Lesson from Rwanda: Using Technology to Provide Access to Therapy (Dieudonne Nsabimana)

About the Author: My name is Dieudonne Nsabimana, I am the Coordinator of the African Stuttering Centre (ASC) and Chair of an umbrella organization of people who stutter in Rwanda.Because stuttering is big stigma in Africa, I became an activist and I fight for the rights of people who stutter.

There are only two Speech-language Pathologists (SLPs) in Rwanda for a population of over eleven million people. Using the universally accepted incidence rates of stuttering (one percent of the population), there are 110,000 people who stutter in Rwanda, resulting in an estimate of one SLP for 55,000 people who stutter.  Clearly access to treatment for stuttering is not available to all who need it.

The application of telehealth technologies offers effective solutions to this challenge.  Distance Stuttering Therapy Program Africa (DSTPA) has been developed in Rwanda to deal with this shortfall.

The DSTPA is unlocking the voices of people who stutter across a part of Rwanda by providing free speech therapy using video conferencing calls. It is delivered by graduate students from the Florida Atlantic University (FAU) and the Southeast Missouri State University (SMSU) who are supervised by certified and licensed SLPs.

DSTPA is the first program to provide tele-therapy to patients in Africa where there has been no access to therapy services, and also heals the negative emotions caused by stuttering. This program was initiated in 2010 by two people, who once stuttered themselves; Mr. Dieudonne Nsabimana, Founder of the African Stuttering Center (ASC) and Dr. Dale Williams, Professor at the Florida Atlantic University (FAU).  After years of working out logistics, the program welcomed its first patient in February 2014.

Dr. Williams says the all clients have made great progress towards their long-term goals. In fact, one of his clients, Francois, states: “The treatment is perfect for me and helping me to improve my speech — it’s also easy to take part in since I don’t need to travel elsewhere. We are using Skype video calls and sharing documents through e-mails.”

The program is clearly popular, with the experience of conversing via Skype proving to be just as personal as face-to-face therapy.

I am confident that other universities will follow the generous involvements of FAU and SMSU in providing tele-therapy — already having been contacted by University of Ottawa and University of California Riverside School of Medicine for more information.

Note this related submission from Dale Williams.

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Comments

Lesson from Rwanda: Using Technology to Provide Access to Therapy (Dieudonne Nsabimana) — 22 Comments

  1. I am a graduate in an advanced fluency class in Minnesota. I enjoy learning about how speech therapy services impact the lives of others living outside of the United States. What difficulties have you faced using telehealth technologies and what have you done to overcome those challenges? Do you believe the patient’s receive the same benefit by providing speech therapy via video conference calling versus face-to-face interaction?

    • Thank you for your nice comments. We have bad connection, but we are working hard to overcome these challenges, by looking the ways we can using 4G during distance therapy session.

  2. Dear Mr. Dieudonne Nsabimana,

    Thank you for sharing your articles at this online conference. I am a graduate student in Speech Language Pathology, but as someone who received an undergraduate degree in Asian Studies, I am always interested in learning about the way that other societies address speech language differences and disabilities.

    In your other article, you mention the hardships that are placed on children who stutter from within their own communities.

    Do you think that using tele-therapy technology for larger, community-based outreach would be helpful for educating rural areas? For instance, do you think it would be helpful to bring a tele-conference or interactive workshop to a school or rural community, besides providing translated pamphlets? I only mention this because it seems that resources may be limited, and perhaps your partnering graduate students could contribute to a community outreach effort using technology such as Skype. Similar to organized community prevention activities, educational outreach initiatives can be impactful.

    Most Sincerely,

    Juliana P.

    • Hi Juliana, thanks for your comments!
      Yes, we can organize train-the-trainer workshops by teleconference. It is often thought that if someone is competent in a certain region, he can easily pass on his knowledge to others.
      If you have some ideas on train-the-trainer, do not hesitate to contact me directly at: africanstutteringcentre@gmail.com

  3. Mr. Dieudonne Nsabimana,

    Thank you so much for your insights on this topic, and for sharing your personal experience. I have a passion for serving other countries’ communication disorders. One barrier I thought existed is the lack of privacy most video chat software provides. Have you found this to be a dilemma in the aspect of HIPAA?

    Thanks so much,
    Kacie

    • Thanks for your comments!
      Only in this year we referred more than 50 patients / clients.
      Other universities are welcome to follow the generous involvements of FAU and SMSU in providing tele-therapy. Because demand is very high.

  4. First off, thank you for taking the time to share this program with us. As future SLPs living in a part of the U.S. that is more rural, we are very interested in how we may be able to build off of your model to reach people here in the rural U.S. as well. As we consider barriers to access, we were wondering if you could address how the technology is provided and the rate of “technology trouble shooting” that happens for the average client? Are clients given a personal device and wifi hot spot, are there computer hubs, or government provided computer spaces such as free public libraries were clients are able to go and use free internet services? Furthermore, do your clinicians and clients often have to trouble shoot technology freezing during the session, and if so what are some effective strategies you’ve developed to address technological issues?

    We are very excited about the prospect of teletherapy and appreciate your groundbreaking work.

    • Thanks for your comments!
      Yes, you can build this model to reach people in rural areas of the United States, but you must see the US law, on Teletherapy and regulatory obligations.

      First of all, we have a center called “African Stuttering Reseach Centre” ​​which has an appropriate placement for teletherapy.
      the role of our center is to connect clients / patients with partner universities. The staff of our center are the facilitators.
      For now, our center does not have enough computers for clients / patients yet. Therefore, some clients / patients use their own computer in our center to receive therapy. I believe we will have all these materials in the future!

      Sometimes, we have a weak connection, which can cause freezing problems during the session. but we are working hard to overcome these challenges, by looking at the ways we can use 4G in distance therapy sessions

  5. Hello Mr. Dieudonne Nsabimana,

    My name is Haley Dorrell and I am a first year SLP graduate student at Western Carolina University. Throughout my stuttering course, we focus a lot on diversity and multicultural awareness. I really enjoyed reading about this new technology. As an aspiring speech language pathologist, it is interesting to learn about new intervention approaches. You mention that this technology is still healing the negative emotions that can be caused by stuttering. Would you say that the graduate students providing the therapy use techniques such as Stuttering Modification or Fluency Shaping? I learned that the stuttering modification approach specifically addresses ones avoidance behaviors seeking to reduce these and increase one’s fluency. However, the fluency shaping approach focuses only on the increase of fluent speech rather than one’s feelings that go along with stuttering. Which of these approaches would be best with this type of technology? Furthermore, what severity of stuttering would you say this technology works best for?

    Thank you for your contribution, I look forward to your reply!

    • Hi Haley, thank you for your comments!
      in our center, we are facilitators, our role is to connect clients / patients with partner universities. we are not involved in the techniques and procedures of therapy
      Can you address your question to Dr. Dale William at: dwilliam@fau.edu

  6. Hi Dieudonne

    What a fantastic approach. More grease to your elbow. I am sure increasing use of smartphones have made it easier for you to have much success.

    How do you assist clients that do not have access to Internet services?

    Thank you

    Jonas

  7. Hello! Jonas, thanks for your comments! I appreciate you taking the time to read my article.
    However, patients/clients who do not have access to Internet services have used the Internet services of our center,services are free.
    But, we have limited computers, and we need to add more IPD / computers

  8. Hi Dieudonne,

    I am a student of Speech-Language Pathology and was very interested to hear about DSTPA. Thank you for taking the time to share about this exciting program. It’s wonderful that you are able to use technology to help facilitate therapy and help individuals decrease their negative feelings about stuttering. I was wondering, how do you recruit clients for DSTPA? At this point, are you able to provide therapy to all who are interested, or is there a waiting list?

    Best,
    Charlotte

  9. Thank you for sharing this information! I am currently a speech language pathology graduate student and am extremely interested in one day participating in tele-therapy. It is great to hear that tele-therapy is so effective where you are from. From your experience, what suggestions would you make to SLP giving online therapy? It may be challenging to perform therapy without face-to-face interaction and I am curious to know which therapy strategies have shown to be the most effective.

    Thank you!
    Dani M

  10. Hi Mr. Dieudonne Nsabimana, 

    Thank you for sharing this post. I am a 2nd year graduate student, working toward becoming a Speech Language Pathologist. I am attending graduate school at the University of Redlands, California, but received my undergraduate degree in Israel. As someone who received their degree outside of the states, I am always interested in learning about how speech language pathology is addressed in other societies. Do you think that the reason that there are few SLPs Rwanda has to do with people’s lack of awareness about the existence of this field? In Israel, working in the field of Speech Pathology is much less common than in the states, and I have wondered if this has to do with the little knowledge people have about the field itself. Personally, I have thought about moving back to Israel after completing my graduate studies, however, the few opportunities of working as an SLP there makes me think otherwise.

    Thank you for your time,
    Gal Y.

  11. Thank you so much for sharing your story and experiences. It is so impressive to see that you were able to cause positive change in your country and make a difference by allowing people who stutter access to tele-therapy. Would you be able to share more about the initial collaboration between you and Dr. Williams? What challenges did you encounter in the beginning? How did you overcome these challenges? What is your advice for others trying to create tele-therapy spaces in rural areas/ outside of the United States?

    Thank you for your time,
    Marisol

  12. Hello Mr. Dieudonne Nsabimana,

    Thank you for sharing your article. I am currently a graduate student in a Speech-Language Pathology program, and I find the work you are doing genuinely inspiring. I was curious to know if you only provide teletherapy to individuals above a certain age, or if there are any criteria in place that must be met for someone to be a candidate for teletherapy. Additionally, I read in the above comments that the program currently serves 50 clients at once, do these clients rotate and if so, how often?

    Thank you so much,
    Maria N.

  13. Hi Mr. Dieudonne Nsabimana,

    I am a speech-language pathology student in Idaho and I am very interested in tele-health as a means of reaching more people. The discrepancy that you described between the number of people who need services and the number of providers is staggering. I would love to know more about this program and any of the results that have been gathered about the outcomes. From what I’ve researched about tele-health, often the outcomes for online clients are on par with clients receiving in-person treatment.

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