November 1, 2011 Features

The China Gap for Speech-Language Services

The smiling woman who greeted me at Shijiazhuang No.1 Hospital wore a traditional white nursing uniform and nursing cap, so I was a bit surprised when she identified herself as the hospital's speech-language pathologist. It turned out Yan Ling had trained first as a nurse and then as an SLP—a typical career path in China, where there are an estimated 1,000 SLPs for the country's 1.3 billion people. Compare that statistic with the United States, where there are more than 126,000 ASHA-member SLPs for 312.4 million people.

When I traveled to Shijiazhuang City for two weeks in October of 2009, my goal was to work with Yan Ling to make a small, albeit fleeting, dent in the enormous need for services there: In Shijiazhuang City, for example, there are more than 9 million people and Yan Ling is the only SLP. I was there with Rotaplast International Inc., which sends teams of medical and nonmedical professionals around the world to provide care to children with cleft lip and palate.

On my arrival, Yan Ling led me through the ward to her speech-language treatment room, which was outfitted with a hospital bed, desk, and round table for working with children. She was well-equipped with materials for treatment and articles on cleft palate translated into Chinese from English. In addition to performing nursing duties, she conducted regularly scheduled speech-language treatment sessions for children after cleft lip and cleft palate surgery. She graciously handed me the key to her office to use during my time there. Although neither of us knew one word of what the other said, the nonverbal communication between us immediately solidified us as professional peers.

Across Languages

I am bilingual (Spanish-English) and have traveled with Rotaplast International to the Philippines, Peru, El Salvador, Venezuela, and the Dominican Republic. But China was the first country where I had to use an interpreter. I learned how it felt to not be able to communicate a single word in the language of the people. It was frightening and eye-opening at the same time. Over the two weeks, my interpreter, Eric, grew to love the work of an SLP and expressed a desire to come to the United States to receive his master's in communication sciences and disorders. He is now a teacher in the phonetics field.

While in China, I worked with many children, most of them from impoverished rural families. These families receive free transportation and accommodations through government funding. One 5-year-old girl with cleft palate came to the treatment room with her parents, first on the screening day, then six days following her surgery. I was allowed to videotape the speech-language treatment session for later use in my cleft palate course at the university. Using pictures, I showed the girl's parents where a glottal stop had occurred. Then I asked the girl to repeat Chinese words and showed her how to allow air to flow from her mouth by producing an /h/ sound followed by the target sound. The parents were attentive and conversed readily, and the girl successfully performed every task requested of her.

I also worked with many families and their babies. My interpreter and I walked the wards talking with parents and playing with their babies before and after surgery. Many times, as I talked with one family, the other families quickly came around and listened.

I had created a basic information sheet for parents on speech-language treatment after palate surgery. As my interpreter translated this sheet, Yan Ling gave me a similar sheet she had created with instructions that almost exactly mirrored mine. Now she has an English version and I have a Chinese version. I also gave out picture books to the children in the hospital. They loved these little books, and followed me up and down the wards carrying them.

Continuing Challenges

I also had the opportunity to videotape a cleft lip and palate surgical procedure. I stood on a step stool over the surgical space and videotaped the intricate workings of the plastic surgeon's hands connecting muscle fiber to muscle fiber. Each of these experiences allows me to be a better teacher and clinician in the United States.

This hospital had excellent dental and audiology/otolaryngological services. In fact, the orthodontist on the Rotaplast team and I collaborated to make several speech bulbs—speech aids that partially close the space between the throat and soft palate—for some young adults who were not good candidates for the surgery and who could be followed later by the site dental team. Several children with ear anomalies were having their hearing tested by the hearing specialists in the hospital. Although the field of communication sciences and disorders did not start until 1988 in the Republic of China, its people continue to make strides in providing services to the 10 million children with disabilities (see Aungst and Battle (2007) for an overview of speech-language pathology, deaf education, and audiology services in China).

Unfortunately, families of children with communication disorders have little hope of receiving the care they need because of the paucity of professionals. However, the few that do receive services appear to receive excellent care from very competent professionals. ASHA's new Special Interest Group 17, Global Issues in Communications Science and Related Disorders, provides a way for ASHA members to connect with their international colleagues to exchange knowledge and provide services. Through efforts at global outreach, SLPs are making a difference in places such as China, where the numbers of professionals available to provide the service are woefully inadequate for the need.

Marlene B. Salas-Provance, PhD, CCC-SLP, is director of the Program in Communication Disorders at New Mexico State University.She is also associate and incoming coordinator of Special Interest Group 17, Global Issues in Communication Science and Related Disorders.

cite as: Salas-Provance, M. B. (2011, November 01). The China Gap for Speech-Language Services. The ASHA Leader.

Spotlight on SIG 17

ASHA's new Special Interest Group—SIG 17, Global Issues in Communication Sciences and Related Disorders—has in its first year:

  • Attracted 321 affiliates.
  • Published two issues of its Internet member publication, Perspectives.
  • Enabled its affiliates to earn ASHA CEUs for self-study of Perspectives for $5 per issue.
  • Conducted a live Web chat for ASHA members on the World Health Organization Disability Report and its meaning for the professions.
  • Developed an ASHA Convention short course and seminar, which SIG affiliates can attend for half price.

Serving on the SIG's founding Coordinating Committee are Carolyn Higdon, coordinator (2010-2011); Marlene Salas-Provance, associate and incoming coordinator; DeAnne Owre; Dolores Battle; and Catherine Crowley. Other volunteer leaders include Maria Diana Gonzalez, editor, and Clarissa Rodriguez, continuing education content manager. Leigh Deussing serves as the National Office Ex Officio to this committee.

The Coordinating Committee aims to increase SIG 17 affiliate numbers by 10% in 2012. If you are interested in global issues related to speech-language pathology and audiology and would like to network with others who do—consider joining SIG 17. For more information on how to join and to learn more about this SIG's activities, visit the SIG 17 news and events Web pages. Once you join, you'll have access to the new online community for SIG 17.


Aungst, R., & Battle, D. (2007). Communication disorders in china: Audiology and speech-language pathology. The ASHA Leader, (Vol 12, No. 7).


Advertise With UsAdvertisement