December 11, 2001 Feature

A Speech-Language Pathologist in Vietnam

"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.

Screening Procedures

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.

Charlotte A. Ducote, is director of the Division of Communicative Disorders at Ochsner Clinic Foundation in New Orleans, LA, and is the chairperson of Operation Smile’s Speech Pathology Medical Specialty Council. In honor of her accomplishments with Operation Smile, she received the 2001 Louis M. DiCarlo Award for Recent Clinical Achievement. Contact her by email at caducote@aol.com or by phone at 504-837-6421.

cite as: Ducote, C. A. (2001, December 11). A Speech-Language Pathologist in Vietnam. The ASHA Leader.

Operation Smile

Operation Smile is a private, not-for-profit volunteer medical services organization providing reconstructive surgery and related health care to indigent children and young adults in developing countries and the United States. Operation Smile provides education and training around the world to physicians and other health care professionals so that they can achieve long-term self-sufficiency. Through partnering and sharing knowledge and skills, Operation Smile volunteers around the world learn from one another.

Operation Smile was founded by Dr. William P. Magee, Jr., a plastic surgeon, and his wife, Kathleen, a nurse and clinical social worker. In 1981, the Magees traveled to the Philippines with a group of medical volunteers to repair children’s cleft lips and cleft palates. They found hundreds of children ravaged by deformities—they helped many children, but the volunteers were forced to turn away the majority of those who sought help. The Magees promised those children that they would ret urn the following year to offer more surgeries. They kept that promise and, in 1982, Operation Smile was born.

Since then, Operation Smile has helped tens of thousands of children in the United States and 20 countries around the world. The typical Operation Smile mission takes place during a two-week schedule and comprises patient screening, a surgery schedule, and post-operative care. A publicity campaign proceeds the mission to inform potential patients. Volunteer medical teams include plastic surgeons, anesthesiologists, pediatricians, nurses, dentists, and speech-language pathologists. Operation Smile’s mission countries include Bolivia, Brazil, China, Colombia, Ecuador, Gaza Strip/West Bank, Honduras, India, Jordan, Kenya, Morocco, Nicaragua, Panama, Peru, the Philippines, Romania, Russia, Thailand, Venezuela, and Vietnam.

For more information, contact:
Operation Smile
6435 Tidewater Drive
Norfolk, VA 23509
Phone: 757-321-7645; 1-888-OPSMILE
Fax: 757-321-7660
www.operationsmile.org



The Story of One Child

Many people whom I have seen for speech-language pathology services in Vietnam have made an impression on me. One of these was a 6-year-old girl whose mother brought her to the Odonto-Stomatology Institute in Ho Chi Minh City (Saigon) during the second week of my visit there in the spring of 1999.

The child had previously had a cleft lip and palate repaired, but now the mother wanted her to have surgery to correct speech problems so that she would be accepted into first grade at a local school. The child’s lip and palate surgeries had been done by a group from another country that did not include SLPs on its teams. My evaluation indicated that the child had language skills within normal limits, but she exhibited developmental misarticulations and compensatory articulation errors (i.e., glottal stops) that, according to her mother, she had prior to her palate surgery the year before. The child also sounded hypernasal but had normal resonance when she would open her mouth just a little more when she talked. Dentition and velopharyngeal function were judged to be adequate for improved speech.

We discussed the speech problems and recommended intervention at length with the mother. She kept insisting that her child needed surgery to make her speak better, and she was concerned that her daughter would be denied this operation that she wanted her to have. A Vietnamese and an American surgeon and I spent time talking with the mother about the treatment that was needed and how surgery was not the treatment for the speech problems. Finally, the mother consented to let the child work with me.

Within minutes of beginning treatment and having success with the child imitating a word that began with a phoneme with which she had particular difficulty, her mother was in tears. "I never thought my child would be able to say that word. How did you do that? It is like magic!" she said in Vietnamese. We again discussed the basic principles of correcting speech problems, what I could do to help while I was there, and what the mother could do to assist. She said, "I never knew I could help my daughter learn to talk better. You make me very happy!"

During the next week, the mother brought the child two times a day for treatment. A nurse at the hospital worked with us so she could help the child after I left. This nurse had been identified by the hospital director as one who would try to learn more about speech therapy. There were no speech therapists anywhere in Ho Chi Minh City, so the nurse would be the person the child’s mother would have to rely on for further help. Through the use of phonetic placement techniques and various cueing strategies for the developmental misarticulations, in addition to gentle whispering and use of a sustained /h/ to eliminate the glottal stops, the child made significant progress daily. There was some resistance on her mother’s part to letting the child learn to open her mouth a little more to facilitate improved oral air flow and reduce hypernasality, but she relented when she heard the change in her daughter’s speech. She had been reluctant to let the child open her mouth more because she thought it would make her unattractive to future suitors.

Each day, the child’s mother followed through with what was recommended for speech activities at home. I marveled at how she did this despite the time she had to spend working in the family shop 12–15 hours a day, going to the market each day to buy food because they did not have a refrigerator or much storage space, cooking and cleaning, assisting other family members, and traveling to the hospital to bring the child to see me. I thought of how I often needed to convince parents here in America to be more consistent with implementing home programs.

This child is now in school and doing well according to the last report I received from the nurse at the hospital. The type of speech treatment this child received is commonplace for children seen by cleft/craniofacial teams in the United States, but it is still a rarity in Vietnam where so much more needs to be done to help people with all kinds of communication disorders.



  

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