Cultural Perspectives in Language and Speech Disorders - Ndung'u - Disability Studies Quarterly

26/12/2015
CulturalPerspectivesinLanguageandSpeechDisorders|Ndung'u|DisabilityStudiesQuarterly
CulturalPerspectivesinLanguageandSpeechDisorders
RuthNdung'u
MathewKinyua
Abstract
Culturehasaheavyoverlayontheperceptionsandthesubsequent
handlingofpersonswithlanguageandspeechdisorders.Thisarticle
reviewstheculturalperspectivesoflanguageandspeechdisordersas
portrayedbypersonswithlanguageandspeechdisorders,parents,
teachers,andlanguageandspeechpathologists.Theinformationon
culturalperspectiveswascollectedbetweenNovember2006andAugust
2007duringOperationSmile,KenyaChapterMissions.20persons,aged
between8and53years,wereinterviewed.Theresearchobjectivewasto
establishtheculturalperspectivethatdeterminestheinterpretationsof
languageandspeechdisordersandtheirsubsequentmanagement.
Thefindingofthestudyisthatthereisanotableculturalassociationor
correlationbetweenculturalbeliefsandlanguageandspeechdisorders.
Thereisalsoignoranceofthecausesandmanagementproceduresof
languageandspeechdisorders.Weconcludethatthereisaneedtoprovide
assessmentandtreatmentprotocolsthatareculturallyfair,effective,and
acceptable.Suchprotocolsincludetakingintoaccountgenderpreferences,
adheringtoculturallyrelevantcommunicationpatterns,andusing
collaborativetherapy.
CharacteristicsofLanguageDevelopment
Communicationissopervasiveinanycommunityinitsdaytodayactivitiesthatit
isoftentakenforgranted(Steinberg,2001).Normalcommunicationincludesall
meansbywhichinformationistransmittedbetweenthesenderandtherecipient.
Themeansofcommunicationareverbalandnonverbaloralandwrittenformal
andinformalorintentionalandunintentional.Humanbeings,unlikeotheranimals,
mainlycommunicateusingasystemofsymboliccommunicationreferredtoas
language,whichmaybespoken,written,orsigned.
Normallanguagedevelopsoveraperiodanditissequentialorordered(Crystal,
1992).Achildacquiresvocalization,speechsounds(vowelsandconsonants)and
thenprosodies.Thisacquisitionisinrecognizablestagesthatentailacquisitionof
form,content,anduse(SeymourandNober,1997).Theformisthesystemof
symbolsthatconveymeaninganditismadeupofthephonology,morphology,and
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syntaxofalanguage.Thecontentincludestheindividualwordsandcombinations
ofwordstoproducemeaninginthelanguage.Contentismadeupofthesemantics
ofalanguage.Useinvolveshowweusewordsincontextsandismadeupofthe
pragmaticsofalanguage.
Thereispredictableculturaldiversityinlanguageacquisitionduetothecontextof
acquisition.BattleandAnderson(1997)observethat:
Theacquisitionoflanguageisadynamicandcomplexact.Children
acquirelanguagewithinthecontextofthefamily.Thereisadynamic
interactionamongculturalbeliefs,familyvalues,expectations,
experiences,andchildrearing,whichinfluencesthelanguage
developmentofyoungchildren(213).
Culturalperceptionsareatplayrightfromthebeginningofthelanguageacquisition
process.Forinstance,thesoundsthatachildfirstacquiresaredeterminedbythe
languageorlanguagesthechildisexposedtointherearingcontext.The
expectationsintermsofhowmuchlanguageandinwhatorderitshouldbe
acquiredarealsodeterminedbythecultureinwhichthechildisreared.
Manythingscouldgowrongwiththenaturalorderoflanguageacquisitionand
development.Ineverycommunity,weencounterindividualswithlanguageand/ora
speechdisorders.Unfortunately,thereismuchignoranceasfarasidentifying
thesedisordersisconcerned.Theignorancemoreoftenthannotleadsto
mishandlingofthepersonswithlanguageandspeechdisorders.
DefiningLanguageandSpeechDisorders
Languageandspeecharesaidtobedisorderedorimpairediftheydifferfromwhat
isconsideredthenorm.Asalreadyindicated,theyardstickisembeddedinthe
cultureofeachlanguagewhatmaybeconsidereddisorderedinonelanguagewill
notnecessarilybedisorderedinanotherlanguage.Thereisneed,therefore,to
distinguishbetweengenuinespeechdisorderandpeople'sculturaltendenciesor
practices.Forexample,Kim(1985)notesthatAsianAmericansfavourverbal
hesitancyandambiguitytoavoidoffence.Theyalsoavoidmakingspontaneousor
criticalremarks.Oneshouldrespectsuchacommunity'scultureandthusthe
hesitancyshouldnotbeconfusedwithafluencydisorder.
Theuniquenatureofthelanguageandspeechdisordersisthattheyarenotvisible
sincemostlytheyarenotphysicallymanifested,exceptdefectsthataffect
articulation.Mostdisordersarenotevidentuntilapersonopensher/hismouthto
speak.Thedisorders,forthesamereason,areoftennotconsideredadisability,
evenbythepersonswhohavethem.
Languageandspeechdisordersmaybeduetofactorssuchasphysical,mental,or
socializationdefects(Crystal,1988).Thoughlanguageandspeechdisordersare
classifiedtogethertheyareslightlydifferentfromeachother.
SpeechDisorders
Speechisthevocalutteranceoflanguageanditisconsidereddisorderedin
threeunderlyingways:voice,articulation,andfluency(RoseberryMcKibbin,
1995).
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Voiceinvolvesthecoordinatedeffectsofthelungs,larynx,vocalchords,and
nasalpassagetoproducerecognizablesounds.Voicecanthusbeconsidered
disorderedifitisincorrectlyphonatedorifitisincorrectlyresonated.Inthe
incorrectphonationanindividualcouldhaveabreathy,strained,husky,or
hoarsevoice.Withtheincorrectresonationanindividualcouldhavehyper
nasalityorhyponasality.
Paralanguageissues,suchasuseofpitch,volume,andintonation,arediverse
fortheyareculturallydetermined.Everysoundofvoicehasapossiblerange
ofmeaningsthatcouldbeconveyedsimplythroughthevoiceratherthanthe
wordsweuse.Thefeaturesthatshouldbeconsideredindeterminingavoice
disorderare:
Volume:howloudlyorsoftlywespeak
Pitch:howpleasantorunpleasant
Quality:thehighnessorlownessofonesvoice
Rate:thespeedatwhichonespeaks
Voicedisordersareduetodamagetoorganssuchasthelarynx,lungs,vocal
chords,andthenasalpassage.Thevoicedisorderscouldalsobedueto
impropervoicinghabits.
Voicedisordersareinterpretedvariouslyindifferentcultures.Forinstance,in
manyAfricanculturesmasculinityandfemininityaredeterminedby
paralinguisticfeatures.Amanwhospeaksinalowvolume,ahighpitch,ora
smoothandslowvoice,wouldbefrowneduponandcalleduponto"speaklike
aman."
Articulationinvolvestheuseofthetongue,lips,teethandmouthtoproduce
recognizablespeechsounds.Articulationisdisorderedifsoundsareadded,
omitted,substitutedordistorted.Articulationdisordersmaybecausedby
factorssuchasstructuralabnormalities,forexample,acleftlipand/orpalate,a
tonguetie,missingteeth,aheavytongue,oradeformedmouthfaultyor
incompletelearningofthesoundsystemordamageofthenervoussystem.
Physicalappearanceisveryimportantasfarasarticulationdisordersare
concerned.Wearejudgedbythewaysocietyhasdeterminedweshouldlook.
Thisisespeciallytrueinthecasesofthosewithcleftlipsandpalates,missing
teeth,oratonguetie.Theseconditionsarevisibleandtheydisfiguretheface.
Apartfromaffectingarticulation,theconditions,therefore,alsoaffecttheself
conceptofthepersons:"Theimportanceofhavingagoodselfconceptis
universallyaccepted.Appearanceorattractivenessisregardedasamajor
componentofselfconcept.Appearancealsodeterminesthedifferential
treatmentofchildren"(Leonardetal1991:347).Personswithcleftlipand/or
palatethusoftenhaveanadditionalsenseoflowselfesteemduetothe
deformity.Forinstance,TomlivesinGithurai,asuburbofNairobiandworks
asafruitvendor.Hehasacleftlipandpalatethatwasnotrepairedfullyduring
anoperationatKenyattaNationalHospital.Tomcouldnotaffordfurther
surgery.Hethereforestilltalkswithheavynasality,despitetheoperation.Due
tothis,heisshyofthepublicanddoesnotliketotalktoanypersonthatheis
notvaguelyfamiliarwith.Peoplewhoarenotfamiliarwithhiswayofspeaking
willnotbuyfromhim.Ittakesalotofpatienceandfamiliaritytodetermine
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whathehassaid.Thishasnotonlyaffectedhisbusinessbutalsohissocial
life.
Fluencyinvolvesappropriatepausesandhesitationstokeepspeechsounds
recognizable.Fluencyisdisorderedifsoundsareveryrapidwithextrasounds
(cluttered),ifsoundsarerepeatedorblockedespeciallyatthebeginningsof
words(stuttered),orifwordsarerepeated.Fluencydisordersaremore
prevalentinchildrenandtheyareduetoacombinationoffamilial,
psychological,neurological,andmotoricfactors.
Thesocialnatureofcommunicationisaffectedwhenonehasdisfluent
speech.Humanbeingsaresocialandtheyspendmuchoftheirtimetogether.
Theyfirstlearnhowtocommunicateinasocialsetupforinstance,with
parents,siblings,relations,orfriends.Socializationisadverselyaffectedifone
hasafluencyspeechdisorder.Apersonwithdisfluencyisoftenmishandledat
home,inschool,orinpublicplace.Oftentheindividualbecomeswithdrawn.
LanguageDisorders
Languageistherulebaseduseofspeechsoundstocommunicate(Steinberg,
2000).Disorderedlanguagemaybeduetoareceptiveproblem,thatis,a
difficultyinunderstandingspeechsounds.Itcanalsobeduetoanexpressive
problem,thatis,adifficultyinproducingthespeechsoundsthatfollowthe
arbitraryrulesofaspecificlanguage.Alanguagedisordercanalsobedueto
problemsinbothreceptionandexpression.Languagedisorders,therefore,
refertothefollowing:
Theuseofspeechsoundsincombinationsandpatternsthatfailtofollow
thearbitraryrulesofaparticularlanguageisalanguagedisorder.For
instance,thelackofcommunicationetiquetteisconsideredalanguage
disorder.Talkingoutofturn,nottalkingwhenitisyourturn,ornot
respondingwhenyouareexpectedtocouldbedisordersiffrequently
observedinone'slanguagebehaviour.
Thedelayintheuseofspeechsoundsrelativetonormaldevelopmentin
thephysical,cognitive,andsocialareasisanotherlanguagedisorder.
Mostlanguagedisordersareoftendiagnosedinconjunctionwithother
developmentaldelaysforinstance,health,sensory,motor,mental,
emotional,andbehaviouraldevelopment.
Speechandlanguagedisordersarereportedtobemoreprevalentthan
anyotherdisabilityinprimaryschools.Theyoftengoundetectedand,
therefore,unattended.Thisisespeciallysoifthedisordersareoften
concurrentwithotherdisabilitiessuchasdeafness,autism,compromised
mentation,traumaticbraininjuries,orbehaviouraldisorders,whichare
givenattentionattheexpenseofthespeechandlanguagedisorder.
SeymourandValles(1997)reinforcetheimportanceoftheschoolsetting
indetectinglanguageandspeechdisordersandininstitutingintervention
measures.
DisordersintheContemporaryCulturalContext
Datafromobservationsandsurveysprovidedtheculturalviewsoflanguageand
speechdisorderspresentedbelow.Personalinterviewswithpersonswhohave
beenadverselyaffectedbylanguageandspeechdisordersprovidedinformation
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ontheneedforchangeinattitudesandhandlingofpersonswithlanguageand
speechdisorders.Thefindingsoftheobservationandsurveyindicateaneed"to
provideassessmentandtreatmentprotocolsthatareculturallyfairandeffectivefor
languagedisorders"(SeymourandValles,1997:89).Thefindingscontradictthe
beliefthatpeoplehavechangedattitudesandperceptionsinregardtolanguage
andspeechdisordersduetoeducationand/orreligion.Contemporaryculturestill
associatesorcorrelateslanguageandspeechdisorderstopracticesandbeliefs.
Thelargerpercentageofthepublicisignorantofthecausesoflanguageand
speechdisorders.
Thereisstillaveryheavyculturaloverlayinwhatisconsiderednormallanguage
andspeech.Thisinturnaffectsthewaysocietytreatsthosewhohavelanguage
andspeechdisorders.Manyculturalstereotypesarestillbeingusedtoexplain
languageandspeechdisorders.InKenya,variouscommunitiesattributethecleft
lipand/orpalatetophenomenafoundintheirimmediateenvironmentortocurses.
Forinstance,theBorana,Redile,andSamburuassociatethecamelwiththecleft
(OperationSmile,MeruMission,April,2007).Thecamel'snostrilissplitandthe
commonbeliefamongstthesecommunitiesisthatacleftoccurswhenapregnant
womanlooksatacamelgivingbirth.TheAmeruassigntheclefttocursesfora
socialwrongdoing,suchasdisobeyingparents(OperationSmile,MeruMission,
April,2007).DuringtheKisumuMission(November,2006),theLuoandKisiialso
indicatedthatthecleftwasbroughtaboutbycurses.IntheNyeriMission(August,
2007),theAgikuyuindicatedthatitwasbroughtaboutbyfamilyplanningmethods
suchasthepillandthecoil.Theeducatedonesindicatedthattheconditionis
genetic.Suchbeliefscoulddiscourageindividualswithcleftsinthesecommunities
fromseekingprofessionaladvice.
Religionorbeliefsareseentoplayakeyroleinsomecommunitiesthatmay
determinewhetherthosewithlanguageandspeechdisordersseektreatmentor
notandtheextentofthetreatment.Forinstance,thosewhobelievethatacleftisa
punishmentfromGodwouldbeoffendingGodmorebyhavingitclinicallyrepaired.
Childrenwhoseparentshavesuchbeliefsoftenseektreatmenttoolate,whenthe
surgerymaynotbeaseffectiveasitwouldbeifearlyinterventionoccurs.
SomeparentsbelievethattheirchildrenstammerwhentheyspeakinEnglish,
makingitdifficultforaspeechtherapisttotreatthiscondition.Otherssuchasthe
Agikuyuassociatestammeringwithplayingwithchameleonsinearlychildhood,
whileothersassociatethedisorderwithlaughingatanotherwhostammers.There
isaneedtomakeitclearthatstammeringisnotaresultofacquiringasecond
languageorachildhooddeed.Tobesuccessfulintreatingthisfluencydisorder,
thespeechtherapistwouldhavetostartbyhelpingtheparentunderstandthe
conditionthroughaclearexplanation.Lateornoninterventioniscommoninmany
otherKenyancommunitieswherelanguagedisorders,suchasstuttering,are
associatedwithevilspiritsorcursesbytheancestors.
CulturalbeliefsarenotanAfricanphenomenon.Severestrokesoftencausesevere
speechproblems.YetamongmanyNativeAmericancommunities,apersonwho
suffersstrokeisthoughttohavebeen"hitbythewind"(WestbyandBegay,2002).
Thecommunitiesbelievethatthisconditionoccurswhenanindividualisoutof
harmonywithnature.Thiskindofbeliefwouldaffecthowthecommunitydescribes
thedisorderandfromwhomtheyseekhealthcare.
InKenya,asintherestofAfrica,culturesarecollective,apropertyofthesociety.
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Thatmeansgreatvalueisplacedinthegroupandmembershipinthegroup.For
thisreason,explanationofcertainoccurrencescanonlybegivenbytheconcerned
society.Thisoftenaffectsanindividual'sdecisioninthecourseofseeking
treatmentortherapeuticservices.
TheInterpretationoftheCulturalAssociations
Duetotheignoranceofthecausesoflanguageandspeechdisorders,persons
withdisordersaremishandledandmismanaged.Societygenerallyreactsto
languageandspeechdisordersnegativelyoutofthisignorance.Personswith
languageandspeechdisordersareignored,feared,pitied,mimicked,laughedat,
consideredhelpless,rejected,ordeniedopportunitiesbybeinghidden.Inrare
casesaretheygivenlanguageandspeechtherapyorpathologicalcare.
Personswithdisordersareoftenunemployedduetoprevailingattitudesthatthey
areincapabletowork.Manyareunabletoaccesssuitableeducationduetolackof
asuitablecurriculum,institutions,orpolicy.Theacademicperformanceofthe
personsisaffectedandthusthechancesofcompetingfairlyandequallywith
othersarealsominimised.AcaseinpointisWainainawhowouldhavewantedto
beateacherbutbecamediscouragedbyhisfather"Whowouldwantyouto
teachtheirchildren?"hisfatherwondered."Ifyoucan'tspeak,howdoyouexpect
toteachothershowtospeak?"Thereforemanypersonswithlanguageandspeech
disordershavefinancialproblems.Theirfinancialstatuscompoundstheirproblems
becausetreatment,whereitisavailable,isoftenveryexpensive.
Someofthepersonsfeargivingbirthtochildrenwhiletheirparentsalsofear
havingotherchildrenincasetheysharesimilarproblems.Femalesareknownto
besexuallyexploitedastheymovefromonetorelationshiptoanotherseeking
socialacceptance.Femaleswithcleftlipand/orpalateoftenconsiderthemselves
unattractiveinappearance.Languagedisorders,asLeonardetal(1991)observe,
leadsadolescentgirlstohaveamorenegativeselfconceptthanyoungergirls.
Personsgenerallysufferfromdepression,anxiety,lowselfesteem/perception,and
maladjustedbehaviour(MillardandRichman,2001).Thereisneedforprofessional
interventioninordertopreventorinterruptthesenegativepsychosocialoutcomes
aswellascommunicationchallenges.
Personswithlanguageandspeechdisorderssufferfromtheinabilityto
communicateaseffectivelyandefficientlyasdesired.Thespeechoftheindividual
hasimpairment,rangingfrommildtosevere.Thefourlanguageskillslistening,
writing,reading,speakingareaffecteddependingonthedisorder,leadingto
negativelabels.
Listening
Personswhocannotlistenaspertheculturalnormsareoftendismissedas
antisocial,immature,orimpolite.Forinstance,DanielLyimo,ayoung
Tanzanianstudent,isoftenmisconstruedtoberudebecausehedoesnot
answerquestionsinclass.Hehasahearingproblem.Lyimohastolookata
speakerkeenlysothathecancombinehislimitedhearingwithlipreading.
MostAfricanculturesconsidersuchintenseeyecontactrude.Thelabel"rude"
hasaffectedLyimo'sstudiesnegatively.
Lyimoisalsoshyandreserved.Accordingtohim,makingfriendsisanuphill
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taskbecausetheytooconsiderhimodd.Hehastokeepaskingpeopleto
speakloudlyorlipread.Thetwopracticesdonotendearhimtomany.Noone
wantstodiscussintimatethingsloudlyorwhenkeenlywatched.Eventhose
whoareclosetohimmakefunofhishearinglossandoftenrefertohimas
"thehardofhearingone."
AlthoughLyimousesahearingdevice,hishearinglosshaspersistedandhe
hascontinuedtograduallylosehishearingability.Thishasdevastatedhim
considerablyandheoftenwondershowhewillcopewithcompletehearing
loss.Asaresult,hesuffersfromdepressionandhastoseeacounsellorona
regularbasis.Thecounsellingsessionsareanadditionalcost.Thiscostwould
nothavebeenincurredifLyimowerelivingina"friendlyandunderstanding"
environment.
Writing
LemmyEjoreisayoungKenyanman,whowritesverydifferentlyfromothers.
Heturnshisbookupsidedownandwritesfromtherighttotheleft.Toreadhis
writtenwork,onehastoturnthepage.Thishasputhimthroughalotof
troublewithteacherswhowanttoknow:"whyishebeingcheeky?"Ejore's
problemisduetoasightdefect.Hisworldisupsidedown.Oftenheisteased
byhisclassmates,whowanttoknowwhatheseeswhenhelooksatthem.
LikeLyimo,Ejoreisveryreservedandheisoftenlabelled"antisocial."His
classworkhasalsobeenaffectedbecausehehastokeepexplainingtoothers
whyhedoesnotwrite"properly"meaninglikethem.Ejorealwayschooses
tositatthefrontoftheclassroomtoavoidhisclassmates'staresandrude
remarks.
Reading
Personswithfluencydisordersareattasktoreadthewayothersdo.Theywill
oftendesistfromreadingunlessthesituationdictatesthattheydoso.Insuch
situations,theygetdepressedanddistraught.Forinstance,Achieng,eight
yearsold,isstillinclassoneattheprimarylevel.Atheragesheshouldhave
beeninclassthree.Achienghasacleftlipthatwasnottreatedininfancy,the
besttimeforsurgeryiffullrecoveryisexpected.Achieng'smotherhadbeen
informedbyanurseatahealthclinicinKisumuthatnothingcouldbedonefor
herdaughter.WhenshemovedtoworkinNairobi,aneighbourcorrectly
informedherthatnotonlycouldAchienggetsurgicaltreatmentbutalso
languageandspeechtherapy.Achieng'smothertookhertoKenyattaNational
HospitalandthegirlhadhersurgeryundertheKenyanChapterofOperation
Smile,whichisaCharitableOrganisation.Achiengisnowundergoingspeech
therapy.However,duetothedelayingettingthesurgery,Achiengcannotread
thewaychildrenofheragedo.Herclassmates,whorefertoheras"kibaby",
oftenlaughather."Ki"isanegativemarkerforanexceedinglybigsizeandit
carriesanegativeconnotation.Thelabel,thoughinnocentlyused,meansthat
Achieng'isaverybigbabybecausesheinnotfluentinreading.
Speaking
Speakingisthelanguageskillmostaffectedbylanguageandspeech
disordersbecausewecommunicateorallymoreoftenthanthroughreadingor
writing.Personswithspeakingdisordersresulttousingnonverbal
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communicationwhereverbalcommunicationwouldhavebeenmore
appropriate.
Personswithspeechdisordersarethusverydisadvantagedineveryday
communication.Thisinturnaffectstheirsocialization.Thepersonswith
languageandspeechdisabilityareoftenrecluses.Theyareeitherexcludedby
thegeneralpopulacefromsocializationusinglanguageortheyexclude
themselves.Whatallthismeansisthatthepersonaldevelopmentofthese
individualsisoftenstuntedandtheyareunabletoachievetheirgoals.
AssessmentandIntervention
Thecorrelationorassociationoflanguageandspeechdisorderswithcertain
practicesandbeliefsdisplaysmuchignoranceofthecausesofthesedisorders.
Practicesandbeliefsthatdisplaysuchignoranceshouldbedoneawaywith,for
theyinterferewithassessmentandintervention.However,peoplecannotoperate
inavacuum,andsoassociationshavetodevelopnewadequateandeffective
structuresandguidelinestoreplacetheexistingones.
OurfindingscallforwhatKuehnandMoller(2000)refertoasa"Stateoftheart
activity."Thisisanactivitywhich,accordingtothem,demands"alookback,alook
around,andmoreimportantly,alookintothenewmillennium"(KuehnandMoller
2000,348.1)inrelationtothedevelopmentandprogressionofourknowledge
base.Thereisneedforstrategiesthatwilltakeintoaccountthetwoapproachesto
managementoflanguageandspeechdisordersphysicalmanagementand
behaviouralmanagement.Theguidelinesproposedinthenextsubsectionare
thusdrawnfromtheauthors'experiencesastherapistswiththeKenyanChapterof
OperationSmile(2004todate)andfromresearchingonwhathasworkedinother
cultures.Theguidelinestakeintoaccount:genderpreferencesadheringto
culturallyrelevantcommunicationpatternsuseofculturallyrelevantmaterials
duringtherapysessionsanduseofcollaborativetherapysessions.These
guidelinesaremainlydrawnfromtheKenyancontext,withinwhichtheauthors
havebeenworking.Theyarealsobiasedtothephonologyofpersonswith
languageandspeechdisorderssincethatisourspecialization.
GuidelinesforCulturallyRelevantIntervention
AsKuehnandMoller(2000)suggest,thereshouldbesomelookingbackthatwill
enablethecontextualizationofthechangesthatweinstitute.Thereshouldalsobe
somelookingaround.Inamulticulturalcontext,weneedtolookatwhathas
workedinothercultures.Thereisalsoneedtolookintothenewmillennium.
Whateverchangesareinstitutedmustbecognisantwiththecontemporaryculture.
Fromourfindingsweproposethefollowingnineguidelinesforinterventionthatis
culturallyrelevanttotheKenyancontext.
1. Ourfindingsindicatethatgenderpreferencesinfluencetheintervention
process.Statisticsindicatethatfemalesarefocusedmoreongetting
acceptedbythecommunityandadheringtothenormsofthecommunitythan
males(OperationSmileInc.2009).Females,therefore,gooutoftheirwayto
seektreatmentforcleftlipsandpalatesandtoimprovetheirspeech.The
largenumbersoffemaleswhoturnupforpostsurgerytherapyatteststhisto
genderdifferencesascomparedtomales.Theratiois1:2,yetthepre
surgeryratiosare50:50(OperationSmileInc.2009).Findingsalsoindicate
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thatmostmalepatientsthinkthatthecorrectivesurgerywilltranslateinto
correctlanguageandspeech,yetthisisnotthecase.Suchviewsneedtobe
counteractedthroughtheinterventionprocess,duringwhichthepersonsare
presentedwiththerightinformationthatlanguageandspeechtherapyis
necessary.Malesshouldbeencouragedtoattendthepostsurgerytherapy
sothatthelanguageandspeechcorrectioncomplementsthephysical
correction.
2. Adheringtoculturallyrelevantcommunicationpatternscreatestrustand
rapportbetweentheSpeechandLanguagePathologists(SLPs)andthe
patientsorclients.Womenavoidadmittingtheirspeechandlanguage
challengesinpublicevenduringthescreening.Thisisduetotheshameand
guiltassociatedwiththelanguageandspeechdisorders.Weshouldtryto
alleviatethisdiscomfortbyusingSLPsorinterpretersfromthesamespeech
communityastheindividualwithadisorder.Wealsodonotaskdirect
questionsforinstance,aboutpronunciationvariations.Weshoulduseour
phonologicaltrainingtogaugethesoundsthepatientshaveproblemswithto
avoidembarrassingthem.
3. Culturalcommunicationnormsarealsotobeobservedinthepostsurgery
therapy.Forinstance,inthefollowuptherapywithAchieng',thefatherhadto
bepresentthoughitisthemotherwhoexplainedtheprogressthattheir
daughterhadmade.Achieng'sfatherrepresentedthefamilyauthorityandwe
respectedthatthroughoutthesessions.Hehadtopermitthemothertotalk,
thoughitwasevidentthatshewastheonewhowasmorefamiliarwiththeir
daughter'sspeechandlanguageprogress.
4. TheageoftheSLPneedstobetakenintoaccountintheassessmentand
interventionprocessbecause,culturallyspeaking,itcanleadtoabreakdown
incommunication(BallandBernhardt,2008).Forinstance,inour
assessmentsessionswehavenotedthatmanyoftheoldpatientsfindit
embarrassingandinsultingtobeaskedtoopentheirmouthswideorto
repeatsoundsaftertheSLP.Therefore,youngtherapistshavetodisplay
expertiseandauthority,suchasusingtheirprofessionaltitles,whichgets
themrespectevenfromtheelderly.Theyoungtherapistsalsouseculturally
relevantcodestocreaterapport,forinstancewhengreetingtheelderlyor
callingthemintotheassessmentroom.
5. Thereisalsotheselectionofculturallysensitivematerialsandactivitiesin
followupsessionsafterreconstructivesurgery.Fortheschoolagechildren,
weusestuffedanimalsthatareprogrammedwiththesoundsthatthechild
hasproblemsarticulating.Wealsousealotofroleplayingandgamesinthe
therapysessions.Fortheadultsweusecardswithsoundswrittenonthemor
tapes,andencouragethemtopracticeontheirown.Manyoftheadultsdo
notwanttopracticearticulationinthepresenceoftheSLP.However,we
havenotedthattheyarewillingtosaythesoundsthattheyhavemade
progresson.Wethusguidethemalongwhattheyfindeasytoarticulate.
6. Collaborativetherapyisalsoadvocatedbyourfindings.Intherapyguidelines,
theassessmentinformationtheSLPgathersisoftenviewedinconjunction
withtheresultsofinvestigationscarriedoutbyotherprofessionals,suchas
psychologistsandcounsellors(OperationSmile1999PenaandQuinn,
2003Baueretal,2009).Theinterventionprocessalsoincorporates
"interestedothers,"whichincludesteachers,parents,theextendedfamily,
andpeers.Thefamilyunit,coreandextended,isimportantinKenyaasinthe
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restofAfrica.Disordersaffectthefamilysocially,psychologically,and
financiallyinthepreandpostcorrectivestages.Interventionprocessesthat
protecttheselfesteemandthefaceofthefamilyaremoreproductivethan
thosethandonotdoso.AsSLPs,wethusconsiderthefamilyperceptionsof
theindividual'scommunicationabilitiesandhowtheyimpactonthefamily.
Thefamilyisinvolvedinthetherapyandwealwaysensurethattheyare
presentforthesessionsandthattheykeeparecordoftheprogressmadeby
theindividualwiththedisorder.
7. Informationaboutspeechdisordersshouldbepresentedinan
understandablelanguagetothepersonwiththedisorder,thefamily,and
otherprofessionals.Theinformationshouldbeaccurate.Incorrectcultural
associationsshouldbereviewedandcorrected.Forinstance,apersonwho
stammersshouldnotbeblamedforthecondition.He/sheshouldalsonotbe
misinformedthatshe/hecannotbeassisted.Inourtherapywehavebeen
counsellingthosewhohavesufferedbecauseoftheirstammersandtraining
themhowtoimprovetheirspeechthroughpacingutterances.
8. Speechpathologistsandotherhealthcareprovidersshouldunderstandthe
client'scultureinordertooffereffectiveassessmentandtreatment.Insteadof
dismissingculturalexplanationsasbeingwrongorinadequate,correct
informationshouldbeprovided.Personswithdisordersshouldbegiven
advicesothattheycanseektheappropriatephysicalorbehavioural
management.Pamphletshavebeenpreparedthathighlightthespeech
languagedisordersthatwehaveidentifiedduringtheOperationSmile,Kenya
ChapterMissions.Thoughwedonotgivetherapyforallthedisorders,we
directthepersonstothosewhocanassistthem.
9. Advocacyandsensitizationforumsthatspecificallyaddressspeechand
languagedisorderscouldbeorganizedbytheMinistryofHealthandother
concernedorganizations.Otherdisordersareoftengivenprominenceon
DisabilityDayattheexpenseoflanguageandspeechdisorders.Thepublic
shouldbemadeawareoftheadvantagesofearlyrecognitionofchildrenwith
possiblespeechdisorders.YoshinagaItanoandApuzzo(1995)emphasize
theneedfortimelyintervention.Mostlanguageandspeechdisorderscanbe
alleviatedconsiderablyifmanagementisprovidedintimeforexample,
cleftrepairforindividualswithcleftlipandpalateshouldideallytakeplace
beforethepersonstartsher/hisspeechtherapy.
Conclusion
Ourconclusionisthatsincecommunicationisintegraltoallaspectsofhuman
development,theculturalbeliefsofacommunityshouldnotmakeitdifficultfor
individualswithspeechdisorderstocommunicate.Individualswithspeech
disordersshouldcontinuetoseekpositiveviewsasactiveindividualsinasociety
toenablethemovercometheculturalprejudicesthathaveregardedthemas
helplessindividualswhoaretobepitied,feared,orignored.
Thoughpeoplearefamiliarwithsomespeechdisorders,thegeneralknowledge
concerningmostdisordersislimited.Thereisthusagrowingneedforpublic
awarenessofthedifferencebetweenculturalbeliefsandspeechdisorders.Parents
haveanimportantroleinhelpingtomonitorthehealthandlanguagedevelopment
oftheirchildren.Iftheirchildrenhaveanyspeechorlanguagedisorder,the
informationprovidedbytheparentsiscrucialforanadequateassessmentbya
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speechpathologist.Someparentsandpathologistsmayincludeculturalbeliefs
andthusaffecttheassessmentofthedisorders.Therefore,aninformeddistinction
shouldbemadebetweenatypicalculturalbeliefandaspeechdisorder.Theneed
forcorrectassessmentandinterventioninordertoavoiderrorsinjudgement
cannotbeoveremphasised.Errorsinjudgementcouldleadtonegativeeffectson
theperson'sselfworth,language,andcommunicationpotential.
Thetrainingofthegeneralpublictoenablethemtounderstandwhattruly
constitutesdisorderswouldhelpthemapproachthesedisorderswithanopen
mind.Theinformedwouldputasidetheculturebasedattitudesthatdonot
necessarilyexplainorthatoftenconcealtheactualcauseofthedisorder.
Knowledgewouldhelpinreducingthestigmaattachedtospeechdisorders.
Negativeperceptionsandreactionstothedisordersortomodesoftreatment
wouldthenbecomepartoftheculturethatwewilllookbackto.Thesewould
belongtothepast.
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