Moving to India Taught Me To Be An In-Home Speech Therapist

Aug 12

A surprise gig as a live-in speech therapist in Delhi transformed me personally, and opened my eyes to a better way of practicing speech-therapy.

From Medical Speech Therapist to “In-Home, Ex-Pat” Speech Therapist

In the summer of 2014 I was a young clinician enjoying the challenging and stimulating environment of my dream job. I was a speech therapist at NYU’s Rusk Institute of Rehabilitation Medicine, helping children who struggled with communication and cognitive skills after brain injuries and strokes. It was hard, but I loved it; and I felt so grateful to have a position on an elite team of therapists and doctors.

While on a vacation in California, I received an email from a cousin of my then roommate. He and his wife lived in Delhi, but were with their 27 year old daughter in Philadelphia while she recovered from a severe traumatic brain injury. She was receiving intensive cognitive rehabilitation. She was re-learning how to talk, could no longer read and had difficulties with memory and impulse control. Now she was getting discharged, and they had to move back to Delhi with her where there was no speech therapy.

They heard about the work I did, and in what I imagine they thought was a long shot, asked me if I would be interested in living with them for three months. They wanted me to provide intensive, around-the-clock speech-language therapy for their daughter, Avanica.

I said yes, and those three months turned into three years of me living in Delhi and discovering that there are better ways to be a speech therapist.

Integrating Speech Therapy into Everyday Life

Ten years after that email, the element of my live-in speech therapy program at Chez Khosla that comes up most often in our reminiscing is of me putting post-it notes printed with “Shhhh” up-and-down their staircase. These were a visual cue to remind Avanica that we need to avoid conversations on the stairs so that she can focus on her balance.

Avanica’s parents Arjun and Shibani welcomed me as a family member into their home. We ate meals together, I had my own bedroom, I attended family gatherings and celebrated Diwali with them; we went to the movies and ran errands together. Shibani helped me tie a sari, and Arjun warned me against eating raw vegetables to avoid Delhi-Belly. In these moments I was a guest in their home, but a speech therapist to Avanica. I learned to be an expert and a guest, a skill I practice daily here in Brooklyn as a speech therapist who makes house calls.

Avanica and I had daily, intensive 1:1 therapy sessions where we worked on her expressive language skills, and learned the basics of reading with content that interested her: A cool 27-year old working in global economics. I would rewrite tweets on paper in large font, and we practiced sounding out the words to figure out what the tweet meant. We eventually progressed to short news articles, poems and stories. I would support Avanica in bringing up these topics in conversation over dinner that night, or during our car-ride to the market.

Now, Avanica loves to joke about how little she liked me: I was pushing her and I was always there (eye-roll)!

Building Therapy Connections

Working in the hospital instilled in me the necessity of developing a team around a patient/client…or in the case of Avanica: my housemate? As it came time for my three-month stay to end, my priority was finding professionals in Delhi who could continue to help Avanica with her cognitive-linguistic goals.

I branched out into the community to meet a reading specialist with extensive international training who ran a learning center; I befriended the wife of a Canadian diplomat working as a teacher who was able to help Avanica with language practice and social communication. Avanica’s parents spearheaded this team building, and made it their mission to ensure she continued to receive the support she needed.

The best therapy programs are made of these elements: Collaborating professionals who are willing to think outside of the box, and a family dedicated to learning.

Avanica and her parents are my forever inspiration.

Breaking From Speech Therapy Convention

“Maybe I should move to Delhi…”

Building a therapy network for Avanica laid bare the need for this “niche” service of speech-language therapy in Delhi, and India more broadly. Everyone I met knew of someone whose child was struggling with communication development, but had nowhere to turn aside from the daunting prospect of going to London or the U.S. for a therapy program. The opportunity to be able to help local families, and continue to work with Avanica lured me in, so I moved to Delhi permanently in 2015.

From 2015-2018 I worked as a speech therapist at a preschool, ran a private practice from my home, and eventually worked with a team to start one of India’s first early intervention centers. I quickly realized how inessential the energy-draining, behind the scenes work of a speech therapist in the U.S. actually is. We are trained to write and treatment-plan according to the bureaucratic demands of large school systems, hospitals and insurance companies. For instance:

You can’t work on that goal because insurance won’t cover it
You can only spend ten minutes with that family because hospital admin needs you to see 15 patients today
You can’t take your student to practice their speech at the coffee shop because it is a legal issue
You need to test, diagnose, and write a seven page report about a child after only spending two hours with them

I could go on.

Paving my own way in Delhi allowed me to shed the weight of these structures, develop my own systems and get to work more efficiently in ways that really mattered. I wrote session notes like journal entries to myself (How can I do this better next time?), rather than maps for insurance companies. I took my young clients out in the community for practice and motivation, visited them at home, and worked with them in my own home. We practiced language and executive skills in the kitchen, did social skills groups in the park, and articulation drills while on a neighborhood walk.

Speech-Language Therapy Transformed…Back in Brooklyn.

There was no way for me to turn back from this way of practicing. Returning to the U.S., solidified that conviction, and thus Brooklyn Speech Therapy was born. Here in Brooklyn I am a house guest/therapist on a smaller scale (60 minute play visits!), but I still stick post-it reminders in people’s stairways, love an outing, and build therapy teams around my little clients.

Brooklyn Speech Therapy has since grown to include a team of therapists who delight in the freedom from clinical procedures that would otherwise bog down their creativity, or take time away from connecting with parents. Our therapists share a spirit of bucking convention and working with a family rather than an individual child.

TheraPals…

…is the title of an entry Avanica Khosla herself wrote on her blog about her brain injury recovery. Avanica and me: Therapist and client, but also pals. She is my “sister from another mister” (her words), and I am so blessed to be able to have a second family in hers. Avanica, Arjun, and Shibani blew my world open in the best way, and were the nudge I needed to create a speech therapy practice here in Brooklyn that simply works better.