"Why would you want to go to Vietnam?"
"Aren’t you worried about the living conditions over there?"
"How can you do your kind of work in a country where you can’t speak the language?"
These were some of the questions I was asked after I agreed to go to Vietnam in 1996 as a volunteer speech-language pathologist with Operation Smile, a not-for-profit organization based in Norfolk, VA, that provides reconstructive surgery and related care to children and adults in developing countries and the United States.
As an experienced SLP—currently a member of the Cleft Palate-Craniofacial Team at Ochsner Clinic in New Orleans—I was less concerned about providing services on a team working primarily with people with a cleft lip and/or palate who lived in the northern region of Vietnam than I was about communication barriers. But, after conversations with volunteers who had been to Vietnam, I was certain that I would be able to determine enough about the adequacy of a person’s speech and language to make decisions on the best course of action for them or their caregivers. I was assured that, with the help of a translator, I would be able to apply speech-language pathology theories and principles to accomplish the screenings, evaluations, treatment, and educational objectives of the Operation Smile Vietnam mission. With this in mind, I studied the Vietnamese language and phoneme system and acquainted myself with the country’s customs and culture.
So Much To Learn
Since 1996, I have learned more each year about being an effective "speech therapist" in Vietnam —"speech therapy" is the preferred term in Vietnam for speech-language pathology. Ours is a nascent discipline there that is showing promise of further development, but so much more needs to be done to establish university training programs and comprehensive services for people with communication disorders. Despite the challenges, it has been this need that has made me want to return to work in this Southeast Asian country and to network with others who are interested in doing so.
Each time I have been in Vietnam, I have struggled to keep tabs on my thoughts and emotions about my experiences. The level of poverty has been very high in most of the northern, central, and southern areas of Vietnam in which I have worked. Yet I have been continually amazed at the depth of determination and perseverance by the Vietnamese to make the best of what they have and to do what they can to move on to whatever life holds for them.
I have been happy to do my small part to help people in Vietnam. It has been dismaying, though, that there have been very few speech therapists in the country for follow-up. This is done by caregivers, volunteers, or community-based rehabilitation workers who have been trained to do what they can to help the child or adult continue to make progress.
It still amazes me to arrive at a hospital in Vietnam and see perhaps hundreds of people of all ages who have unrepaired clefts or other craniofacial abnormalities waiting to be screened for surgery and related services. It has been possible during screenings to obtain enough information to determine if the patient or caregiver needs additional information about speech-language stimulation and facilitation, post-surgical speech improvement, or feeding guidelines. Consultations with the plastic surgeons, dental specialists, and others on the team have taken place during and after the screenings, particularly regarding velopharyngeal insufficiency in people who have had an initial palate repair or who have another etiology for hypernasal speech or nasal emissions, contribution of an oronasal fistula to a speech problem, need for a prosthetic device, or factors that might interfere with progress after surgery.
During screenings, we use culturally appropriate materials, including books, pictures, and other materials specific to Vietnam. For very young children, caregivers are requested to provide information about hearing, receptive and expressive language, speech development, interactions with others, and adequacy of eating and drinking. Older children and adults are asked to count, name, and/or describe pictures; repeat sentences; follow directions; and participate in other activities that allow for screening communication skills. In addition, questions about hearing, play skills, school, work, peer interactions, and problems with eating or drinking are included in the screenings for the older children and adults. An oral examination is included in screenings for all patients.
Records are kept during screenings so that patients and families can be contacted about group educational sessions, evaluations, treatment, or other instructions. Follow-up is based on what was identified during screenings or subsequent contact with the patient. Speech errors due to clefts are relatively easy to recognize in Vietnamese. Non-maturational types of misarticulations require determining what is considered normal dialectally and developmentally. Determining adequacy of basic skills for language comprehension, expression, and pragmatic communication is easier than obtaining information about more specific development with respect to acquisition and use of the tones, grammar, and syntax of the language. Screenings have also included people who have sought services for such conditions as sensorineural deafness, cerebral palsy, Down syndrome, autism, stuttering, and impairments due to brain damage from trauma or illness. Efforts are made to assist them to the extent possible.
A typical day of work after the days for screening might include lectures at educational symposiums for health care professionals, presentations to individuals or groups of parents to provide information and demonstrations on speech-language stimulation and facilitation and/or issues regarding surgery and its effect on communication skills, more in-depth assessments of speech and language, articulation treatment, intervention to determine if improved oral-nasal resonance is possible via various strategies, teaching one or more parents how to feed their baby with a cleft more effectively, and writing home programs to be translated.
In-country speech therapy counterparts or personnel identified by a hospital or university for training in speech therapy have worked with me during screenings, evaluations, therapy, and educational sessions. Of the 80 million Vietnamese individuals in the country, fewer than 10 have held the title of "speech therapist," and none of them have a degree in speech therapy. Their degrees are in medicine, physical therapy, dentistry, linguistics, psychology, nursing, or other areas. None have attended a formal university course in speech therapy as this has not been available in Vietnam, and no interested individuals have had sufficient foreign language skills to be admitted to a speech therapy program in another country.
Financial support for further study or establishment of a university program has also been an issue. Vietnamese speech therapists have primarily learned from clinicians who have visited Vietnam and provided one-on-one training or seminars for short to extended periods of time, attendance at seminars out of the country, observations at U.S. clinics and hospitals, and textbooks and other materials that they have diligently translated from English and reviewed. I have been impressed with what they have been able to learn and apply in their work with people with communication disorders. I have seen some very good efforts in rehabilitation programs, as well as in an early intervention program.
Speech Therapy–Vietnam Project
Under the auspices of Operation Smile, I co-founded the Speech Therapy–Vietnam Project in 1998 with Ann Marie Juul, an Oregon SLP who was once a colleague of mine at Ochsner Clinic. She was also a member of Operation Smile’s Speech Pathology Council and a Vietnam volunteer. Each year since 1998, the project has helped to "put another drop in the bucket" to help build a foundation for more speech therapy services in Vietnam. Even though only a little has been able to be accomplished each year, people in Vietnam have shown a remarkable ability to make that "drop" go very far. They are fabulous at being able to do a lot with limited resources!
To date, the Speech Therapy–Vietnam Project has sponsored seminars and clinical presentations at hospitals and universities throughout Vietnam, in cities such as Can Tho, Danang, Dong Hoi, Hanoi, and Ho Chi Minh City (formerly Saigon). Approximately $25,000 worth of equipment, supplies, and textbooks donated by individuals and corporations have been brought to Vietnam. But there is so much more to do.
I have been so lucky to have the support of family, friends, and colleagues for my endeavors in Vietnam. I expect that I will continue to be involved with the Speech Therapy–Vietnam Project for years to come, even though the challenges seem overwhelming at times. My hope is that one day there will be comprehensive services in all regions of Vietnam for people with communication disorders. That day, however, is probably a long way off.
Anyone interested in additional information about the Speech Therapy–Vietnam objectives for materials development, educational projects, clinical services, and fundraising for 2001–2002 or in getting in touch with individuals working—or who have worked—to bring more services to Vietnamese individuals with communication disorders can contact me. I also will be glad to discuss many other aspects of Vietnam, including the food, markets, hotels, weather, crossing streets without screaming in fear of getting hit by some kind of vehicle, rides in cyclos and on motorbikes, encounters with water buffalo, and some of my humorous and more serious attempts at speaking and even singing in Vietnamese. I am always happy, too, to discuss the astonishing friendliness of people in Vietnam toward Americans.