Hello, I am Helena and I have just returned from Phnom Penh, Cambodia where I have been volunteering for the past three months as a speech and language therapist for City-Cambodia Project which was founded by Professor Tim Pring. Tim has been sending eight newly qualified speech and language therapists from City, University of London out to Phnom Penh for eleven years now. I qualified as a speech and language therapist in July 2017 making this September my chance to join the project in Cambodia. I was selected in April and assigned to the cleft lip and palate team along with my colleague Caitlin.
Twelve years ago Tim visited Cambodia on holiday and realised that speech and language therapy was none existent. He thought ‘what Cambodia needs is speech and language therapists’ and he knew just where to find lots of newly qualified ones! – City, University of London. A year later Tim started the project. Over the years Tim and a grand total of 76 newly qualified therapists have worked very hard to build relationships with paediatric institutions, raising awareness of speech and language therapy and teaching locals about the benefits it can have to children they reach. Now we have three teams: schools and outreach; developmental disorders; and cleft lip and palate. The project has reached many different settings over its lifetime. Here is a quick breakdown of the settings each team was working with this year.
The schools team were training teachers and speech advisors in three different schools while also delivering training programmes out of Phnom Penh to reach schools in different provinces such as Kratie, Kampot and Siem Reap.
The developmental disorders team spent most of their time at a centre for child and adolescent mental health where they trained staff in speech and language therapy techniques such as Parent Child Interaction. They also helped the centre start up a communication group called Toddler Talks and joined them on two outreach projects to Battambang.
On the cleft lip and palate team we divided our time between National Pediatric Hospital, Children’s Surgical Centre and One-2-One Cambodia. We also joined Smile Cambodia on two missions at Khmer Soviet Friendship Hospital, where we formed the speech department to provide speech, language and general feeding advice to patients and their families before they receive cleft lip or palate surgery.
The project’s mission statement is ‘to establish local expertise by empowering local staff to offer basic speech and language services within a multi-disciplinary context, with the aim to improve quality of life and social inclusion for people with speech and language difficulties’. To achieve this and to ensure the project’s work is sustainable much of our work involved raising awareness of what speech and language therapy is, what we can achieve and who we can help. We also did lots of training to equip Khmer staff with the skills they need to carry out speech or language therapy work after we had left. In Cambodia, while there is more awareness about speech and language therapy than there was before the project started, it is still not a recognised profession, in fact, there is not even a translation from English! As it is not a recognised profession we provide staff from local hospitals and schools with training in certain areas of speech and language therapy that we believe will be beneficial to them in their place of work. Typically staff are qualified nurses, doctors or teachers. We deliver training in many different forms such as modelling therapy sessions, role-playing scenarios and training programmes. The main thing about the training is that it fits in with their already busy work day. There are now seven Khmer locals, known to this project, who are able to deliver specific aspects of speech or language therapy. We call them speech advisors. The local hospitals and schools have provided these speech advisors with a room and set times each week where they can use their unique skills to provide speech and language therapy to the community.
A special addition to our role on the project this year was to create and deliver the anatomy and physiology module on the first speech and language university course in Cambodia. This was a short introductory course to the basics of speech and language therapy at Paññāsāstra University. It was a great success and has laid foundations for the development of a full university course which will bring recognition and self-sustainability to speech and language therapy in Cambodia. It was also an amazing opportunity for me as a newly qualified therapist where I was able to share my knowledge and teach others as opposed to the very familiar role of being the studying student. Caitlin and I also had the chance to create and lead a tutorial session on cleft lip and palate. Each of the 13 students (pictured below) on this leading course were amazing and very friendly. Their dedication to the course, which ran on Tuesday and Thursday evenings and all day Saturday was admirable and their hard work paid off as they all passed with excellent marks. This enables them to incorporate aspects of speech and language therapy into their daily work.
While in Cambodia, Caitlin and I were asked to present at the first National Rehabilitation Conference. This was held in Phnom Penh and there was a range of professionals involved in rehabilitation in attendance including, occupational therapists, physiotherapists, social workers, teachers, nurses and two of our speech advisors. The aim of the conference was to raise awareness amongst these professionals about the work that the other one does, to build links and communication platforms, and to help Cambodia’s rehabilitation services work collaboratively for the good of the patients’ progress during their recovery. We spoke about the developments of speech and language therapy, what services we can offer and our hopes for the future of speech and language therapy throughout Cambodia. The presentation was well received and we had a lot of interest shown from other professionals who wanted to work with City-Cambodia project. It was a great success both for the progression of speech and language therapy in Cambodia and for the development of City-Cambodia Project.
The general population of Cambodia is still not aware of what speech and language therapy is and who it can help. There is still a lot of work to be done to raise awareness about health care professions and the help that can be provided. However, I witnessed a few patients coming into hospitals saying that their neighbour had told them to visit the hospital as there was ‘someone’ that could help with their speech. In a country where smartphones and reliable internet is only just becoming the norm in the cities and is not yet established in rural communities, spreading awareness of speech and language therapy relies on word of mouth. This makes progression slow. The speech advisors that I worked with expressed their hopes that over time patients and their families will no longer be afraid or embarrassed to visit the hospital or attend a specialist school. They would also like families to realise the importance of speech and language therapy and to be motivated and able to attend regular follow-up therapy. Finally the speech advisors look forward to the day when speech and language therapy is a recognised profession just like teachers and doctors.
Looking back on my time in Cambodia I feel very privileged to be part of the developing world of speech and language therapy. I am very proud of everything we have achieved and we met some amazing people along the way. I can’t say it was all smooth sailing though! The language barrier posed a lot of problems and even though I attended Khmer lessons every week, there were still many times when meaning got lost during training sessions, one translator leaving in the middle of a presentation because his wife was giving birth, or not being able to build a good rapport with parents or children. Cambodia is a very poor country which causes challenges when all speech and language therapy is based in Phnom Penh. Often families travelled over five hours to come and visit a speech therapist and then they had no money to come back for follow up appointments or regular therapy – most families cannot even afford one journey to Phnom Penh. Typically Khmer people have two careers, this can be anything from a doctor or nurse to a tuk-tuk driver or banana seller. This made it incredibly hard to pin people down to deliver regular training as they did not have time available to focus solely on speech and language therapy. As every speech and language therapist is trained to do, everything we did had to take into account differing cultures and lifestyles.
Of course, as a newly qualified speech and language therapist I do not have the experience to provide training or clinical support in all aspects of speech and language therapy. Some of the speech advisors have been working for many years and there were times when I had to step back and learn from them. For the times when I was unsure how to respond to a situation, I was able to draw on the expertise of the project’s committee. The committee is made up of experienced speech and language therapists who volunteered on the project in previous years. We were also provided with supervision from members of the committee, via skype and in-person, during the three months.
The project continues to provide training to all speech advisors and support is offered to them in-person during the three months that volunteers are out in Cambodia and via emails when we are back in the UK. This year was a turning point for the project as two of the Khmer speech advisors who we have been training since the start of the project said that they now feel confident using the skills they have learnt from us and can provide speech and language therapy independently. This is a very positive outcome but it is not the end as we will still provide support and advice for their work when necessary.
The positive experiences far outweighed the challenges. The amazing and dedicated people I worked with, the new friendships I’ve made, the experience of living in a developing country, the resilience I’ve built up both in daily life and the working environment, knowing that I have shared my skills with others to help them improve their health care services for their people, not to mention the memories. I am so proud of the eight of us newly qualified speech and language therapists and all the ten teams before us. The work we have achieved, little by little each year, has built up to enable parts of Cambodia to deliver speech and language therapy.
The next step for my seven colleagues and me is to feedback to the committee on the progress made in 2017 and our thoughts and ideas for 2018 and the future. We must continue to improve the awareness of speech and language therapy. We hope to create a recognised speech and language therapy qualification by working with other local organisations to develop a full university course, with clinical placements and competences for students to complete. This in turn will provide recognition for speech and language therapy as a profession. And finally, our long term goal, is to have Khmer speech and language therapists training their own people enabling sustainability of the profession.
Helena Gruenstern
Newly Qualified Speech and Language Therapist (UK)
Communication Therapy International 