Week 3:
Phu My Orphanage and Medical Clinic

July 8, 2014

This week I have developed a routine for the children and the therapy that we provide to them.  I am still getting to know the children, their different personalities and how best to work with each child.  The work is rather frustrating as the children’s progress is rather slow, and it can take nearly a week to achieve a small goal.  The most frustrating aspect though is how over the weekend many of the children forgot what we had been working on the week before.  I know this is because over the weekend the caregivers do not work with the children on any of the skills that we have been trying to develop.  In many of my Psychology classes we talk about how there needs to be constant reinforcement to learn a new behavior.  One technique that we have used to teach the children new skills is approximation.  We have talked about this in many of my Psychology classes but it is a good experience to actually implement the theories we learn.

We most commonly use approximation for teaching self feeding and walking.  We reward the child when they do something similar to the behavior that we want, so when the child attempts to move the spoon to their mouth or when the child tries to take a step.  The reward can range from just the intrinsic value of the behavior, saying good job, or some physical reward like a toy that they like.  Eventually through modeling and approximation, the hope is that they child will learn that behavior.  It is exciting when the children make visible progress, one such case is a boy who is extremely underdeveloped.  He is nearly 5 years old but seems like a big 1 year old and can not walk or feed himself.  Yet I have been working with him on self feeding and this week he has begun to really respond to the therapy.  With assistance he can bring the spoon to his mouth, but now he has learned that when I say “hands” he will reach up and grab the spoon.  This is a small accomplishment but it is exciting to see the the child responding to our work.

Besides feeding we work a lot on developing the children’s ability to walk.  There is one child who has Autism and has had trouble learning to walk.  I feel the reason for this is he does not have an interest in learning to walk, but I have found that he loves physo balls.  So to work on his walking we will have him chase the physo ball around the clinic, he absolutely loves this and I feel that this makes the behavior much more reinforced as its intrinsically rewarding.  There are other children with Cerebral Palsy who have trouble walking because their tendons and muscles are so tense.  Before working on walking with them we stretch their muscles.

Besides these therapies each afternoon we have group activities for the kids.  These help the children learn to play together, how to share, and helps develop creative thought along with physical skills.  The activities are generally some sort of craft, such as painting, or mask making.  Overall the work has been good and I feel that I am learning a lot, yet there are some problems at the clinic.  I know that how the Vietnamese view disabled children is different than in the United States but I feel that there are some major differences between how the nurses view the children and how I do.  This has caused some minor conflicts over some issues, yet this is to be expected when working with a multicultural team.