Sometimes professional life can become complex. In speech-language pathology, work is much more than just doing a job; there's also keeping up with the research, following policies that affect the profession, and (of course) maintaining the ever-lengthening paper trail.

But what if you had to provide treatment with no resources? No materials, no records—just an adult or a child in need. For most speech-language pathologists, the idea is an interesting mental exercise, but for the few SLPs in some non-industrialized countries, it's reality. That's what 35 SLPs discovered during a trip to Vietnam and Cambodia in September 2009. For 11 days the group met with education and health leaders who are trying to establish a speech-language profession in these countries. Among the group was Alex Johnson, provost and vice president of academic affairs for MGH Institute of Health Professions in Boston and 2006 ASHA president. Although Johnson has traveled on similar excursions to South Africa and Russia, he said this particular experience gave him a lot to think about.

"It was hard to see the lack of the resources available to help so many people who need it," Johnson said. "I think everyone on this trip came to realize how fortunate we are. Over here we are arguing over sub-specialization and finding resources to do complicated and advanced treatment, but going over there was really like taking a trip back to the basics. It made us think: If there was nothing there, what would be the first thing you would do?"

The purpose of the trip, sponsored by the humanitarian organization People to People, wasn't for participants to provide speech-language treatment, but rather to provide insight into starting a speech-language program from scratch. The challenges, participants discovered, are formidable. Vietnam is still recovering, physically and emotionally, from war; likewise, Cambodia still bears scars from the Khmer Rouge regime, which caused 1.7 million deaths 30 years ago.

Today both countries have vast pockets of poverty and thousands of citizens in dire need of speech and hearing services. The traveling SLPs visited rehabilitation centers, children's hospitals, colleges, and schools, and found that services for communication disabilities often take a back seat to those for physical disabilities.

"Although there are some professionals coming in and doing some occasional work through programs such as Operation Smile, it's certainly not enough," Johnson said. "There really is no educational training for speech-language pathologists in Vietnam, so therefore there aren't any."

Carol Koch, chair of Rockhurst University's department of communication sciences and disorders, was one of the SLPs in the group. Although she felt prepared to understand the professional situation in the two countries, the degree of poverty and need surprised her. 

 "On an emotional level it was so hard to see such a need for services," she said, "especially the children who had communication needs. You know the potential they have, but they won't get the services. I kept reminding myself that that's why we're on this trip—so in the future there will be services for children and families who need them."

In the tradition of such ambassadorial trips, Koch organized the group to make donations to the people they met. The visitors handed out books and toys to teachers, health workers, and families and all gifts were received with deep appreciation, Koch said. "They were overwhelmed, especially by the books—every family who received a book immediately opened it and started looking through it."

Despite the tremendous challenges the group witnessed, they also found inspiration from the burgeoning efforts. In one instance the group met with the special education faculty members at the National College of Education in Ho Chi Minh City (formerly known as Saigon) who are eager to begin a speech-language pathology program and are sending one faculty member to attend a PhD speech-language pathology program. In another instance, the group met with a pediatrician in a children's hospital who is developing a psychology unit to provide speech-language services to children with communication disorders. But because of the meager resources and staffing, physical therapists on staff are providing the services.

The hospital has dedicated four or five physical therapy positions to learn to work with the parents of young children to focus on helping them to communicate, Johnson said. "They are working with these children in a way that looks very much like what we would call speech treatment."

The group also met with Western-born travel writer Paige Stringer, who has created a new foundation, Global Foundation For Children With Hearing Loss. Stringer, who was born with hearing loss, is raising funds to bring a panel of 15 American experts to Vietnam this summer. The panel, which will include audiologists, SLPs, and educators, will work with Vietnamese teachers on educating infants and children ages 0–6 who have hearing loss. The foundation is hoping the program will extend into three consecutive years and possibly develop into a larger degree program that includes mentorship and distance-learning possibilities.

There are some signs of progress in Cambodia as well. Cambodia also has no formal training programs for speech-language pathology or audiology, but one American SLP, Alice Smith, lives in Cambodia nine months out of the year and works with Cambodian children (see sidebar). A British audiologist, Glyn Vaughn, runs an audiology clinic in Phnom Penh called All Ears Cambodia. Together, these two professionals "are the Cambodian Speech-Language-Hearing Association," Johnson remarked.

Overall, the travelers agree, the take-away from this trip was a sense of optimism. Johnson and Koch commented on how everyone they met on the trip was upbeat and welcoming.

"I think we all discovered how resilient these people are," Johnson said. "It's amazing how they have bounced back and have such energy."