of our day was to talk with a father of twin boys who are 6 years old. They both came to the clinic, but had to wait for some time and were incredibly out-of-control and were at great risk for hurting themselves or us, as the larger of the 2 twins was throwing himself about the room. Amy and I agreed that it was unsafe for them to stay, so the father and grandfather took them home and then the father returned to talk with us. Amy explained to him that the boys will need great supports throughout their lives and we just tried to provide this father support. He commented that he has been researching options for his boys, as he knows they will need a lot of help. It was a very sad conversation and Amy and I both felt so bad for this family.
This is the frustrating part of our work here ~ that we cannot always provide the support these families need. We were discussing how challenging it is to (a) have a child with autism or any types of delays, (b) to access services in the US that they need, but also discussed the challenging and almost insurmountable odds of managing this here without any supports and in an environment where there is always noise, cars honking, constant movement and many dangers, from the sidewalks being in disrepair to all of the cyclos flying about.
But, at the end of the day, we have tried our best to help in every way we can and the families were so gracious and kind and were a pleasure with which to work.
Onward we go...
xoxo
Stacy
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