Webwords 56: Minority World SLPs/SLTs in Majority World Contexts - November 2016

The modes of service delivery, and the settings in which Speech-Language Pathologists / Speech and Language Therapists (SLPs/SLTs) work, are remarkably diverse. The “modes” can be push-in or pull-out in schools; hospital-, office- or clinic-based: face-to-face in the flesh, or face-to-face via telepractice; or “mobile”—boating, driving or flying between sites. The settings, at home and abroad, can be in aged-care facilities, charitable and philanthropic institutions, clients’ or clinicians’ own homes, community health centres, custodial or care facilities, early intervention centres, hospitals, missions, online, orphanages, preschools and schools, private practices, rehabilitation units, social enterprises, and university clinics, in the minority and majority worlds.

Altruists bitten by the travel bug

SLPs/SLTs, affected by some combination of altruistic values—around social justice, equity, freedom and wanting to make a contribution to the greater good—and the travel bug are often inspired to work in the majority world. They can do so for short periods, long periods, or in regular bursts, as interested onlookers, volunteers and paid employees. Their international workforce participation can involve study tours or fact-finding trips to become better informed about communication and swallowing disorders' services in the visited country or region, with no delivery of direct services, or with service delivery as an ancilliary goal; international work experience for undergraduate and graduate students; information sharing-and-training-only missions; and sustained and sustainable direct service provision (Crowley & Biagorri, 2011) taking full advantage of local "social capital" in the host community. Where providing clinical services is concerned, sustainability is a central concern, with a "best practice" focus on upskilling local individuals to continue the work, with ongoing support, increasingly via the Internet (Salas-Provance, Marchino, & Escobedo, 2014).

Association support

SLP/SLT professional associations support international outreach in a variety of ways. For example, ASHA has two relevant Special Interest Groups: SIG 14: Cultural and Linguistic Diversity and SIG 17: Global Issues in Communication Sciences and Related Disorders, and Speech Pathology Australia has a closed Facebook group for members interested in working in developing communities.

Recruiters

Recruitment agencies often tap into professionals' philanthropism and thirst for adventure with promises that the overseas experience will be "personally rewarding", taking advantage of (free) social media and the goodwill of individual practitioners to spread the word. Since 1998, speech-language-therapy dot com has attracted a flow of enquiries and requests for help, often relating to SLP/SLT services in the majority world and in remote places, partly as a consequence of the "professional interest" section of the site. In the first half of 2016 alone, email from recruiters arrived directly from Bali, Bolivia, Cambodia, Ethiopia, Mongolia, Myanmar, Papua New Guinea, Peru, Romania, Rwanda, Ukraine and the US. This one was from the US:

“I am recruiting an SLT (I do hope it might be YOU) and an OT who would like to live in Shenzhen for one year to train paraprofessionals on SLT and OT skills for ages 0-8 years old. China has just recognized the need for SLTs. No universities offer it as a major and few courses are offered except via other universities. A CEO of a rehab center for young children wants to offer services, but the therapists would have to speak Chinese, which has many variants. In the interim, the CEO seeks an SLT to train or share basic info to the current teachers/paraprofessionals who have worked with disabled children for years (very experienced and dedicated). Translators are available. If you have a better solution, please share. Please inform your wonderful network.”

For the record, the (somewhat misinformed) writer was directed to The Hong Kong Association of Speech Therapists, SLP/SLT academics in the Division of Speech & Hearing Sciences at the University of Hong Kong, the Chinese International Speech-Language and Hearing Association (CISHA), and to various personal contacts in the PRC. Another 2016 enquiry was from Africa:

“We seek to recruit a Speech Pathologist to train rehab technician staff to provide the highest quality assessment and therapy services (with a main focus on AAC, ASD and speech) over 6 to 8 weeks in Malawi. We will pay airfares board and lodgings and meet-greet you in Lilongwe”. Like so many of these enquiries, it came with an appeal for a six-figure “suggested sum”.

Again, factual information, and conservative advice were proffered, but as is also usual when an answer is not the one “hoped for”, no further correspondence was received.

Volunteers or voluntourists?

The site also receives regular email from SLPs/SLTs and students, variously interested in working somewhere foreign, wanting an adventure, or seeking to contribute to the world community. Much of it betrays a breath-taking arrogance, a sense of superiority over potential host communities, little humility (Bleile, 2015), and scant cultural competence and cultural sensitivity (Bowen, 2009). Here are five representative unedited samples:

“Hi. I have very recently finished my BSc (honours) degree in Speech and Language therapy, acquiring many exportable skills at a prestigious British university. I would like to work as a speech therapist in Asia (possibly Honk Kong or Singapore but anywhere else would be good too) since I think I would find it extremely interesting to work in that part of the world, especially since the profession is less developed in that continent. Can you put me in touch, as soon as possible, with contacts who can read English since I do not speak any overseas languages?”

"After 30 years as an SLP in the schools, I am retiring. I have given my recent "SLP acquisitions" to younger colleagues and to the clinic at my alma mater. I am left with 3 large boxes of tests, texts and therapy manuals (Hanen, LinguiSystems, ProEd, HBJ, Super Duper, etc.) and materials (flash cards, etc.). They are not current enough, or in good enough condition for my young colleagues or the ____ University Clinic, as they are quite fussy. I hate to throw them in the trash and I wanted to know if you know of an SLP clinic or school service in the third world where they might be appreciated. I would be happy to donate them if the recipient covered p+h from MN."

“Please allow me to introduce myself. I'm an S-LP from Canada who graduated from a top ranking university and I've been starting to consider a move to asia with hopes to work as an S-LP there. I stumbled across your website and wanted to ask you about availability of jobs for English speaking S-LPs in asia (e.g. thailand, malaysia, singapore, etc). I've emailed the malaysian speech pathology college etc to ask for information as I cannot seem to find any online postings for jobs. However, they do not respond to my many emails so I'm writing to you for your insights. You'd actually think they'd be glad of high quality input from a civilized country like mine with high S-LP standards. If I cannot find something that suits me in asia I am quite interested to work in africa if you can send any info for that area.”

“My background is that I am a CCC-SLP from the US and a member of AAPPSPA. I am interested in setting up a center in a city in the Asian region to work with young children 0-5 in Fiji, Japan, Sirrilancah, Vanuatu, South Korea, Siam or similar (not China, Bali, India, Pakistan or areas with too much poverty and disease or slums). If you would provide contacts in that area, that would be great. Also, any thoughts on working thru telepractice on accent modification with Asian adults wanting to improve their English pronunciation?”

“I am a 24-year-old German SLP student (for MA) speaking German and English urgently wishing for an internship in Thailand for three months in the summer, but I am not having too much luck finding a post. It will give me much happiness to work with poor children who have cleft palate in exchange for housing, meals, insurance and small stipend and flights to-from Munich. I am searching such an internship since 4 months without anybody answering or supporting me. I need this internship very much for my thesis. Thank you for your website.”

Unfortunately, some of the cultural incompetence, self-serving motives (Salas-Provance, et al., 2014) and attitudes implicit in the email spill over into the standards of clinical practice observed in developing communities, and in some underserved majority and minority world contexts, and with culturally and linguistically diverse client populations in the industrialised world (Scheffner Hammer, 2011), including in Australia.

Troubling scenes

Webwords is not immune to either the urge to volunteer or the travel bug, expressed as a love of weekends away, and trips to many parts of the world for work and leisure. In her work travels, she has been troubled to see fully qualified SLPs/SLTs “make do” with superseded, photocopied (from colour to black and white) and incomplete assessments; and tests and intervention materials translated from English to local languages and dialects. She has also witnessed colleagues employ culturally inappropriate materials, such as: the (British) Renfrew Action Picture Test for Zulu and Xhosa speakers; Brown’s Stages (English) “norms” for morphological development applied to African, Asian and European languages; and picture resources, made for the UK and US, used with indigenous and non-indigenous Australian, Filipino, Malaysian, New Zealand and South African children.

Some fully qualified SLPs/SLTs also engage, with mixed motives, in “importing” non-evidence based methods for use by naïve practitioners with vulnerable populations, enjoying Big-Tobacco-style sponsorship.

The TalkTools® Blog for example, records that four Australians, two SLPs and two OTs, volunteered for a week in November 2015 at the Dzherelo Centre, in Lviv, Ukraine. The “mission trip” was sponsored by TalkTools®, who also donated (their) merchandise to the centre. The SLPs taught staff how to use TalkTools® exercises and products, “to turn mealtimes into therapy to support the children in developing their oromotor skills. All of the children … required support with the strength and coordination of their jaw. Chewy Tubes with the pre-feeding chewy hierarchy were trialled successfully”. Meetings were also held at The Lviv Catholic University, the Polytechnic University and the Military Hospital, where the sponsor’s products may have been discussed in an approving light, with no mention of their lack of supporting evidence.

Standards

Ethical issues permeate each of these circumstances, relating to complex, even alien settings where barriers to E3BP far outweigh the facilitators. Doing your best, as a qualified service provider in difficult situations, should not equate with knowingly advocating or delivering inferior service, especially when grateful, hospitable, and sometimes adoring recipients believe you offer “the best”, and want you back.

References

Bleile, K. M. (2015). A Nicaraguan experience. In C. Bowen, Children's speech sound disorders (2nd ed.). Oxford: Wiley-Blackwell, pp. 157-160.

Bowen, C. (2009). Multiculturalism in communication sciences and disorders. ACQuiring Knowledge in Speech, Language and Hearing, 11(1), 29-30.

Crowley, C. & Baigorri, M. (2011). Effective Approaches to International Work: Substance and Sustainability for Speech-Language Pathology Student Groups. ASHA SIG 14 Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse (CLD) Populations, 1, 27-35.

Salas-Provance, M., Marchino, M., & Escobedo, M. (2014). Volunteerism: An Anchor for Global Change through Partnerships in Learning and Service. ASHA SIG 17 Perspectives on Global Issues in Communication Sciences and Related Disorders, 4, 68-74.

Scheffner Hammer, C. (2011). Broadening Our Knowledge About Diverse Populations. American Journal of Speech-Language Pathology, 20(2), 71-72.

Links

#StopOrphanTrips
ASHA Special Interest Group 14, Cultural and Linguistic Diversity
ASHA Special Interest Group 17, Global Issues in Communication Sciences and Related Disorders
Australian Volunteers for International Development (AVID) program
Become an ASHA International Affiliate
Better Care Network
Communicability Global
Gone to Ghana

Kianh Foundation
Operation Smile
Save the Children
Speech-Language Pathology in East Africa
Speech-Language Pathology in West Africa
Speech Pathology Australia: Facebook Group: Working in Developing Communities

Speech Therapy Cambodia (don't believe this!)
Speech Therapy in Vietnam
Trinh Foundation Australia

UBelong
United Nations Sustainable Development Knowledge Platform

Yellow House Children's Services