Pre-school children’s incorrect pronunciation is commonly regarded as immature development. The elderly’s difficulty in chewing and swallowing is often accepted as a process of degeneration. These are all misconceptions. Professional speech therapy is, unknown to many, the solution to these problems in various stages of life such as difficulties in conversing and swallowing. It can improve the quality of life, physical well-being as well as social and communication skills of patients.
In this issue of Cubic Zine, Prof Kathy Lee, Associate Professor & Chief, Division of Speech Therapy, Department of Otorhinolaryngology, Head and Neck Surgery, Faculty of Medicine, CUHK shares with us the key to communication and secrets “beyond words” in her 30-plus years in speech therapy. Kathy is founder of CUHK Division of Speech Therapy and among Hong Kong’s first batch of graduates in Bachelor of Science (Speech and Hearing). She is also the first to establish the test of oral language in Cantonese.
The first graduate
Kathy completed her bachelor’s degree in Anthropology at CUHK in 1986, then spent 4 years to study another undergraduate course in Speech and Hearing. Some say doing 2 undergraduate degrees is a waste of money and time. Kathy thinks otherwise, “Anthropology taught me how to understand and embrace different culture and people. The study of language is one of the main subject areas of Anthropology.. I was intrigued by language and linguistics. I realised that linguistics could be applied in speech therapy.”
It was not a detour to change course academically, rather it was a fearless attempt to drive oneself forward. “Upon graduating from Anthropology, I worked in a special school as Teacher Assisting in Speech Therapy and had to lead student training sessions independently. I tried hard for 2 years but did not quite master the skills. It was not ideal to spend time without much progress, especially that of the students in need.”
“I was certain that I would regret not taking it. I might become a panel head or even school principal if I had stayed in the school. But it might not be the kind of work that I really liked to do. I hence quitted and studied again. I was the first batch of graduates of the programme of Bachelor of Science in Speech and Hearing Sciences at HKU, and I became a speech therapist.”
”This job was just fascinating!”
Intensive practicum is a prerequisite for becoming a speech therapist. For instance, students of Master of Science in Speech-Language Pathology at CUHK have to undertake at least 300 hours of practicum with direct contact with service users. Kathy continues, “Do not even think about taking part-time job or having any leisure time at all. 24 hours are simply not enough for a day. Stress? It depends how resilient and passionate you are.”
“Fortunately the job was fascinating, and have been in love with in since then.”
Kathy goes on with the joy as a speech therapist. “We spend most of our time seeing clients. Each who comes in is different. Even for two clients suffered from stroke, their symptoms and conditions vary. You never get bored with meeting new challenges every day.”
Healing life’s beginning and end
Speech therapy is a professional rehabilitation service for people with difficulties or impairments in communication including listening, speaking, reading, writing and/or swallowing. “Speech therapists serve a diverse clientele. One may have to see a speech therapist in different stages of life due to various reasons. We deal with cases such as premature babies who are unable to suck or eat, children who do not pronounce correctly, adults who do not use their voices properly or cannot speak fluently, and elderlies who suffer from aphasia or cognitive impairment after a stroke.”
For the first 3 years upon graduation, Kathy worked at the Child Assessment Centre of the Department of Health. It was a bitter-sweet experience. “What I learnt in the 4 years’of study was really very limited. I remember most vividly my first autistic child client. Every time he came he would walk round the walls or keep crying. None of the things I prepared was of use. I was so frustrated that I even had nightmares. Fortunately the Centre adopted team approach and I had assistance and advice from paediatricians, psychologists and ccupational therapists. Later I realised I should have referred children with this kind of disorder to an occupational therapist as soon as possible for attention training.”
Kathy is grateful that work gives her lessons of life. “I I met a chronically ill patient in her 20s during my first visit to Cheshire Nursery Home. I have only 5 years’ therapy experience then. She had an ischemic stroke and became vegetative overnight. Worse still, she was pregnant at that time and the child had to be delivered by emergency caesarean section. I was responsible for finding a medium for her to communicate. One day I saw a photograph by the bedside. The photograph was brought by her family, featuring her toddler. I showed her the photograph and she smiled — she was not unresponsive to the outside world. I hence trained her to communicate with eyes to indicate ‘yes’ or ‘no’ with the number of winks. This was how I opened the door of communication for her.”
“We tend to complain a lot of things. Yet it’s a blessing to be able to breathe and walk. I am not religious, but I think we should have a grateful heart to all people and in all circumstances.”
Cultivating her own garden
From having to bring unfinished tasks home everyday, Kathy had more confidence in handling clinical duties. She kept exploring and pursuing for better. “At this stage I was looking for a change. At a career talk the speaker compared career development to horticulture. The land is teemed with wild flowers and grasses. You have to keep pruning to clear a way, otherwise everything is in chaos.”
“I wanted to switch to a wider spectrum. I hence went to Hospital Authority and joined the project team on cochlear implant as a speech therapist. It was a new project and the team had speech therapists, audiologists, otolaryngologists, psychiatrists and so on to design and deliver a series of assessment and training. Unexpectedly, I also met a lot of other case types at this post, like seeing 7 to 8 elderlies in an hour to determine their diet types by their eating conditions. The 10 years at Hospital Authority gave me solid experience to deal with adult cases, and to prepare for another change.”
Kathy emphasises, “Continuous learning is very important in career development. Upon graduating from the university, no one is obliged to teach you, and you will have to learn or look for learning opportunities on your own.”
“At that time there was a lack of speech therapy assessment tools, and those available were introduced from abroad that might not be entirely suitable for local application. Different institutions developed and implemented their own sets of assessment tools. So I had this wish of creating a systematic assessment tool for Hong Kong.”
“How to force myself to get this done? Enrol in a study programme.. People asked me if I wanted to switch to the academia. This was out of my consideration as I only wanted to work on assessment tools. I decided to do PhD and created the first ever test on speech perception for hearing impaired children.”
Establishing the Division of Speech Therapy single-handedly
Kathy joined CUHK in 2005. “It was a new department split into various divisions. I established the whole division single-handedly — another huge challenge indeed. In the past I mainly saw patients, now the scope that I oversee is a lot larger. Its another challenge for me.” The division has since grown from a one-man band to a team of nearly 20 persons. Kathy underplays the tremendous achievement, “We are as poor as church mice! We have to strive for research funding to keep the whole team. We have to look for funding for research, education and community activities to promote speech therapy in mainland China, Hong Kong and Macau.”
How to run a social enterprise with low profile and zero business experience?
Speech therapists are generally regarded as highly paid professionals, who can practice till retirement by replying on the professional licence alone.
Kathy instead thinks this is a stumbling block to professionals to move between different posts and fields deftly. “Acclaimed as it seems, many fellow colleagues got big-headed by their own ego and become self-important. The world actually keeps changing. What we have learnt may not be the best answer. We have to be humble and move on.”
It is important for professionals to keep learning and striving for better. Kathy continues, “One’s knowledge is never enough. Since I joined CUHK, I have been organising research and related trainings every year. I attended overseas courses, and invited the instructors to teach in Hong Kong when I found their sharing useful. I worked my way up from the bottom in clinical therapy then to the academia. That’s why our courses are popular — they are relevant and practical. At this point I pondered, can we set up a company to operate these courses and services? We wanted to go B2B to answer the demand in the profession for training programmes.”
Having travelled extensively, Kathy found that there are some general misunderstandings towards speech therapy, and she also saw the pain points in the profession. All these prompted her to set up a social enterprise to serve the community with her experience and expertise.
In 2021, Kathy and her team were awarded the CUHK Sustainable Knowledge Transfer Project Fund (S-KPF) to establish Speech and Hearing Social Enterprise Limited (Speech and Hearing Social Enterprise).
Does Kathy know how to run a company sustainably before the start-up? “Honestly I don’t! But I have nothing to lose. I’m particularly grateful to CUHK for the provision of funding and consultancy in business operation. Given the support we should give it a try, and carry on if we succeed!”
Kathy is thankful to the coaching of Ms Fiona Wat. “I am quite lily-livered and struggle a lot to leave my comfort zone. My hesitation in setting up a social enterprise is that I do not want to be high profile. Self-effacing as I am, I try to decline interview opportunities and keep a low profile. I am not at all comfortable with a lot of people knowing me. Yet when I hear people promoting misconceptions, for instance, tongue-tied children could speak properly with more tongue exercise, I will jump in and speak out. This is quite exhausting, but I just can’t help it. Fiona teaches me, Kathy, keep a low profile personally, but high profile in your work. ”
Ripple effect
Last August, Speech and Hearing teamed up with CUHK Department of Otorhinolaryngology, Head and Neck Surgery and Institute of Human Communicative Research to launch the Hong Kong Cantonese Language Assessment Scale for Preschool Children (HKCLASS-P).To the team’s surprise, 187 of the participants registered with Speech and Hearing as volunteers. Among them 100 were speech therapists. Others included psychologists, teachers and social workers. “I told the story behind the social enterprise — we work in the community with educational activities and assessment tools to turn over and give back, such as low-income families and those who are unable to afford therapies. I believe this is a platform for all.”
“I know not all 187 sign-ups were ready to commit. We had a few zoom meetings around Christmas to gauge the outturn. Only some 10 of them stayed. They were still further nice surprise though. Apart from offering free consultation, they brought up home visits including those for refugees. They also raised issues with elderlies not following dietary requirements after leaving hospital, and problems that school-based speech therapists faced.”
“Speech therapists in Hong Kong work on their own, and often painstakingly. It would be great if these scattered resources can pool into Speech and Hearing. For instance, there are research projects done abroad to trace the relationship between speech disorder of perpetrators and crime rate, and provided the findings to the government for consideration of preventive measures.” “I was so excited after the zoom meetings. I realised that there are a lot of people who want to do good. Professionals are sometimes too aloft to see needs of the grassroots. Speech and Hearing can channel professionals into the community and do good to the society.”
Psychological clock
“For a period I was totally stressed out. I was working at Prince of Wales Hospital, overseeing the New Territories East Cluster of Hospital Authority. I would have to go to North District Hospital for one or two afternoons per week. Patients kept coming in. At one point I had to see 20 patients in a single afternoon to decide for each of them whether they could eat. I was so stressed that I had stomach-ache even before starting to work. I told myself that this could not go on. I adjusted myself, and evened out the workload till 7pm. Knowing that I had more time to work, my stomach-ache disappeared.”
“Mentality aside, work-life balance was also much discussed. People ask me, Kathy, are you busy? In the past I would say I am, likewise for now. Before that I felt guilty doing yoga in the morning — I should be working in the office. Not now. Now my mentality is work-life integration. You simply cannot separate work from life. I check emails and answer questions during vacations. For every hour in my life it’s either work or life. They are inseparable, so I do not feel bad about that.”
Keep learning for better
Kathy likes yoga. She finds similarities between yoga and speech therapy. “I started doing yoga for health reasons, then studied for 4 years to become a yoga instructor. The license course was hard. One has to apply theory and teach on the spot poses to students to tackle their various physical and posture problems. I think it’s more difficult than the speech therapy exam! As a learner, I empathise the anxiety of students. I realised pressure could indeed affect performance, now I am more cognisant of what students need in their learning process.”
No matter how old you are, if you are hesitant in chasing your dream, here’s Kathy’s advice. “Back then a lot of people told me it’s a waste of time to spend 4 more years to study speech therapy. Come to think of it, one lives at least 60 years, 4 years really isn’t that much. Young people often ask me whether they should go for something. I say, if you like it, it’s definitely worth. I would ask instead, how much do you want to go for it? How eager are you to make a change?”
“You will do whatever you put your mind to, not for a particular purpose but just from the bottom of your heart. Everyone is unique. My motto — start from people, with all your heart.”
Tips in running a social enterprise
Kathy shares, “I got to know Professor Ann Zubrick when I studied speech therapy at HKU. She came from Australia to Hong Kong and founded the speech therapy programme here.”
“This is me. I don’t talk about plans. It’s like bluffing when one talks about things that have not yet been done. I don’t like to brag.”
Yet Professor Ann Zubrick encouraged me to talk about new plans to anyone no matter how little to start with. The more you talk, the more the plan will be known to others, and the more likely it will succeed. Maybe only one out of ten persons who get to know your plan may come to help you. One who actually helps is already good enough. But if you don’t talk, no one will come to help at all. Amazingly, it works! When I promote speech therapy in mainland China, a lot of people approach me about collaboration. I guess not all of them are really serious, perhaps just half. Had I not spoken my mind, I would not even get to know people who really want to make things work.”
