Plastic and Reconstructive Surgery News
Dr. D'Antonio and mission work from LLUMC TODAY
As a speech-language pathologist who specializes in cleft palate, Linda D'Antonio, PhD, has for many years given of her time and money to travel abroad and do what she can to improve the delivery of speech services to needy children.
Recently, with the assistance of an organization called the Smile Train, the department of surgery at the School of Medicine, and a contribution from the Don Sargent Fund, Dr. D'Antonio has increased her commitment to fostering comprehensive care for children with cleft palate in developing countries. During recent trips to the People's Republic of China, India, and Thailand, she evaluated how to establish or enhance speech therapy programs for children with cleft palate.
As the only rehabilitation specialist on the medical advisory board of Smile Train, Dr. D'Antonio talked with local medical professionals in each country and developed a report identifying problems hindering delivery of speech services, as well as potential solutions.
People's Republic of China
Although the field of speech-language pathology doesn't exist in China, there is a strong interest
within the fields of pediatrics, oral & maxillofacial surgery, and otolaryngology in providing
services, developing training programs, and conducting research. Clinicians in a number of centers have trained themselves or received basic training from visiting professionals and are successfully providing speech services to their patients.
Chinese professionals agree that the ultimate solution to their problem is to develop a university or technical training program for speech-language pathology in China. Because of the immediate need, however, and because such a program will take a great deal of time and cooperation to begin, the consensus is that in the interim surgeons must receive training to provide speech services.
The plan that Dr. D'Antonio developed for enhancing speech services in China is three-fold. This May, a three-hour breakout session at the next Smile Train meeting in China will be conducted to teach professionals about the theoretical and practical relationship between surgery and speech. At the same time, a consensus planning meeting will be held to further refine the country's goals.
Second, a workshop is planned for spring, 2002, that will focus on evaluation and treatment strategies for speech disorders. With a strong hands-on format, the workshop will provide attendees with knowledge and materials for providing very basic speech therapy. In addition, the workshop will be structured to identify further training needs and stimulate ideas regarding the development of training materials for prospective clinicians, as well as training materials for parents or community-based workers.
Third, a two-week training course is planned as an extension of the workshop. The curriculum will be developed based on the experiences and needs identified during the 2002 workshop. Sir Run Run Shaw Hospital in Hangzhou, People's Republic of China, with which LLU has an ongoing relationship, has offered facilities for the courses and housing for visiting foreign faculty.
Speech-language pathology is an established discipline in India, with 11 training programs and about 2,000 practicing speech-language pathologists (SLPs). Approximately 40 percent of the students in these training programs come from other countries and generally return there upon completion of the program. It is estimated that only 15 to 20 graduates per year take jobs in hospital settings in India.
Approximately 35,000 children are born each year in India with cleft lip and palate. The number of SLPs available in the country will never be adequate to provide direct services for all the children in need.
Dr. D'Antonio's solution to India's speech needs hinges on a master trainer, who will be trained as a specialist in the area of cleft lip and palate in exchange for a commitment to work in India for several years.
Simultaneously, some training will be provided for SLPs at each of the Smile Train partner centers. Together the master trainer and the partner SLPs would come together during and at the end of their training period to develop programs for community-based speech therapy services.
The field of speech-language pathology is relatively new to Thailand, with only one training program. There are approximately 40 SLPs working in Thailand. All of them are employed as generalists and have relatively little experience in treating speech disorders associated with cleft palate. Most of the SLPs are also relatively isolated, with only one SLP per regional government hospital.
The need for speech services differs dramatically in Thailand from the needs in China and India. The most important difference is that only approximately 2,000 children with clefts are born each year. But SLPs currently working in Thailand expressed a need for more SLPs, more training in the area of cleft for SLPs currently in practice, and training programs and materials for parents and teachers.
During her recent visit, Dr. D'Antonio met with 13 of Thailand's 40 SLPs. As part of the solution to Thailand's need, the professionals agreed that an early intervention program should be developed to help prevent some of the disabling speech impairments that can accompany cleft palate.
The group also felt that a one-day workshop for parents and teachers should be developed. Such workshops would train parents and teachers in methods for remediating speech disorders associated with cleft palate.
Dr. D'Antonio also hopes to find funding for a low-cost high-impact grant program to stimulate the development of clinical materials and community-based training programs in each of the countries.
'To make man whole'
"I came to Loma Linda 11 years ago because I knew that the institutional mission was consistent with my personal mission for international outreach," Dr. D'Antonio says. "The institution, and in particular the department of surgery, has been wonderful in supporting my work.
"When I travel, I'm very proud of Loma Linda's history and commitment to international health care. I'm always surprised at how many people know about this commitment. I'm really the envy of my colleagues who work for institutions that don't share this mission. Certainly the institution's mission "to make man whole" could not be better realized than in the area of cleft, where the need is not just a single intervention, but requires a commitment to the child's physical and psychological needs, and the need to function as a productive member of society who is able to communicate effectively."