November 21, 2014
What made you decide to do your summer internship in the Philippines?
I needed to fulfill 400 hours of clinical work as a requirement for my degree, most of which had to be in an off-campus setting; but I wanted to go home to the Philippines for the summer to be with my family, and to fulfill my summer concert season. I am an opera singer by profession before I came to UMASS for a second degree.
I asked my clinical advisor, Dr. Sarah Poissant, if I could arrange to have my summer internship in the Philippines. She said that as long as I could find ASHA-certified (American Speech-Language-Hearing Association) supervisors with at least 3 years of clinical experience, I could do it. So I contacted the Philippine Association of Speech Pathologists (PASP) to ask if there were any ASHA-certified SLPs in the country. I waited nearly the whole Fall semester of last year before I heard back from them, and fortunately they recommended two people, both professors at the University of the Philippines, who met those requirements. I worked with Dr. Poissant to get the contracts ready and to make the arrangements between the two universities. It all worked out in the end, and I was able to go home to the Philippines and start my practicum.
Did you receive academic credit? What did your practicum experience consist of?
I received credit for 65 clinical hours over the summer. In all, it was a 7-week practicum, and I was placed in a private clinic, in a public elementary school, and in a government-run hospital. All three rotations were in a pediatric setting, and I worked mostly with children from three to twelve-year-olds, though I had the opportunity to work with a small number of adults in their 20s who had autism spectrum disorders (ASD).
What were some of the challenges you faced?
I found it difficult treating individuals in a bilingual setting. I consider English as my first language because I went to the American school when I lived in the Philippines. I’m proficient in Tagalog, as well, which is the primary language in the Philippines, but because I use Tagalog more for conversation and not so much in academic or a clinical setting, sometimes I had difficulty coming up with the right words. I treated patients in English, in Tagalog, and in Taglish (which is a mixture of the two). Sometimes I would teach the same word in three different languages, and I was constantly trying to figure out which language to go with. I found it very challenging. There were also a lot of “lost in translation” moments, where they did things differently or where I had to justify doing things a certain way. I was very careful not to step on toes and respect cultural boundaries.
I spent most of my time treating kids and adults with autism, so not only did I have cultural issues to consider but there were also language and cognitive delay issues to manage. Sometimes a delay could be the result of cognitive issues, but other times, it could be the result of cultural norms, so I always had to factor that into the equation.
But my major challenge was behavioral management, working with kids with ASD. I was thrown into a pediatric setting – it was all that was available at the time – and not only did I not have a lot of experience working with kids, but it was also my first off-campus clinical practicum. Therefore, it was really a whole new experience for me in so many ways. Sometimes the children would throw temper tantrums; one started running “laps” around the clinic and we had to chase him around as he was tearing the place down.
How did the department help you to prepare for this experience?
As far as I know, I am one of the few students to do clinical work overseas, so in a lot of ways I was breaking new ground. I felt very confident going into my placement. But I think a lot of that was I just didn’t know what I was getting into.
Both of my supervisors in the Philippines were schooled here, one in Illinois and the other in San Diego. They gave me some advice on things to watch out for such as things that exist in the Tagalog language that don’t have an equivalent in the English language. They wanted to make sure I didn’t “treat” something that’s part of the language. Otherwise, it was here you go, here are your clients. And I had to figure it out. But what a great experience to have, to be thrown into a setting and have to sink or swim on my own!
What did you learn from this experience?
I learned a lot! And am truly grateful for the experience. I understand now why there is such a high need for bilingual therapists. It’s a difficult position to be in, to understand the cultural differences and be proficient in that language and yet have the western ideology and to be able to translate that into practice in another culture. I learned to be adaptable in terms of what is being thrown at me. I’m currently in a hospital placement, which presents its own challenges, but I am calmer now and being thrown into deep waters – as my current supervisors always say – doesn’t faze me as much. I can deal with the situation, and remain “in the moment.”
What was the most memorable part of the experience?
In the end, I enjoyed the kids so much. I became very attached to them. One of the children, whom I still think about today, had Dandy-Walker Syndrome, which is a congenital malformation of the brain affecting the cerebellum area. It affects motor skills, cognitive, speech and language skills. His parents would help him walk by holding both hands, and help him pace his steps by telling him which foot to move. He was a very smart and affectionate child, and I became very attached to him. He looked forward to our speech sessions, and would always have a huge smile as he entered the treatment gym. Those moments were very precious to me.
I also learned a lot about my native language and how it works. It made me more aware of my own culture and reminded me of how I grew up. I thought a lot about my childhood as I was interacting with the children, and I think that helped me build a better rapport with them.
I grew up in the Philippines, but I came to the U.S. in 1991 to go to grad school for music. I’ve lived in the U.S. ever since and sang professionally up until 2010 when I decided to return to school. I am still actively performing, but due to a very busy schedule and demanding coursework, I have to choose my singing engagements. I knew I wanted to become an SLP after caring for my father who had Parkinson’s disease, and needed speech therapy, but could not avail of it in the Philippines. However, because of my background as a musician, I didn’t have the prerequisites to go straight into a degree program in Communication Disorders. I looked around for courses where I could take the prerequisites, and UMass had what I needed – a post-baccalaureate program. So I applied and came here. I enjoyed it so much that I felt it was the right decision for me to come here for grad school. Going back to school was tough since I’d been out of school and working for 20 years. But I can’t begin to tell you how worthwhile it has been. It’s difficult, I won’t deny that, but it’s very fulfilling.
What do you plan to do after graduation?
It is part of our course of study that we do a Clinical Fellowship, which is a 9-month full-time residency at either a school or medical setting, or private practice. This is part of our SLP requirements to earn our Certificate of Clinical Competence, which we call our C’s. After that, I plan to continue into a clinical doctorate program in my field of study.
You know, when I first came here, I thought I’d be a clinician who specialized in voice, just because singing is my strongest suit. It’s the other reason why I entered an SLP program in the first place. As a professional singer, I teach voice, give master classes and workshops, and occasionally work with people who have vocal problems such as singer’s nodules. I shied away from these clients because I did not know how to handle them, and felt they needed medical attention instead. Then I realized that if I was going to be a voice specialist, I should know how to help this population. Knowing what I know now, I am very confident in handling these situations, and have thus far gotten positive results from the students that have come to work with me.
As I finish my 2nd year in grad school, I am also now beginning to discover the research aspect to my coursework. I am enthusiastically considering research opportunities in my field of study; hopefully I can find one that can incorporate research centered in the Philippines. I would like to look into possible avenues that somehow incorporate singing as an approach to therapy. I am reading a lot about its use with individuals with aphasia (a language impairment often caused by strokes), autism, and other neurological disorders. I would like to go deeper into this process to better understand and clearly define the true efficacy of music training in treating speech and language disorders, in the hopes of contributing to more evidence-based methods for future treatment protocols.
I would also like to take this opportunity to thank once again the people behind the success of my summer clinical experience: Dr. Sarah Poissant, who was then the Acting Clinical Director in the UMass Amherst Communication Disorders Department; Dr. Jocelyn Marzan, PhD, CCC-SLP, and Ms. Nadine Joy Sy, M.S., CCC-SLP, from the College of Allied Medical Professions, University of the Philippines, Manila.