I hope to become certified and practice in Speech and Language Pathology (SLP). Finding myself especially drawn to medical issues, it is my sincere hope that the healthcare community will continue to accord increasing respect and attention to the role of the Medical SLP. I consider speech therapy to be foundational to health care in every dimension since verbal communication makes every form of health care provision possible. Since I hope to practice as an SLP in the future in the Kingdom of Saudi Arabia, I focus my report on that country. Saudi Arabia has invested much of its wealth over the last few decades in projects that are seen as sustainable. Thus, the concept of ‘sustainable’ is now pervasive among Saudi professionals, including those in health care, with public health care assuming a prominent role in debates over the future of health care policy for the Kingdom.
Saudi Arabia has been dramatically blessed economically with the means to provide increasingly state-of-the-art, long-term care in its medical facilities. I am pleased to see the Kingdom investing some of its resources in numerous long-term care facilities that serve as models to other parts of the world, especially the Middle East. Long-term care is the area in which I look forward to practicing as a Speech and Language practitioner, so it serves as the central focus of this report and the reflections that follow.
The most advanced long-term care facilities in Saudi Arabia now provide a broad range of services and comforts for patients and residents that have not been provided in the past and are very seldom, if at all, provided in other middle eastern countries. However, some of these facilities, although considered state-of-the-art for Saudi Arabia, still do not include any role for the Med SLP. The trend, however, is towards greater recognition of the importance of that role or function, even in the long-term care facility. As I see it, Medical SLPs, serving alongside a wide range of other healthcare professionals - in addition to nurses and doctors - have a positive and critical role in long-term care. From my perspective, their position or presence is at least justified, if not necessary, for long-term care to represent our most acceptable and most sustainable effort to provide the finest possible care for the sick, aged, and disabled who experience problems communicating verbally - with professionals, caregivers, and family alike.
The image above is taken from the NMC Chronic Care Specialty Hospital website in Jeddah, Saudi Arabia, one of the country's most advanced long-term care facilities, along with the caption, “Our Patient-Centric Care Model.” I see this graphic as helpful in illustrating my professional hope that the support of SLPs will increasingly become fully incorporated into strategies for long-term care in Saud Arabia tomorrow. It is exciting to understand what is missing in this graphic and what is present. Understanding what is missing in this graphic visual and what is present is exciting. In fact, what is present helps us better understand what is missing, especially from the perspective of an aspiring SLP professional who looks forward to building a career in her field in Saudi Arabia. Most importantly, I have my heart set on working in long-term care for the elderly and incapacitated. The above graphic does not yet have an image of the SLP alongside the Social Worker and the Psychologist. I hope to contribute to the efforts of a new generation of SLP professionals in Saudi Arabia so that this image will, in time, appear the full recognition of the Med SLP as an intrinsic part of the healthcare team in the long-term care facility.
The Jeddah Institute for Speech and Hearing (JISH), a non-profit organization, was established in 1991, focusing on children in response to the absence in the Kingdom of qualified professionals and the great need for SLPs to help children with communication problems. Many parents had to take their children to the West for extended periods, and treatment was the only alternative available, simply out of reach financially for all but the wealthiest. The JISH is our flagship organization in Jeddah, the Kingdom’s second most important and international city. The JISH helps hundreds of children to realize their maximum communication potential, providing them with support with articulation, fluency, voice, receptive and expressive language delay, pragmatics, oral/aural rehabilitation, aphasia, etc. (JISH).
The close, collaborative relationship between the KSA and the USA is reflected in the SLP community, particularly by the JISH, which provides ongoing intensive continuing education through courses, workshops, and internships at accredited university programs and clinics in the UK America. The JISH continues to grant scholarships to its staff for graduate and doctorate degrees in Speech-Language Pathology and Applied Behavior Analysis, helping to ensure that our speech-language pathologists are updated with the latest clinical techniques and stay abreast of research in the field.
I laud the efforts of long-term care institutions such as NMC Chronic Care in Saudi Arabia to incorporate Psychologists and Social Workers into their patient care teams. This is a clear recognition that care includes and is based on communication. The most critical factor of all is the patients' communication with not only caregivers but also family. Especially concerning end-of-life care, for example, when “last words” are seen as having enduring importance, the patient must be able to speak or communicate in some fashion, and it is desirable to have a professional on hand to facilitate this. For this reason, I see the inclusion of an SLP professional on a long-term-care institution's team as integral and even foundational, helping patients or residents to communicate with caregivers and family. Without that capacity to make themselves understood and to convey their feelings, it isn't easy to know how to fully benefit from having both a social worker and a psychologist on a health care team.
While a full recovery and the healing of independence lost is always the goal, especially for older adults who cannot adequately care for themselves, many, if not most, spend the balance of their lives in long-term care. I feel strongly called to advocate for the importance of the role of the SLP throughout the aging process, with even special attention paid to communication as a patient nears the end-of-life stages. I fully understand why our professional efforts in Saudi Arabia began focusing on children with speech and language issues, with their whole lives before them. But I hope to see the Med SLP working with people of all ages in need of their services, and I base this hope on concrete trends that we see developing today toward greater inclusivity and less age discrimination in the decision-making involved in who benefits from the services of a Med SLP, and who does not. Within my lifetime, I hope to see Med SLP services available to all who need them throughout the Middle East and the rest of the world. I see communication in all its forms, primarily verbal, to always be positive and not something that should be excluded from any program that considers the benefits for the patient from holistic care.
I could not feel more strongly that the added value of the services of a Med SLP would certainly be worth the cost, reaping numerous dividends in terms of the quality of life of patients and residents as well as their caregivers whose lives are also improved by the general enhancement of the ability of the patient to communicate. The Med SLP that is most needed is well-trained. It is hoped that to the extent to which Med SLPs become increasingly valued by health care policymakers, the numbers of those members of this profession will increase over time, both as a result of growing numbers of Saudi students being trained abroad in this area as well as helping to an educated new generation in the field within the Kingdom.
As populations age – and this is very pronounced in the KSA, SLPs are presented with a varied caseload that has become more acutely ill than in the past. Speech-language pathology services are increasingly becoming medically necessary to treat speech-language, swallowing, and cognitive-communication disorders common among patients with head injuries, Parkinson’s disease, stroke, autism, cerebral palsy, etc. Medical necessity is determined based on what is deemed to be essential and appropriate to the diagnosis and treatment of an illness, injury, or disease.
Developmental disorders, conditions, disabilities, or delays are often accompanied by a natural progression in physical and psychological maturation from previous, lower, or embryonic stages to later, more complex, or adult stages, resulting in challenges that will exist throughout the individual's lifetime in question. Taking this into account and thinking about healthcare sustainably can make a compelling case that speech-language treatment services are as medically necessary for patients with developmental disorders that stay with them for a lifetime as they are for an adult who has suffered a stroke and subsequently lost speech and language function.
It pleases me greatly that the Cambridge Medical and Rehabilitation Center (CMRC), one of the flagship long-term care organizations in the UAE, has opened a branch in Saudi Arabia. This organization does include Med SLPs on its team. Last year, in 2019, they opened a 60-bed facility between Dhahran and Al Khobar that helps patients requiring acute care and rehabilitation. They are already making a significant contribution to the Saudi healthcare system, serving as a model for future developments that include physical, occupational, and speech-language therapy, complete with multi-sensory room sessions (TVM Capital Health Care).
This writer hopes that the role of the Med SLP will increasingly come to be seen as of vital importance to the team in long-term-care institutions of Saudi Arabia and the UAE, continuing to learn from the West and from each other as we march forward together in our advancement as SLP professionals.
My ideal position would be serving as a Med SLP at the CRMC facility in the KSA, providing long-term care for patients with chronic illness or injury. I especially appreciate how the CMRC tailors its respect to the individual patient's treatment needs, encouraging the family to become involved in the patient’s treatment plans, including a rehabilitation plan for after the patient is discharged. This requires our best effort to enhance communication for all parties involved, especially the patient.
List of References
Jeddah Institute of Speech and Hearing (JISH). Founders’ Message and Vision. http://www.jish.org/
American Speech-Language-Hearing Association. Speech-Language Pathology Medical Review Guidelines. (p. 10). file:///C:/Users/HP/Downloads/SLP-Medical-Review-Guidelines.pdf
TVM Capital Health Care. Cambridge Medical and Rehabilitation Center (CMRC) admits the first patients understanding understand what is missing in this graphic and what is present is exciting patient treatment needs in the new Saudi Clinic. https://www.tvmcapitalhealthcare.com/cambridge-medical-and-rehabilitation-center-admits-first-patients-in-new-saudi-clinic/
SLP Speech and Language Therapy Personal Purpose