Imagine an ancient country containing more people than anywhere else on the planet, where each speech-language pathologist serves 1.3 million people. A country where a meager handful of training programs prepare SLPs to treat a staggeringly huge population. The People's Republic of China urgently needs an estimated quarter-million graduate-level SLPs, yet daunting challenges stand in the way of developing graduate-level training programs.
Speech-language pathology is relatively new in China, according to Shaozhen Chen, an SLP at the First Affiliated Hospital at Sun Yat-sen Unviersity (SYSU) in Gaungzhou. Chen described the history and current state of the profession to faculty from Rush University's Department of Communication Disorders and Sciences (CDS). Dianne Meyer, Patricia McCarthy, Richard Peach, and Emily Wang presented a day-long Research Symposium on speech-language pathology and audiology at the SYSU School of Medicine. Their hosts at SYSU were Hanjun Liu and Dongfen Huang, both associated with the Department of Rehabilitation Medicine at SYSU, and Dahong Zhuo, director of the World Health Organization Collaborating Centre for Rehabilitation at SYSU. "Drs. Liu, Huang, and Zhuo and their colleagues could not have been more gracious, generous, and collaborative," observed McCarthy.
Chen explained that disorders such as aphasia, pediatric language delay, dysarthria, and dysphagia have been addressed only since 1980. The first speech-language pathology department in China was established in the mid-1980s by the Rehabilitation Center of China in Beijing. Shortly after, Dahong Zhuo directed the master's degree education of two SLPs at Sun Yat-sen University. According to Chen, these were the first SLPs to receive advanced training in China.
Today, an estimated 1000 SLPs—less than 1% of America's 126,000 clinicians—serve a population more than 400% larger than in the United States. They receive training from only three programs. The Capital University of Medical Sciences in Beijing offers a degree in rehabilitation medicine that includes coursework in speech-language pathology. Two universities, East China Normal University (Shanghai) and the University of Hong Kong, provide undergraduate and graduate degrees in speech-language pathology. "From what we learned, most non-physician clinicians who supply SLP services in China have received a general "rehabilitation" degree at the bachelor's level," explained Peach. "In that bachelor's degree there is more coursework emphasis for occupational therapy and physical therapy than there is for speech and hearing. Much of the preparation for SLPs appeared to be through brief courses consisting of a few or more hours of instruction as well as from on-the-job training." Chen pointed out that because there are so few specially-trained SLPs, services are provided by other health care specialists, including physicians, nurses and occupational therapists. Chen herself offers services in both speech-language pathology and occupational therapy because she is qualified in both areas. Her caseload at The First Affiliated Hospital includes both children and adults with pediatric language delay, aphasia, dysarthria, dysphagia, hearing, stuttering, and voice problems.
Over a quarter-million speech-language pathologists, according to Chen, are needed to adequately treat China's enormous--and rapidly aging—population. In addition to the newness of the profession and the current scarcity of specialized training, language ironically also poses a critical challenge to the development of graduate-level speech-language pathology programs. Seven major dialects are spoken in China, and within each dialect there are a large number of sub-dialects. "Unlike English, most of the dialects and even the sub-dialects are mutually unintelligible," observed Wang. "Although Mandarin has been adopted as the official national language since 1913, most people still speak dialects. This situation presents a significant challenge for training programs in SLP and for service delivery models." The different dialects spoken by Shaozhen Chen's patients in south China make it difficult to treat them. She speaks and understands two of the dialects (Cantonese and Chaozhou); she speaks but does not understand one (Min Nan); and she understands but cannot speak another (Hakka). The language problem also affects SLP training when faculty who are non-Chinese native speakers or who may be Chinese, but not fluent in a specific dialect, attempt to teach language theory, assessment, and treatment. Clearly, careful thought is needed about the best way to prepare SLPs in China's unique linguistic environment.
How best, then, to increase the number of qualified SLPs in China? The tremendous need in China for SLP graduate education and for certified SLPs is not a problem that we in the United States have experienced on a national level. Rush University faculty continue to talk with colleagues at SYSU about ways to address the problem. One approach, perhaps the easiest to implement, would be to add speech and hearing coursework to the existing undergraduate degree in rehabilitation in China. In the short term, that approach could produce clinicians with better knowledge about speech, language, and hearing. Another approach, preferred by Zhuo and other professors at SYSU, would be to develop a master's degree program at their university. Language issues notwithstanding, a curriculum would need to be developed, clinical sites identified, and arrangements made for faculty. A third option raised during discussions between faculty of Rush University and SYSU during the day-long symposium would be to facilitate the education of Chinese SLP students in the United States, who could then assist with training of SLPs when they return to China. In actuality, all three approaches—plus others—may be required to meet China's pressing needs.
Wang summarized the increasingly dire necessity for trained Chinese SLPs. "China's population has been aging rapidly, and it is estimated that more than 30% of the population will be older than age 60 by 2042. This is for a population that is measured in billions, not millions. The great need for speech-language services presents unique opportunities to help our Chinese colleagues."