DEPARTMENT OF PLASTIC SURGERY

International Outreach

Bhutan, India, February 2005
Linda L. D'Antonio, PhD
Professor and Director of International Outreach
Department of Plastic and Reconstructive Surgery
Loma Linda University

In assessing the availability of speech services in Bhutan, we learned through research and personal contacts that there is no discipline of speech-language pathology nor are there any speech pathologists available in Bhutan. Additionally there did not appear to be any allied health professionals or paraprofessionals who were providing such services. Next we assessed the need for services by interviewing patients and/or parents of children with cleft lip/palate.

Finally, we met with officials from the Ministry of Health to learn about the Ministry's awareness of and view of communication impairment in general and associated with cleft palate in particular.

A formal plan was developed for establishing speech and language services in Bhutan that would be available not only for children with cleft palate but that would in turn be available for other individuals with communication impairment.

Following is a summary of the report:

• There is a unique constellation of factors in Bhutan that would readily facilitate the immediate development of speech and language services for children with cleft palate in the country and at the same time make such services available for other populations.
• There is a clear need for speech services for children with cleft palate that is increasing rapidly. As the availability of surgical repair is increasing there will be increased need for speech services.
• The Ministry of Health is aware of the high incidence of speech and hearing impairment in the country and acknowledges the immediate need for speech pathology and audiology services.
• The government also acknowledges the need for a multi-tiered delivery system for speech and language services including: trained speech-language professionals at tertiary institutionally based rehabilitation centers; outreach programs; training for allied professionals, Basic Health Unit workers and community-based rehabilitation (CBR) workers.
• Short-term, medium-term and long-term solutions are suggested for meeting these needs within the strategies developed by the National Community Based Rehabilitation Program and relying on our experience in establishing such services in India and other countries in Asia.
• Finally, both Dr. D'Antonio and Ms. Nagarajan are committed to lending their combined expertise and support to assisting in the development of speech and language services in Bhutan and have plans to return in October, 2005 to initiate the first training program.

Our inquiries about speech and hearing services led us to Bhutan's only school for the deaf. It is a model program designed and directed by a teacher who had no formal previous training in deaf education but saw the need and rose to the challenge with great success.

The King was educated in India and England. He has emphasized modernization of education, health services, rural development and communication but stresses that development should not affront beliefs or the environment. All volunteer development plans are scrutinized carefully by the government.

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