Varkala

On February 26th, I left Asadeepam early in the morning to catch the train to Trivandrum where Georgie's flight was arriving at noon. Once we met, we decided to take the bus to Varkala because some of Georgie's friends were planning on visiting there that weekend. We took the train to Varkala and then caught the public bus to the beachfront. We checked into Mango House Bed & Breakfast, which had been recommended by other interns. It had a beautiful garden with deck chairs and a hammock. Georgie and I sat and talked about our ideas for our trip. On the first night we walked along the beach at sunset. We had dinner at a beachside restaurant that served fresh seafood caught by the local fisherman that day.

The next morning, we visited a local temple. It was my first time in a Hindu temple, and it was interesting to walk around and observe the building and people worshipping. In the afternoon, we went down to the beach to swim. The waves and currents in the Arabian Sea can be very strong, and we were tossed around a lot while swimming. In the evening we had dinner at a nearby restaurant which had live music. We met an Australian student who had just completed an internship for medical school. He had also spent a couple weeks trekking in Nepal.

The next morning we planned to spend an entire day at the beach. We alternated between lying on beach chairs and cooling off in the water. By the end of the day, both Georgie and I were very sunburnt. We bought some after-sun lotion and applied it about every hour for the rest of the day.

Travelling

Before beginning my internship, I asked permission to take a month off in order to meet with my cousin Georgie from England. She is taking a gap-year before heading off to her first year of university. We haven't seen each other in 3 years so I'm very excited to have the chance to reconnect with her while exploring more of India. I'll be meeting her in Trivandrum on the 26th of February and travelling until the 26th of March. I can't wait!

Saritha

Saritha is a 14 year-old girl with autism and severe mental retardation. She is a student in the Pre-Primary class at Asadeepam. Saritha is unable to speak, however her understanding is quite good. Saritha is one of four girls living at Asadeepam, where there are approximately 50 students. It is not surprising that only 1/10 of the students are female, since both autism and mental retardation are more prevalent in males. Autism is 3 to 4 times more common in males, and the ratio of males to females with mental retardation is approximately 2:1. This ratio changes to 1.5:1 when we look only at severe cases, therefore females are overrepresented in the lower ranges of intellectual disabilities. Girls are less likely to be affected by autism, however if they are affected then their intellectual impairments tend to be more severe. If a true male excess exists for these disorders, then it is possible that the cause can be an X-linked genetic disorder, but more research is needed.

According to her family, Saritha appeared to be developing typically until the age when she received several vaccinations. After this, she began to withdraw and develop autistic symptoms. There have been individuals who have attributed the cause of autism to vaccines, however this progression of autism is actually fairly common, even in children who do not receive vaccines. Some children will begin to develop early milestones, and these skills will disappear before age 2. This coincides with the period in which children are typically vaccinated, so some individuals have drawn an illusory correlation between these two independent events.

Like many children at Asadeepam, Saritha comes from a very poor family. Her mother was a single-parent who needed to provide for the family, so during the day she would often lock Saritha alone in a room while she left for work. Whenever possible, Saritha's grandmother would watch her during the day, however she was very ill. This upbringing has definitely had negative effects on Saritha's socialisation and communication skills.

Saritha needs help for eating and toileting, and the staff are working to help her develop skills that will help her become less dependent. Saritha will often collect dust and waste and brush it with her hands into little piles on the floor. This may be a habit that was formed while she was locked alone in a room, and the teachers have worked to decrease this behaviour.

Saritha is learning vocational skills such as colouring, using scissors and glue. She is also learning to write some letters in Malayalam and to identify her written name. It is difficult for me to work with Saritha because children with autism have difficulty understanding non-verbal cues such as gestures, and this is my primary method of communication at Asadeepam since I do not speak Malayalam. When working with Saritha, I must physically guide her hands to show her the task that I would like her to complete.

The one action that Saritha can mimic is a smile. She will always respond with a smile when I call her name or if I first smile at her. She will also maintain eye-contact, which is unusual for children with autism. Children with autism show a difficulty in recognising emotion and relating to others, so perhaps Saritha does not smile because she is happy or recognises that I am happy, but because she has simply learned that by mimicking this action she will be met with positivity.

Unfortunately, Asadeepam does not have the resources to provide adequate care for Saritha and other students with autism. In order to see significant improvement in her language, academic and social skills, Saritha would need about 40 hours a week of individual attention from a trained teacher. Also, the best interventions for autism begin at a very early age and as the child matures it becomes more difficult to teach skills and habits. Looking at Saritha's past assessments, we can see that she is making progress in her personal, social, academic and vocational skills, however the development is slow and minimal.

Renju

Renju was brought to Asadeepam four years ago by Childline, an organisation that helps underprivileged children. Renju comes from a very poor family: his father is a labourer with alcoholism and his mother works in a fish-packing factory. They live at their workplace, and Renju's older brothers have been placed in orphanages because their parents are unable to provide for them. During the holidays, Renju either stays at the school or goes to his uncle's house. We have been taking meetings with the local supermarket chain to see if we can find a job for Renju's mother.
Renju is 12 years old with moderate mental retardation. He also has several behaviour problems such as lying, stealing from other students and staff, pica (eating inedible substances), and aggressiveness. I always know where to find Renju because he makes a loud, deep noise whenever he is focusing on a task. Some of these behaviours are most likely due to his poor home environment. Several of the behaviours that are considered problematic in the school setting may have been adaptive in his neighbourhood, such as aggressiveness and theft.
Mental retardation is much more prevalent among children of lower socioeconomic status (SES), especially for children with less severe mental retardation. The stress of poverty and an unstable home environment is suspected to play an indirect causal role for mental retardation.
In class, Renju is developing his Math skills, English and Malayalam. He is also learning important abilities like telling time and how to handle money. He enjoys math and is learning double-digit addition with carry-over. He has a good number sense and understands meaningful counting. When he makes a mathematical error, it is usually due to lack of concentration. He is not very interested in language, and when I have worked with him in class he has only been interested in learning how to spell my name. He writes it on paper and carries it with him in his pocket. Renju is very good spatial awareness, and can copy letters, numbers and shapes very well, even though he cannot identify the individual characters or what any of it means.
Renju has difficulty pronouncing the letter 'R' and like many other students at the school, he would benefit greatly from working with a speech therapist. He is often inattentive in class, and his teacher has difficulty getting him to concentrate on his work. Renju becomes very upset when he is disciplined and runs away, refuses meals, or locks himself in the bathroom. Renju enjoys being the leader or helper, so as a reward the teachers will allow him to lead the group during fitness class, set the table, or take care of the younger children.
Renju has become very attached to me since I arrived at Asadeepam. He follows me everywhere and takes care of me by bringing me to each activity, teaching me words in Malayalam, and filling my water bottle. He will always save me a seat right next to his own. Renju is very frustrated by the fact that I cannot speak Malayalam, since he always wants to speak with me. When he tries to speak to me in Malayalam and I can't interpret what he is trying to say, I ask him to speak in English. He replies by sighing loudly and saying "I AM GOING...", then repeating exactly what he had said in Malayalam...as if saying that small English phrase will magically translate the rest of what he's said into English. It's cute, but not very helpful for my understanding.

Renju is also very protective

of me, and gets jealous when I interact with other children. He says that he is the only student who is allowed to come back to Canada with me. He will travel by helicopter, live in my house and drive my boat. I have told him that he will have to keep studying English if he wants to come to Canada, and this helps to motivate him. In the mornings when I check my email, Re

nju sits with me and I show him pictures of friends, family and my home. He has learned how to use many functions on my computer and camera, so it can often be difficult to get work done when he is around. Renju loves to play, and some of his favourite activities are yoga, karate, pretending to be racecar drivers, badminton, and arm wrestling. Renju loves to garden, and he is very proud of his own patch of plants that are growing in the yard. He spends an hour each day clearing the ground, watering the plants, digging new holes for planting, and pulling out weeds.
Renju is very good at taking care of the younger children at the school. He helps them get to each activity and protects them when other children are teasing them. He treats me the same way as he treats the young children. I believe he sees the fact that I do not speak Malayalam and I am less familiar with cultural practices as my own disability, which is quite understandable.

Renju becomes very sensitive when he is punished, or when it seems as though others are angry with him. Renju has difficulty expressing how he feels, and he often interprets discipline as rejection from others. Renju is attached to me, and when he oversteps his boundaries and I must discipline him, he withdraws and will hide from me for the rest of the day. If I pull away from him when he wants to play, he gets upset and ignores me. Renju has problems becoming close to others, and has difficulty understanding my relationship as both a teacher and a friend. In the past, I have always considered myself to be very good at remaining friendly towards the children I work with, without becoming their friend. I was always able to maintain that necessary distance, but I find this much more difficult with the children here...especially Renju. It might be due to their special needs, however I have worked with this population before without any problems. I think it is the fact that I live with the children and interact with them much more than I would at a regular school or day camp. Also, the children come from such disadvantaged backgrounds that I can't help but want to give them as much love and encouragement as I can. The other teachers and staff have a different approach, and focus much more on punishing bad behaviour rather than rewarding good behaviour, so perhaps I am overcompensating for their methods. I am learning to keep my distance, but still remaining friendly with the children.

Kannan

I will begin by writing about Kannan, who has been a student at the school since its founding 16 years ago. He is originally from Tamil Nadu and he spoke Tamil, but he has learned to speak Malayalam while at the school. Kannan is in his mid-forties and is part of the vocational class at Asadeepam. He has mild mental retardation and is visually impaired. He becomes frustrated very easily when he is disciplined or when things do not go according to schedule. The power went off one night during dinner, and he became very agitated. His hands display scars from his problem behaviour of biting his hands. With the help of the staff at Asadeepam, this behaviour has decreased significantly, however I have still seen him bite his hand (with the few teeth he has left) when he is upset. Kannan is very interested in the principal's son, and will always ask her how he is doing. When his star is in the sky, Kannan reminds the principal to visit the temple. Because Kannan is almost completely blind, it is difficult for him to participate in the vocational class (making envelopes, jewelery, knitting...) but he is still eager to help so he carries the materials to and from the storage room and stands by if anything needs to be done. He is also one of the students who acts as a watchman for the school. He sits by the front door and opens the gate for visitors.

Kannan has not seen his family in 10 years. They live in Tamil Nadu and they have not made the trip to visit him or to take him home for the holidays. This has put a big burden on the principal of the school because she must be responsible for Kannan throughout the entire year. The family cannot afford to contribute to Kannan's expenses, however it is unfair that they have not visited their son in 10 years. The principal spoke to the parents this week and said that they must come to take Kannan during the holidays in April. He is very excited to see his family again, and I really hope they choose to come.

Kannan has quite an extraordinary gift. He has memorised calendars from about 1950 to 2020 so he can remember the day of the week for any date in between this period. He told me that I was born on a Sunday under a certain Malayalam star, and that this past Saturday marked my one-month anniversary at Asadeepam. The principal of Asadeepam takes advantage of Kannan's gift when she needs to remember the dates of visitors of appointments. I have used Kannan's gift to plan visits to upcoming festivals. Despite Kannan's extraordinary gift of memory, he is still unable to integrate into society due to his mental and physical disabilities, along with his behavioural problems. At Asadeepam, he is learning to find alternatives to his problem behaviour, and he is developing social and vocational skills.

Case Studies

"... [patient] histories are a form of natural history- but they tell us nothing about the individual and his history; they convey nothing of the person, and the experience of the person, as he faces, and struggles to survive, his disease...To restore the human subject at the centre- the suffering, afflicted, fighting, human subject- we must deepen a case history to a narrative or tale; only then do we have a 'who' as well as a 'what', a real person, a patient, in relation to disease- in relation to the physical."

- Oliver Sachs, The Man Who Mistook His Wife for a Hat and Other Clinical Tales

For the following blog entries, I have decided to write case studies for individual students here at Asadeepam. I will describe their specific disability, their personality, the assets of the student, and the work that is being done to improve the student's academics, vocational skills and behaviour.