ACQ Vol 12 No 2 2010

The speech pathology profession in the Philippines The majority of the speech pathologists (SPs) practising in the country are graduates of UP, which since 1982 has graduated 377 SPs. More than half (51%) are known to practise locally, a third (35%) have pursued graduate studies in other countries (usually the US or Australia) and/or are practising abroad, and the remaining 14% are in the country but are no longer practising speech-language pathology (Cuadro, Marzan, & Munar, 2008). A handful of Filipino SPs with graduate degrees from foreign institutions have returned to the country to further develop the undergraduate and graduate SP curricula. On occasion, foreign-educated SPs have provided services to international schools in the Philippines. Governmental overseas aid programs (e.g., AusAID) have also recently offered SP services in Bacolod, one of the provinces in the Philippines. Most SPs work in at least two different work settings and carry the roles of clinician and advocate of the profession. A smaller number of SPs extend their roles of clinician to being an educator, researcher and administrator (Cuadro et al., 2008). Accessibility and availability of SP services remain a challenge. To date, health insurance programs do not cover most SP services and these services are thus primarily paid out-of-pocket. Some government hospitals (e.g., Philippine General Hospital, Veterans Hospital), educational institutions (e.g., University of the Philippines internship programs) and community-based rehabilitation programs offer services free- of-charge or at minimal cost to those of low socioeconomic status. These programs, however, are few in number, and are not available in most regions of the country. Speech therapy services in public schools are also nonexistent. Sometimes teachers with limited background in speech correction provide services in elementary schools (Cheng, Olea, & Marzan, 2002). The distribution of SPs across the country is disproportionate. In spite of efforts to increase services in remote provinces and cities, Cheng et al (2002) indicated that most SPs practise in the National Capital Region (NCR), within or around Metro Manila. Oftentimes, the reasons for practising in the NCR are financial and professional in nature (i.e., availability of continuing education, more opportunities at collaboration with medical and allied health professionals, etc.). Given the uneven distribution of SPs, families from remote areas travel to the nearest city where SP services are offered. Often, the SP does an evaluation, provides the family with education and a home program, and schedules a follow-up visit to monitor progress. This service delivery model appears practical but its effectiveness has yet to be evaluated.

There is also disproportion in terms of the areas SPs specialise in. Currently, the majority of SPs work with preschool children with speech/language disorders secondary to Down syndrome, autism, cerebral palsy, mental retardation, and hearing loss. Only a limited number of SPs specialise in managing speech and language disorders in the adult population. SPs who work with voice and swallowing disorders are even scarcer. The important contribution of the SPs in the evaluation and treatment of dysphonia and dysphagia, however, is gradually receiving recognition among the otolaryngologists, physiatrists, and other medical disciplines. Cases handled by SPs are diverse but oftentimes severe. Families frequently do not seek services until the disorders significantly disrupt an individual’s quality and way of life. This may be attributed to lack of public awareness, education and financial constraints. The number of dialects and languages used by the clients can pose as a challenge for clinicians. Therapy sessions are mainly conducted in Filipino because this addresses communication needs in the clients’ daily environment. English, however, is also incorporated in order to address educational needs since the primary language of instruction is English or Taglish (codeswitching between Tagalog and English) (Cheng et. al., 2002; Marzan, 2007). Service delivery is also affected when working with multilingual clients; SPs who do not speak the client’s dialect /language compensate through modifying evaluation tools and resorting to family for translation when providing intervention. Normative data on speech and language milestones of Filipinos are minimal. The “Early Childhood Care and Development Checklist” has recently been developed and was normed on Filipino children nationwide by the Council for the Welfare of Children et al. (2005). Research on other speech and language developmental milestones, however, is limited to undergraduate and graduate theses. Evaluation tools used in clinical practice are non-standardised adaptations/ translations of western tests, which raises validity and reliability concerns (Cheng et al., 2002). Thus, SPs are prompted to rely heavily on informal assessment and sound clinical judgment when evaluating and treating clients. The professional association With the aims of advancing speech pathology both as an academic program and as a profession in the Philippines, promoting its relevance to society, and building camaraderie among SPs in the country, the Philippine Association of Speech Pathologists (PASP) was established in 1991 with Cynthia Rodriguez-Quiazon as the founding president. To date, PASP is the only national association for SPs with approximately 80 certified members. Typically, highly skilled professionals have to pass a national licensure examination in order to be registered

Jocelyn Christina B. Marzan (top), Winston T. Cheng (centre) and Fernando Alejandro C. Ligot

Electronic copies of ACQ Speech Pathology Australia members are able to access past and present issues of ACQ via the Speech Pathology Australia website. www.speechpathologyaustralia.org.au Hard copies are available to everyone (members and non members) at a cost by emailing pubs@speechpathologyaustralia.org.au.

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ACQ Volume 12, Number 2 2010

ACQ uiring knowledge in speech, language and hearing