Stuttering expert goes intercontinental

There are an estimated 110,000 people in Rwanda who stutter — and just two speech therapists.

Binghamton University’s founding director of speech and language pathology, Rodney Gabel, is hoping to change that and not just in Rwanda, but across the African continent. And one day, perhaps even farther.

In conjunction with the African Stuttering Centre in Rwanda, Gabel recently completed the Stuttering E-Training Africa program, an initiative to teach healthcare providers in eight countries about stuttering and how to help those who stutter.

Many African countries lack speech- or stuttering-therapy services and have limited access to accurate information about the condition or its treatment. As a result, some of those who stutter turn to physicians and other healthcare professionals, but most of these providers have little training in stuttering or speech therapy.

Gabel, an expert in stuttering and the psychosocial impact of communications disorders, combined recorded lectures, live Zoom discussions and WhatsApp communications to bring together his more than 80 students from Kenya, Rwanda, Ghana, Botswana, Tanzania, Zambia, South Africa and Nigeria. Participants included medical students, mental health counselors, nurses and speech therapists, along with members of self-help groups for those who stutter.

The program, which is provided free of charge, was split into two four-week sessions. During the first four weeks, Gabel provided an “Introduction to Stuttering,” as well as what caregivers should and shouldn’t do to help their patients. He also presented an overview of how to deliver both self-therapy and speech therapy.

“There is a free book, Self-Therapy for the Stutterer, by Malcolm Fraser, which is put out by the Stuttering Foundation. That is our text,” Gabel said. “I teach the course from that perspective.”

Gabel explained that the second four-week session, which was optional and concluded at the end of October, was similar to office hours where he was available to consult with students and answer their questions.

“Most of the people who continued into October were speech therapists and others who have active caseloads,” he said.

The response from students, according to Gabel and Dieudonne Nsabimana, coordinator at the African Stuttering Centre, was overwhelmingly positive.

“I gathered suggestions and ideas that will help me work with clients to overcome the impact of stuttering,” said Basilisse Mukamana from Rwanda, a psychotherapist with the National Commission for the Fight against Genocide. “This training will help me teach others to embrace their identity as a person who stutters and to reduce their avoidance behaviors, since these only increase the physical struggle and promote negative feelings about speech.”

“I will use the guidelines I have learned in my daily work with clients in the future,” said Cecile Umurazawase, a clinical psychologist at Health for Community Development, a nongovernment health organization in Rwanda who completed the course. “But, I think the community must become informed about stuttering because they have no information about this.”

More than just a fluency disorder

“There is a complete lack of knowledge among African teachers about stuttering; they don’t know how to help students with communication disorders,” said Nsabimana. “And in most African schools there are no speech-language pathologists who can help students and teachers understand the problem and manage it more effectively.”

He added that not only don’t students who stutter receive the support they need to succeed, but they are also frequently subject to physical and verbal abuse.

“Teachers in some East African countries use corporal punishment when a student hesitates to answer a question, hitting pupils with a stick, their hand or another object,” he said. “Schools should not be places of fear and violence, but this is the reality for students who stutter.”

Many African countries have high dropout rates for students who stutter, but the difficulties these individuals face don’t stop when they leave school.

“Stuttering can have an extreme impact on communication and all parts of a person’s life,” Nsabimana added. “Individuals of all ages who stutter are often marginalized, missing out on equal access to education and employment opportunities.”

Additionally, he said stutterers sometimes turn to drastic measures including spiritual or faith healing, unnecessary surgeries (cutting the lingua frenum, a membrane beneath the tongue) or ingesting potentially dangerous items.

A program with a past, and a future

Committed to helping those who stutter, like themselves, Gabel and Nsabimana decided that developing a training program would be the best use of their limited resources, since the project is not funded. The recent program is their third collaboration.

“We ran a pilot program in January, but we had to stop because of the pandemic,” Gabel said. “Then, we restarted it in May with an eight-week course that followed a similar model, but without the Zoom meetings. Six people completed that.”

Following the May course, Gabel and Nsabimana determined that an eight-week commitment might be too much for students. As a result, they made the last four weeks optional.

“That’s what is great about this program,” Gabel said. “We’re able to adapt it to fit participants’ needs.”

Nsabimana hopes to expand the program to additional African countries. He also intends to organize a Train-the-Trainer workshop for school leaders so they can learn how to assist students with communication disorders within the school environment. His aim is to stop students who stutter from dropping out of school. Both initiatives would be free to participants.

Expansion is likewise part of Gabel’s plan. And, if he can secure funding, he would like to bring clinicians into the program to provide stuttering therapy. In the future, he’d also like to add speech-language pathology students to the initiative. Binghamton’s Decker College of Nursing and Health Sciences is developing the speech-language pathology program, which is expected to welcome a first cohort of master’s-level students in 2024.

What other plans does Gabel have for the future of Decker College’s Division of Speech and Language Pathology?

“I really want to set up a worldwide or nationwide consortium for speech therapy, and within that we would primarily focus on stuttering,” he said. “I would like Decker to offer a teletherapy clinic where we provide services in rural communities across New York state. Stuttering would be a big part of that because there’s such a shortage of people providing stuttering therapy.”