Opportunities and responsibilities towards people with communication disorders in less developed countries

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ABSTRACT At a time when the Royal College of Speech and Language Therapists is celebrating its 50th anniversary I would like us to consider people in less developed countries (LDCs) with communication disorders. Professional services for people with communication disorders in the UK have grown from a service which, in the early 1940s, concentrated largely on children with speech‐production difficulties, people with voice disorders and dysphasic people, to a multi‐faceted service which addresses the needs of people with a multiplicity of communication disorders. This history is well‐known to some older members of our profession, but has seldom been recorded (Eldridge, 1968, Wirz, 1993). This growth of services for and with people with communication disorders is reflected in most of the Western world. For example, Wilson (1990) states that the USA alone has 50% of the world's speech and language pathologists. However, 86% of the world's population does not live in developed countries. This paper concentrates on services to children with communication disorders. A common indicator of development of services for children is to look at Under‐5 mortality rates among 1000 live births in a population. In the 25 countries where the child Under‐5 mortality rate is less than 12 per 1000 live births, there is an Under‐16 population of 182 million children. These 182 million children have access to most of the world's speech and language therapists. This compare with about 1839 million children in LDCs who have negligible access to speech and language therapy services (UNICEF, 1994). The World Health Organization stresses that the communication disorders, or what they insist on labelling ‘speech problems’ is the second most prevalent disability, after mobility in LDCs (Hellander, 1993). It must be remembered that there are a great cultural variations as to how disabilities, including communication disorders, are viewed and this has a great impact on which communication disorders are seen to be more or less disabling. In many countries there is a dual service for children with communication disorders. A service for some urban (often wealthy) children which mirrors the services provided in the developed world, and research by the clinicians which reflects the very highest standards (for example, Lichtig, 1992, 1993)). Clinicians are prepared by following undergraduate and postgraduate courses which are very similar to those of Western countries, for example, the University of Sao Paulo, the All India Institute in Mysore. The time intensive, centre‐based ‘traditional speech and language therapy’ provided by some clinicians in LDCs exacerbates the very low coverage levels of service. Some instititutes and universities have developed alternative forms of service delivery which reflect the needs of the less advantaged and go some way towards addressing low coverage rates (for example, Thorburn, 1991; Krishnaswamy, 1992). Many, perhaps most, children with communication disorders will never see a speech and language therapist and they and their families will, with luck, receive some assistance from other sectors (Wirz et al., 1991; Hartley & Wirz, 1993). Community disability programmes, including CBR programmes, do address the needs of communication disorders in children, but differently from speech and language therapy (Hellander et al., 1987). This paper discusses these differences in relation to models of disability, issues of service delivery, and perceived needs by the community. It also also discusses the development and services which complement indigenous systems.