Header imageInternational Directory of Communication Disorders  

World Views

These accounts are written by people who have been there and done it.  Click on the region of the world that interests you.

If you have an account to share, please let us know!


Across Regional Boundaries


Communication Therapy International (CTI)
Mary Wickenden

We have about 120 members worldwide, some of whom are SLT/SLPs, while others are doing related work in places where the profession does not exist as such (teachers, nurses, doctors, community workers, and also a few parents of disabled kids).  We have quite a few members in various parts of Africa and South Asia, but fewer in North, Central or South America.  Interestingly we are deliberately not an official SIG of the Royal College of Speech and Language Therapists (our professional body).  We definitely didn’t want to do this because that would restrict membership to RCSLT certified therapists.


Twelve Countries
Katandria Johnson

Have you ever wished you had studied abroad in the field of communication sciences and disorders?  Well, there is no time like the present.  With a little planning just about anyone can participate in an unforgettable experience that can mold and train you into the professional you desire to be.  I too had this same desire, which was finally fulfilled last year.  Over a five-month period, I traveled, studied abroad, conducted research and executed volunteer work in 12 countries, including Italy, France, Spain, Portugal, Canada, Dominican Republic, Puerto Rico, Costa Rica, Mexico, Brazil, Argentina, and Chile.  Having desired to complete a clinical fellowship year in another country, this was my opportunity to fulfill this desire and investigate how our services are viewed and rendered in other countries.  I will discuss just how you can have the same experience

Planning & Support
The first consideration any student or professional must consider when traveling abroad is whether one is mentally and physically prepared for the cultural and linguistic changes that accompany such an assignment.  Secondly, you must collaborate with university advisors when carefully evaluating continuing education programs, your career objectives and the feasibility of traveling abroad.  In other words, what are the pros and cons forinternational experiences/studies in comparison with those within the United States?  Will continuing education credits be awarded?  Who will supervise and ensure that the tasks scheduled will be fulfilled? 

When entering a foreign country, one must be prepared for cultural and linguistic differences.  Reading about countries ahead of time and becoming aware of their customs is pertinent for successful and less stressful experience abroad.  Information regarding cultural immersion may be found on Amerispan.com, the United States travel website www.travel.state.gov, and www.cdc.gov/travel/.   The latter US websites can also provide useful information regarding immunization recommendations. Published information regarding professional travels of other American speech pathologists, such as Nora Costa’s article in the Aug. 16th edition (2005) of the ASHA Leader, “An SLP in Malaysia” is another valuable resource, as is the fine article in the same journal by Tomoeda and Bayles (2002). 

There are many agencies which provide varied services prerequisite to travel abroad (language courses, internships, volunteerships, international health insurance, housing airport pick-up, etc.) for a one-time fee.  AmeriSpan was my choice and comes highly recommended.  You may choose to go through your university or a local travel agency.  Regardless, it is imperative to obtain all contacts and information needed to complete the project type and length.

Types of Activity
The current American Speech-Language Hearing Association (ASHA) database of speech pathologists that practice internationally is sparse.  However, contact with these professionals via e-mail can create mentorships and live chats regarding speech-language-hearing issues among culturally and linguistically diverse (CLD) populations.  These contacts may be foreign professionals as well as Americans who are temporarily or permanently working abroad.  Those professionals whose time and finances permit may opt for a language study program that offers language studies, volunteer and professional development opportunities. 

Another choice may include traveling abroad to develop or sharpen your linguistic and cultural competencies through language immersion or volunteer work.  My travels resulted from this choice, in addition to conducting a Texas Speech-Language Hearing Association (TSHA) Independent Study.  Such travels accommodated related field work in support of continuing education units to maintain state licensure and national certification.   You may also seekspecialized credits or continuing education units (CEUs) throughyour local university and/or national state organization, depending on your academic or professional status.  Keep in mind that a database of professional contacts is not readily available and inquiries may need to be made upon arrival.  It is not recommended that one plan this way; however in some countries it is inevitable. 

Post Script
My travels resulted in a research paper titled Cross-cultural perspectives of disability views among culturally and linguistically diverse populations (Johnson, 2004).  Additionally, at the conclusion of the experience in Mexico, I was invited to continue volunteering at a private clinic in Puebla, Mexico, which provides occupational, physical, special education, and psychological services for community families.  I have also been executing service delivery workshops and on-site personnel training.  The first international clinical externship and TSHA-approved workshop recently took place at the Center of Integrated Development clinic (CEDI) in Puebla.  BusinessWeek Magazine’s September 2005 edition of its Personal Business section included an article entitled, “Schools with a View,” which highlighted my international travels and those of several other professionals.

If you have any questions or how to set up your own study abroad program, please contact Love Johnson via e-mail at amortcu@yahoo.com.  Happy travels!



Tomoeda, C. and Bayles, K. (2002).  Cultivating Cultural Competence in the Workplace, Classroom, and Clinic.  The ASHA Leader, 7(6), 4-5; 17.

Johnson, K.L. (2004).  Cross-Cultural Perspectives of Disability Views among Culturally and Linguistically Diverse Populations.  TSHA Independent Study.


Useful Websites
Comment:  Website of the World Health Organization.  Excellent sections on health care in individual countries and on persons with disabilities.

www.un.org/esa/socdev/enable/diswpa04.htm- top

Comment:  Website of the United Nations.  Excellent summary of disabilities from an international perspective

Comment:  United States Department of Labor.  Valuable listing of labor statistics related to disability.




A View from Bangladesh
Melanie Adams


Is there a professional association in Bangladesh?
No, not yet.

Are there any university student training programs? 
Yes, the course I was involved in - which has been running for a year now, at the Centre for the Rehabilitation of the Paralysed (CRP), Chapain, Savar, Dhaka, Bangladesh. It is a 4 year programme plus one year compulsary internship at the hospital.

In terms of the course - I believe it was started because Centre for the Rehabilitation of the Paralysed (CRP) saw a need for people to do some in-depth training in this area to provide a service to the millions of people with communication disabilities in Bangladesh. CRP runs a training institute (Bangladesh Health Professions Institute) which has been the first place in Bangladesh to offer degree courses in Physiotherapy and Occupational Therapy - and now Speech and Language Therapy. These professions are in their early stages in Bangladesh.

At the moment, the first year group of 12 students have nearly finished their 1st year. We hope to enroll another group of 1st year students soon. It is a 4 year BSc (Hons) degree followed by a 1 year internship at CRP. More information about SLT and the course is available at http://www.crp-bangladesh.org  We also are very keen on finding people who want to come and volunteer at CRP in training the students (clinical supervision and classroom teaching).

In terms of the number of Audiologists and SLTs in Bangladesh - I'm not sure. Mel may be able to provide this information. As far as fully-trained SLTs - Mel and I are the only ones in the country at the moment that I know of. There are also several people in Dhaka working as SLTs who have completed short courses from SLTs. Bangladesh also does not have a degree course in Audiology. I know of 1 Audiologist who has trained in the UK and several Audiologists who have been trained by her. Again - Mel probably has more information about this.

How many SLTs and Audiologists are in Bangladesh?
There are a handful of people providing “Speech Therapy”. They have received short training courses provided by visiting overseas therapists or they have been taught by local people who attended these short courses and are now training others. I get the impression that what they provide is limited and very procedural – ie. Not tailored to meet the needs of the individual. There are audiologists who have full qualifications from overseas.

In what kinds of settings are SLTs and audiologists employed?
In special schools and centres for hearing impaired children, or children with disabilities. These are all non-government organizations (NGOs).

What do you see as the major challenges and issues in providing services for communication disorders in Bangladesh?
1. Ensuring that people receive adequate training before they provide such a service and call themselves
a Speech Therapist. This is rarely the case.
2. Ensuring the funding to pay for people to provide the service.
3. Being able to provide a service families can afford.
4. Reaching the rural communities.
5. Achieving a coordinated approach amongst therapists.
6. Achieving communication within “the multidisciplinary team.”
7. Fully qualified Therapists achieving recognition for their level of training and finding employment once trained.
8. Getting the government on board.
9. Providing continued professional development.
10. The need to introduce a Masters qualification for therapists, as only this level of uni qualification is really recognized.



A View from Cambodia
Alice E. Smith


Can you tell us a little about Cambodia?
The Kingdom of Cambodia is a country of approximately 13 and a half million people situated in Southeast Asia between Vietnam, Thailand, Laos, and the Gulf of Thailand.  Cambodia comprises approximately 181,000 square kilometers (70,000 square miles) and is roughly the size of the State of Missouri with a little over twice the population.  The country is divided into 21 provinces and 4 municipalities.  The present government was established in 1993 as a multiparty democracy under a constitutional monarchy. The people of Cambodia are 90% Khmer, with small percentages of Vietnamese, Chinese, Hill Tribe people and others.  The official language is Khmer with French and English as the secondary languages. The primary religion in Cambodia is Theravada Buddhism (95%) followed by Cham Muslim, Christian, and animist.  The capitol city of Cambodia is Phnom Penh, a city of 2 million people situated at the confluence of the Mekong and Tonle Sap Rivers.  Phnom Penh is the center of tourism, commerce, and industry as well as the location of the Royal Palace and the governmental offices. 

The mass destruction of the population and the culture of Cambodia during the Pol Pot years in the 1970’s left the country in an uproar from which it is still recovering.  Libraries, hospitals, museums, and temples were ravaged or destroyed.  Cambodia has the highest population of land mine victims in the world following the last 3 decades of war and destruction. The median age of the overall population is approximately 20 years, with 60% of the population between the ages of 15 and 65 (3.9 million males, 4.2 million females).  Thirty seven percent of the population is under the age of 14 years and 3% is over the age of 65 years. Life expectancy at birth is approximately 59 years.  Much of the population is rural and uneducated, although an estimated 74% of the population over the age of 15 can read and write (85% of males, 64% of females). 

Due to high levels of corruption in the government and worries regarding future political unrest, support from foreign aid is spotty.  The Cambodian government works with multiple donors to rebuild its infrastructure.  Non-government foreign organizations (NGOs) are prolific in the country, although there is little to no coordination amongst their efforts.  The greatest challenge to the government is providing an economy that will support the creation and sustenance of jobs for the relatively young population.

What about health care in Cambodia?
Medical care exists in a growing number of hospitals and clinics throughout the country.  The level of education of medical personnel is variable, but there are a growing number of well trained surgeons and specialists in the country.  Tourists are warned that routine problems may be treated in the country, but that they should carry medical travel and evacuation insurance in case of significant medical problems or emergencies.  Thailand has some of the best medical care in Southeast Asia, and even well to do Cambodians routinely catch a flight to Bangkok for care.  Cambodian approaches to medical care vary between western medical approaches, Buddhist views, and magic.  Understanding those views is critical to providing appropriate services to those in need.

What about services for persons with communication disorders?
Supportive services such as speech-language pathology and audiology are difficult to find.  There is little coordination between available services due to a lack of a national “yellow pages” system, and professionals and the public alike have a difficult time identifying their availability.  Hearing aids have been available recently to the public but no one now seems to know where to get them repaired since the people who made them have left that hospital.  Some deaf children use sign language but no one seems to know where or how it was learned.  Children with speech and language difficulties are generally not permitted to attend school if they cannot be understood.  Even if services were available, the majority of people would be unable to afford them given the level of poverty and the need to provide basic food and clothing to their children. 

There are well-trained surgeons in the country to repair cleft lip and palate who are also working to offer limited speech services to those children who appear to need help.  Broader services that do exist are generally short term and are offered by volunteer organizations such as NGOs or groups offering missions which bring professionals into the country for a short period of time.  For example, an Australian Speech Pathologist lived in Cambodia while she worked for an NGO in 2002-2003 and provided some services to children of foreign families living in Phnom Penh. 

Operation Smile has been in Cambodia since 2002.  Each spring, a team of specialists screens adults and children with unrepaired cleft lip and/or palate as well as burn scars and occasional other deformities to determine the potential for improvement with surgical intervention during a two week period.  The team members train in-country personnel in many aspects of cleft care with the long range goal of stimulating independence from the help of the mission.  At present, Operation Smile is working to set up an in-country office to work with Cambodian surgeons trained in cleft palate care to offer coordinated services to people in need. 

Can you tell us about your work in Cambodia?
I have two children who both had unrepaired cleft lips and palates when they were adopted from an orphanage in Phnom Penh.  I have traveled to Cambodia annually from 2002-2005 with Operation Smile and for conference and workshop presentations.  Through my work with families there and with the American Cleft Palate Craniofacial Association I have networked with surgeons at National Pediatric Hospital (Vuthy Chhoeurn, M.D. and Long Vanna, M.D) and Norodom Sihanouk Hospital (Mok Theavy, M.D.) in Phnom Penh, who are working to develop a speech pathology program in each of their hospitals as well as community based models of training.   I have given workshops and lectures regarding issues related to speech, language, and feeding needs of children with clefts or with developmental speech and language disorders to nurses, dentists, medical students, and province physicians.  When in Cambodia I see children (and adults) who come to the Operation Smile screenings with a variety of communication disorders other than cleft speech, ranging from spasmodic dysphonia to hearing loss to language delays to individuals in need of augmentative communication.  I have been following some children for 4 years now, teaching their parents 1 or 2 new goals a year and providing follow-up with a speech aide I have trained in-country. 

I have also worked as a consultant for the American Embassy in Phnom Penh for embassy families who have children needing speech-language pathology care.  Word of mouth has led to work with children of foreign families who are working in Phnom Penh on a temporary basis and discussion with one of the two International Schools in Phnom Penh regarding service needs. 

A View from India
Sanyukta Jaiswal

What are the major challenges facing the professions in India?
There are two major challenges.  The first is of course, the population.  There’s a very varied dichotomy in income levels in India.  You can have someone who can afford to fly down to the US and to have their hearing aids, and then you have the other end of the spectrum-- someone who doesn’t even feel like hearing is important in their lives.  They’re struggling to make ends meet; they can’t even afford the batteries for the hearing aids. There’s also no central insurance, though the government tries to do something.  They give free hearing aids to people, but they cannot make sure that the person is using it right and the person may not be able to afford batteries the rest of their lives. 

The second biggest challenge:  there are 16 official languages in India and God knows how many dialects.  So, it is very challenging to know what language to test in, what language to do therapy in.  For example, a person may speak one language at work, and another language with their grandmother, and another language or dialect with their family.  What language do you test in?





A View from France
Amelie Carvallo


When I was little, it seemed as if the families that moved frequently from country to country were most often those that counted bankers, diplomats, and employees of the military within their ranks.  Nowadays, those same families continue to be uprooted time and time again.  However, they are no longer the only ones.  Certain IT Directors, Engineers, Sales Executives, Managers, CEOs, CFOs, etc., seem to globe-trot just as much.  Whether this perception is correct or not, no one will argue that there are large amounts of expatriates throughout the world, especially in and around big cities and capitals.

Another phenomenon that is on the rise is the number of children and adults being referred for speech-language services.  Until the age of twenty, I had never heard of the field of speech-language pathology.  When I tell people what I do today, 10 years later, it is rare that they don’t share an anecdote about their cousin, child or brother’s experience with speech-language therapy.  In effect, since the field of speech-language therapy emerged in Europe in the 19th century, speech-language pathologists (SLPs)--or their namesake in foreign countries--have been increasingly sollicited to assess, counsel and treat individuals suffering from communication, and more recently, swallowing disorders. 

How can these two phenomena, the large amount of expatriates world-wide on one hand, and the increase in  children and adults having recourse to SLPs on the other hand, be reconciled? 

Ideally, speech-language therapy should be provided by a native or native-like speaker of the client’s language.  For obvious reasons, a clinician cannot provide speech-language therapy if she does not master the linguistic aspects of the language her client speaks.  Therefore, what happens to individuals who live in foreign countries and require speech-language services?  An SLP can work alongside an interpreter.  However, qualified interpreters can be difficult to find.  Additionally, working with a client via an interpreter, while very useful if it is the only option available, cannot be as effective as working directly with a client.  Finally, few SLTs have actually been trained to work with interpreters. 

To give a concrete example, in Paris, there is a big need for English-speaking SLPs due to the number of English-speaking expatriate families residing in France’s capital.  Since there are no measures in place to facilitate the movement of English-speaking SLTs to France, and few French clinicians work with interpreters, many children are lacking the services they require.  Some are even forced to go without any treatment at all.

One solution to this issue--the most difficult to obtain, but the most satisfactory—would be to allow SLPs to assess and treat clients who speak the same language in foreign countries, provided these clinicians were certified in their home countries and had working papers.  There are currently agreements between Anglo-Saxon countries (i.e., Great Britain, Canada, the United States, and Australia), facilitating the mutual recognition of speech-language pathology diplomas.  The same holds true for SLPs with diplomas from certain countries belonging to the Euro Zone (e.g., France, Spain, Belgium, etc.).  It will unfortunately take much time and effort before the mutual recognition of diplomas can be extended further, but it is well worth it. 

Another solution, particularly since world-wide recognition of diplomas will not be an overnight phenomenon, is for international schools abroad to employ SLPs as part of their staff.  Some international schools do, but it appears that the majority do not.  An SLP on staff means that there is a highly qualified professional present on a full-time basis to assess and treat students with speech-language needs.  A clinician can also complete hearing, language, and speech screenings to identify children potentially at risk, provide in-services to train and educate school staff, aid teachers who have voice problems, and serve as a resource for the parents in the community.  Given all of the benefits, it is difficult to comprehend why international schools in foreign countries do not recruit SLPs more systematically.  

Another idea of great value is to create non-profit associations to support individuals with special needs and the professionals who seek to help them.  In Paris, such an organization, SPRINT, was created for English-speaking professionals in paramedical fields (e.g., psychologists, special educators, SLPs, social workers, etc.) and individuals with special needs.  SPRINT’s purpose is for members to share professional resources, ideas and new techniques, as well as to help match needy families with the appropriate specialists. 

A final solution would be to create schools for children with special needs abroad, with regular classroom teachers, special educators, psychologists, SLPs, occupational therapists, physical therapists, etc., on staff.  This would of course require that there would be enough specialists willing to engage in such a project.

Initial steps by European and Anglo-Saxon countries to mutually recognize diplomas are positive.  It is also encouraging to note that international schools have begun to recognize the need for having SLPs on staff.  Nonetheless, more needs to be done to facilitate the movement of SLPs throughout the world. 

As a result, SLPs in the international community have a very important role to play.  They should encourage their national organizations, as well as international organizations such as the International Association of Logopedics and Phoniatrics (IALP) to fight for international recognition of diplomas.  It is important that SLPs living abroad be pro-active with the international schools in their communities, as well.  They ought to encourage school administrators to hire qualified SLPs.  If the administrators are unwilling, it might be helpful to enlist the help of parents of students with special needs to add a little pressure. 

An important factor to hold into mind is that SLPs world-wide have a lot to learn from one another.  A free and open exchange between practitioners of different countries would be very enriching.

A View from Germany
Carola Becker

Could you tell us about professional associations in Germany?
In Germany there are really a lot of associations that have to do with communication disorders. Many links you can find under "Links" on the website of the Deutsche Gesellschaft für Phoniatrie u. Pädaudiologie (www.dgpp.de). They provide an English version, too.

Here are the major associations:
Deutsche Gesellschaft f. Phoniatrie u. Pädaudiologie e.V.
  Georg-August-Universität Göttingen
  Robert-Koch-Straße 40
 37070 Göttingen

Deutscher Bundesverband der akademischen Sprachtherapeuten e.V.
  Goethestraße 16
 47441 Moers
This is an association where some sub-associations are joined (a so called "Dachverband"). For example, I am a member in the DBKS, and the DBKS is member of the DBS. In the DBS there are speech scientists like me, clinical linguists, sprachheilpädagogen and others. The DBS-website is in English, too.

Deutscher Bundesverband der Klinischen Sprechwissenschaftler e.V.
  Frau Stephanie Kurtenbach
  Wittekindstraße 10
 06114 Halle / Saale
This is a quite small association because only people who studied in Halle can become members. Halle is the only place in Germany where one can study Sprechwissenschaft (speech science). It takes about 4-5 years to finish. Sprechwissenschaft contains of phonological, artificial, therapeutic, and rhetorical subjects. If one wants to work as a speech therapist he or she has to get an additional skill, the KLINISCHEN Sprechwissenschaftler.

Deutsche Gesellschaft für Sprechwissenschaft und Sprecherziehung e.V.
  Frau Dr. Marita Pabst-Weinschenk
  Beekfeldweg 35
  46519 Alpen
This association deals with verbal communication in general. The clinical aspects are not prominent.

Deutsche Gesellschaft für Sprach- u. Stimmheilkunde e.V.

Deutscher Bundesverband für Logopädie e.V.
  Augustusstraße 11a
  50226 Frechen
This association seems to be the largest. Logopedics don´t need academic skills. Their education takes place at a school, not at a university. They only deal with communication disorders and not like in my education with other aspects of speaking.

Could you tell us a little about yourself?
I studied Sprechwissenschaft at the Martin-Luther-University Halle-Wittenberg from 1998 until 2003. My foci were diagnostic and therapy of communication disorders, and since 2003 I have worked on my promotion (doctorate). I want to compare the impressions that disordered German voices make on people around the world. But that will take a lot of time... At the moment I am also working in a logopedian practise as a speech therapist. I mainly deal with children whose language development is disordered.



A View from Iceland
Thora Masdottir

Is there a professional association in Iceland?
Yes.  The address is:
The Icelandic Association of Speech Therapists and Speech-language Pathologists
Sigridur Magnusdottir
Hjardarlandi 1
270 Mosfellsbaer, Iceland

We change presidents (of the association) every three years.  We are such a small association that we do not have a proper address; just the home address of the sitting president.  There are 53 members, but not all of them are working as SLT/SLPs.  The association was formally founded in 1981. 

Are there student training programs in Iceland?
We have just started some discussions with the University of Iceland to start a program in SLP/Communication Disorders.  It’s, of course, going to take a few years to be established but the university is showing a great interest in this matter.”

Could you tell us a little about yourself?
About 11 SLPs in Iceland are educated and trained in the US. Five people have a doctorate (one of them from Finland) and two of us are currently working towards a PhD degree (I’m in the UK and the other is in the medical department of the University of Iceland with a supervisor from the University of Santa Barbara, CA).  Currently (since I’m studying) I only work one day a week at a private clinic owned by six other SLPs  (I used to be a part of the group but recently sold my share). For a long time I specialized in voice disorders but I gradually became more true to my undergraduate background in linguistics and my specialty now is in the area of severe phonological impairment.  However, since we are the only private clinic in Reykjavik, we work with a variety of disorders.  I also do a bit of teaching at the University of Education .”



A View from Norway
Heidi Gudmundset

Is there a professional association for professionals in Communication disorders in Norway?
Yes, but with a population of only around 4 million people living in Norway we are a "small" group.  Their websites are:    
Speech and language = http://www.norsk-logopedlag.no
Auds = http://www.naf-nytt.org

Do you know how many SLTs and audiologists are in Norway?
Auds = 300 who are registered
SLT's = 1300 who are registered

Are there university training programs in communication disorders?
I can only speak about the speech-language therapy programs.  At present there is an "old" training programme, based in Tromsø, at what is called a high school for further education. This "old" programme was/is only a one year training in the basics of what a "logoped" is expected to work with. The students are usually special teachers who have worked in schools and wish to specialize more in working with speech and language. The main focus here is voice, fluency, speech and language - it is assumed that SLT's are teachers, i.e., that they will continue to work within an educational setting. In addition to this there are many small courses on working with speech and language which have sprung up around in various institutions - these are not approved by the Norwegian Logoped Association (NLL), so those who have taken these courses are not allowed to use the title "logoped" (SLT).

As we speak there is a new "reform" sweeping the country to further the educational level.  At last someone has taken us seriously and is setting up a professional training programme at University level.  This will consist of a 3 year Bachelor degree and a 2 year Masters degree.  At present only the University in Oslo offers this programme, and those who study there have the right to call themselves "Logopeds" - SLP/SLT's.

Here in Bergen they have a 2 year masters degree (which I feel is the same as my bachelors degree from the UK), which they offer only to those who have the "old" qualification and have worked as SLT's over a five year period. I suppose you could call it an up grading at present.  In 2006 this will change when Bergen University will be offering a Bachelors and Masters programme.

There is a difference between the two Universities programmes - Oslo focuses more on speech therapy in the special educational setting, reading difficulties + behavioural problems, whereas Bergen has a more medical, linguistic and psychological bias in their programme.

In what kind of places and with which kinds of people do SLTs and audiologists work?
I can only really speak about SLTs.  They mostly work within an educational setting, including educational psychology units, schools, kindergartens, special schools and adult learning programmes.  SLTs are trying to become recognized in the medical world (not so easy if you don't speak the same language - I mean terminology). Those therapists tend to work in stroke units, child development clinics, specialist hospital settings - but they are usually connected to the services which organize teaching within the hospital setting. All of this is slowly changing, but as you know this takes time. Very few work, for example, with dysphagia.

I work in a more advisory role, supporting those therapists and teachers working with children who have speech and language difficulties. My specialist area are those with speech production problems, including motor speech disorders.

Audiologists also work in the educational setting.  I have colleagues who work in the Educational Support system mostly in conjunction with Deaf children.  Children with other types of hearing problems are also beginning to be focused on.  CI has recently taken off here, so there has been a need for SLT's and Audiologists to work together.

What are some of the issues and challenges facing the professions in Norway?
As you can see there are a lot of challenges here, especially those to do with quality of service.  Luckily access to our services is similar to that in the UK - they are all free, funded centrally by government. BUT there are not enough therapists to go around.  We have also challenges regarding informing those around us what it is we actually do. Sometimes I feel like I've stepped back in a time capsule to the UK around 25-30 years ago, as far as the attitudes here to SLT's and what they do.

There has been a steady increase in those therapists working privately, and the Norwegian Logoped Association (NLL) is desperately trying to keep an eye on what is going on here. The NLL runs on a voluntary basis.  Those of us who have a little extra time are trying to do our bit for the future of the profession.

We have, as so many others, to fight for funding. This is difficult when most politicians think we only work with those who have voice problems, stammer or need elocution lessons! So SLTs and their work tend to be marginalized by local authorities. If the authority can pay a teacher, or even worse a teaching assistant, to work with a statemented child, then they will try to get away with it, as an SLT costs a lot more than a teacher per session.



Two Views from Russia
Victoria Tumanova and Ekaterina Smyk


What is the biggest challenge facing the professions in Russia?
The main problem in Russia is there’s no money.  There are lots of people who want to work as speech pathologists, who are interested.  It’s just that sometimes you have to choose another program, just another occupation because nobody is going to pay them…
It’s probably really surprising to people here, but most people in Russia, they just work on inspiration.  I mean, no money, just they like it, they find it interesting or they are really devoted and that’s how we do things.

Victoria Tumanova


What is the biggest challenge facing the professions in Russia?
The burning issue for SLPs in Russia is money, but the problem is deeper than it appears. We have free education primarily because it is funded centrally by government, having both positive and negative sides. First of all, it makes education available for everybody regardless of social and economical status in the society, and at the same time leads to the financial dependency of any educational setting from government which doesn’t give enough money. Therefore, schools need to find different ways of fund raising without making students pay for their education. I believe that this problem has very deep roots in our economic situation. 

The lack of money forces SLPs to spend their own money on different materials for therapy. SLPs are not very well paid in Russia. Many people work on inspiration and devotion, but the profession of SLP is popular because of its flexibility. A person can work in an educational or medical setting, with adults or kids, and (most importantly!) can have a private practice that enables him to make money. Departments of communicative disorders do not have a lack of students who want to be SLPs, but after graduation many people don’t work in speech-language pathology because of a low salary. For them, the study of communication disorders is the focus of their higher education and they go on to work in another field.

Another issue that needs to be mentioned is that most training programs are concentrated in the big cities (especially Moscow and St.Petersburg). Students from rural areas have some privileges for enrollment to universities, but after graduation most of them don’t want to go back to home town because the big cities provide more possibilities. Therefore, there is a lack of SLPs in small towns.

Ekaterina Smyk




Latin America


A View from Brazil
Irene Marchesan

Is there a professional association in Brazil?
We have three different types of associations:

  1. The councils: one federal and 7 regional. To work, the SLPs need to enroll in his/her regional council. The Federal Council congregates all the regional.
  2. The role of the councils is to take care of policy. They do and control the laws of our profession. The biggest regional council is in São Paulo with 12,800 SLPs.
  3. We also have an association that takes care of the scientific area. It is the SLP Brazilian Society. This association edits a Journal.

Are there student training programs in Brazil?
In Brazil we have around 95 colleges of SLP distributed around the country. The main and the oldest colleges are in São Paulo.  We have also specializations, masters and doctors degree courses for SLPs. We have now around 24.000 SLPs.  The bachelor lasts four years, and then you can do specializations (two years) in different areas: voice, language, audiology or oral motoricity. If you intend to be a college professor you need to do a masters and doctor degree.

Can you tell us a little about where you work?
I will describe CEFAC courses because Jaime Luiz Zorzi and I are the directors of it.
CEFAC was funded in 1983. The courses last two years and have a theoretical part and a practical part.
First, the student needs to choose in what area he or she wants to do the specialization.
In CEFAC students can choose among hospital emphases, including dysphagia, voice, clinic audiology, industrial audiology, speech (dysarthria and apraxia), orofacial myology, language (oral or writing or both).  We already had about 6000 students since 1983. Now we have studying with us around 1000 students.

CEFAC also has two more buildings: one for a library only in SLP and correlates subjects, and another for seeing needy patients that call CEFAC Clinic School.
In 26 June 2001.

Can you tell us a little about yourself?
I graduated in 1977 in PUC – SP with my masters and doctoral degrees.
Nowadays I work with:

  1. Seeing patients with speech and/or orofacial myology disorders because this is my specialization.
  2. Giving class about the same subjects in CEFAC and in others specializations courses.
  3. I have an administrative job in CEFAC.
  4. I coordinate the clinic area from CEFAC Clinic School.
  5. I wrote around 6 books, 20 chapters, and several articles. All of them linked with my specialization area. I am doing researches now about frenulum disorders.


Two Views from Guatemala
Lindsey Leacox
Marta Ketter

It truly was an awakening to the disparities that exist in this world.  The ministry offers an amazing refuge for the children that live in one of the city garbage dumps.  I just think if people only knew how others lived down there (and in other places of poverty), just to spend an hour in that place, I really think people would act and live differently.  As for those of us who've seen it first hand, I guess we're in charge of spreading the word of the much needed help. 

Lindsey Leacox, student volunteer


I worked in a huge complex developed by the Catholic Church.  I was working with the children who had different levels of handicaps and had been abandoned by family since they were not able to provide for their high medical needs.  The Universidad Rafael Landivar also provides services for low-income families.  Guatemala's public schools do not provide speech therapy services or other type of specialized services for students.  Most parents enroll their children in a private school.  Private schools vary in the level of services provided.  Most parents will have to contact the services of a SLP and schedule services after school hours.   Some private schools will deny enrollment to children with behavior or other problems.  At the clinical level, hospitals do not hire SLPs into their staff.  They might refer patients to a SLP if needed.  Salaries are low.  Like other countries in Latin America, all services are concentrated in the city.  Guatemala city has approximately 11 million people.  Hospitals, schools, transportation, etc. are concentrated there.  Small communities have no services.  In addition to this, Guatemala's population has a great percentage of Mayan descent.  We have approximately 23 different Mayan languages.  Spanish is the official language.  Mayans tend to retain their ethnic identity despite the constant challenges that this might bring.  They dress differently, they speak their own language, etc, and they assimilate at different levels into the dominant culture.  Therefore, Guatemala has to deal with cultural differences among their own. 

Marta Ketter



A View from Mexico
Glendora M. Tremper

“I/we think it is so wonderful what you do.”  “Thank you for all your hard work.”   Thank you for your dedication.”  Whenever I hear these words addressed to me, in relation to my work with the non-profit group Interface or the cleft palate team in the not-for-profit Hospital Infantil Las Californias in Tijuana Mexico, my immediate response is,  No! I am the one that is thankful for having this wonderful opportunity that fulfills me emotionally, professionally and spiritually. 

I fell in love with cleft palate work as a graduate student in San Diego State University.  My Cleft Palate and Cranio-facial Anomalies professor, Dr. Elizabeth Allen, invited all the bilingual students in her class to join her in a volunteer mission to Mexicali, Mexico with Interface.  I signed up, made that first trip, became hooked and have never looked back these past 12 years.  If I could make you see those innocent eyes, trusting looks, faces smiling through their fear, you could not help but being deeply touched by the experience as I am continually.  Let me share with you what one of our trips may look, sound, feel like.

When the Interface team arrives at the Red Cross Clinic in Mexicali around 10:00 a.m. on a steadily warming Friday morning, you first see a long line of people of all ages and sizes, waiting for us.  Greetings are exchanged as the team, loaded down with medical, therapy and administrative supplies streams into the Red Cross building.  The anesthesiology team and operating room nurses head directly to the Operating Room to set up, the recovery room nurses unpack and prepare the recovery rooms, and the administrative team, speech pathologists, ENTs, plastic surgeons, maxillofacial surgeons, pediatricians, orthodontists, psychologist and translators head up for the main room upstairs to set up the triage center.  Families line up, with youngest children first, as they haven’t eaten since the previous night.  Although the clinic is a cleft palate clinic, many other kinds of cases, burns, scars, hand and foot deformities, craniofacial anomalies, etc., are seen.  As the noise level increases, with hungry children crying and team members consulting, every child, adolescent and adult is seen by a surgeon, speech pathologist, ENT, dentist, and psychologist.  They are listened to and, if at all possible, provided with the appropriate surgery, therapy, counseling or referral.  The teamwork is impressive, the communication among disciplines continuous, the skills strong, the patient’s stories incredible and the end results often startling.  Sometimes, although surgery may be indicated, it is discovered through more in-depth conversations with the speech pathologists or psychologist that of more immediate concern to the parent and/or child is not the surgery, but maybe more information, counseling, or support from the DIF (Departamento Integral Familiar (DIF) (Department of the Integral Family).   Interface is committed to looking at the whole patient, assuring their needs are met.

By 2:00 p.m. surgery begins as triage continues.  Parents hand over their beautiful children with all the trust in the world.  The children are often stoic, trusting implicitly in these strangers in gowns and masks.  We have been fortunate to include in our team a Mexican family psychologist, experienced in working with children with Cleft Palate.  She is of immense value, assisting the parents and children overcome insecurities, fears, often years of misguided beliefs due to their own, or their child’s deformity.  Speech pathology continues with triage, evaluations, therapy and home programs.  Toward the end of the day, I provide a parent information class to those parents whose children are recuperating from surgery.  This if often done in tandem with the psychologist, to provide as much support as possible to the parents.

The first day of surgery winds down about 7:00 or 8:00 p.m. after completing around 15 surgeries.  To restore our energies, we head to the local “taqueria” to load up with quesadillas and beef tacos.   Then back across the border to Calexico where we spend the night, resting in preparation for the next day.

Saturday is less hectic.  The scheduling is completed and, with the occasional modification due to recommendations from a speech, psychologist, dental evaluation or a child coming down ill, moves smoothly throughout the day, through 20 to 30 surgeries.  The surgeons, nurses, anesthesiologists work throughout the day taking breaks as needed, consulting with walk-in patients and discussing various techniques.  Dental makes and fits appliances and support personnel dash from one place to another, obtaining needed supplies, translating, carrying messages or reassuring parents.

In the speech room, we continue to do speech evaluations, provide therapy, and training the parents or responsible adults to provide the needed speech therapy throughout the year.  As we return to Mexicali only twice a year, parents are their child’s primary therapist.  We have many wonderful parents, intuitive therapists, who are able to follow home programs and come back the following visit to demonstrate their child’s progress.  One of my delights is being presented with a child whose learned behavior continues although the physical deficiency has been resolved.  To tease out the targeted sound, establish it soundly enough for the parent to follow a home program and have them return in 6 months with a successfully completed program, is invigorating.  Another joy is the Saturday morning parent class I provide to the parents in Spanish.  In addition to the parents from the cleft palate clinic, parents from other clinics (i.e., orthopedic clinic) also attend, drawn by the need to help their children in every way.  I provide parents with information regarding general language development and typical speech progression.  We discuss language stimulation opportunities and possible areas of concern for children with repaired or un-repaired cleft lip and palate.  Parents share their specific concerns and often provide insight and assistance to other parents in the group.  For the past couple of years, with the guidance of the family psychologist, these parent classes often evolve into the production of parent support groups.

Although surgeries continue till the evening on Saturday night, with a small contingency remaining overnight to follow up on these last surgeries, the speech team typically finishes around 2:00 or 3:00 p.m.  We pack up our materials and head back to San Diego.  We will be back in 6 months time.  Interface is committed to following these children throughout the many years it often takes for them to complete the process. These families become our families and our family theirs.  The commitment is on both sides.  We come away physically tired, but filled with the peace and contentment that can only come from the immense satisfaction of having been allowed to use our skills to make positive changes for so many children and adults. 

This Mexicali trip is only one of several trips that Interface makes throughout the year.  We travel to La Piedad, La Paz, Tuxtla Gutierrez and Merida.  Each trip is unique and brings its own rewards.  In La Paz, Merida and Tuxtla Gutierrez we work cooperatively with Mexican Cleft Palate Teams already in place, providing additional supplies and being a part of a professional exchange with our Mexican colleagues.  In La Piedad we are working with our hosts and the state government to assist in the training of personnel to provide speech therapy during the year.  To find out more about Interface or how you can help, you may contact them at www.interfacekids.org.  As with any non-profit organization, Interface depends on the generosity of volunteers and donors to continue their work.  Here are some things you can do:

  • Donate private funds
  • Become a business or corporate underwriter
  • Donate sterile medical supplies and equipment such as caps, gowns, shoe covers, sutures, gauze, antibiotics, surgical soaps, etc.
  • Donate general supplies (new small toys for surgical waiting areas, water, office supplies, etc.)
  • Donate airline travel
  • Donate your time as a medical professional or non-medical volunteer for organizational/office duties and/or travel

Glendora M. Tremper, MA, CCC-SLP




Middle East


A View from Israel
Lynn Paul

In Israel there are no public laws 94-142, or No Child Left Behind Acts. Children who need speech services are usually divided into several groups: School Districts hire therapists, but not to cover the population of those who are in need. Those with “special needs” are not mainstreamed with regularized. They are in separate buildings, and the therapist for the city will serve them there. Sometimes there are preschools, housed in separate buildings from elementary schools, and some cities will have a “regular ed” kindergarten attached to a “special ed” kindergarten, where some mainstreaming may occur.

If a parent feels their child needs speech therapy, she goes to the family doctor. Unless there is an obvious problem (hearing impaired, autism, physical disabilities), the doctors don’t usually refer a child before age 5. This is due to the high cost of insurance reimbursements, and the fact that most doctors believe that a child doesn’t need speech therapy until they are 5. When referred, a child is tested by a clinic, (located in a free-standing building or a hospital), or early learning center. These places hire speech therapists to test and to serve children, usually preschool.
These centers or private clinics are reimbursed through the Ministry of Health (before first grade), or by the Ministry of Education (1st through 12th). It is unusual for adults to get reimbursements. It depends on the circumstances (stroke, swallowing problems).

If you are a regular ed. child with a lisp, or a language processing issue, (a “mild problem”) you might not be considered to be in need of a therapist, provided by the Ministry of Ed. or Ministry of Health, or if there are children with more severe needs in the regular education system, they get the therapists.

Many parents, go to a private clinic, and try to get their HMO to pay some of the fee. Not all health plans cover speech therapy. Usually there is a waiting list to get a therapist off your health plan, if therapy is covered. If you can afford it, a parent will pay out of pocket, without reimbursement if they don’t want to wait on a list, or are considered ineligible by the Medical or Educational System.

 I worked at several jobs. That is because salaries are a third less than the USA, with the same costs for just about everything. So I worked in a “special education center”, which was funded by the Ministry of Ed. At this job I had retirement and benefits. Then I worked for a clinic that saw children after school, and was reimbursed by the child’s HMO. Here I was considered self-employed, and had to be registered as a self –employed person with the tax authorities and wrote out receipts).  My last job was as a speech therapist, self employed, who went to peoples homes, and these people didn’t want to go through the HMO, (because of long waiting lists), so it was “under the table,” though I did have a few who wanted receipts.

If all this sounds confusing, it is! The bottom line is money. If you have money and will pay privately, you are fortunate. If not, you wait on a list to get an HMO therapist. If you have a child in special ed. and want to supplement the school therapy with extra home or clinic therapy, this is not covered by any HMO.

In Israel I have a lot of voice clients. Possibly because Hebrew is a language said mostly via the throat, it is guttural, and people tend to get vocal nodules and polyps. I also did a lot of pre-speech activities with little kids and their parents, working on oral motor activities (bottles and pacifiers), before the orthodontist refers because of tongue thrust.

I notice in Israel, a parent goes through the medical system, getting the child completely checked out, before any therapy begins. Here I have observed that a child will start in therapy on the say so of the therapist, and then begin therapy, except for voice, which needs an ENT approval/check before beginning the program.

In Israel, there seems to be a shortage of tests and materials. We serve children from many cultures, new immigrants, and there are few tests in Hebrew that are culturally correct. Most tests are translated from English. Materials are very expensive. If I can order something (provided I had a dollar account in America) from a catalogue, and have it sent along with someone I know is coming Israel, that is how I would do it. Shipping directly to Israel is expensive.  When I am in America I can buy cheaply, so I have a large selection of toys and games.



A View from Jordan
Alice M. Dyson, Linda Khan & Laila Q. Marzouqa

Are there student training programs in Jordan?
The primary training program in Jordan is the University of Jordan.  The university offers an MA in speech pathology but not audiology.  I believe there are a couple of BA only programs as well.  The program at the University of Jordan is the Department of Linguistics and Phonetics.

They UJ program has offered an MA in Syria in conjunction with the University of Damascus during the last few years, and is now in the process of starting such an association with a program in Saudi Arabia.  Neither of these countries has MA or MS programs of their own, but Saudi Arabia does offer a BA degree.  The University of Jordan has been graduating MA students in SLP for about 10 years.  Many of them have moved to different countries in the region, so there are quite a few out there, especially in Saudi Arabia.
Are there professional associations within Jordan? 
Not in the sense of ASHA or IALP.  However, several people in Jordan are members of both associations.  There is a national law governing SLPs in Jordan now.

A View from the Middle East
Hiyam Hammad

When I talk about the Middle East, I am referring to the 17 Arabic countries in the region.  Each country has its own dialect, culture, and tradition. However, they all share the Modern Classic Arabic language which is called the language of "Al- dhaad."  Jordan, Saudi Arabia, United Arab Emirate, Lebanon, and others started to learn about communication disorders in the 1990s.  In the Middle East people may laugh at someone who stutters because they don’t know about this disorder.  A person who is Autistic (called Al- Tawahud in Arabic) will be isolated and some people think Autism is caused because a pregnant mother was stressed out and spent too much time by herself.   A lack of knowledge makes people unaware of what kinds of communication disorders exist and how they may be treated.  Culture and traditions plays a great role in communication disorders. It is very hard for Middle Eastern parents to confess that their child has a communication disorder.  Parents hide their children or prevent them from being known, even among relatives, because it is a shame to have a child with a disorder. This makes the child’s problem worse and more severe. I remember when I was at elementary school there was a student who was in my class and who was four years older than me.  She had a developmental delay, but they called her lazy and said she didn’t like to study.  A person with communication disorder in the Middle East needs a lot of attention first in the home, and then in the community and the country. Lack of professionals in communication disorders makes it difficult for families to understand why their children struggle, and they may spend years hoping and praying for their children to get better.  As a result, people with communication disorders suffer even though many times their problems can be treated. I have worked with special education schools and with the mentally retarded population for many of years and I have known many Arabic families who came to the United State with their children with communication disabilities to receive better treatment.





The journey of a German 'Logopaedin' to a Speech-Language Therapist in New Zealand
Kristina Pinto

I did my training to become a Speech-Language Therapist from 1998-2001 in Mainz, Germany.  The 'Lehranstalt fur Logopaedie' is connected to the university in Mainz and trains each year 15 students to become a Speech-Language Therapist.  It is a 'state school' which means that there are no fees for the training (unlike private schools which can cost up to 500 Euro and more per month).  Hence the competition to get a placement was rather high. I applied in 1997 together with approximately 900 other persons. In the first round we had to fill in a questionnaire.  Once I got though that round I had to send in a complete application including CV, reports etc.  I was lucky and got invited to an 'interview'. I was asked to prepare a song, a poem and a text in advance. I competed with 90 other applicants for 15 places that year. On the day I had to read the text and the poem in front of a group of 2 Speech-language therapists and 14 other applicants. I had to sing in front of one Speech-Language Therapy tutor. Our interview took almost the whole day and included a single interview, a hearing test and an examination by an Otolaryngologist.  After an exhausting day I had to wait a couple of weeks for the final decision. But I was one of the lucky chosen ones and three years of interesting and exhausting training followed. 

During our training, we had to complete five practicals in either public facilities such as hospitals or private praxises.  It was the praxis owner of one of my practicals who offered me my first job.  However, when I accepted this offer, I told my employer about my life-long dream to go to New Zealand one day and work there. I had spent an exchange year in New Zealand in 1993-1994 and intended to return. 

After my exams in April 2001 I went back for a holiday and found out that there is an extreme shortage of Speech- Language Therapists in New Zealand. I even got a verbal job offer to start straight away. However, I wanted to gain some work experience in my own language first and declined.  But I decided to go to New Zealand the following year.
The steps to become eligible to work in New Zealand were time consuming but fairly easy. First I had to be eligible for membership of the 'New Zealand Speech Therapy Association" (NZSTA). Once that was confirmed I applied for a Speech-Language Therapist position with the Ministry of Education in three different regions.
Finally an answer from one office in the North Island – they wanted to set up a phone interview with me.  It had to be at 7 am for me so it would still fall into work time in NZ. The interview was very nice- however, what surprised me a bit was that they knew about my application to another region and told me that I could expect another phone call. Small New Zealand!  As the other office was closer to the area where I had spent my exchange year I preferred to go there. However, I did not want to miss out on a job offer. So we agreed that I would wait until I had heard from the other office and get back to her.
A couple of days later I had the other interview.
I remember that the lady kept telling me that I would be working with children with very 'severe' communication difficulties and whether I thought that I could cope. I kept telling her that I was sure to be prepared for that while trying to look up the word 'severe' in my dictionary.

My interview was successful and I got the job offer. I then had to apply for a work visa which I got without much hassle for two years.  In September 2002 I left my private praxis in Germany and in November I started my new positing in New Zealand.
Work was very supportive towards me, paying for a one-way ticket from Germany to New Zealand, offering me accommodation and the use of a car for the first 2 weeks and paying me NZ$1000 moving expenses.

I was welcomed to my new work with open arms.  I think I was very lucky to start working so late in the year as the big school holidays started in the middle of December and therefore I had a very small caseload to begin with. This gave me some time to get used to all the new things which I was confronted with (e.g., instead of the clients coming to me I now had to drive to the clients – sometimes up to 3 hours drive).  I was in a school team which looked after children mainly between the ages of 5-8 years.  I had to learn to be very organized and pack my bag for all possibilities- and sometimes I had difficulties finding a room for therapy in the schools.  It was new for me to work in a team with other professionals such as psychologists, special education advisors, occupational therapist, physiotherapist etc. and I had a lot learn about abbreviations (OORS, SEA, SLT,DMT, NMT etc.). I learned about policies, how to write a report in English, the NZ curriculum, new assessments and a lot more.

And on top of all that I was trying to build a life away from work, meeting new people, finding a car, a place to live and new friends.  I consider myself very lucky that I was already a little familiar to the NZ lifestyle, the area, culture and had some friends to rely on.

At work, one of my biggest difficulties was to clarify some of the following questions e.g. how long is a therapy session?  And 'How often will I see a child?'
In Germany these things are very restricted by the health insurance and the prescribing doctor.  But I learned that these kinds of things are a lot more flexible in New Zealand and to some of these questions there was no definite answer. The sessions were as long as the child could cope and you saw a child as often as needed. 

Another new thing for me was the position of a Communication Support Worker. This is an (often) untrained person, who will work with the child approximately three times for thirty minutes a week on a programme which the Speech-Language Therapist provided.

To identify which children meet the 'severe' criteria and are eligible to our service you go through a checklist which asks questions such as 'is the child younger than eight?', 'is the communication difficulty likely to resolve itself within the next 6 months?' etc.
A full case load is approximately 40 clients- but this seems to vary from district to district. It also depends on the distance you have to travel to get to the client.

I have been working in New Zealand longer now than I did in Germany- and in 2004 I asked to be transferred to another district for personal reasons. This district covers a huge area, approximately one and a half hours drive by car south and 3 hours north. 

I think more and more I have found my way in the New Zealand Speech-Language Therapy world and the Ministry of Education.  I find that New Zealand offers a lot of opportunities in all areas of life.  Working as a Speech-Language Therapist in a language other than my mother tongue is sometime challenging and an adventure.
Another challenge is finding my way in a different culture, especially the indigenous Maori culture.  It is a whole new world to explore with another language, different traditions and sometimes different values.  But the Ministry of Education caters well for situations when I have to see a client in a total immersion class or bilingual class and I am usually supported by one of my Maori colleges.

As for my personal life, I just recently got married in NZ and am very happy to settle here. I have come to love this beautiful country with its friendly people.

I can recommend anyone who would like to experience working in a different country to come to New Zealand. At present there is a big shortage of Speech-Language Therapists. Maybe trial it for a two year work visa- and who knows, it might be for a lifetime.





Sub-Saharan Africa


A View from Kenya
Erica Meeks

Kenya is a diverse country of 26.5 million people. There are more than 40 distinct tribal groups throughout the country, each with its own language and culture. Kenya’s official languages are English and Kiswahili, which are used by government officials and taught in school, however most people’s mother tongue is that of their tribal group. The majority of Kenyans speak three or more languages (their native tribal language, English and Kiswahili). Kenya is a poor country, with a 50% unemployment rate and an average annual family income of under US $250.

There is a great need for speech & language services in Kenya in all areas of practice. Although there are many public and private universities in Kenya, none of them offer training programs for speech therapy. At this time, there are approximately four speech therapists practicing in Kenya, all of whom are expatriates trained overseas. Services are offered privately or through a cooperative at one of the local hospitals. Since therapy services are so limited, teachers, doctors, and nurses all lack understanding of this field and who might benefit from therapy.

As mentioned before, the average family income is less than US$250/year so families have little to no disposable income for speech therapy. Most work with Kenyans is pro bono or at very low cost to the recipient. There is also demand from expatriate families living in Kenya for speech & language therapy for their school-age children, most of which is funded by the parent’s employer. Currently, the fee structure is set on a sliding scale depending on the economic status of each individual. Fees for local Kenyans range from free to US $10-15/hour; expatriates or privately funded patients’ rates range from $30-60/hour.

A work permit is required for anyone working or volunteering in Kenya. Acquiring this work permit is time-consuming, bureaucratic, and expensive. The easiest way to get a permit is to be sponsored by a school, hospital, or organization that applies on your behalf. With this type of permit (Class A), you are only allowed to work at and for the specific organization that sponsored you. This type of permit needs to be renewed annually. The “consultant” work permit (Class H or Class J) is more versatile. There are several different requirements that may or may not be enforced when applying for this permit, including the need to register your “business” with the Kenyan government, showing adequate funds of 10 million Kenyan shillings (approx US$130,000) in a local bank account, and the ability to prove that your job cannot be filled by a Kenyan citizen. The cost for this type of work permit is 30,000 Kenyan shillings (approx. US $400) per year plus a refundable100,000 Kenyan shillings (approx. US $1335) bond which is technically refundable upon your departure from Kenya. Processing of work permits takes anywhere from three weeks to 1 ½ years, depending on your circumstances, the current backlog of applications, and your willingness to give into corruption. Within the past few months, the Kenyan government has been cracking down on people working illegally through arrests, jail stays, and deportation. There has also been talk of a newly formed panel that will interview all foreign work permit applicants to determine that a local employee cannot fill the job he or she intends to do.

I am in Kenya accompanying my husband, a diplomat at the US Embassy. In Nairobi, where we live, there is a base for the UN, many regional non-governmental organizations (NGOs), and Embassies from around the world. There are a great number of English-speaking expatriates and since most locals are fluent in English, the language barrier is less of an issue than in more rural areas of Kenya. There are many potential areas for SLP’s to work, volunteer, and train local professionals in Kenya. Schools from preschool through high school have expressed interest in collaboration for their students. Universities and training hospitals have increased awareness of the field of speech language pathology, and have expressed interest in creating training programs or offering seminars and classes to professors, doctors, and students alike. The speech therapists (under a dozen in total) working in East Africa try to meet annually and stay in contact with each other as a professional support network. There are many ongoing projects and ideas in the works, including creating university-level training programs, in-service training for health care professionals, free support groups for patients, and traveling therapy teams hoping to provide services in rural areas.




Volunteering as a Speech Therapist in Swaziland
Brenda Connell

This summer (2005) I had the amazing opportunity to spend 6 weeks in Southern Africa working at Good Shepherd Hospital in Siteki (pronounced “steggi”), Swaziland. Swaziland is a small landlocked country between South Africa and Mozambique. With a population of approximately 1.1 million people and an estimated Human Immunodeficiency Virus (HIV) prevalence of 40%, this kingdom is currently the focus of many international aid groups. Myths about HIV and its transmission are rampant. Many Africans believe HIV is something that the west is using to punish Africans (for example “America puts HIV in condoms”). There are 80 Peace Corps volunteers in the country working in community development and HIV education as well as approximately 20 Australian Volunteer International professionals working in various capacities.

As a speech therapist in Swaziland it is beneficial to have a basic understanding of HIV, how it is transmitted, how antiretrovirals work and how HIV impacts speech and language development. Many of the children I saw presented with poor oral hygiene coupled with untreated oral thrush. This common symptom of HIV is basically a fungus that colonizes the oral cavity.

Outpatients would generally come to the clinic without an appointment and just wait to be seen. Outpatients are either referred from the out-patient clinic or from one of the volunteers working out in the neighboring communities. On the hospital wards, I typically helped patients take their morning tea as well as providing feeding support services. I also visited the hospital’s nursery and spent time with the babies. Newborns typically go back to the maternity ward with their mothers. The only children in the nursery are those that have been abandoned, are premature or present with some other qualifying circumstance. The nursery is a small and extraordinarily hot room with babies lying naked in plastic tubs on a bench. There are very few special services provided in the nursery and very limited equipment for special care. One day I picked up a baby lying on a pillowcase on a padded table and asked the nurse when the child was born. “15 minutes ago” was the response! I also spent time in the children’s ward but typically just for arts and crafts, card games and other general language stimulation, though another facet of the job was teaching the nursing students and training the nursing staff on the children’s ward.

Most volunteers typically worked 8 hour days Monday through Thursday. Friday was a half-day and I typically left for weekend trips including Maputo, Mozambique, Kruger National Park in South Africa as well as the Swazi National Game Parks.

The opportunity was also available to spend time going out to communities that received home based care. This is a fairly depressing venture that is much like hospice care. Home based care teams follow up with patients too sick to get to the hospital and provide food, medicine and clothing as needed. This is a pretty grim day’s work. One of the children I saw on such a visit was perhaps 7 years old, had no language and played in the corner of the homestead alone all day. The child was friendly and receptive to attention, but wet himself and had difficulty staying in the presence of the adults. We later witnessed his younger sister taking a stick to him. Because of the lack of services available for a child like this (education or otherwise) it was difficult to make recommendations that would have an impact.

In addition to the hospital work, I spent one day a week at St. Joseph’s Mission School on the outskirts of Manzini in central Swaziland (40 minute drive from the hospital). There are four special education classrooms there, as well as a preschool room and a special education preschool room. My time there was overwhelming. The students were an unbelievable mix of undiagnosed syndromes and cognitive disorders. Cerebral Palsy and Down Syndrome were prevalent and there seemed to be little recognition about the inherent differences in profile for these students. When meeting with one student the teacher told me she was “hypersexual.” I did point out that she was in her teens and perhaps didn’t have the mental capacity to understand about the hormonal changes that were going on in her body. That said, it seems that the teachers and everybody in Swaziland are doing their very best with exceptionally limited resources and training. Children in Swaziland typically learn by rote. Teachers lecture and the children chant back memorized information. I spent my time working with them on curriculum development to help them think about educational goals for their children as well as modeling techniques for language stimulation. Teachers were very receptive to any information I had and I tried to ensure that suggestions would fit with the model of teaching currently in practice. 
Interested in Volunteering?
As a volunteer in Swaziland there are three sites that could benefit from a speech therapist. These sites are Good Shepherd Hospital, The Deaf School and St. Joseph’s Mission School.  St. Joseph’s is in dire need of volunteers on a full time basis.  I feel the potential for making positive change would have the greatest impact here. Good Shepherd Hospital and the Deaf School are within walking distance of each other.

What does it cost?
Volunteers are responsible for their own flights.  Volunteers at Good Shepherd pay $30 per week room and board on campus. This covered a basic room in the student house with running water and electricity. If you were interested in volunteering at Good Shepherd on a more long term basis (6+ months) a stipend of approximately $350/month + room and board may be available through Catholic Medical Mission Board (www.cmmb.org).

In addition to room and board we each paid a housekeeper $10/week to clean and do laundry. I shopped and cooked vegetarian meals for myself rather than eating at the cafeteria. These food costs were minimal. For example a massive bag of tomatoes was less that $1. The vegetable market and supermarket were a 20-25 minute walk away in town. There were also fruit and vegetable stalls outside the hospital entrance.   

The nearest big city, Manzini, is accessible on public transportation for $2. There is a much better supermarket in Manzini as well as a big craft market and more restaurant options.

Accommodation could be arranged with St. Joseph’s and/or the Deaf School if you were to be based at either of these sites. If you were full- time at either of these sites, it is likely that your room may be provided free of charge.  

Other ways to help
If you are interested in helping, I am currently collecting new or used children’s books to create classroom libraries at St. Joseph’s Mission School. I am also collecting cash donations to both fund the classroom libraries and to pay a disabilities program to build the bookcases in Swaziland. Additionally, any arts and craft materials (i.e., pens, markers paper, glue, are always useful for both the school and children’s ward.

For the hospital, simple toys (e.g. dinosaurs, cars/trucks, dolls, board games) would make the children’s ward a more interesting and stimulating place. Children’s videos would also be wonderful. Home-based care can always use Tylenol, triple antibiotic creams, soap, waterless hand cleaner, etc.
Donations to ‘Friends of Good Shepherd’ fund are also appreciated. It costs families $2.50 to make an outpatient visit but often times they can’t afford this. Inpatient stays (also $2.50 per day) rack up and until the bills are paid patients can’t go home, while accruing more costs. This fund covers hospital services and transportation for families in need. During my stay we also used this fund to pay for the building of a special chair to support a child with cerebral palsy.

For more information feel free to email me at br_connell@hotmail.com


A View from Tanzania
Pauline Ndigirwa

Tanzania is only in its infancy where SLT is concerned.  As far as I am aware there is only one Tanzanian SLT in Tanzania. While I was there for 6 years there were a couple more from UK who came on 2 year placements. The Tanzanian SLT is working for Comprehensive Community Based Rehabilitation Tanzania (CBR) in Moshi with children with hearing impairment and learning disabilities. This organisation also runs small schools for hearing impaired children.

Along with general recognition of disability, awareness of communication disorders is just beginning. When I first came to Tanzania in 1997 I did a very basic screen in the special schools in Dar es Salaam concerning the number of children with communication difficulties in order to justify the need for my post. During my time there (6 years) I worked wholly within the special education system and the government still felt I needed to show more of what I could do before they perceived a need for a specialist’s help on communication.
There is no student training program. I ran a lot of general training about disability and communication for teachers and parents. I also trained community workers visiting children with special needs in the community.  I trained a communication assistant to a basic level who is continuing work in the school and outpatient clinic.  I had little contact with Audiology, though I know there was a department at the government hospital. I found that they were not skilled in assessing children with other difficulties and as I was not seeing children with hearing impairment I did not have much to do with them.
At the moment the concept of SLT is very new. Although awareness of the need is beginning to grow, basic services are still struggling and SLT not seen as a priority. With no training course in country the service relies on input from overseas. A big need is for appropriate local-based training. Otherwise services will need to be provided within existing services such as CBR.


By international schools, I am referring to any school in which the language of instruction differs from the language spoken in the country in which the school is located.



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