Etapas para la Elaboración del Proyecto Educativo Institucional

The second global theme describes how outsiders recognised the strengths of Ugandan SLTs. However, outsiders expressed concern over insiders’ abilities to be fully independent from outsider support, chiefly because of a lack of clinical experience. Outsiders were uncomfortable with the potential of their own work to be associated with Uganda’s colonial history. Outsiders acknowledged a desire for specific things or milestones to have occurred, but had not been achieved and were not currently possible. Outsiders aimed to reconcile this need by accepting the reality of the present situation.

Table 4.14 Outsider global theme 2. Reconciling Ugandan control and outsiders’

expertise

Organising theme 1. Idealism and realism

This organising theme describes outsiders’ often-held ideal that Ugandan SLTs were better suited to work and take the lead in delivering Ugandan SLT

services. In reality, however, outsiders felt Ugandan insiders were not yet

Basic themes Organising

themes

Global themes

1. Transition period 1. Idealism and realism

2. Reconciling Ugandan control and outsiders’ expertise 2. Reconciling ideals with concerns

3. Uncertainty about future services for PWCD

1. Identity 2. Colonial history 2. Roles

experienced enough for this to be completely successful. This doubt was

directed at the Ugandan profession as a whole, the SLT course specifically and individual SLT clinicians.

BT1. Transition period

Outsiders felt there should have been a gradual transition and handover of outsider support. This mainly focused on the unplanned withdrawal of support of the main NGO providing outsider SLTs to work on the course. However, for a variety of reasons this did not happen. The majority of outsiders described how the support from the outsider organisation was planned to gradually reduce over a five year period to allow for Ugandan sustainability. There was

disagreement amongst the outsiders over whether the NGO had prevented a transition period. The majority believed that a memorandum of understanding had been signed (guaranteeing a longer commitment and staggered transition from the NGO), however one outsider claimed this memorandum of

understanding had not been signed. Outsiders felt that a lack of transition had threatened the sustainability of the SLT course and, in turn, the profession as a whole.

OU11: “If you can imagine running a course here … with initial graduates…it would be limited… relying heavily in what you’d been taught, um, and you wouldn’t have time… to be reading more

widely and finding out about things that you weren’t taught that you might bring into your teaching”

This theme explored outsiders views that Ugandan SLTs need to be

independent from outsider support in order for the Ugandan SLT service to be sustainable.

BT2. Reconciling ideals with concerns

This theme explored how outsiders had difficulties reconciling the ideal of a Ugandan SLT and Ugandan SLTs leading change, with their concerns about the changes that the Ugandan SLTs were making. Outsiders had specific concerns about how services and Ugandan SLTs were developing, as well as specific ideas of what they felt insiders should do to lead change. This included activities

and ways of working such as raising awareness with the public or other health professionals; the need for research and normative data on Ugandan PWCD; working with PWCD to develop the service in line with their needs; and

strengthening the profession by obtaining recognition. Outsiders recognised that Ugandans needed to have ownership and responsibility of the service. Outsiders felt that Ugandan SLTs provided a more appropriate service for Ugandan PWCDs. This could be seen by descriptions of it being an “African version of SLT,” and therefore “good”.

OU6: “yeah I’m pretty sure they don’t want any outsider support…[it] gives the impression that they now want to own it for themselves which is fair enough really”

BT3. Uncertainty about future services for PWCD

This theme explored how outsiders were anxious or uncertain about the future of services for PWCD in Uganda. Outsiders were largely uncertain about the future of the profession, particularly in relation to the sustainability of the

Ugandan SLT programme. This uncertainty was felt by outsiders still working in Uganda, and those who had left. When describing the future, outsiders typically used optimistic language such as “hope” while simultaneously indicating

differences in what they hoped for, and what they thought would happen in reality.

OU1: “You know some of the students are committed [to] speech therapy and it is their future and it is going to be their career and they're going to be turned out without being able to practice properly as a speech

therapists… that really is very very sad”

Organising theme 2. Colonial history

This second organising theme in this global theme discusses how outsiders were aware of the colonial history of Uganda and of comparisons of this to their work today. Outsiders were uncomfortable with the history of colonialism, and were keen to avoid practice that continued (or was associated with) its legacy.

BT1. Identity

This theme explored the differences between insider and outsider identities. Though outsiders never felt like full members of Ugandan society, there were both positive and negative dimensions to this. Outsiders felt they typically had a higher status than Ugandans, and were seen as having more power. However this meant they had to be careful not to misuse their power. This aspect of identity was seen as a consequence of colonial history. It also allowed them to break cultural norms for therapy and suggest interventions for the clients’ benefit that may be considered culturally strange. Outsiders often felt that they were not the best person to work with Ugandan PWCD because of their

outsider status, and described anxiety when working as an outsider. They had to consider the most appropriate ways of working in conditions where there was little support, with CDs of which they perhaps had limited or no experience, and consider how their clinical expertise could be culturally appropriate, avoiding working in a way that was culturally imperialistic. Outsider relationships with insiders were often compared using a mother / child analogy.

OU1: “she started talking about colonial times and breastfeeding

babies…and I I didn't know if I was the mother that was breastfeeding or I was the baby being breastfed… breastfeeding the baby and the baby and the baby biting the mother…and I thought ‘oh I’m the mother here and I'm being bitten by the baby’…and then she start talking about colonial input and mzungus”

BT2. Roles

This basic theme relates to how outsiders saw their and Ugandans’ roles. Outsiders were perceived as “experts” in SLT. Insiders were perceived as

outsiders’ “cultural guides.” This suggests a divide in power based on perceived expertise, as insiders were always basing their understanding of SLT from outsiders’ views. There was no suggestion of if and when there would be an exchange of power and roles, or ability for insiders to not only have their existing cultural expertise, but clinical expertise.

OU9: “it needs to be collaborative with the outsiders bringing knowledge of speech and language therapy services of how things should run and

what a gold standard is or what the end goal is umm but then also having the insider side of knowing understanding that culture”

BT3. Being useful

Outsiders attempted to reduce the differences between roles and status and to allow for more fair and equal exchanges and relationships. One approach was to ensure that outsiders coming to Uganda were actually highly skilled,

adaptable and experienced, and therefore could be genuinely seen as having more clinical expertise than insiders. This was seen as preferable to outsiders who were perceived as not highly skilled, but were nevertheless endowed with a higher status than insider counterparts. In this way, perhaps outsiders felt relatively less uncomfortable when treated better than their insider counterparts: at least they were “better” than other, less useful, outsiders.

OU1: “you [need to] have considerable experience and knowledge and something to offer”

This meant that outsiders needed to evaluate their overall ability to contribute to services for PWCD in Uganda. Insiders felt long-term workers were more

desirable overall in all contexts and working roles. Exceptions (for short-term work) occurred when there were specific skill sets missing from existing SLTs where a specialist SLT would be able to offer short-term but focused training. Some outsiders talked about discouraging short-term volunteers as they found their presence disruptive. Some outsiders also asked the researcher how she could be part of offering something useful to insiders.