|Matthew Sandoval, a WSU senior, models how to use a basic picture communication system with a staff member from the Hangzhou Welfare Institute as part of a presentation on augmentative and alternative communication methods. Laminated photos of food and utensils are attached to each apron pocket. Leona Ho translates beside him (although minimal translation was needed during this demonstration).
I am the mother of one of the 67,842 children in the United States adopted from China between 1985 and 2007 (Families with Children from China, 2008). My husband and I adopted Jasmine (Zhu Xin Rui) from Xining, China, in March 2006. In a visit to my daughter's orphanage—the Xining Welfare Institute—I noted that the majority of children there had severe disabilities in motor skills, cognition, and communication. The caregivers worked on range-of-motion exercises and proper positioning, suggesting that they had received training in occupational (OT) and physical therapy (PT), but there were no communication aids. This organization receives financial assistance and training from the Hong Kong Christian Action Network. Organizers from this nonprofit organization confirmed that the caregivers received some OT and PT training, but none in speech-language pathology or audiology.
This experience inspired my desire to return to China and offer some basic communication training for caregivers in the orphanages, known in China as "children's welfare institutes." In April 2007 I met Sheila Purves from the Hong Kong Society of Rehabilitation at the first China International Conference on Speech Therapy in Beijing, where she presented on the need for training in speech-language pathology in mainland China. During a break we discussed the possibility of bringing students and faculty to China to provide training. When I shared the idea with my students their first question was, "Are you serious about this?" and then, "Can I go?"
In March 2008, nine undergraduate seniors and two colleagues (speech-language pathologist Carla Jones and audiologist Susan Forbes) from the Department of Speech and Hearing Sciences at Washington State University (WSU) accompanied me to China, in the department's first faculty-led trip abroad. (WSU seniors are experienced, having had two semesters of clinical practica; in addition, WSU encourages faculty-led trips abroad to help undergraduates become more globally minded.) We had six months to raise money and collect materials (e.g., otoscopes, books, an audiometer, feeding aids, toys, etc.), and 10 months to work out the logistics with WSU, Purves, and the sites we would visit. With Purves' connections we were invited to visit several locations in Shanghai and Hangzhou and were able to travel inexpensively ($1,300 per student for transportation, meals, and lodging). We had raised $8,000, which helped bring down the cost for the students and pay for the materials we donated.
To prepare for the trip, students enrolled in a course that included reading assignments and discussions of children's welfare institutes, rehabilitation centers, the fields of audiology and speech-language pathology in China, and Chinese language and culture, as well as language stimulation, creating and using basic augmentative and alternative communication devices, and pediatric feeding and cleft care.
We were in China for eight days during our spring break. We spent the first few days in Shanghai visiting a center for children with cerebral palsy, a children's hospital, and the Shanghai Children's Welfare Institute, where we observed treatment and discussed current American and Chinese practices in speech-language treatment and audiology. In mainland China, there are approximately 1,000 SLPs. Training programs for SLPs range from two weeks to six months, but there are no standardized training guidelines. A category of staff called "rehabilitation workers" also may provide speech-language treatment, but their training emphasizes OT and PT.
Consultation and Training
At the hospital, we were asked to consult on five children with varying degrees of cerebral palsy. The rehabilitation workers and parents were concerned mainly with the children's drooling and helping them speak clearly. We spoke about saliva management and the importance of communication through means other than speech. The staff also had many questions about pediatric dysphagia; unfortunately, time allowed us to touch on only the basics of diet modification and positioning for feeding infants.
We spent the second half of the week at Hangzhou's Welfare Institute, chosen for its openness to new information and desire to learn how to help the children in any way possible. We provided six interactive, hands-on workshops on hearing screening, hearing loss, alternative and augmentative communication (AAC), language stimulation, autism, and pediatric dysphagia.
We split into three teams of one faculty leader and three students; while two teams provided workshops, the third interacted with children who had delays and modeled various techniques to facilitate language. The workshops were well-attended by medical staff and caregivers from the host and surrounding children's welfare institutes. Each presentation had an interpreter and all PowerPoint slides were translated into Chinese. All presentations were video recorded for others to view.
Cultural differences became clear in our work in both the rehabilitation centers and the children's welfare institute. For example, Chinese children are typically told what to do and say; trying to get them to make requests was considered culturally inappropriate. In discussing this issue with our Chinese translators, we explained that our goal was to get the children to communicate and having them make requests was an effective way to reinforce their communication attempts. When the caregivers saw how this method encouraged the children to communicate, they were quick to try what we had modeled.
Knowing we'd be in China for only a week, I tried to keep my expectations realistic and thought of the trip as a way to build relationships for future work. Even with our short stay, however, it was rewarding to see the caregivers demonstrate that they learned from our workshops and use the materials we shared with them. For example, at the hearing screening workshop, the medical workers and caregivers happily practiced screening one another's hearing and using otoscopes. They said that they looked forward to implementing a hearing screening in their regular health check protocol. Given the risk of ear infections, we were very excited about their enthusiasm.
Our plan is to continue collaborating with the Hong Kong Society for Rehabilitation and working at children's welfare institutes that would benefit the most from our visits. We hope to take six undergraduate seniors and graduate students on two-week trips to China every other year to help the welfare institutes and foster families facilitate communication with their children with communication disorders.