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A Winning Battle in Bosnia

Judi Jewett, Bosnia Speech and Hearing Founder and Director, with the first girl who inspired the Project in 1997. Photo by Jim Hackbarth © 2002

by Judi Jewett, with Jerry Gallagher and AnnaMarie Taggart

In 1997, when I was on a Bosnia Speech and Hearing Project work team at the Sarajevo Youth House, and not long after the city’s airport reopened following the war, I noticed an 8-year-old girl sitting in on an English class with her friend, even though she was unable to communicate in English or even in Bosnian. When I went to help her in the pen pal activities, her teacher told me, "She’s deaf. So there is nothing you can do. It’s a sad story."

Wrong. There was a lot that could be done.

Ajla

We needed to find hearing aids to help Ajla—a challenge in a country with no phone books and few businesses actually running. The local medical center was only able to perform a pure-tone hearing screening (both air and bone conduction) on an ancient machine. No further tests were available.

And there was another problem—the audiologist did not want to give us a copy of the audiogram. He told us that the girl was not worthy of a hearing aid. She should first learn to talk to demonstrate that she would benefit from a hearing aid. Finally, he released the audiogram to us, but only after writing on the back that she should not be given a hearing aid. Fortunately, the hearing aid dealer did not choose to follow that advice.

Getting Ear molds made can be scary! Photo by Jim Hackbarth © 2002

We first tried hearing aids from the American Refugee Committee, but Ajla did not respond to those as well as the aids available for purchase from a hearing aid dealer in town. We had to "fit by behavior," since no aided audiograms were available. An American church group—the Walnut Creek (CA) United Methodist Church Volunteer in Mission Team—pooled their money and two hearing aids were purchased for Ajla. Her smile was incredible when she tried the hearing aids on and was able to hear for the first time.

Of course, Ajla needed aural rehabilitation and speech-language pathology services. She understood about 20 words in her native language and had no expressive speech. She had no knowledge of Bosnian sign language. She used eight meaningful gestures with her family, but these were of limited value since her father was blinded during the war. She was withdrawn and sat quietly for hours.

The Last Bosnian SLP

This boy and his mother travel by bus daily from a village outside of Sarajevo so he can attend school, since no services are available in his village. Photo by Jim Hackbarth © 2002

The search for a Bosnian speech-language pathologist had to be undertaken from California after I returned home because the search for the hearing aids took so much of my time in Bosnia. Finding an SLP took about two months, since the Bosnians we met had never heard of such a profession and did not believe the service was available in Bosnia. We later found that many SLPs had left the country. The one remaining SLP in Sarajevo was employed as a teacher of students with hearing impairments at the Center for Speech and Hearing Rehabilitation. But no hearing services, aural rehabilitation, or speech-language pathology services were offered at the school at that time.

We contracted with this SLP for speech-language pathology services, and Ajla began receiving intensive treatment at the Sarajevo Youth House. By the summer of 2001, Ajla, now 12 years old, was typically speaking in four-word sentences.

The next year, the Bosnian SLP referred two more girls for hearing aids and speech-language services. After learning about their difficulties in school, I began to realize just how handicapping a hearing impairment could be in Bosnia. Students could attend one of two schools for deaf and hard-of-hearing students. In northern Bosnia, there is a school available for students who are considered to be unable to derive benefit from hearing aids. There is another school in Sarajevo available for students who are thought to benefit from a more oral approach. In this school, no signs or gestures are allowed. But the vast majority of Bosnian students with hearing impairments are unable to attend either school, and special services for them are virtually non-existent.

One of the children with a hearing impairment was attending a regular class and struggling. She had no hearing aid, no auditory trainer, received no speech or hearing services, and there were no accommodations or modifications made for her. As in many Bosnian classrooms, there were not enough textbooks for the students, and they were expected to learn from dictation. This student was failing because she was not able to take dictation while the teacher paced the room, her back frequently to the students. After receiving her hearing aids and starting services, this girl was better able to keep up with her class in school.

Kevin Miller and the Bosnian co-therapist working together. Photo by Jim Hackbarth © 2002

In 1999, the Bosnian SLP and I addressed the need for hearing aids for children in Sarajevo. She provided me with audiograms, and I searched for donated hearing aids in the United States. An American audiologist evaluated the children’s audiograms, tested the donated aids, and matched them to the audiograms. The dealer in Sarajevo is unable to perform audiological evaluations, but he could fit the hearing aids to the children’s ears. New hearing aids were purchased for children when donated hearing aids could not be found that matched their needs. These students then began to receive speech and language services as well.

The hearing aids are maintained annually or as needed. New earmolds are crafted annually. Audiological evaluations are provided, although the families need to travel to Croatia for anything more than a simple unaided audiogram.

New Developments

Anita Ouellette enjoys a game of Go-Fish with her client and the Bosnian Co-Therapist. Photo by Jim Hackbarth © 2002

This year, more sophisticated services are available within Bosnia. In Sarajevo, there is now a second hearing aid dealer with an audiologist who can perform audiological evaluations. And at the end of 2001, a pediatric sound booth was donated to a clinic in Medugorje in southern Bosnia. Although it will be years before cochlear implants are available in Bosnia, they are at least starting to be discussed. The best news is that the government has finally decided to approve an expenditure of up to 400 Bosnian marks ($200) toward the purchase of one hearing aid for each child who needs it.

The Bosnia Speech and Hearing Project travels annually to Bosnia to assess the progress of the students we have treated and to develop the next year’s goals in conjunction with the Bosnian SLP. The Bosnian SLP then provides speech and language services to the children throughout the year. Seeing the students’ progress from one year to the next is wonderful. When I left one summer, one boy was working on CV syllables. When I returned the next summer, he was asking questions like "How long do we have to wait for the bus?" He also had been mainstreamed into a regular classroom.

The boy’s father had been shot through the throat in Srebenica and had a paralyzed vocal fold. Previously, their communication was limited to affection and play since the son’s hearing loss had been unaided and the father’s speech was difficult to hear. This boy had a close relationship with his father, and it was rewarding to see they could now communicate with words.

Sharing Treatment Methods

Monica Bein playing Tic Tack Toe. Guess who's the winner! Photo by Jim Hackbarth © 2002

In the summer of 2001, three SLPs—Anna Taggart from Southwest Missouri State University, Jerry Gallagher from Buffalo, NY, and I—went to Bosnia to work with these children. We adapted the Ling Phonetic Evaluation for use with Bosnian phonemes, with Dr. Ling’s permission. Anna said that we seemed to be the ones with the speech and language disorder when we tried to discriminate and produce some of the phonemes that were new to us and communicate basic ideas in Bosnian! We worked with the Bosnian SLP on an exchange basis. We learned about the "verbo-tonal" method that she uses, and she learned about the Ling method for teaching speech to those with hearing impairments.

When we were familiar enough to start working with the Ling phonetic evaluation using Bosnian phonemes, we introduced it to the children and held a training session for the parents as well. We also presented the Bosnian translation of the Ling Phonetic Evaluation and the Ling system to the university students at the University of Tuzla in northern Bosnia.

While at the University of Tuzla, we were able to learn more about the practice of speech-language pathology in Bosnia. There is a four-year training program that includes special education classes as well as speech-language pathology, and students may choose to focus on hearing children or children with hearing impairments. Now approximately 12 students can graduate annually from the University of Tuzla, but they work primarily in special schools as special ed teachers since there is little integration and mainstreaming in Bosnia.

Jean Anne Jordan and Mitzianna Atkinson test hearing aids. Photo by Jim Hackbarth © 2002

We learned that there is now one SLP in the regular school system in northern Bosnia. He serves seven schools and has a caseload of 70 students. There is also now a second SLP in Sarajevo. He works in a clinic at the hospital. With an entire city to serve, he has little time for more than consultation. The first SLP, the one we worked with earlier, is at the Center for Speech and Hearing Rehabilitation and also continues with us at the Bosnia Speech and Hearing Project.

The interpreters that work with us are a valuable part of the team. They are able to interpret English, Bosnian, and Bosnian sign language. Some of them now have four or five summers worth of experience in translating for us and are becoming very familiar with speech-language pathology jargon.

Over the past 4 1/2 years, the Bosnia Speech and Hearing Project has provided over 1,500 hours of treatment and 21 hearing aids, maintained and repaired hearing aids for 13 children, and provided new earmolds annually. It has been rewarding to see the students’ progress in their ability to communicate.

Another measure of success, however, has been the acceptance of these children within their families. After beginning to work with one student, the SLP, Azra, and I made arrangements to go to a restaurant with the family to discuss the girl’s progress. The parents ended up tricking me to get us to the restaurant without the little girl. They were not comfortable with having their little girl seen in public. So she was not allowed to go to the restaurant with everyone else and had to stay hidden away at home. Today, when I am in Bosnia, all of the families go out to a restaurant together, with the children as the centers of attention.

Future Plans

Grace McPherson, the Bosnian Co-Therapist, and the interpreter, pilot the Bosnian Articulation Test. Photo by Jim Hackbarth © 2002

The Bosnia Speech and Hearing Project is actively recruiting SLPs and others to join the 2003 work team in Bosnia on a volunteer basis. The duration of the project is three weeks, although participants are welcome for shorter time periods. The project is also seeking donations of behind-the-ear hearing aids and financial assistance to support year-round therapy services in Bosnia.

For more information, contact Anita Ouellette, info@bosniaspeechandhearing.org or Anna Taggart at ant635s@smsu.edu. You can also visit www.bosniaspeechandhearing.org for more information.

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.

Jerry Gallagher works with a diverse caseload at Windermere Blvd. Elementary School in the Amherst Central School District near Buffalo, NY. He is currently co-president of SHAWNY, the Speech-Language-Hearing Association of Western New York.

AnnaMarie Taggart is a graduate student at Southwest Missouri State University. She will graduate in May and hopes to begin her career in pediatric trauma in the hospital setting. She plans to return to Bosnia this summer.

Reprinted by permission from The ASHA Leader, Vol. 7, No. 5, pp. 1, 20-22, March 19, 2002. © 2002 American Speech-Language-Hearing Association.

Photo by Jim Hackbarth © 2002