November 29, 2005 Feature

The Point at the Tip of the Spear

Providing Speech and Language Services in Japan

Working in the land of the legendary Samurai Warrior has been the opportunity of a lifetime. We are both civilians who work with the U.S. Department of Defense and have served the diverse military and civilian communities on two continents.

Who We Are—Some Background

Both speech-language pathologists, we met in Germany 16 years ago. Isabel was serving as Chief of Speech Pathology at the U.S. Army Hospital in Nuernberg, Germany, providing services to patients of all ages, and was instrumental in initiating the city's Exceptional Family Member Program. This program worked in concert with the Department of Defense Dependents Schools (DoDDS) to provide medically related services, family support, and special educational services to family members and children ages birth to 21. At the time, Rhonda was working with the school-age population who were attending the Department of Defense Dependents Schools.

After many years of service in Germany, Isabel was selected to attend the Army Management Staff College, the preeminent college for Army leaders, and participated as a student alongside high-ranking officers, and equivalent civilians, from various Army career fields. Students at the college gained a total understanding of how all Department of Defense personnel work together to support the mission and vision of the military. Key to the success of this support is taking care of the needs of families and assuring that family members with special needs have every opportunity to receive intervention services and medically related services in their most natural environments.

Isabel then chose to take a position as clinical Speech and Language Pathologist in Seoul, Korea, where she readily embraced the culture and provided the intervention services necessary to facilitate language development in young children from birth to age 3 from dual-language households, as well as services to patients of all ages. She was also appointed by the commander of the 121st General Hospital as the continuum of care team leader on the Korean Peninsula for activities that lead to accreditation, with commendation, by the Joint Commission on the Accreditation of Healthcare Organizations.

Isabel was awarded the Order of Military Medical Merit for her contributions and significant impact on the U.S. Army. Apart from her work with speech-language pathology clients, she also worked with soldiers returning from the Gulf Crisis who were without means of communication. She created numerous story boards and picture boards for soldiers suffering from post-traumatic stress syndrome and those who were without limbs and with limited ability to speak or to point.

Rhonda remained in Germany until substantial military base closures required that she transfer to northern Japan. Unexpectedly, two years ago, we reunited when Isabel transferred from Korea to work for Educational and Developmental Intervention Services (EDIS) in the land of her fondest childhood memories, Japan. As the daughter of a military career officer, she grew up on the northernmost island of Hokkaido. EDIS is a collective team of professionals whose work aims to foster normal development in children from birth to age 21. The EDIS team evaluates and provides health services, including speech-language pathology services, for children who have disabilities affecting their ability to receive public education.

We are currently both assigned to Misawa Air Force Base, the northernmost military base on the main Japanese island of Honshu. Because Misawa is so far north, it is referred to as "The Point at the Tip of the Spear." The mission of Misawa Air Force Base is to assist in the defense of Japan, and to promote regional security in the Pacific through a forward presence and rapidly deployable military forces. Should a conflict occur anywhere in the Pacific area, the 35th Fighter Wing at Misawa AFB will defend the area.

To Isabel, the opportunity to serve in Japan is both an honor and a memorial to her parents, as her father served in WWII and the Korean War.

Rhonda, born with wanderlust, was always intrigued by other cultures. She traveled extensively throughout the Caribbean, Mexico, and Europe as a young adult. She also holds in high esteem members of the armed forces, as her father served in the Korean War and her oldest brother paid the ultimate sacrifice in Vietnam.

Our job is to provide speech-language pathology services to authorized Department of Defense military and civilian family members. We feel that service in Northern Japan is vital because the need is great. It is imperative that service members living overseas with children who have special needs have access to world-class services. It's a privilege to partner on foreign soil with members of the Armed Forces in service to our country. There is truly no limit to our professional opportunities.

Multicultural Relations

Working overseas has numerous benefits and is often viewed as exotic. Many believe laboring in this venue is comparable to being on a perpetual extravagant vacation, but in reality working overseas might best be considered as primarily a professional growth opportunity in multicultural relations.

A great number of military and civilian families living overseas are dual language multi-ethnic multicultural families. To work optimally with this population, it is important to possess a global view of communication services and a broad vision of the world community.

Isabel provides services for children with, or who are at risk for speech, language, and swallowing disorders. Given her background, she is uniquely qualified to address the broad spectrum of needs presented by her clients (families, infants, and toddlers) who are at-risk or who have developmental disabilities. To be effective in working with this population, it is necessary to understand the family's beliefs, values, and priorities. Because each family has a culture of its own that may be separate and apart from, or greatly influenced by, its ethnicity, race, and religion, service providers must be sensitive, open, and good listeners who respect differences in childrearing and family traditions.

Consequently, when Isabel enters a Japanese-American family home she becomes a part of its tranquil nature. Although she educates parents on how they can take advantage of opportunities to learn the language of the country, her program is tailored to meet the dynamic needs and cultural practices of the family. With this in mind, Isabel respectfully removes her shoes at the door before entering her families' homes. She sips the green tea she's offered by her host, and is enchanted by the creative origami cranes carefully made by the children.

Rhonda works with students ranging in age from 3 to 21. Although her work does not take her into students' homes, she invites parents to actively participate in weekly treatment sessions. Her preschool students' parents take full advantage of this invitation. This natural exchange keeps Rhonda abreast of the families' needs, dynamics, and priorities.

She must be mindful of the different cultural styles of her Asian-American students and their non-American (Japanese, Korean, Philippine, or Guamanian) parent. In this community, the Japanese, Korean, Philippine, or Guamanian parent is most often the primary caregiver, as their spouses are typically military servicemen who work long hours and are often deployed for months at a time. It is imperative to be familiar with the social nuances prevalent in these cultures in order to best serve them.

Working Abroad

We face cultural and professional challenges living in Japan and working with predominantly Asian-American children. A considerable challenge is the understanding of phonemic systems as well as the nuances of each Asian language in order to determine if a child possesses an articulation disorder or is merging the sound systems of the languages spoken in the family home.

It is also our role to explain these differing linguistic behaviors and the impact of the differences to our colleagues. Often, a new position with DoDDS is a teacher's initial exposure to a foreign culture and language. Because the lack of familiarity may lead to inappropriate special education referrals, it is very important that the SLP and classroom teacher work in concert with native language speakers to determine if a student indeed exhibits signs of a language delay or disorder.

For another example of cultural differences, prevalent in Asian cultures is the practice of children respectfully listening to their teachers without initiating conversation or participating in verbal repartee. In Western-run schools, these children might be referred for language assessments because they could be perceived as non-verbal. Although their language may indeed be delayed or disordered, there are other linguistic-cultural nuances as well that teachers and SLPs must consider. The quiet mannerisms and gentle expressions of these children from dual-culture households may be a direct result of the influence of their Asian heritage, and not necessarily a sign of delayed or disordered language skills. One of the first lessons teachers and SLPs learn in Japan is the different expressions, words, gestures, and levels of bowing that depend on the relationship of the child to the adult. Awareness of such cultural sensitivities makes it easier to determine if a child's response reveals a disorder or is simply a result of cultural difference.

Similarly, in Asian cultures direct eye contact is usually avoided. For Asian children, making eye contact with adults is considered a great act of disrespect. Thus, during articulation treatment, using a mirror when teaching a technique allows students to look directly at the clinician's mouth through the mirror and model articulatory movements while respectfully averting their eyes. Classroom teachers who are unaware of this cultural difference often report that students don't make eye contact and mumble a lot. Indeed, this is not the case. Therefore, it is often the job of SLPs to point out these nuances and work collaboratively with the classroom teacher to provide a culturally sensitive, linguistically enriching academic setting.

Professional Challenges

Working in foreign countries can sometimes make it difficult to stay abreast of the latest trends in the profession. Resource materials must be ordered from the U.S. well in advance of a school year, as materials may take as long as nine months to arrive. Although self-study and the Learn & Earn programs are advantageous, we appreciate our planned trips to the U.S. for the ASHA Convention and for networking at state speech-language-hearing association conferences.

Since we are 15 hours ahead of U.S. time, we are busily at work when our stateside support system and counterparts are enjoying a good night's rest. Telephone calls may cost $50 to $200, which prohibits teleconferences and telephone consults. Online options provide a more affordable avenue by which to access stateside speech-language pathology colleagues. But the frequent earthquakes in Japan often make computer connections a challenge even for the skilled technologist.

Attending annual stateside conferences is challenging too because overseas employers often do not grant paid leave for attendance. They also do not reimburse employees for expenses incurred even if the employee takes leave without pay. Because of the high cost of overseas air travel, it is often financially prohibitive to incur such a great expense annually. Rhonda earns CEUs by matriculating online. Isabel attends the annual ASHA Convention. We both take ASHA courses in the U.S. during summer vacations.

There can be a real sense of professional isolation when working overseas. Although membership forums and mailing lists are great ways to connect with colleagues, limited access to resources and facilities places considerable strain on service provision. Learning how to work within a multi-tiered trans-continental military medical system, for example, to secure plastic surgery for a middle schooler with congenital atresia or a high schooler long overdue for final-phase cleft repair can be frustrating. The frustration stems from the fact that medical facilities specializing in hearing or craniofacial anomalies are located on military bases in the U.S. (San Antonio and Hawaii).

As daunting as some of these challenges appear, they are professionally the most rewarding of our work. They bring to the forefront the magnitude of speech and language services needed overseas. These challenges also highlight the reasons why we choose to provide those services.

Personal Challenges

The personal challenges of living overseas revolve around learning the language and embracing dietary differences. The Japanese language, for instance, is melodically produced with a rise in intonation on the last syllable. To westerners, most Japanese women sound as if they are singing soprano. It's awkward at first to imitate their prosody and pitch but with practice it becomes very possible.

There are challenges to reading the Japanese language as well because of its hundreds of Japanese and Chinese characters. In most major cities, maps, menus, and street signs are written in the Roman alphabet. However, in the remote location where we work, many public signs are written solely in Japanese and Chinese .

And there are other, minor challenges that are not usually discussed. For example, Japan still has an abundance of public toilets set in the floor (malls, restaurants, museums) that are affectionately called "squatty potties." They are tricky to navigate.

Serving the American military community at the "tip of the spear" in northern Japan is both exciting and tremendously rewarding. Our awareness of the world has increased greatly by living here. If you ever find yourself in Japan, look us up.

Isabel Polakof, is a Department of the Navy speech-language pathologist serving the early intervention population at Misawa Air Force Base, Japan. She is a member of the Educational and Developmental Intervention Services team, which provides services that foster normal development in children ages birth to 21 years.

Rhonda Jackson, is a speech-language pathologist serving the Department of Defense Dependents Schools in Misawa, Japan. She serves students within the full spectrum of communication concerns, including those who have hearing and language impairments, deafness, mental retardation, and autism.

cite as: Polakof, I.  & Jackson, R. (2005, November 29). The Point at the Tip of the Spear : Providing Speech and Language Services in Japan. The ASHA Leader.

Tips for Living in, Working in, or Visiting Japan

Here are some general tips for living and working in Japan:

  • Instead of shaking hands when you meet a Japanese person, bow. It's respectful and a cultural tradition.
  • When entering Japanese homes, always remove your shoes in the front foyer. Your host will provide house slippers.
  • Avoid direct eye contact. It is acceptable to avert your glance by looking periodically at your host or hostess, and then respectfully looking away.
  • Avoid patting children on the head. This gesture is viewed as insulting. A smile and slight bow are appropriate.
  • Speak in a soft tone. Loud voices are discouraged.
  • Always take a bite or sip of whatever foods and drinks are offered you when dining in a Japanese home. Your willingness to taste their delicacies is a sign of respect.
  • If you like to relax, visit the Japanese onsen (hot baths). They're beautiful and hold the secrets to clear skin and rejuvenation.

For More Information

If you're interested in working overseas for the Department of Defense Dependents Schools, check out the online application process. If you'd like to look into overseas job opportunities with Educational and Developmental Intervention Services (EDIS), contact the Department of Defense.


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