We have two wonderful students, and a two room suite, so we can break into two teams when we are busy. As always, Helen and I let the students take the lead, and Bruna and Jeanette are doing a fantastic job.  Our office has air conditioning, and wifi…we are feeling very spoiled!

Patients have been coming every day, all day. Most have hypernasality in their speech as a result of their history of cleft palate.  We work with them on getting a better oral flow and on correcting any articulation errors. We have had a few patients with clefts that cannot be fixed surgically, and the wonderful volunteer women of Unima arranged for these patients to have false palates made (like a bite plate), to separate the oral and nasal cavities into two.

In addition to the patients we see in our office, we go up to the post-operative wards and visit with the families.  We instruct the families on how to work with the child until we see them again next year.  These small innovations have made a great difference in the children we have seen over the years in Peru.  I’ll outline two small but meaningful interventions we do.

1.  Babies who have just had the cleft lip repaired, and who have a cleft palate, must return in one year to have the palate surgery.  During this year, we expect all the sounds the baby produces to be coming through the nose (because the nose and mouth are basically one big cavity) and that’s ok.  But, we do not want the babies to produce what we call “glottal stops,” which is the sound in the middle of “uh-oh.”  That is a sound that does not occur in Spanish, but babies with cleft palate are very likely to make them, and then have trouble giving them up once the palate is closed.  We work with the parents on learning the difference between the preferred sounds, which are to be celebrated,  and the glottal, which is to be ignored.   The parents who are able to implement this small intervention find that the sounds are in place and ready when the palate is closed.

2.  For babies and older children who have just had the palate repaired, we work on teaching the parents the difference between oral and nasal flow.  The one cavity has now been divided into two!  Although the kids are tired after surgery, we work with the parents before and after,  and teach and re-teach about how to help the kids along.  Every family gets simple handouts (prepared by alum Lindsay Naylor) and, of course, regalitos (little gifts).

So, it’s been a hectic few days, but the Unima ladies have looked after all the details and the parents are so very appreciative.  Even the security guard and cleaning woman have been so good to us.

As we wave good bye to the children as they are discharged, we know we have done all we can to help them along on their road, to be the best communicators they can be.

Hey, it’s 2 pm.  Maybe the Unima ladies have un cafecito for us!


About Shari Salzhauer Berkowitz

Shari is a speech language pathologist and assistant professor of communication disorders at Mercy College in Dobbs Ferry, NY.
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