Stop for a second and imagine you are standing next to a friend. That friend asks you a question, and as you begin to respond, everything stops.
Your throat seizes up and the only sounds coming out of your mouth are unintelligible. You push, and push, and push, and push some more, yet nothing but indecipherable sounds leave your lips.
Few can fathom the feeling of being a child watching his or her peers move from mumbling toddlers to non-stop talking kids while you are trapped inside yourself. The confusion, fear and sadness that washes over you when you first find your words trapped in your throat can lead to a lifetime of anxiety whenever you are prompted to open your mouth.
Many children in Western countries have access to both government programs and organizations willing to help provide speech therapy and make sure children with speaking disabilities are able to go to school and live lives similar to their peers. But even in places like the US, the woeful lack of awareness and resources for lower income children leaves many behind, with few options available to assist them in their effort to communicate and contribute to society.
The situation in Cambodia is even worse. There are no Cambodian speech therapists, no university courses to teach potential therapists and very little awareness about speech disabilities and all that comes with them. Researchers say one in 25 people in Cambodia is in need of speech therapy.
The Happy Kids Clinic is trying to change that. Started by OIC Cambodia, an NGO working to make speech therapy accessible to all those who need it, the clinic is hoping to address a myriad of issues that those with speech issues in Cambodia are forced to battle against.
Happy Kids opens officially on September 3, but has already had consultation sessions with 20 children over the past three to four weeks.
Claire Salter, a speech therapist working at Happy Kids, said the clinic would allow them to give Cambodians an idea of what speech therapy is and offer an opportunity to train Cambodian therapists so they can eventually take over.
“It is providing us with a platform to show people what speech therapy is instead of just trying to explain what it is,” she says. “It’s good to have a space where people can come and see but it’s also good because it can generate some income for OIC’s efforts.”
OIC is trying to increase awareness about speech disabilities and the need for speech therapy in Cambodia while prodding the government to take the lead in future programs and developing a university course to train the first generation of Cambodian speech therapists.
Philip Nalangan, OIC’s communication manager, said the clinic was not a magic bullet, but would help make a difference for children struggling with speech issues.
“This service can give kids a voice to communicate with their family and friends, and ultimately go to school. We’re not only helping our clients, but also the community,” he says.
The clinic is located inside Khema International Polyclinic in Phnom Penh, and Happy Kids plans to split profits between Khema, the therapists working at the clinic and OIC. Consultation sessions will be $60, assessments are $140 and following therapy sessions will range from $60-$80 depending on the length. Many families in need are looking to NGOs and their own workplaces to cover the costs, which can be pricey for some.
Two Khmer therapy assistants are employed by the clinic, helping western speech therapists translate for Khmer parents and children while picking up strategies from the certified therapists that they can add to their own arsenal of skills.
Yim Sreysrors, a 21-year-old Royal University of Phnom Penh graduate, said she was glad to work at the clinic herself, but was overjoyed at the fact that it even existed.
“I will be able to develop professional skills here and get some basic knowledge of speech therapy so that I can help children in Cambodia learn to communicate,” she says. “I think speech therapy is truly needed in Cambodia because these children need to know how to take care of themselves and interact with others.”
Her psychology degree and training in art therapy, amongst a host of other disciplines, has led her to speech therapy, but she is hoping to branch out into a variety of other types of therapy eventually.
Salter told Khmer Times that working with Sreysrors and the other therapy assistant was an integral part of pushing forward OIC’s goal of creating a healthy stable of speech therapists in Cambodia able to handle a community that has been underserved, or not served at all, for so long.
“This gives us a chance to train these guys and the eventual hope would be that they would be our first cohort of speech therapists once the university course is set up,” Salter says.
But the effort to provide some of the first speech therapy Cambodians have seen has not been without its bumps and bruises. One of the major issues, Salter says, is the lack of awareness about what speech therapy is and can accomplish. Parents have come to Happy Kids expecting it to resemble a general physician visit, only interested in knowing what is wrong, what the doctor can do to fix it and how long it will take, ignoring the often complicated and long-term treatment their child may actually need.
“We’re getting kids coming here with quite complex needs. When I ran a private practice [in Australia], I kind of got the kids who weren’t severe enough for government services so they had more straightforward speech and language difficulties. The kids coming here have complex needs that will need more than speech therapy,” she says.
“We have to balance our work against the expectations of families, which is tricky because this hasn’t been a profession before here, so parents come here expecting it to be like seeing a doctor. So it’s hard to break it to them when you say to them that this is a long-term partnership, and that it will take years.”
Happy Kids is working to secure partnerships with a number of organizations so they can refer families to other doctors or groups that can provide them with care they are unable to.
“Because of the kids we’ve seen come through the door, we may need an occupational therapist. Some kids have lots of sensory needs, so if you don’t get that addressed, you can’t get the kid to focus on speech therapy,” she says.
But the situations facing many of the children coming to Happy Kids are dire. Some of the children are 10 years old, yet don’t attend school because they have been summarily turned away or refused service. Some parents have looked at schools but felt the teachers were not sufficiently trained to accommodate their child’s needs. Part of Happy Kids and OIC’s efforts are to train teachers to be able to handle kids with speech disabilities.
Happy Kids is also serving as an advocate for children, telling schools that these kids deserve to be able to participate just as any other student would.
Weh Yeoh, OIC’s founder and managing director, told Khmer Times that kids, parents and teachers all needed support in assisting children with these kinds of issues, and said the clinic would further their efforts to break any taboos surrounding disabilities in Cambodia.
“Hopefully, all of this helps to raise awareness of speech therapy in Cambodia, and reduce stigma about disability in this country too,” he says.
But the difficulty with speech therapy is expectations, Salter adds.
“It’s what the priorities of the family are, what their key concerns are. I might think that something else should be a priority, but if it’s not important to the family, they’re not going to participate because it’s really a team effort. It’s not about the therapist ‘fixing’ the kid. It’s offering techniques, ideas and strategies,” she says.
“I talk about speech therapy being three things: its working with a child, training the people in the child’s environment and making adaptations to the child’s environment to help them participate. So in a school, that might look like a teacher helping a student understand instructions by repeating it, checking with the child and setting them up with a buddy.”
Addressing a child’s daily environment is integral in helping them cope and succeed with a speech disability. Parents and teachers are instrumental in making a child feel safe and welcome to speak despite their issues.
“So [the goal is to] not just make the child the problem. You’re also addressing the environment that makes their problem more difficult,” she tells Khmer Times.
“That’s why there is benefit here in promoting what speech therapy is so we can get people’s expectations to be a bit more realistic. There are very few kids who you could see for two months and have them speaking perfectly. Sometimes perfect speech isn’t the goal; it’s just being able to be understood by others. You have families coming in basically saying they want their kids to be ‘normal’ and you have to tell them ‘we can’t do that’.”
“Normal can’t be the goal here,” she adds.
Happy Kids is hoping that the already burgeoning demand is evidence that they are providing a service people desperately need.
Nalangan says they have received inquiries from a number of Cambodian and expat families, with one family traveling all the way from Battambang just to see a therapist in Phnom Penh.
“This really tells us that the demand for speech therapy is huge,” he says.
In the future, Salter said Happy Kids wants children to be brought to them earlier, as the 0-5 age range is critical for language development.
“The hope would be to start with kids at a younger age. By the time kids are 10, it’s very hard. For kids with speech therapy, you want them as young as possible, preferably age three or four so that you can prepare them for school,” Salter says.
“If we can get them during that time, we have a better chance of setting them on the right path so that they have a better chance of participating in school, making friends and just being happy kids.”
First Published in Khmer Times.