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Creating sustainable services: Minority world SLPs in majority world contexts

www.speechpathologyaustralia.org.au

JCPSLP

Volume 18, Number 3 2016

139

KEYWORDS

CULTURAL

COMPETENCE

EAST AFRICA

SPEECH-

LANGUAGE

PATHOLOGY

THIS ARTICLE

HAS BEEN

PEER-

REVIEWED

Helen Barrett

2003). It is therefore crucial that the external practitioners

involved are culturally competent to deliver appropriate,

responsive, ethical and effective support.

The need for a culturally competent

profession

Many national speech-language pathology associations

stress the need for professionals to offer appropriate and

sensitive services to diverse client groups (e.g., ASHA

2011; RCSLT 2003; SPA, 2016), but more guidance is

needed on

how

to fulfil these obligations, specifically

regarding issues beyond bilingualism and multilingualism

(Leadbeater & Litosseliti, 2014).

Much of the available literature exploring speech-

language pathology with clients from a range of

backgrounds describes practice in multicultural societies

in the minority world

2

(e.g., Leadbeater & Litoselliti, 2014).

However, literature is also emerging on how external

speech-language pathologists working in the majority

world can do so ethically and effectively (e.g., Crowley &

Baigorri, 2011; Hickey, McKenna, Woods, & Archibald,

2014). Current literature addressing the needs of people

with communication disabilities in the majority world

primarily focuses on issues and methods of professional

or service development (e.g., Wickenden, 2013; Wylie,

McAllister, Davidson, & Marshall, 2013) and, though this

literature identifies the need for speech-language pathology

education programs and services to be developed

using culturally appropriate methods (e.g., Wickenden,

Hartley, Kariyakaranawa, & Kodikara, 2003), the question

remains as to

how

external speech-language pathologists

can develop competence to facilitate these processes

effectively.

For speech-language pathologists to become sufficiently

competent to practise internationally, it is essential to

reflect upon motivations, skills and learning needs (Brown

& Lehto, 2005; Hickey et al., 2014) and upon what cultural

competence means in relation to their home, and overseas,

practice. In addition, it is critical to consider the concept of

cultural humility in relation to cultural competence; cultural

humility being the acceptance that it is not possible to be

fully knowledgeable about a culture other than that which

one is born into (Levi, 2009; Walters, 2015). Practitioners

must therefore understand that cultural competence and

cultural humility are critical prerequisites to the delivery of

appropriate, relevant and effective services and apply both

concepts to their practice.

As global mobility increases and populations

diversify, challenges to delivering

appropriate, responsive, ethical and effective

SLP services have emerged and services

users, practitioners and national bodies are

increasingly calling for delivery of culturally

sensitive services. It is therefore crucial to

look beyond our own cultural reference

points and adopt an attitude of open-minded

and continuous learning about others in order

to provide the best services to all clients.

Models of cultural competence have been

developed across the allied health

professions and have been described as:

practitioners’ awareness, knowledge, skills,

and sensitivity in relation to their clinical

practice with people from cultural and

linguistic backgrounds other than their own.

This paper draws on the author’s experience

of working across east Africa, with reference

to two frameworks for cultural competence

which are applicable to speech-language

pathology practice. The paper highlights the

multifaceted and interactional nature of

different dimensions of cultural competence

and queries whether this is accurately

represented in the current theoretical

frameworks.

E

ast Africa is a region defined by diversity, and the

challenges to developing cultural competence

for external speech-language pathologists are

enormous. Not only is the ethnic and linguistic diversity in

the region extensive, but explanatory models of disability

are often heavily influenced by the medical profession,

stigma surrounding disability, and religious and /or cultural

beliefs (Barrett, 2013). Professional training courses and

services to meet the needs of people with communication

difficulties are emerging

1

but are in their infancy, are

frequently facilitated by external speech-language

pathologists and often require ongoing support once

established (e.g., Robinson, Afako, Wickenden, & Hartley,

Applying theories of cultural

competence to speech-

language pathology practice

in East Africa

Helen Barrett