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Finding a Common Language: In El Salvador, clinicians learn from communication students and impart their own lessons in treating speech and language disorders


When four University of Texas at Austin students traveled to El Salvador to train clinicians to better serve people with communications disorders, they had no idea how much they’d learn. The College of Communication students arrived at Centro de Audición y Lenguaje clinic in San Salvador with stacks of informational packets, plans for PowerPoint presentations and a slew of classroom knowledge. They left 10 days later with lessons and stories that will shape their careers.

Holly Kolanko, Caroline Spelman and Scott Prath
Holly Kolanko, Caroline Spelman and Scott Prath pose in the patio of the clinic where they spent a week in May training Salvadoran clinicians.

“It was an amazing exchange,” says graduate student Scott Prath of his time at the clinic. “I think both groups started out timid. They thought, ‘Here are all these young kids coming in with book knowledge,’ and we thought, ‘Here are all these self-made experts.’ And the exchange couldn’t have been better. Toward the end, we fought over who got the education, whether it was us or them.”

This is the fourth year graduate students in the bilingual program in the Department of Communication Sciences and Disorders have journeyed to El Salvador. As always, they came home with experiences that “blew our minds wide open,” as one student put it. They watched 10-year-old Katy, whose family couldn’t afford cab fare to the clinic, hear bird song for the first time through donated hearing aids. They created a therapy strategy for a boy who couldn’t verbalize the word “no” nor any negation. And their Salvadoran colleagues cranked up salsa music during the breaks and taught them to dance.

In El Salvador, a developing country with a population of 5.5 million, only 40 to 50 clinicians serve about 150,000 citizens who have communicative impairments. (By comparison, North Carolina, with a similar population, has more than 3,200 speech/language pathologists and audiologists.) Moreover, clinicians receive no formal training. They graduate with degrees in special education and learn on the job to work with clients with often very complex disorders.

Katy Arias Mejia
Katy Arias Mejia was able to hear for the first time through hearing aids donated by a patient at Austin’s Audiology Diagnostic Clinic.

“They are very committed and very hungry for information, but they are poorly trained,” explains Professor Rodger Dalston, who heads the El Salvador initiative.

Dalston first traveled to El Salvador in 1998, at the urging of Kendyl Richards, director of Austin Smiles. Austin Smiles provides corrective surgeries to cleft lip and palate clients in Austin and in El Salvador, as well as other countries. While cleft lip and palate, both congenital defects, can often be corrected with surgery, the client needs rehabilitation to relearn how to speak. Austin Smiles is not able to provide that rehabilitation, and was seeking ways to make that available to its clients. Richards drafted Dalston to help her.

In 1998, Dalston and graduate student Kim McCollum met with government officials in El Salvador and did an assessment. When comparing training in El Salvador with that of his students in Communication Sciences and Disorders, where the bilingual program is considered the best in the country, Dalston saw an opportunity. His students could benefit from immersing themselves in a different culture and training colleagues with the knowledge they were mastering in classes. Salvadoran clinicians could receive for free the clinical education they hadn’t received.

It was a perfect match. Each year that students travel to El Salvador they are greeted by lines of clinicians waiting for them outside the clinic at 8 a.m. Many travel long distances to attend the presentations. Attendance averages between 40 and 50 participants, which accounts for nearly every clinician in the country. And they keep coming back year after year.

A recent attendee wrote on her evaluation form: “Cada vez que vienen me ensañan algo nuevo, lo cual pongo en práctica,” or “Every time that you come, you teach me something new which I put into practice.” Another wrote, “Me gustaría que vinieran seguidos para capacitarnos más,”or “I would like it if you could come again to teach us more.”

Clinicians from all over El Salvador attend the presentations
Clinicians from all over El Salvador attend the presentations and create a lively, informal environment.

For students, who are selected for the project for their ability to speak Spanish and their clinical skills, it offers an opportunity they couldn’t receive anyplace else. And their enthusiasm is apparent.

“When Dr. Dalston introduced the program at orientation at the beginning of the year, I said, ‘Whoa, sign me up now!’” says Holly Kolanko, who participated in the project this year.

Kolanko chose the university based on the strength of its bilingual program, and the El Salvador initiative gave her the opportunity to combine her career goals with her love of Latin America.

“Even though it was such hard work doing all those presentations,” she says, “I felt so lucky to be there and realize what an effect we were having, and in such a culturally relevant way. We weren’t going down and saying, ‘This is what you should do.’ We were saying, ‘This is how we look at things, what do you think of this? What could be valuable to you?’ It makes people a lot more receptive, but it also makes sure that what they’re doing will still be culturally relevant to the people they’re working with.”

The students devoted a semester to preparing materials for use in their presentations. This year, they presented two broad modules: one on speech and articulation and one on preschool language. The information was not simple, but it was basic, a foundation for other learning. Much of the information was familiar to the clinicians, but its organization and application were new.

“They learned a structure,” explains Prath. “They know how to work with kids, but we shared how we structure therapy, lining up goals and taking all this brand new information that comes out every year and making yourself a better speech pathologist to improve your kids and accelerate their growth.”

Faculty member Gail Goodrich Totten teaches articulation to four deaf children
Faculty member Gail Goodrich Totten teaches articulation to four deaf children in a clinic classroom.

With this in mind, the presentations took the form of an exchange. Clinicians engaged in discussions with the students, participated in game show format exercises and worked with case studies. There were also tamale breaks, a two-cake birthday celebration for Prath and shared stories about the challenges each group faces.

The students also had the opportunity to work directly with Salvadoran children in the clinic. In these interactions they felt the measure of the success of the project and the relevance of their training.

On their last day at the clinic, they were asked to evaluate four boys, aged 4 to 5, who were nearly completely deaf and had no language skills. The Salvadoran clinicians posed the question, “How do you do speech therapy on these kids?”

Gail Goodrich Totten, a clinical faculty member in Communication Sciences and Disorders who accompanied the students on the trip, took the lead. The group got stuffed animals out and engaged the boys in a competition to get the toy they wanted. Each animal was represented by the sound in its name. The boys lay on the floor, playing and competing, and by the end of an hour, the group was able to chart which ones had which sounds, which ones were missing which sounds and what type of plan could be used to help them.

“It was the first time we were forced to apply everything we were learning,” says Prath, “and it came across cleanly. It kind of gave you the shivers.”

The cross-cultural exchange that the El Salvador project offers students provides incomparable training for the realities of being a bilingual speech and language therapist. Melissa Poole made the journey to El Salvador in 1999, when she was a graduate student. She now works as a bilingual speech language pathologist in Tuscon, Ariz., at a clinic that serves mainly Spanish-speaking families, and she volunteers at a clinic serving indigenous children from northern Mexico.

Spelman poses with children in a San Salvador market
Spelman poses with children in a San Salvador market. The students were delighted to discover a Longhorn in the crowd.

“My experience in El Salvador not only helped me with my clinical skills, including learning Spanish jargon for my profession, but also allowed me to have an understanding of the cultural aspects and its relationship to disability,” she says. “The latter has been of immeasurable value in my professional career and has allowed me to be a more effective and compassionate clinician.”

Dalston says the ultimate goal of those involved in the El Salvador initiative is to work themselves out of a job. The Minister of Special Education in El Salvador has expressed interest in establishing more formal programs in speech and language pathology at two universities in the country, with University of Texas at Austin students and faculty teaching modules to future Salvadoran faculty.

Until then, however, the College of Communication will endeavor to send students down to work with their Salvadoran counterparts. The clinicians will go back to their jobs armed with better information and skills. And students will come back with more than just stories to tell their friends and family. They will have irreplaceable lessons to take to their careers.

“I learned that there is never a situation in which you cannot help a kid,” says Prath. “I saw the worst cases I’ve seen in my life yet, and they were nothing compared to what this clinic sees. And there was always an answer. It doesn’t matter—you can do something, and it’s going to work.”

Vivé Griffith

Photos courtesy Holly Kolanko

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  Updated 2014 October 13
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