Many speech-language pathologists and audiologists have interests that extend beyond their national borders. Some seek international connections for information exchange, discussion, and a sense of belonging to a large professional community. Some hope to visit, study, volunteer, or work abroad. Others are motivated by wanderlust, or the urge to "make a difference," or by concerns about disparities in health care, educational opportunities, and social challenges faced by persons with communicative disorders in various places around the world. Many others wish to participate in international activities without leaving their home country—perhaps collecting books and supplies for professionals in a developing country, or simply reading about communication disorder services in professional journals. The recent quadrilateral agreement among the United States, Canada, England, and Australia both reflects and is likely to spur interest in international issues (Boswell, 2004).
To judge by letters to international Web sites and frustrations voiced at professional meetings, far more clinicians seek international connections than obtain them. Often, professionals cite lack of readily accessible, reliable information as the single biggest stumbling block to obtaining international experiences. Those who would like an international experience sometimes feel they must "re-invent the wheel" to obtain one. As Caroline Bowen wrote in her Web site in response to a query asking how to obtain an international experience, "I get a lot of inquiries about this sort of thing, but as far as I know there is no central office that adventurous, globetrotting SLPs can turn to for advice."
Fortunately, a person who wants to develop a more international perspective on communication disorders need not re-invent the wheel. Great stores of information and advice already exist. The difficulty is that the information is spread across numerous places, including a multitude of Internet sites, books, articles, and discussion forums. An important step toward developing an international perspective was to pull this wealth of information together.
The information that follows is based on the International Directory of Communication Disorders (IDCD), a free Internet resource (www.comdisinternational.com). The IDCD is a contribution to the attempt to facilitate international communication among persons in the professions. It required two years to complete and involved the efforts of many students and colleagues—including an advisory board that began as eight colleagues meeting in the author's hotel room at the 2003 ASHA Convention and grew to include a diverse group of 27 clinicians, academics, and students from many places around the world. Tracking down information for the IDCD felt like detective work—following leads, interviewing in person and via e-mail, contacting colleagues of colleagues, visiting programs, collecting stories. Many more leads ended in dead-ends than in somewhere fruitful. Sometimes, though, patient labor was rewarded with a huge cache of information, or a single hard-to-find address, or a great, fascinating story from a colleague in a distant country.
Six insights emerged from the effort to develop the IDCD:
1. The impact of a communication disorder varies depending on where a person lives.
The amount of attention a country gives to communication disorders depends on its history, cultural views on language and disability, economics, and availability of services (Kotby, 2006; McLeod & Bleile, 2007). As a result, someone with a fluency disorder may lead a normal and productive life in one country, while in another may spend life shut away in the family home (St. Louis & Andrade, 2004). In many countries a developmental language disorder is considered a treatable problem; in others, it may prohibit an education. In some countries a person with a severe hearing impairment may elect to enter the Deaf community or receive a cochlear implant, while in others a severe hearing impairment effectively denies or limits access to education, health services, and community (Jewett, 2003).
Challenges encountered by a person with a communication disorder may be aggravated in countries with more limited health and education resources. In an impoverished country, not all children may be permitted to attend school. As the World Bank's Millennium Project (World Bank Group, 2005) emphasizes, child mortality rates are tied to poverty, lack of education, and limited access to health care. To illustrate, in the West African country of Mali, the mortality rate in poor, rural families is twice as high as that in wealthy urban families. Worldwide, 100 million primary-aged school children remain out of school, almost 60% of them girls. A disability that limits a person's educational and vocational opportunities, including those in communication, contributes to poverty and, consequently, to higher childhood mortality. In recognition of the impact of education and disability on childhood mortality, the Millennium Project's five-point agenda includes improving human development services by rapidly increasing the supply of skilled workers in health and education (World Bank Group, 2005).
2. Titles, education levels, and responsibilities of professionals vary widely among nations.
Clinicians in the U.S. professions of speech-language pathology and audiology have different names elsewhere—including speech and language therapists, logopedics, speech-language pathologists, speech pathologists, phonoatricans, phonoaudiologists, audiologists, and audiometricists. Differences go beyond name. A bachelor's degree is required to practice in many countries; associate and master's degree requirements are less common. Importantly, because university systems differ, a bachelor's degree in one country may not be equivalent to the same degree in another. Responsibilities of professionals also differ: some countries blend speech-language pathology and audiology services, while in others the professions more closely resemble a branch of special education.
3. The professions of speech-language pathology and audiology are new or non-existent in many countries.
Poverty may preclude a nation's ability to train professionals (Ndigirwa, 2006). In less-affluent countries, communication services may not exist or may be provided by family members, volunteers, or members of another discipline, including nursing, psychology, or education. In Turkey, for example, the profession of speech-language pathology is newly established. As a result, 97% of speech-language pathology services are still performed by persons in other disciplines, including audiologists [Topbas S., & Özdemir, S. (2001)]. Formal education for such persons about communication disorders may be nonexistent or consist of a single course or seminar.
4. At least 55 nations or territories have national professional associations focusing on communication disorders.
Approximately one-quarter of the world's nations have national professional associations focusing on communication disorders (see Table 1). In countries in which the professions are well-developed, an increasingly typical pattern is to have two national associations, one focusing on speech-language pathology and the other on audiology. Some countries have more than two. For example, Germany has at least five national associations, and Argentina and Brazil each have four. Table 1 lists the largest national association in each country (in English when reliable translations are available); a maximum of two are listed for countries in which each of the professions has a national association.
National professional organizations are well- established in Europe, throughout the Americas, and in parts of the Middle East and Asia-Pacific. In sub- Saharan Africa, national associations are found in South Africa and Nigeria. As of this writing, the newest national association is in Turkey. National associations in some countries comprise many thousands of members, while others consist of a few pioneers. Information on numbers of persons within these associations is not always available.
5. At least 24 international professional associations and groups focus primarily on communication disorders.
These organizations differ enormously from one another in perspective and scope (see Table 2). For example, the International Affairs Association and Communication Therapy International share broad perspectives, with the former focusing on the entire world and the latter on supporting SLPs in countries with no or limited services for persons with communication impairments. The International Hearing Society, Humanitarian Audiology, the International Society of Audiology, and the International Association of Logopedics and Phonoatrics have missions nearly as broad—they have the entire world and either audiology or speech-language pathology within their purviews. Associations such as the International Stuttering Association, the International Society for Augmentative and Alternative Communication, and International Clinical Phonetics and Linguistics Association focus on a narrower range of disability. Still other types of associations concentrate on communication disorders as they occur in a specific world region, including the Asia Pacific Society for the Study of Speech, Language and Hearing and the Indo-International Society of Communication and Hearing Sciences.
6. At least 51 nations and territories have post-secondary school programs that educate students in either speech-language pathology or audiology.
Addresses for education programs in these countries are best accessed through national and international associations (see Table 3). This list overlaps extensively with, but is not identical to, the list of countries and territories with national associations. Student education programs are found primarily in Europe, the Americas, Asia-Pacific, and parts of Asia and the Middle East. A single sub-Saharan African country—South Africa—has student education programs. The newest student education programs (as of this 2006 writing) are in Kuwait and Bangladesh. In total, at least 672 student education programs exist worldwide. In countries and territories with student education programs, the number of programs available to a student varies tremendously. To illustrate, two large populous countries—the United States and Brazil—have approximately 300 and 100 student education programs, respectively. However, an even larger and more populous country, China, has one such program—the University of Hong Kong Speech and Hearing Services.
The International Perspective
In countries with more limited resources, a disability that restricts a person's educational and vocational opportunities contributes to poverty and, consequently, to higher childhood mortality. Education programs for students and national associations help protect the public through advocacy and education, and by establishing and maintaining standards of care. International associations facilitate interactions among groups with similar professional interests.
A person seeking an international perspective on communication disorders may be surprised to learn how much international work already is taking place. A quarter of the world's countries and territories have professionals who provide communication services to their citizens—a vast increase in service provision and a shining accomplishment for professions that existed in only a handful of countries 50 years ago.
The professions are largely absent in three-quarters of the world's countries and territories, many of which are also the most impoverished. In such countries, communication services may not exist or may be provided by volunteers or members of another discipline, including nursing, psychology, or education.
Fortunately, a professional seeking a more international perspective on communication disorders has many resources upon which to draw. Whether the motivation is simple curiosity, armchair traveling, fundraising, or the desire to study, volunteer, or work abroad, great stores of information and resources already exist. The challenge is to learn where these resources are and how to tap into them.