Wednesday, March 20, 2013

Speech Language Therapy in East Africa: Developments in the Region



Bea Staley
This article was published in S&L World (February 2013)

Rehana Pasta, Nuala Alibhai and the organizing committee for the fifth East African Conference on Communication Disorders to be held in Mombasa later this year recently put out a call for papers. Mombasa -- is a city on the Kenyan coast, an urban hustle and bustle of a town that is hot, diverse and swims with a brightness like few other places. The heat pervades everything. The air swirls with a complex array of smells and sounds. Conversation is everywhere. Language buzzes: Swahili, English, Giriama. The days are bright; the sky is blue, but like clockwork each night the light leaks out at six pm, leaving seven pm a mass of stars or clouds against the dark of night. Twelve hours later, six am begins in darkness and seven am arrives in day. The call to prayer announces it; the clamor of traffic amplifies it; another day has begun. Bless the routine of equatorial light.
I first went to Kenya as a speech language therapist (SLT) in 2006 and relocated there in 2007 with Voluntary Services Overseas to work on a European Union funded project that supported the training of special education professionals in the area of communication disorders. As I plan for the upcoming conference later this year, it is impossible not to ponder the regional developments of the profession in the last seven years.
This article presents the new training programs slated to start in the region in 2013, reflects on how the East African conference has changed over the years, and touches on the more global discussions about the SLT profession taking place at large national conferences.

Introducing the New East African SLT Training Programs
In early 2008, Makerere University in Kampala, Uganda, began their SLT degree program, which has successfully graduated two cohorts of therapists who now work in Uganda, Kenya, Rwanda and Tanzania. This year there are plans underway to begin three more regional programs as a result of collaborations between foreign organizations and East African universities.
Shannon Benton and CLASP International, in conjunction with Kenyatta University in Nairobi, will be interviewing candidates this April for enrollment in a Masters program planned to start in September 2013. Based on a model developed in Zambia, CLASP conducts much of its classroom-based learning with online real-time lectures taught by professors at universities in the United States. Students participate in two years of online learning, supplemented by a variety of clinical rotations provided by visiting teams of clinicians. Students then complete a one-year clinical fellowship and spend three years working in a government SLT position, whilst also instructing the cohort that follows. This is a model that requires government support and a commitment to fund positions for the graduates of the program. Discussions with the ministry are still in negotiation, but government support is an important part of the CLASP model and reportedly one of the biggest stumbling blocks for fledgling programs in developing countries. 
Another program that is anticipated to start in the next Kenyan academic year will be a Masters program at Moi University in conjunction with Sweden’s Linköping University. The curriculum has been submitted to Moi University for approval and will be run by faculties of both institutions.
 In addition, a third program is being developed by a partnership between the SLT department at the University of Hanover and the special education program at Sebastian Kolowa Memorial University in Lushoto, Tanzania. This Masters level program focuses on SLT for children with special needs and will be supported with visiting lecturers from Germany.

The East African Conference on Communication Disability
As I revisit Dr. Jochmann’s (2006) writings about her work as an SLT in Uganda, I reflect on how much and yet how little has changed ‘on the ground’ over the years. Although I wasn’t present at the first conference Jochmann’s (2005) report indicates that six (of the seven) then practicing East African based SLT’s met for five days to discuss the challenges of the providing SLT services in the region, and well as share expertise.            The second conference took place at Nairobi Hospital in September 2008, organized by Elisabeth Scheltema-Kruger and several other Nairobi based therapists, myself included. By this time, there were eight to ten SLT’s practicing in the region. This conference was attended by a small group of American professors who provided professional development in their areas of expertise to a group of approximately 20  SLT clinicians and related professionals (e.g. doctors, nurses, special educators, occupational and physical therapists).
The third conference took place the following year organized by Emma Shah and Laura Gomersall. It was hosted at Aga Khan Hospital in Nairobi and included a different group of foreign therapists and professors who provided continuing education opportunities to the audience of 20 to 30 participants.
A tension arose at both Nairobi conferences between educating and informing local non SLT professionals about the work of SLTs and providing professional development for practicing SLTs in the region. This tension was managed by 1) covering different topics on different days and 2) advertising different days to different audiences so that the conference might better appeal to a wide variety of interested attendees.
Given the enormous amount of time and energy required to organize the conference by the small pool of clinicians (there are still only 13 SLT’s practicing in Kenya) who were busy treating their own caseloads, a decision was made following the third conference that it would be a bi-annual event.
By the time the fourth conference rolled around in January 2012, the first cohort of SLTs had completed their program at Makerere University and the Association of Speech and Language Therapy East Africa (ASaLTEA) had been established in Uganda with the intention of being a regional association. Eighty-two participants from 15 different countries gathered in Kampala for the conference. Organized by Helen Barrett, Makerere’s course coordinator, the program included research presentations by the Makerere graduates as well as papers from international guests and related professionals.
This conference had a different tone to prior conferences in part due to the increase in size of the audience and the increase in the number of SLTs in the region. Discussions included issues related to the logistical future of the field and the ways SLTs might provide appropriate service provision for local populations in local contexts. Conversations acknowledged that SLT practices as taught in university programs and implemented in clinical settings are typically based on foreign research, resources and views of child development that might not be applicable universally. The fifth conference plans to build on these discussions with a focus on implementing culturally appropriate SLT practices in East African contexts. 
Contextualizing the Development of the Profession
East African conversations and changes in the profession have taken place within the context of notable growth in discussions about SLT practices beyond Western borders, particularly in regards to the sprouting of new programs in developing countries supported by American and European universities. For example:
·      The program committee of the 2011 American Speech and Hearing Association’s (AHSA) Annual Convention sponsored a panel on “SLP University Programs in Developing Countries: Culturally Sustainable Approaches” (McLeod et al. 2011), which focused on the success and risk factors for new programs. For example, included speakers shared their experiences about the programs at Pham Ngoc Thach University of Medicine in Vietnam, and Universiti Kebangsaan Malaysia (National University of Malaysia). 
·      The Council of Academic Programs in Communication Science and Disorders (CAPCSD) held a Global Summit on Higher Education in Communication Sciences and Disorders preceding their annual conference in 2012 that included presentations by professionals from a wide variety of countries.
·      The Asia Pacific Conference on Speech, Language and Hearing in 2013 will focus on “globalization and localization of the discipline.”
·      The International Journal of Speech-Language Pathology recently published a scientific forum with a lead article on “Changing practice: Implications of the World Report on Disability for responding to communication disability in under-served populations” (Wylie, McAllister, Davidson & Marshall, 2013) and a series of articles discussing the growth of the profession in various countries around the world. 

For the past twenty years Kenya has been home to the majority of SLTs living and working in the region. With the new program in Lushoto and Ugandan graduates now residing in Dar es Salaam, Tanzania, and Kigali, Rwanda, we may be seeing the emergence of a trend by which the distribution of the profession slowly changes. Hopefully this will include clinicians moving beyond urban centers into rural settings where the needs of individuals with communication disabilities are largely unmet. While the number of clinicians still remains small compared to the relative needs of the population, the developments outlined above reflect the results of many years of hard work by SLT professionals both locally and internationally. We hope you will join us in Mombasa this September to be part of the ongoing activities in the region.


Call for Papers for the 5th East African Conference on Communication Disability is now open. Please see http://www.sltkenya2013.blogspot.com for more information.   

References:
Jochmann, A. (2005). Speech and language therapy in East Africa: 
The first East African speech and language therapy conference in January 2005 in Nairobi. Retrieved from http://www.cplol.eu/files/East%20African%20SLT%20conference.pdf

Jochmann, A. (2006, February 07). Speech and Language Treatment in East Africa. The ASHA Leader.

McLeod, S., Staley, B., Wylie, K., McAllister,  L., Bleile, K., Marshall, J., Atherton, M., 
Wickenden, M., & Ahmad, K. . (2011). SLP University Programs in Developing Countries: Culturally Sustainable Approaches. . Paper presented at the American Speech Language Hearing Association Annual Convention. San Diego, CA.

Wylie, K., McAllister, L., Davidson B., & Marshall, J. (2013). Changing practice:
Implications of the World Report on Disability for responding to communication disability in under-served populations. International Journal of Speech-Language Pathology, 15(1), 1-13.


Contacts for the Speech Language Therapy training programs:
The program at Kenyatta University, Nairobi, Kenya: Shannon Benton (shannonbenton@claspinternational.org) or CLASP’s website at  www.CLASPinternational.org

The program at Moi University, Eldoret, Kenya: Hillary Sang (hillarysang@yahoo.com) or Anita McAllister (anita.mcallister@liu.se)

The program in Lushoto, Tanzania: Project supervisor Prof. Dr. Habil. Ulrike Luedtke (ulrike.luedtke@ifs.phil.uni-hannover.de) or project coordinator Ulrike Schuette, (ulrike.schuette@ifs.phil.uni-hannover.de)

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