JCPSLP November 2016

Creating sustainable services: Minority world SLPs in majority world contexts

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

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

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

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

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JCPSLP Volume 18, Number 3 2016

Journal of Clinical Practice in Speech-Language Pathology