JCPSLP Vol 18 No 3 2016

89 / 156

Creating sustainable services: Minority world SLPs in majority world contexts
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.
East 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 emerging1 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