Knowledge transfer between minority and majority world settings and its application to the World Report on Disability

Abstract

The purpose of this paper is to provide commentary on the article entitled Changing practice: Implications of the World Report on Disability for responding to communication disability in underserved populations (). It discusses the need to develop innovative ways to provide more services to the populations in need. Further, it offers two examples that demonstrate knowledge transfer and exchange between Minority and Majority World settings and one example of using technology for service delivery and training that might shed some light on possible solutions.

Keywords::

• World Report on Disability
• World Health Organization
• speech-language pathology
• communication
• China

Reflections

The lead article by Wylie, McAllister, Davidson, and Marshall (2013) began by providing the prevalence data available in the World Report on Disability. According to the World Report on Disability, an estimated 15% of the entire world population experience some form of disability. They argued that these figures were likely to represent an under-estimate of prevalence due to issues of how communication disability is conceptualized across the globe. People are doing more business globally and more and more services are being delivered throughout the world using technology. For example, one of the equalizers is access to computers and another is access to medical care. The argument presented by the lead authors provided a strong case that services are not provided equally across the globe and that the way disability is defined and measured may not accurately represent true estimates of the number of people with communication disability. Services to the persons with disability lack consistency and equity, with many under-served populations whose needs are not met.

The authors of the lead article (Wylie et al., 2013) further stressed the importance of advocacy. They noted that persons with communication disability (PWCD) were not foregrounded in the World Report on Disability, which has a direct impact on how the world views PWCD. The authors foregrounded the issue of the complex nature of communication disability conceptualization and measurement, and encouraged speech-language pathologists (SLPs) to become part of the debate in how to improve measurement so that accurate and valid epidemiological data can be obtained. There is a clear disparity between rich and poor, between the Majority World and the Minority World, and between those who receive services and who do not. There is a lack of equity among peoples and large differences between countries in the delivery of services for PWCD. SLPs need to be realistic in proposing possible solutions.

The authors urged us to design new approaches that are culturally relevant, holistic, accessible, sustainable, and responsive. They suggested that SLPs in Minority World countries would have much to learn from service developments in Majority World countries. The principles of knowledge transfer and exchange can inform such two-way learning. Knowledge transfer refers to the provision of best practice models using knowledge accumulated. Exchange refers to the flow of information in more than one direction; for example, through sharing of case studies for comparison, adoption, and evaluation. Three examples of knowledge transfer which may lead to improved services for PWCD are presented in this paper.

Examples of knowledge transfer from the Minority to Majority World

Countries such as Finland and Sweden are providing best practice models for healthcare. These countries operate a high quality system of universal healthcare. All people in these countries receive healthcare and education. According to the Population Register Centre, the population of Finland was over 5.4 million on 31 May 2012 and, according to the Ministry of Education and Culture, Finland has 16 cultural and scientific institutions abroad, and several provide education and training for speech language pathology.

On the contrary, China, the most populous country in the world, with 1.3 billion people according to National Bureau of Statistics of China, has no formal academic training programs for the education and training of speech-language pathology. Very few speech, language, and swallowing services are provided to the populace. Following are three examples which might be adopted and adapted to bring about changes in the greater China areas.

Example 1: Networking in close proximity

The first example illustrates bringing together people who share the same dialect and culture and live in close proximity, yet have very large gaps in knowledge and services to create a more optimal environment for children with autism spectrum disorder (ASD). This model is accessible, sustainable, culturally relevant, and responsive. Accessibility refers to the geographical and linguistic access. Buy-in of the stakeholders enables sustainability of the initiative. Cultural relevance is assured by developing content addressing the needs of a group of people sharing the same culture. Social responsiveness refers to the inclusion of social and cultural values that are attached to the notion of disability.

Since Hong Kong, a former British colony, was returned to China in 1997, more interactions between the people in Hong Kong and China have been taking place. One area of major improvement is in the area of education of children with ASD. There are 18 private agencies and 19 non-government organizations (NGOs) in Hong Kong that provide services for children with ASD. The Autism Children's Foundation (ACF) was founded by a group of parents and specialists in 2005. They work closely with the Autism Society of America and many other international societies. In 2006, ACF organized the first Asian Conference on Autism, and further conferences were held in 2007 and 2010. These conferences drew an audience from near and far and have had a strong impact on neighbouring China. In 2007, the Centre for Special Needs and Studies in Inclusive Education (CSNSIE) of the Hong Kong Institute of Education (HKIED) and the Autism Hong Kong (AHK) worked together to provide training workshops in Guangzhou (China) and Hong Kong, with the main purpose of educating people about ASD and improving the quality of education and service for children with ASD and their families. Hundreds of participants gathered to learn about ASD and discussed how services could be provided and improved to the children in need. This means that the professionals in Hong Kong can help professionals in their neighbouring cities in China. The mechanism by which the neighbouring cities in China received assistance was through regular meetings in various locations. The result of these meetings and discussions enabled the communities to become organized using the Hong Kong models. Increased services have been provided to the children with ASD and their families. Expanded services have been provided by new services in various locations and the number of participants in the regular meetings continues to increase. This example provides a model for the expansion of services for one special group of PWCD.

Example 2: Collaboration among different regions

This second example of knowledge transfer and bringing people together in regional areas is a model which promotes collaboration across different linguistic and cultural groups. The goal is for diverse groups to work together in training the next generation of SLPs to serve not only their own populations, but also under-served populations in other locations. The Intensive Program (IP) is an education program operating in Europe for many years. In 2011, Taiwan also participated in this program. The faculty members are from various countries and campuses sharing their expertise with the student participants.

The SLP-IP network is a network based in Europe, but has networks across the globe. The Department of Speech Language Therapy and Audiology (SLT) at Lessius University College Antwerp Belgium has been running this program. From 1993–2010, they co-ordinated an Erasmus LLP Intensive Program (IP) with SLP-departments in Europe (www.lessius.eu/ip). This Intensive Program was funded by the European Commission (on a yearly basis). From 2011, the SLP-IP-program has been running as a self-supported program through a Speech Language Therapy-IP-consortium. The IP intensive week has been organized each year in August and is geared toward students from educational programs in European and non-European countries and faculty from the different participating departments. It consists of theoretical lectures with hands-on seminars and interactive seminars. Faculty members of the partner institutes and guest lecturers provide all the lectures. For example, a lecturer from Taiwan plans to describe her work with the indigenous populations of Taiwan. These people live in remote areas and they have few services. Participants have traditionally come from many countries in Europe, and recently participants from Taiwan and Hong Kong have joined the program. They engage in multiple discussions and exchanges bringing a global focus to the work of SLPs. By such interactions, the students from Europe have been going to under-served parts of the world to provide services and have learned the needs of the under-served world. Emerging issues are consistently being discussed. Students have the opportunities to meet their peer groups from many different linguistic and cultural groups. Students in the program will have the opportunity to learn about such a group of under-served populations. Students are also encouraged to volunteer to serve in areas where speech and language services are needed. The location of the intensive week can alter yearly and will be decided by the consortium. The intensive co-operation between different SLP departments creates an excellent opportunity to move towards harmonization of SLP programs and to ensure further multilateral research co-operation (Schraeyen, 2012, personal communication). This program is culturally relevant, sustainable, and responsive. Parents have reported improvements in their children, and teachers have reported success in their students.

Example 3: The use of technology

The third example demonstrates the use and adoption of technology to serve remote and rural areas. This model is accessible, holistic, organic, and sustainable. Holistic refers to the teaching of the whole person. Organic means the growth of the program is the result of people connecting, and sustainable means that the participants are fully engaged and committed.

Qualcomm is a telecommunications company headquartered in San Diego, CA, and with more than 150 locations worldwide including London, Bangalore, Hyderabad, Beijing, and Hsinchu, as well as several in the US. This global company has recently launched a project for rural China using wireless technology. This project uses 3G mobile devices to connect rural and urban doctors to improve patient care in China. Access to healthcare resources is severely compromised in many under-served, rural, and remote areas of China. According to the World Health Organization, there are only 14 doctors and 10 nurses for every 10,000 people in China, while there are 24 doctors and 98 nurses per 10,000 people in the US. Many people die due to lack of access and medication. In an effort to address this situation, Project 3G Mobile Medicine demonstrated how 3G wireless technology could be used in rural health clinics to extend the reach of clinicians and improve patient care for under-served populations and marginalized communities.

The main approach of this project is to give urban and rural doctors mobile devices such as smart phones and 3G enabled PCs to access an application with helpful healthcare information. The application has Electronic Health Records, so that designated healthcare workers can locate and receive confidential access to a patient's medical chart via a computer or mobile phone anytime, anywhere, using 3G Internet access. Participating clinics can also share records, which ensures continuity of care even if patients visit different clinics. This is crucial for sustainable care. This application also has access to Rural Health Care Content; clinicians can use cell phones and 3G enabled PCs to access educational and treatment content designed to address the specific needs of rural doctors, such as information on how to treat common medical problems (e.g., respiratory illnesses and broken bones), as well as information on preventative medicine. Access to this new information improves the ability of clinicians to more efficiently diagnose and treat a broader range of illnesses than before the project was implemented. Further, this model provides remote consultation by which rural doctors can consult with physicians in other participating clinics and with urban doctors, allowing each to benefit from the expertise of the others and further increasing the kinds of conditions they are able to treat effectively. This specific technology uses 3G mobile broadband connectivity via China Telecom's network, 3G enabled smartphones powered by Qualcomm chipsets and Internet ready PCs, specialized mobile application that synchronizes in real-time with a customized web portal which allows easy access to other clinicians, educational information, and patient health records. Since 2011, the project has been expanded to 21 clinics in Xian County, Hebei Province, and ˜ 150 rural doctors have received instruction on how to use the application and accompanying devices as well as additional medical and technical training. Participating clinics collectively serve 300,000 patients who have either directly or indirectly benefitted from the project.

Multiple partners have been involved in this project including Xian Kingtone, which oversees project implementation and application development, China Telecom, which provides 3G connectivity at a subsidized rate, China Children and Teenagers’ Fund, which provides assistance in conducting needs assessment, site selection, training, and project implementation, and China Rural Doctors Training Center, which provided doctor training, mobile content, and identified physicians and experts to offer remote medical consultation to rural doctors. This model can certainly be modified to include speech and hearing professional services. In China, self-help groups have been organized to provide services to help address unmet needs of the persons with disability. The Cerebral Palsy Center in Shanghai and the Beijing Stars and Rain Education Institute for Autism are two programs for which Fudan University has developed a program using paramedical personnel to work with patients with repaired cleft palate and lip. Jiaotong University has developed a program for persons with cochlear implant. The key element of this model is collaboration between government, industry, community, and professionals.

Conclusion

Wylie et al. (2013) concluded in their article “To meet the needs of the growing number of under-served PWCD, we must seriously consider the recommendations of the World Report on Disability” (p. 9). However, there is no one-size fits all solution to services for persons of disability. The three examples provided in this commentary demonstrate a range of approaches to providing different solutions for different problems. The solutions attempt to address some of the issues of lack of equity in provision of services to the persons with disability. Meeting local needs requires innovation and think-outside-the-box strategies. What works in one part of the world may not work in another. Understanding the social, cultural, linguistic, and local needs of persons with disability is the first step toward providing relevant and sustainable solutions. What is our shared vision? Do we have a shared mission? Where should we focus our energy? We do have a long way to achieve equity.

Declaration of interest: The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.