A working day

I know I have given very little update on my work here in Malawi, especially given that it occupies a large proportion of my time here. But I realised that the work is rather challenging and is taking a lot of my energy, so to sit down and type about work itself in my spare time has been a bit to much to handle in these early stages of settling in.......
But sit back and relax as a share with you a working day in the life of Tamara here in Malawi

Work starts at 7:30am, it’s already warm enough to open all the windows and put the fan on to prepare the room for the onslaught of heat and crazy kids. The communication room is one of the few that actually has a fan, so I’m pretty pleased about that!! The first hour sometimes includes meetings, sometimes admin or preparations but usually greetings to everyone checking you all had a good night, which is definitely an essential part of the day. From 8:00 we have different groups of children on each day from the special education classes at the primary school. At 8:30 the morning rehab program begins. Basically we collect children and their carers in a minibus, according to their Area (we don’t have suburbs here, people live in numbered areas, which have absolutely no order eg 7 is next to 19, which is next to 35 etc), they are encouraged to attend 2-3 times per week. We are not allowed to use any fancy toys or resources in therapy, as the whole aim is to teach them how to do their own therapy, therefore we can only utilize things they may have at home. This isn’t always possible, however we try our best to stick to this strategy. The day is divided into two therapy blocks of numerous half hour sessions that the children rotate between according to their needs. We have between 30-60 children attend each half day session (plus carers)

There are a variety of physio groups, OT groups and speech groups, ( I think there is a total of 19 different groups they can attend, but they are only able to attend 6 in a session) children are placed according to their functional ability not their diagnosis (which is often not known anyway)
Although to give you a summary, the majority of children have various multi-disabilities. There really aren’t any children here with minor issues. The mix of disabilities includes CP (as an overwhelming winner) muscular dystrophy, hydrocephalus, downs syndrome, unknown brain injuries, seizure disorders, severe hearing impairments, TB of the spine, rare genetic disorders, and acquired brain injuries. Many many children develop normally to ages such as 2 weeks to 2 years then at some point suffer from a variety of infections (largely cerebral malaria) resulting in persisting brain injuries.

It has been three years since a speechie has been at SOS and the staff who were there at the time, and received training directly from that speechie, were both away for the last 12 months studying in canada, so much of the good work, was undone. So I have had to start again in a lot of ways. Before I arrived they had one 30 minute communication group, and a 30 minute oral motor/eating drinking group. We now have 6 different groups, running in a half day session.

The day I arrived I was given a list of 55 children requiring speech intervention, the list has now just hit 240….. and is sure to continue growing. The rumour that I was the only speech therapist in the country of 12 million is definitely true!! I have not completed one formal assessment on anyone, and I don’t see that happening anytime soon, however we now successfully have a database of all the children, and the simplest assessment in the history of speech pathology…… How many words do they have? How do they tell you they want food? How well do they understand you? Describe their development compared to your other children. And that’s it. So although I feel like I have hardly progressed, we have nearly completed this questioning on all of the children, and grouped them all into the 6 groups according to their functioning level. So I think I’m getting somewhere.

Victor & Morgan are the two communication assistants who completed a one year course in Canada and arrived back in Malawi shortly after I arrived. So from a programme with no one focusing on the communication side of things, we now have a team of three, which is great. My role with them is to continue their training, supervise and support them to become independent, and they’re doing a fantastic job! Completely different personalities, styles, opinions & ideas, but both fantastic in there different ways

So the groups include speech sounds, communication for the hearing impaired, early language, socialization, AAC (picture boards & gesture stuff), oral motor, eating & drinking. On average we have between 2 and 12 attending each group, and there is no pattern, despite my desperate attempts to try and keep a bit of order… it just doesn’t happen. So planning for who is attending the group really is out the window, as there will always be different kids than you expect! Common occurances in our communication room – to many bodies crammed into one space, laughing, singing, crying, peeing on the floor and seizures.

Once the guys are a bit more independent in running the groups, I will have more time to do the assignment I came here to do, which involves lots of training of the other staff, developing resources, developing parent workshops, and connecting with other organizations to improve speech therapy in the region/country. Oh and next year in April SOS is opening another village in the south near Blantyre including a rehab program, so my job is to develop the speech services there also. Oh dear. How long am I here for again?

So the first session finishes at 11am, at which time we see individual clients for hearing assessments, stroke patients, three boys with autism, other complex children, or whoever has dropped into the centre for assessment.

Although I have tried to encourage the boys to keep a record of when they book patients in, this rarely happens, and even if they did, most people don’t really follow time or days very well so they could turn up at anytime.

I escape at about 12 back to my house where I rehydrate, eat some food and usually lie on the cool floor for about 30 mins until we start all over again at 1pm. Some days I’ll chat to my family as this is when they usually ring, some days I have visitors for lunch, if the water is out I’ll run home to collect more from the bore whole, or remove my clothes from the line so they don’t melt to the ground or some days I’ll stay at work and just chat with people.

So including the children attending the rehab program, children from special education classes, and individual assessments or therapy, between 100-150 people per day attend our rehab program, of which atleast half attend speech therapy, which is very likely to increase as more education and assessments are conducted.

So gone are the days when I used to think 15 patients was a busy day. And writing this now makes me realize why I’m often so exhausted of an afternoon!


Tuesday afternoons are the only exception to this rule, this is our meeting and or inservice afternoon. There are three terms in a year, and at the end of each term everyone writes a multidisciplinary report of the childs progress… this is often the only documentation that happens. Also at the end of a term workshops are run for two weeks. The workshop programme is sensational, we have a day for each therapy area, and the parents are required to attend for the whole day, they are very practical sessions, and highly valuable. We are currently in the middle of these now, as they are always run earlier in term three, because if they were run in mid December this would be in the middle of the rains starting, so attendance would be terrible, as the first few weeks of rains means everyone is home planting their crops.

After the workshops there are about two weeks of home visits, which is a time to deliver equipment, or check the status of people who havn’t attended in a long time.

The last hour of the day involves locking all of the toys & resources away, reporting any that are lost, things often walk!! Trying to document even a little of what has been done in the day or another meeting of some sort.

Then at 4:30 I stagger home. And never much later than that, as the guy who locks up the building pushes everyone out at about 5 minutes past finishing, so there is no overtime possible.

So that’s a rough outline of work. By western standards we are way understaffed and under resourced for the numbers and diversity we are seeing, but by Malawian standards and western standards combined, I think we have an absolutely amazing programme, which is servicing an extreme number of families, supporting them, empowering them and teaching them, and its sensational to be a part of it!!