Q&A for Students interested in working in low and middle-income countries
Interview with Julie Marshall, chair of CTI
My name is Reem, I’m a 2nd-year speech and language therapy student at Birmingham City University, and currently the student representative of Communication Therapy International (CTI). CTI is a Clinical Excellence Network of RCSLT. In this article, I had the pleasure of talking with the chair of CTI to ask some questions as a student interested in working internationally in low and middle-income countries.
Introduction
Julie: I am the current chair of Communication Therapy International, and I have worked in a number of different Majority World (Low and Middle-Income) Countries, for over 35 years, principally in East, West and South Africa. I’ve been involved in CTI since it started in 1991. I hope I can share some of the collective wisdom and experience of the many people who have been involved with CTI, and others I’ve had the privilege to work with over many years.
Question 1: What exactly does CTI do?
Julie: CTI stands for Communication Therapy International.
CTI’s mission is to support mainly speech and language therapists, but it could also be useful to other professionals, from Minority World countries, to maximise their work with people with communication and/or swallowing difficulties in Majority World countries. We aim to support speech and language therapists from countries like the U.K. to work to the best of their ability, working equitably and collaboratively with our colleagues in Majority World countries.
We don’t have a specific membership, so anyone can access our materials, join our mailing list, and engage with us
Question 2: How does CTI support SLTs working internationally? How does the process work?
Julie: CTI is a fairly small organisation, and everyone who contributes to CTI is a volunteer.
Firstly, we have a comprehensive website with lots of useful resources. This includes information on how to work internationally in Majority World Countries, as well as a competency framework to help you assess how your skills, knowledge, and attitude align with working in Majority World Countries. We also encourage people to actively engage with issues like culturally responsive practice and decolonisation. We have information to help you think about the appropriateness of donating resources (for example, communication aids) to Majority World Countries.
We sometimes advertise jobs, but CTI doesn’t act as a recruiter. We run webinars, which may include speakers from both Majority and Minority World Countries. We sometimes informally mentor people working in Majority World Countries.
We aim to challenge and encourage people to think about the kind of work they’re doing or aspire to do in Majority World Countries, and we work actively against a self-serving voluntourism mentality of working in low-resource contexts. In particular, we try to support people to consider the impact of their engagement in Majority World Countries and how that might impact both positively and negatively on the colleagues with whom we work. We are not seeking to represent our Majority World Country colleagues, but we work closely with them to seek advice about how to provide accurate and appropriate information to our members. We just don’t expect them to do all that work for us.
Question 3: What countries do CTI work with at the moment, and do they hope to expand this list of countries?
Julie: We don’t actually operate a list of countries that we specifically work with, because we’re not a recruitment or an employment organisation. Our work with specific countries is more likely to be in terms of advertising jobs and supporting individuals or Majority World organisations who are hoping to recruit SLTs. The places that we have more expertise or experience are partly affected by the members of the committee, so they change over time as our committee changes.
Question 4: What type of experience is required to work in Majority World Countries, and how extensive should that experience be?
Julie: RCSLT say that you should have an absolute minimum of 2 years of post-qualification experience before you contemplate working in a Majority World Country, and CTI agrees with this stance. Finishing your degree and gaining essential, practical experience in the country where you’ve had most of your SLT training helps you to gain confidence and consolidate your learning, as well as giving you the chance to complete your RCSLT competencies framework and to get your HCPC membership. This is so important because working as an SLT in any Majority World Country (even if you are from that country), will likely be very different from the U.K. Working in ANY new country is hard, so get experience, get to the point where you don’t have to think too hard about, for example, how to carry out an assessment, how to transcribe speech or language samples, how to deliver basic training, how to chat to a carer, etc. I would recommend trying to get experience working in a range of different contexts, building experience of working with people who have different levels of skills and knowledge about communication and/or swallowing difficulties.
Try to get experience of working with people with a range of different types of communication and/or swallowing difficulties, because the chances are that when you are in a Majority World Country, you may not have a choice of the client groups with whom you work. You may be in a context where people don’t have diagnoses or don’t have access to appropriate or standardised assessments, where there aren’t culturally or linguistically appropriate resources. So, you need as much confidence and experience in working in different ways as possible.
Question 5: How might someone contact CTI if they are interested in working internationally?
Julie: The first thing they can do is take a look at our website. One of our main resources that I haven’t yet mentioned is the ‘Working in Less Resourced Settings’ document, which is a document produced jointly with Occupational Therapists and Physiotherapists. It contains a wealth of useful information for those interested in working internationally.
I think you can get the most out of the CTI website by looking at it in ‘bite-sized’ chunks. Please do have a look at each of the tabs on the website, even the things like the blogs can give you some useful insights.
Come to one or more of our CTI webinars, and we might be holding a face-to-face session later on this year. Look out for events at your university, if someone from CTI is visiting or if there is pre-recorded information about CTI.
My biggest message of all is to take time to think and use whatever opportunities there are in your university setting and beyond, to learn about culturally responsive practice and decolonising practice. Although the latter might seem like a difficult concept when you’re only just at the point of working out the difference between aphasia and dysarthria, it is fundamental to international collaboration! If you want to work internationally, the political side of thinking about who you are, your positionality, racism, and discrimination are all so important for us to consider, to work as well as we can in Majority World settings.. Concepts such as ‘International Development’ are constantly evolving, and if we are from the UK, we should work to understand and be respectful of the international context. Engaging with Majority World countries and colleagues is fascinating, informative, sometimes challenging and can benefit everyone, but we must remain mindful of the possible negative, unintentional consequences of UK SLTs working in Majority World Countries.
Communication Therapy International 