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Creating sustainable services: Minority world SLPs in majority world contexts
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JCPSLP
Volume 18, Number 3 2016
Journal of Clinical Practice in Speech-Language Pathology
KEYWORDS
COMMUNICA-
TION DISABILITY
DEVELOPING
COUNTRIES
MAJORITY
WORLD
PARTNERSHIPS
SPEECH-
LANGUAGE
PATHOLOGY
SUSTAINABILITY
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
Karen Wylie (top)
and Clement
Amponsah
Sustainable partnerships for
communication disability
rehabilitation in majority world
countries
A message from the inside
Karen Wylie, Clement Amponsah, Josephine Ohenewa Bampoe, and Nana Akua Owusu
to provide a road map of how such relationships should
operate; however, it provides a perspective of some of the
complexities in developing and sustaining relationships
to support development of sustainable services for
communication disability.
Reflexivity statement
The authors of this paper are four speech-language
pathologists (SLPs) living and working in Ghana, West Africa.
Three are Ghanaian nationals, who trained in the United
Kingdom (UK). One is a long-term expatriate in the region,
who has lived in Ghana for four years and in the region for
thirteen years. Together we work at a government hospital
offering clinical speech-language pathology services. We
also work together at a university to establish a training
program for speech-language pathology. One of our group
also runs an NGO focusing on early intervention and support
for children with communication difficulties. Our regular and
varied contact with SLPs who wish to come to Ghana to
assist in the development of communication disability
services prompted the writing of this paper. We recognise
that our perceptions of the insider–outsider relationships
may differ from the perceptions of those who visit.
While Ghana is rich in history and culture, it is not yet
endowed with well-established rehabilitation systems for
people with disabilities. Furthermore, although our country
is foresighted and has an inclusive education policy
(Ministry of Education, 2013), awareness of disability rights
is still developing and services to support people with
communication disability (PWCD) are severely stretched,
with few speech-language pathology or communication
disability services available in the country. Building services/
systems for the future and improving awareness of
communication disabilities is the focus of our work.
Our context
Ghana is well recognised as a leading nation of West Africa
in areas including governance and economic development.
Ghana is a lower middle income country and is ranked at
140 on the United Nations Development Programme
(UNDP) Human Development Index (UNDP, 2015). It has a
population of 26.4 million (UNDP, 2015) and is a multiparty
democracy. In 1957, Ghana was the first sub-Saharan
African country to achieve independence from its former
colonial ruler Britain. While English is the official language of
Ghana, Ghana has a large number of languages and
dialects in use, with an estimated 25 to 43 main languages
(National Commission on Culture, 2006). Currently, the
Rehabilitation services for people with
communication disabilities (PWCD) in many
majority-world countries are extremely
limited, with speech-language pathology little
known. Collaborations between clinicians
and services in majority- and minority-world
countries provide important contributions to
developing rehabilitation services in the
majority world for PWCD. The effectiveness
of such partnerships may be influenced by a
number of elements within the relationship.
This paper presents insights from a group of
majority-world speech-language pathologists
(SLPs) in Ghana on establishing and
maintaining links between majority- and
minority-world services and clinicians. The
framework of three sustainability dimensions
(service environment, socio-cultural-political
environment, and economic environment) is
used to consider how SLP relationships across
majority–minority worlds can be meaningful
and lasting. Readers are encouraged to adopt
the perspective of SLPs from within the country
to consider the impact and sustainability of
majority–minority world partnerships.
G
lobalisation and technological innovation has made
linking with people from different geographical
regions more possible than at any other time in
history (Friedman, 2006). For service providers and people
with communication disabilities (PWCD) in countries of the
majority world, where services for communication disability
are often extremely limited, it frequently means establishing
relationships beyond their borders to assist with service
provision, service development and improvement in
quality. This article presents an insiders’ perspective and
discussion on relationships between clinicians and services
across minority- and majority-world countries based on
personal experiences of working in Ghana. The aims are
twofold: (a) to encourage readers to view majority–minority
world relationships through the lens of clinicians in the
majority world and (b) to offer a range of observations from
the authors’ perspectives as “insiders” on relationship
development and sustainability. This paper is not intended