In 1995, the Malaysian Association of Speech-Language and Hearing was officially established. In 2016, approximately 300 speech therapists were reported to be working in Malaysia.
In Malaysia, speech therapists work in government and/or public hospitals, specialised centres, non-government organisations, private agencies or independently. Except for international schools, speech therapists do not work in public schools.
There are two public universities offering speech therapy as a Bachelor’s and Master’s degree and a third university is in the midst of obtaining accreditation from the Malaysian Qualifications Agency. Speech therapists working in Malaysia are trained both locally and/or internationally (e.g. Australia, New Zealand, Singapore, India, United Kingdom, USA).
In Malaysia, disability and differences are perceived differently depending on parents’ cultural background, exposure to disability, and level of acceptance and understanding of the severity of a child’s impairment. In my experience, while many amongst the educated middle class may be aware certain diagnosis, family members often have varying degrees of acceptance of their child’s impairment. Some families embrace their child’s impairment and work toward empowering their child with as much support their child needs.
Public awareness about communication disorders from infancy through adulthood as well as the benefits of speech/language therapy and related services are much needed in Malaysia.
Some parents that I work with finally accept the fact that their child has an impairment and needs treatment when the child reaches middle-school. It’s not unusual to hear of preschoolers with suspected speech/language difficulty being advised by their doctors to use the “wait-and-see” approach. Some parents may be only willing to accept that their child has a “language delay” and may delay on seeking other consultation services recommended to them (their child is showing signs of other neurobehavioral impairment).
Speech therapy is often perceived to benefit young children at a certain period in their lives and not as a service across lifespan that may be necessary and beneficial. Parents who are already seeking treatment are accepting of their child’s condition to some degree or other. However, depending on their understanding and exposure to the field of rehabilitation, some may have unrealistic expectations of treatment results, in that that some parents are seeking a cure for their child (with an incurable diagnosis), some are expecting significant changes after a few sessions.
Parents may not fully understand the roles of various professionals in the rehabilitation field. Some may expect the speech therapist to intervene as another professional (e.g. expecting the speech therapist to teach their child maths, manage their sensory or behavioral issues), and some expect their private school teachers, private tutors, or domestic helpers to take the role of therapists. If these expectations are not carefully managed, either through personal or public awareness, they can be a hindrance for the child’s progress.
In my experience, by and large parents with non-verbal children still prefer their child to use speech as the primary communication method. They may accept some forms of augmentative and alternative communication, yet insist clinicians work on helping their children talk. This can be the case despite extensive parent education as well as diagnoses of communication problems that indicate the need for other other means besides speech to communicate. It is also not surprising to hear of families seeking pseudoscience or non-evidence based treatment to help improve their child’s function (e.g., use of magnetic therapy, or use of non-speech oral motor exercises to improve a child’s speech and language).
Not all providers provide records of their services to patients. Some parents may not provide full disclosure of their children’s diagnosis (perhaps due to shame, or difficulty accepting the diagnosis), and some caregivers (extended families or domestic helpers) may not be fully aware of the child’s diagnosis. Therefore, when evaluating clients, clinicians may sometimes be limited to patient’s verbal descriptions of their conditions. Without the crucial information of a child with complex medical needs, it is difficult for clinicians to make accurate diagnosis, plan effective intervention or exercise appropriate precautions. For instance, a parent whose child’s medical record was not available for review at the time of assessment described his child has having “lost half his brain due to cerebrospinal issue”. That left me with many questions unanswered – which parts of his brain were affected? Which parts are intact? How were they lost?
With parents who are still dealing with shame or difficulty accepting their child’s condition, establishing trust and rapport are often needed, over a period of time, before the full disclosure of a child’s medical condition occurs. Likewise, I find that I often need to wait until trust has been established (it may take weeks or months), before making further referrals for other assessments or services with other providers, that the child can benefit from.
Final thoughts and requests
Public awareness about communication disorders from infancy through adulthood as well as the benefits of speech/language therapy and related services are much needed in Malaysia. Misconceptions and misinformation about the roles and services of speech therapists exist not just with families, but with teachers and other healthcare professionals, and needs to be addressed at various platforms. It is my hope that communication across healthcare professionals in Malaysia can be improved in order to enhance patient outcome and reduce medical errors.
I work with many children with cerebral palsy who can greatly benefit from low tech as well as high tech communication devices, and am also in the midst of sourcing for agents/companies to loan high-tech communication devices to Malaysia, as to my knowledge, we do not have any agents/resellers or public lending library here. Any suggestions/advice on this is greatly appreciated.
Written by Chihui Yong, M.S., CCC-SLP
Note: The author is a Malaysian who graduated from the Pennsylvania State University in 2011 with a Master’s in Communication Sciences and Disorders. Post-graduation, the author worked in Philadelphia and in Shanghai, before returning to Malaysia to work as a speech therapist in September 2017. This article is a reflection of her personal observations as a speech therapist who has recently returned to Malaysia, practicing in an urban setting; hence, the views expressed here may not be representative of the overall speech and hearing landscape in the ethnically diverse country of Malaysia.