Where We Work
2006; American Speech–Language–Hearing Association; Volume: 11; Issue: 7 Linguagem: Inglês
10.1044/leader.wb4.11072006.20
ISSN1085-9586
Autores Tópico(s)Balkan and Eastern European Studies
ResumoYou have accessThe ASHA LeaderWorld Beat1 May 2006Where We WorkA Labor of Love in Bosnia Judi Jewett Judi Jewett Google Scholar https://doi.org/10.1044/leader.WB4.11072006.20 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Bosnian children with hearing loss are often socially isolated. Nezla, left, who has a cochlear implant, had a rare chance to spend time with Amina, on right, who also has hearing loss, after the summer speech and hearing clinic. I will always remember my first trip to Sarajevo in 1997. When I arrived at the old airport, I saw bullet and mortar holes in the airport walls. My eyes opened wide, as I had never seen anything like the devastation of the airport and the surrounding neighborhood. That volunteer trip with the United Methodist Committee on Relief (UMCOR) was a life-changing event for me. I did not know the depth of need that existed there. During that first trip, I helped mentor teachers of English at the Sarajevo Youth House, and noticed an 8-year-old girl in an English class who was not participating in the classroom activity. Her teacher told me that nothing could be done for her because she was deaf. The girl had a profound bilateral sensorineural hearing loss with no hearing aids, and no receptive or expressive language, either signed or spoken. She was unable to communicate with her father-even with simple gestures, since he had been blinded in the war. Our volunteer team pooled money to search for and purchase hearing aids. The search took a full week, as there were no "yellow pages" in the country. A Bosnian audiologist said bluntly, "This girl is not worth a hearing aid." The audiologist and the director of the school for the deaf/hard of hearing had agreed that she should "learn to speak first" to prove she could benefit from a hearing aid. We did not agree, and bought her a pair of hearing aids, which had to be fitted by "behavior" as the hearing aid dealer had no equipment to perform an aided audiogram. Her smile was unforgettable when she turned her head to listen to sounds. After the hearing aids were fitted, we spent three months searching for aural rehab services. Finally, her mother found someone who had taught students with hearing loss before the war. We believe that this was the only Bosnian SLP practicing at that time in the country. The 8-year-old girl received intensive speech and language treatment until she was 13, and progressed from having no language to being able to participate in conversations. Bosnia Speech and Hearing Project The donation of this first pair of hearing aids and the girl's subsequent treatment led to the birth of the Bosnia Speech and Hearing Project (BSHP). Every summer since 1997, I have traveled to Bosnia for one or two months to direct the BSHP, which has provided speech, language, and audiology services to children in Bosnia. The BSHP team, which works with children at our summer clinic, promotes the development of the speech-language pathology profession in Bosnia and advocates for the needs of children with hearing loss and their families. Over the years BSHP teams have included SLPs, audiologists, educators, a physical therapist, and others who went to care for the children. Thirty-two professionals have volunteered their time in Bosnia, a number of whom returned to Bosnia several times. In addition, 30 Bosnian co-therapists have gained clinical experience, which is not readily available at the university. When our summer visit is over, we leave a full-time Bosnian SLP in place under contract to the BSHP to continue the treatment we have agreed on. Through her, we provide year-round speech, language, and hearing services to children with hearing loss, preschool children and children who live in an orphanage. Since 1997 more than 5,500 hours of treatment and 75 hearing aids have been provided, and more than 200 children have been served. Then and Now: Communication Disorders in Bosnia Parents participate in a forum with Bosnian co-therapists and American SLPs. Ten years ago the communication needs of deaf and hard of hearing students in Bosnia were not within the scope of practice of the SLP, who worked only with hearing students. The "teacher of the hearing-impaired" focused on academics. Neither professional worked with the speech and language needs of children with hearing loss. Today as a result of BSHP, both professions have had the training to work with the speech, language, voice, and auditory skill needs of children with hearing loss. The fields of speech-language pathology and audiology in Bosnia have expanded significantly through the expertise brought by the volunteers, the skills demonstrated by the American clinicians, several symposia we have given at the University of Tuzla and other presentations in other venues. Three audiologists have been to Bosnia and each one has brought invaluable expertise to a country with limited options for audiological evaluations. Play audiometry and evaluation of children have been significant advances. Robin Newbold was invited to attend the first cochlear implant operation performed in Sarajevo. Kevin Miller, Newbold and other BSHP volunteers presented seminars on topics regarding speech, language, and deaf education at the University of Tuzla and at the SOS Kinderdorf Hermann Gmeiner Clinic in Sarajevo. Through BSHP we developed articulation materials and an articulation test, which master's degree candidates at the University of Tuzla standardized. The Bosnian Language Expression Scale was developed to assess semantics and syntax for the Bosnian language. Another master's degree candidate at the University of Tuzla will standardize the language test. Given the focus on articulation, measurable language goals for the Bosnian language had to be developed, introduced, and implemented. Andrea Cronin, from San Francisco, shared dysphagia techniques and demonstrated these to Professor Salihovic on her professional tour of the US in 2002. Today there are approximately three dozen SLPs in the country, five of whom have decided to become SLPs after their involvement with BSHP-four of our Bosnian interpreters and one American volunteer. For the first time, autism has been recognized in the country. This followed a presentation by BSHP's Anita Ouellette two years ago. SLPs such as Kay Strickland now are introducing fun techniques to use with preschoolers. One SLP introduced the Picture Exchange System to one girl, her family, and the faculty and administration at her school. Moving Ahead The concept of phonological processes must be developed in Bosnia. Services for adults including dysphagia and aphasia are also areas of need. Exclusion-of children with special needs and of their parents-continues to be a problem. For example, children with hearing loss are excluded from attendance at local schools after a trial period, which does not include amplification, support, or even having the teacher face the class while giving dictation. There are no speech and language services in schools. The concepts of language disorders and learning disabilities affecting school performance and academic success are not recognized or re-mediated in any way. Parents were excluded from their child's education in the past, and continue to be unable to discuss or have input into their children's placement or treatment in most cases. Parents' meetings have been a major focus of the BSHP both in our seminars and in our treatment. Annual parent meetings for special education were once unheard of, and are now a part of the curriculum at the University of Tuzla. Our group was criticized at one point for sharing information regarding hearing losses and audiograms with parents. Today the parents expect to attend seminars and forums, and have parent meetings. They have formed an association to have the legal status to be able to advocate for services for their children from the city schools. Making a Difference Volunteers in Bosnia have shared their expertise, caring, and concern in many ways over the years, from providing resources for clearing of three landmine fields, giving a cow to a struggling family, and donating 100 leg braces. We have been fortunate to work with SOS Children's Villages for several years, an international organization that has been nominated for the 2006 Nobel Peace Prize. Their orphanages around the world have outstanding facilities and model programs. We have provided services for children in their facilities, and in return, they have given us space to serve our young clients with hearing loss. Currently, our year-round SLP, Dzevida Sulejmanovic, is an SOS employee. Orbiko, the largest importer of groceries in Bosnia and Herzegovina, will now donate funding for the treatment through SOS, and will fund some cochlear implants as well. Through the company's public relations campaign, people also will become more aware of the needs of hearing-impaired students in Bosnia. We welcome volunteer SLPs and audiologists for our 2006 Summer Clinic for assessment and treatment of children, as well as anyone interested in playing games and interacting with children. This year a major focus of the team will be meeting with principals of schools and directors of programs to discuss the inclusion of students with hearing loss in general education schools. Bosnia has many needs in the areas of speech-language pathology and audiology. It will take an ongoing effort to develop and expand these areas in this country that is recovering from war and struggling to catch up from years of being isolated from developments outside of the country. As future volunteers come to this country, they will continue to develop speech-language pathology and audiology according to their own areas of interest and expertise. I look back to 1998, when I'd scheduled a meeting with the family of the 8-year-old girl who received our first hearing aids. The family secretly brought her home to avoid sharing a meal in public with her. Today that doesn't happen-the families of the children with hearing loss routinely have outings and field trips. Much has changed since that time for children with communication disorders. And now flying into Sarajevo, I look eagerly at the rolling green hills and small villages and search for landmarks that are now familiar, and finally see it-the city of Sarajevo and its nice new airport-and look forward to a reunion with the people with whom I've worked over the years and who have become my second family. Author Notes Judi Jewett, started the Bosnia Speech and Hearing Project in 1997. She is an SLP with the Antioch Unified School District in California and has a background in both deaf education and communicative disorders. 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