The history of Speech-language Pathology in Minas Gerais state: the main characters' impression

Abstracts

PURPOSE: to present the course traced by Speech-language Pathology in Minas Gerais state since the arrival of the first professionals up to the current time. METHOD: it is an exploratory and historical field research based on a quality-quantitative approach. Twenty-seven professionals including speech-language pathologists and doctors involved in the process of implementing, organizing and managing services, courses and Speech-language pathology offices took part in this study. Data were collected by using documents research and semi-structured interviews. Then, there was a categorization of the documents and interviews. RESULTS: the historical report begins with the arrival of the first speech-language pathologists in Minas Gerais. The description of the interviews is divided in the following categories: first time in touch with Speech-language pathology; motivation for choosing this professional occupation; insertion in Speech-language pathology; motivation for working in Minas Gerais; context of this science from the 1970s to the 1990s; career development; boost to the recognition and progress of the profession; Speech-language pathology perspectives; evaluation of the historical study. CONCLUSION: it was possible to demonstrate the course traced by Speech-language Pathology in Minas Gerais province since the arrival of the first professionals up to the current time.

Historical Article; Speech, Language; Hearing Sciences

OBJETIVO: apresentar o percurso seguido pela Fonoaudiologia no estado de Minas Gerais desde a chegada dos primeiros profissionais até os dias de hoje. MÉTODO: trata-se de pesquisa de campo, exploratória e histórica, de abordagem qualiquantitativa. Participaram 27 profissionais, fonoaudiólogos e médicos envolvidos no processo de implantação, organização e gestão de serviços, cursos e consultórios de Fonoaudiologia. A coleta de dados ocorreu por meio do levantamento de documentos e entrevistas semi-estruturadas. Após essa fase, houve a categorização dos documentos e das entrevistas. RESULTADOS: o relato do histórico se inicia com a chegada dos primeiros fonoaudiólogos em Minas Gerais. A descrição das entrevistas se divide nas seguintes categorias: contato com a Fonoaudiologia; motivação para a escolha da profissão; inserção na Fonoaudiologia; motivação para o trabalho em Minas; contexto da Fonoaudiologia em Minas Gerais nas décadas de 70 a 90; formação profissional; impulsos para o reconhecimento e avanços da profissão; perspectivas da Fonoaudiologia; avaliação do estudo histórico. CONCLUSÃO: foi possível demonstrar o caminho que a Fonoaudiologia traçou no estado de Minas Gerais desde a chegada dos primeiros fonoaudiólogos até os dias de hoje.

Artigo Histórico; Fonoaudiologia

The history of speech-language pathology in Minas Gerais state: the main characters' impression

Fernanda Caroline Braga Pereira^I; Poliane Cristina de Lima Aarão^II; Karoline Lopes Seixas^III; Hildinéia das Graças Silva^IV; Amanda Pereira Nunes Tavares^V; Fernanda Rodrigues Campos^VI; Stela Maris Aguiar Lemos^VII; Ana Cristina Côrtes Gama^VIII

^ISpeech Therapist graduated at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil

^IISpeech Therapist graduated at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais - Brazil

^IIISpeech Therapist graduated at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais - Brazil

^IVSpeech Therapist graduated at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais - Brazil

^VNurse graduated at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais - Brazil

^VISpeech Therapist; Master's degree in Ciências da Saúde - Saúde da criança e do adolescente (Health Science - Child and Adolescent's Health) from Universidade Federal de Minas Gerais

^VIISpeech Therapist; Assistant Professor in the Speech Therapy course at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Doctorate degree in Ciências dos Distúrbios da Comunicação (Communication Disorders Science) from Universidade Federal de São Paulo

^VIIISpeech Therapist; Assistant Professor in the Speech Therapy course at Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brasil; Doctorate degree in Ciências dos Distúrbios da Comunicação (Communication Disorders Science) from Universidade Federal de São Paulo

^{Mailing Address}

ABSTRACT

PURPOSE: to present the course traced by Speech-language Pathology in Minas Gerais province since the arrival of the first professionals up to current time.

METHOD: it is an exploratory and historical field research based on a qualiquantitative approach. Twenty-seven professionals including speech-language pathologists and doctors involved in the process of implantation, organization and management of services, courses and Speech-language pathology offices took part in this study. Data were collected by means of documents research and semi-structured interviews. Then, there was a categorization of the documents and interviews.

RESULTS: the historical report begins with the arrival of the first speech-language pathologists in Minas Gerais. The description of the interviews is divided in the following categories: first time in touch with Speech-language pathology; motivation for choosing this occupation; insertion in Speech-language pathology; motivation for working in Minas Gerais; context of this science from the 1970s to the 1990s; career development; boost to the recognition and progress of the profession; Speech-language pathology perspectives; evaluation of the historical study.

CONCLUSION: it was possible to demonstrate the course traced by Speech-language Pathology in Minas Gerais province since the arrival of the first professionals up to current time.

Keywords: Historical Article; Speech, Language and Hearing Sciences

INTRODUCTION

Knowing the path outlined by Speech Therapy in the State of Minas Gerais and understanding this process allows greater consideration on the profession today. A greater consideration is important for the new paths of the Science to be traced, changing paradigms, breaking down barriers and prejudice.

The scarcity of documentation about the history of Speech Therapy in Minas Gerais boosted the performance of a historical-social study. This allows knowledge of the transformations in Speech Therapy overtime, undoubtedly important for the definition of this science in Minas Gerais.

The analysis of the history of speech therapy in Minas Gerais allows the construction of a critical view of the facts, from the knowledge of events and the difficulties and achievements of professionals who started the Speech therapy in the State.

This study aims to show the trajectory followed by speech therapy in the State of Minas Gerais and it started from the collections of documents and the reports of the first speech therapists in Minas, thus underscoring the journey from the arrival of the first professionals until the present day. A historical perspective, therefore, was designed from the perspective of the subject, in this study represented by the first working professionals in Minas Gerais.

METHOD

This is an exploratory and historical field research with a qualitative and quantitative approach.

First, we collected documents such as articles, scientific publications and documents of regional entities of Speech Therapy as the Conselho Regional de Fonoaudiologia - 6ª região (Speech Therapy Regional Council - 6^th region) and the Sindicato dos Fonoaudiólogos de Minas Gerais - SIMFEMG (Speech Therapists Union of Minas Gerais).

For the collection of documents, telephone contact was made followed by visits to these entities. A list of keywords related to the subject of interest was also prepared for the search for publications with online contents and visits to the libraries of colleges and universities, which have in their collections, journals related to Speech Therapy and related areas.

After this search, we realized that it would not be possible to accomplish this historical rescue only by the analysis of these documents. Most of the documents were not filed in the Regional Council and the Union, but belonged to individuals who participated in the history of Speech Therapy in Minas. In addition, scientific publications presented articles on the history of the profession in some Brazilian states, but there hadn't been found any publication about the state of interest in this research yet.

Due to the scarcity of documentation about the history of Speech Therapy in Minas Gerais, there was a need to carry out structured interviews with professionals involved in this historic process.

For data collection, we used structured interviews conducted in person or by e-mail by the researchers through open questions, prepared in advance in a semi structured script.

These interviews comprise interviewee identification data and data that allow the researchers to trace the trajectory of Speech Therapy in Minas Gerais, according to life history and individual perception. At the end, 27 professionals were interviewed, 24 speech therapists, 2 otolaryngologists and 1 ophthalmologist, all involved in the processes of planning, implementation, organization and management of services, courses and clinics of Speech Therapy.

For the choice of interviewees, the snowball sampling^1,2 technique was used. In this methodology, we start from a group of reference, which points out to other actors and mention connections that will be added to the list, forming a network from successive indications. The reference group was composed of three professionals currently working in Minas Gerais, which were involved in the regulation of the profession. The sample was defined by the saturation criterion, that is, the interviews were interrupted at the moment when the historic route was traced and the answers started to repeat themselves. Moreover, the amount of new names and connections decreased significantly (Figure 1). The recruitment of respondents was conducted by telephone or e-mail contact or in person.

The interviews were recorded in compact cassette or digital recorder and transcribed, and one of them was sent by electronic mail. All study participants signed a consent form.

In this study, we chose to use the content of the discourses analysis, which is a methodology of texts analysis drawn from a qualitative standpoint, numerically analyzing the frequency of occurrence of certain terms, constructs or references³.

The most frequent categories were listed and defined as follows: contact with Speech Therapy, motivation for choosing the profession, insertion of Speech Therapy, motivation to work in Minas Gerais, context of Speech Therapy in Minas Gerais from the 70's to 90's, professional training, impetus to the recognition and development of the profession, prospects of Speech Therapy, assessment of the historical study. After selecting the categories to be reviewed in each issue, we found the frequency of occurrence in the speeches. After collection, the data were analyzed through the categorization of documents and interviews and, based on this analysis; there was the restoring of the history.

The Ethics and Research Committee (COEP) of the Universidade Federal de Minas Gerais - UFMG (Federal University of Minas Gerais) approved this research, number 496/05.

RESULTS

27 professionals were interviewed, 24 speech pathologists, 2 otolaryngologists and 1 ophthalmologist.

As shown in Table 1, the speech therapists began their work in Minas Gerais in the 70's.

In Figure 3, the historical background of Speech Therapy in Minas Gerais can be seen, according to professional milestones, over the decades. In the 70's, clinics accredited by the Legião Brasileira de Assistência - LBA (Brazilian Legion of Assistance) were set up and the first manifestation of class organization was enrolled, the Núcleo Mineiro de Fonoaudiologia. In the 80's, the profession was regulated and the 1st course of Speech Therapy in Minas Gerais was created. In the 90's, also in Minas Gerais, the 1st public Speech Therapy course and the Speech Therapy Regional Council were created. In 2001, the Speech Therapists Union was created.

Figure 4 shows the percentage of the most frequent responses in semi structured interviews.

In the category "Contact with Speech Therapy", it was seen that 30.76% of respondents had their first contact through subjects who had communication disorders, 23.08% by professions guides; 23.08% by indication of speech therapists and other professionals and 23.08% by working in related areas. In the "Motivation for choosing the profession", 55.6% were motivated by the rehabilitation role of speech therapy and 44.4%, by the possibility of complementing the knowledge of other sciences.

The category "Insertion of Speech Therapy" points out that 45.83% were included in Minas' labor market working with the rehabilitation and medical specialties; 33.34% in private clinics, and 20.83% in clinics accredited by the Legião Brasileira de Assistência - LBA (Brazilian Legion of Assistance).

In the category "Motivation to work in Minas Gerais", it could be seen that 50% of them were born in Minas Gerais or had relatives who lived in Minas Gerais, 37.5% had family moved to Minas Gerais and 12.5% moved to the state, attracted by the labor market.

In the category "Context of Speech Therapy in Minas Gerais from the 70's to 90's", it's noticed that 48% of respondents reported a shortage of professionals, 28% reported the creation of the first course in Speech Pathology and 24% the beginning of the mobilization to organize the class.

The category "Professional training" characterizes the training of pioneer speech therapists, which occurred with a mostly practical and a little theoretical basis, according to the respondents: 76.47% reported difficulty in training and updating of the pioneer ones and 23.53%, the importance of establishing the first course for this process. Yet in the category "Impulses for recognition and advancement of the profession", 52.38% reported the commitment of professionals, 33.34% reported the creation of the regional council and the union and 14.28% highlighted the regulation of the profession.

The question "Prospects of Speech Therapy" indicates that 53.85% concern about the labor market and 46.15% believe in the growth of the profession.

In "Assesment of the historical study", 80.95% reported relevance of the research to Speech Therapy and 19.05% for the recognition of the pioneer professionals.

DISCUSSION

Crossing over the interviewees' reports and documents reviewed, it can be seen that in the 70's, the first speech Therapists came to Minas Gerais. From the participants interviewed in this study, 29.17% (n = 7) of them arrived in this decade, with the first speech therapist with a degree arriving in Belo Horizonte in 1971.

According to one interviewee, the Legião Brasileira de Assistência - LBA (Brazilian Legion of Assistance) played an important role in the development of speech therapy in Minas Gerais. The accreditation by this institution began in 1979, when the speech therapists were invited to join the assistance service. Several clinics had been accredited by the entity and thus the professionals that had graduated in other states found work in Minas Gerais. The majority (25.83%, n = 5) of the respondent pioneers graduated in Rio de Janeiro and came to Belo Horizonte through clinics accredited by the LBA. This charity organization provided assistance primarily in Belo Horizonte, meanwhile expanded its accreditation to other cities in the state, favoring the growth of Speech Therapy in Minas Gerais, which is confirmed by other profissionais⁴.

On December 15, 1979, the National Commission for the Regulation of the Profession of speech therapist was created in order to support the bill that regulated the profession^4,5. The Núcleo Mineiro de Fonoaudiologia, created in November 1979 with just 12 members, was part of that commission, along with other centers, associations and societies, and it was strengthened by the increasing number of professionals in the State and the efforts of the participants towards regulation of the profession. This growth generated the need for the creation of an Association that would give greater support and political strength for the class. In a meeting held on July 14, 1980, the creation of the Associação de Fonoaudiólogos de Minas Gerais - AFOMIG (Association of Speech Therapists of Minas Gerais), which would replace The Núcleo Mineiro de Fonoaudiologia, was unanimously approved.

The AFOMIG aimed to defend the interests of the class, encouraging the improvement of technical and scientific knowledge. The first president of the association was one of the interviewees, and the headquarters was provisionally located in south-central area of Belo Horizonte. In addition to promoting scientific events, the AFOMIG was concerned about checking the values that were collected in therapy sessions^4,5.

The profession of speech therapist was legislated in December 1981 by law 6965 of December 09. A speech therapist from Minas Gerais was present, in Brasilia, at the time of approval of the bill that regulated the profession. Before that date, there were only teachers working as speech therapists in Belo Horizonte, as reported by respondents. After this milestone, the ones who graduated before the regulation of the profession had to go through a process of adapting the curriculum.

In 1992, the Speech Therapy Regional Council (CRFa) was created and Minas Gerais belonged to the first region along with Espírito Santo and Rio de Janeiro. The CRFa was created because of the high number of professional and the need of the operation of a Regional Council. At the time, the Council's headquarters was in Rio de Janeiro. Five years later, the Speech Therapy Regional Council - 6th Region - was settled, assisting the states of Minas Gerais, Espirito Santo, Mato Grosso and Mato Grosso do Sul^5,6.

The majority of interviewees (45.83%), when moved to Minas Gerais, started to work with otolaryngologists and phoniatrics, operating in a various areas of speech therapy. Of the pioneers in Belo Horizonte, 33.33% (n = 8) chose the academic life, after the creation of the first undergraduate courses in speech therapy.

One of the challenges reported by the professionals interviewed was the difficulty of updating due to the scarcity of scientific publications in Portuguese, specific for speech therapy, at the time of their graduation. They resorted to foreign articles, in German, French and English, for example. They formed study groups focused on specific topics, and many of these meetings were held at the now defunct Núcleo Mineiro de Fonoaudiologia.

In the mid 80's, the idea of creating the first course in speech therapy of Minas Gerais came out. The protagonist institution was the Faculdades Metodistas Izabela Hendrix - FAMIH (Methodist Izabela Hendrix College) then, now Instituto Metodista Izabela Hendrix (Izabela Hendrix Methodist Institute)⁷.

The implementation of the course was a difficult process because there weren't in Belo Horizonte a significant number of professionals with qualified skills that could favor the opening of the course and structuring of the curriculum. Another reason that made the organization of the course more complicated was the opposition of some audiologists who had already been working in Belo Horizonte, concerning the interference of new professionals in the labor market. Despite the interference of some factors, on the 1st of February 1990, the operation of the first course of a Speech Therapy in Minas Gerais began.

In the 90's still, there was also the structuring of the speech therapy course at the Universidade Federal de Minas Gerais. In 1995, the proposal for the creation of the course was drafted and the implementation project started, a process that was assisted by professionals, at that time professors at the Instituto Metodista Izabela Hendrix. On August 21, 1999, the law that regulated the existence of the first public Speech Therapy course in the State was approved. In the following year, there was the hiring of teachers and the first class of Speech Therapy in the Universidade Federal de Minas Gerais started⁸. Then, other courses were created in the State. For example, the courses at the Pontifícia Universidade Católica de Minas Gerais - PUC-MG (Catholic University of Minas Gerais), created in 2001, at the Fead-MG, authorized in 2001 and recognized in 2008 and at Fumec University, recognized in 2008, in Belo Horizonte. Upstate, at the Universidade de Uberaba - UNIUBE (University of Uberaba), recognized in 2001, at the Fundação Presidente Antônio Carlos - UNIPAC (President Antonio Carlos Foundation) in Barbacena, recognized in 2003 and at the Centro de Educação Superior de Juiz de Fora - CES/JF (Center for Higher Education of Juiz de Fora) recognized in 2005^35-40.

On September 22, 2001, the Sindicato dos Fonoaudiólogos de Minas Gerais - SINFEMG (Speech Therapists Union of Minas Gerais) was created, aiming to implant an entity that would foster discussion of labor issues, demonstrating the maturity of the profession⁹.

The most frequent categories in the interviewees' reports were accompanied by clinical examples.

Contact with Speech Therapy

The majority (70.83%, n = 17) of professionals who had moved to Minas Gerais in the 70's and 80's had their training before the legislation of the profession, which occurred in 1981. For this reason, they took notice of Speech Therapy and chose it as a profession, through contact with other professionals (23.08%) or because they were already involved with subjects who had communication disorders (30.79%). In the latter case, the involvement occurred through contact with relatives or acquaintances or even within educational institutions, where many worked as teachers, schoolteachers or specialist teachers (23.08%). This may be seen by the divergence of the reports described below.

Some took notice of the profession through education, because they had students with learning impairment, so they tried in another area a way to solve these problems.

"... I was a very dedicated teacher ... I began to wonder why some students, even with help from a teacher, mother, still didn't learn? So I started researching about these children who did not learn, spoke wrong and had other speech problems... then I discovered that there was Speech Therapy..."

Other took notice of Speech Therapy through professional guides (23.07%).

"... I started studying and then when I was doing high school, I bought those students guides and read about the occupations... And I found interesting, especially for working with disabled people, specifically with Down syndrome..."

Others had their first contact through the story of relatives who developed phonatory diseases and were treated by speech therapists.

"... My first contact was with my father-in-law who had larynx cancer..."

It may also be noticed that some of the respondents had their first contact with speech therapy in the academic period, by indication of speech therapists and other professionals and by working in related areas.

"... and what do you do ma'am? I'm a speech therapist. And, as you may have heard, I already asked... what? Then she told me that there was this course in Rio de Janeiro, which works with learning disabilities, and I said, look, my God, it was everything I wanted. "

Motivation for choosing the profession

The main concept of health in Brazil until the structuration of the Unified Health System (SUS), in the 80's, was based on the welfare and preventives-healing model ideas, which focused on the etiology, diagnosis and treatment of diseases. Speech Therapy was guided by this model and remained based on the axis pathology / treatment / control / prevention, also being recognized by the society from this focus^10-12.

The main motivation for the choice of Speech Therapy by these professionals was its rehabilitation role (55.6%).

"... my biology teacher had a daughter with cerebral palsy ... that was when I tried to know what it was, how it was, what it worked with"

"... it all started when my first son was born with severe hearing loss ... I was very young and tried every way to know the cause of my son's illness"

Another motivating factor appointed to the entry in the Speech Therapy course was the need for additional knowledge, participation in other sciences such as Pedagogy and Music (44.4%).

"... I began to wonder why some students, even with help from a teacher, the mother, still did not learn? Then the Speech Therapy came."

"... I went to speech therapy also for having relationship with music, because I think voice is music. "

Insertion in Speech Therapy

The state of Minas Gerais was considered a promising and extensive market for Speech Therapy, especially for the great demographic expansion occurred in the state capital from the 40's and the shortage of professionals in the area^13,14.

Prior to the 70's, there was misinformation about the existence and role of the speech therapist, which created a great-suppressed demand. The motivation for the establishment of Speech therapy in Minas Gerais was the accreditation by the LBA, which required the presence of speech therapist in the team in the accredited clinics. The LBA was a civil society founded by Darcy Vargas, in 1942 to assist families of soldiers sent to the Second World War. After the war, it began to provide assistance to families in need. This civil society became extinct in 1995¹⁵.

So, at first, the performance in Minas was predominantly clinical. The vast majority of respondents (45.83%) began their work in Minas Gerais in practices and specialist clinics. Thus, otolaryngologists, who were already in the state, and LBA, had an important role in the integration of speech therapists in Minas Gerais (20.83%).

"... I started working at the Clínica de Otorrino (Clinic of Otolaryngology). At the time I worked at a hearing aid company and in a newspaper and I got a job in a LBA clinic."

"... My first workplace was one of those clinics accredited by the LBA that today no longer exists…"

Moreover, 33.34% of the professionals began their work in private practices in the state.

"... I came here and immediately set up an office, I think I already had a good knowledge baggage and also a lot of good will..."

Motivation to work in Minas Gerais

Currently the Brazilian speech therapists are divided into eight regions. According to recent data from Conselho Federal de Fonoaudiologia -CFFa (Federal Council of Speech Therapy), the region of highest concentration of speech therapists is the 2nd region, which includes São Paulo, state with the largest number of speech therapists in Brazil followed by the 1st (Rio de Janeiro) and the 6th Regions (Minas Gerais, Espírito Santo, Mato Grosso end Mato Grosso do Sul. In this region, the speech therapists are concentrated in Minas Gerais¹⁶.

As to what motivated the speech therapists from other states to come to Minas Gerais, the following were identified as motivations: been a native of Minas Gerais an the presence of relatives in the state (50%), transfer of spouses to the State (37.5%) and labor market (12.5%).

"… My parents were returning to Minas Gerais and Belo Horizonte was a big city."

"… I came back here because my husband was transferred in 1979…"

"… I had a proposal to stay there at the college (PUC-Campinas), but I thought I should go to another place, another state, another city and decided to come to Belo Horizonte… I got to know… the first speech therapist working with an otolaryngologist. And I stayed with the same otolaryngologist that she worked with and I am until this day."

Context of Speech Therapy in Minas Gerais from the 70's to 90's

In the 70s, the beginning of the movements to the recognition of the profession led to the creation of the first bachelor's degree courses in Rio de Janeiro, Sao Paulo and Rio Grande do Sul. Despite the intense fighting permeated by the formation of centers for the legislation and various attempts to present their proposal to the government, the success only came in the early 80's, when Law No. 6965, which regulates the profession, was enacted. With it the Federal (CFFa) and the Regional Councils (CRFa) were also created^17,18.

CFFa activities began in 1983 and in the following year the first Code of Ethics of Speech therapy was approved. It determines the rights, duties and responsibilities of the speech therapists^19-21.

"... in 1980, we made a move to the regulation of the profession... then we created here in Minas a Center for Speech Therapy from Minas Gerais... we were 12 speech therapists here in Minas Gerais... in Belo Horizonte we were nine... there were meetings all over Brazil to fight for the regulation of the profession… and we were able to create an association which was called AFOMIG (Association of Speech Therapists of Minas Gerais)."

In the early 90's, the first Speech Therapy course in Minas Gerais was created. The absence of an undergraduate course in the state until this decade explains the shortage of local professionals in previous decades.

The majority of professionals interviewed (48%) reported that when they arrived for work, there were few speech therapists in Minas Gerais.

"... when I got here, there were very few speech therapists"

"... and the demand to be met was great ... we had waiting lists in the offices"

"... I just think the Izabela Hendrix really gave a great impulse for Speech Therapy in the State of Minas Gerais. It was a pure watershed..."

In the late 90's, the organization of professionals for the creation of the Speech Therapists Union of Minas Gerais started.

"... We began to gather and mature the idea of founding a union. There were many meetings, until the founding of the Speech Therapists Union of Minas Gerais - Sinfemg…"

Professional training

Lifelong learning is a solid basis for the restructuring of training practices, health care and management, enabling the reorganization of education at the undergraduate, graduate and technical education levels, according to the needs and rights of health of the population^22-24.

Despite the welfare and empirical character of professional practice and teaching of Speech Therapy at its origin, the focus has changed over the training of professionals. The institutionalization of speech therapy has occurred in the 60's, with the establishment of the first university courses in Speech Therapy^{19, 20, 25-27}.

Such courses were essentially practical, due to the scarcity of scientific publications related to the area, and also to be considered as technical because they had short hours¹⁹.

By the end of the 70's the first scientific initiatives in the Brazilian context appeared with the creation of journals, magazines such as "Atualização em Fonoaudiologia (Updates in Speech Therapy)" "Distúrbios da Comunicação (Communication Disorders)" and "Lugar em Fonoaudiologia (Place in Speech Therapy)^{19, 28}.

The respondents (76.47%) reported that, after graduation, they asked for tutorial supervisions with professionals, due to lack of experience and educational resources for additional training or specialization. The supervision took place in courses, prepared by them own speech therapists, to which were invited dentists, psychiatrists, pediatricians and speech therapists from other states and even overseas. The creation of study groups for updating was common, they pointed out as being essential for supporting the practice.

"... There was a study group... we had meetings, we had case discussions, we also brought in people from overseas to teach us..."

The supervision also had the objective of exchanging information between professionals, when such practice happened between fellow students.

"... I had a case and wanted to discuss some questions, I looked for a colleague.."

The academic knowledge was being built through the experience acquired with the creation of the first course of speech therapy in the State of Minas Gerais in 1990.

"... we had no academic culture, you know? We started at Izabela… professionals with a lot of clinical experience and no academic experience."

Within this academic context, 23.53% of respondents reported the difficulties and the pioneering in shaping in the profession training of new speech therapists in the State.

"... the Izabela hosted the first Jornada de Fonoaudiologia (Journey of Speech Therapy), but everything was always too difficult to be done."

"... I just think the Izabela Hendrix really gave a great impulse for Speech Therapy in the State of Minas Gerais. It was just like that, a real watershed..."

Impulses to the recognition and improvement of the profession

The Speech Therapy in Sao Paulo and Rio de Janeiro was already a recognized science, and the work of speech therapists was recognized and respected, unlike in the context of Speech Therapy in Minas Gerais^19,29.

It was then necessary strong commitment of the professionals who came to Minas Gerais in order to show the importance of speech therapy, driving the growth of the profession in the state. A big part of the professionals interviewed (52.38%) reported that helped the growth of Speech Therapy in Minas Gerais, through lectures, symposia and courses.

"... when I came here (1975) I did many speeches, I was a promoter of Speech Therapy"

"... Speech Pathology were disclosed well with symposia, congresses and courses and, thus, Speech Therapy began to attend events in the area of Pediatric Neurology, ENT, Orthodontics, Neurology and Neonatology."

"... at first it was difficult to the point of pediatricians did not know what speech therapist was ... as I had some kind of "easy access" what would I do? I would go to Sociedade Mineira de Pediatria (Society of Pediatrics of Minas Gerais) and lectured. "

Another way to make the speech pathology known by other professionals and even by the general population, were articles published in newspapers and on television news reports.

"... we had a very good opportunity to also promote our profession through articles in newspapers ... every week each one of us (speech therapist) would write an article that was would be published in the newspaper (Estado de Minas) "

The regulation of the profession was a major boost to the growth of speech pathology and the role of class struggle was essential to this achievement. In the 70s, a movement began led by speech therapists from Rio de Janeiro and Sao Paulo with the attendance of audiologists from other states. Initially, they were fighting for the approval of a bill, but with no success by the end of several attempts. The effort of Speech Therapists was only then rewarded on December 9, 1981 with the approval of Law No. 696 517.

The professionals of Minas Gerais, along with audiologists from all over Brazil contributed to this achievement³⁴.

"... in 1980 we made a move to regulate the profession... then we created here in Minas a Núcleo Mineiro de Fonoaudiologia... there were 12 speech therapists here in Minas Gerais ... in Belo Horizonte we were nine... there were meetings all over Brazil and we had to fight for the professional regulation... we created an association which was called AFOMIG (Association of Speech Therapists of Minas Gerais). "

"... And then when we were creating the sixth region (CRFa - 6th Region), which is our current, Rio Janeiro was alone: there was Minas, Espirito Santo, Goias, Mato Grosso and Mato Grosso do Sul Then it was created a so called administrative board, this administration board was the one who organized the whole legal and administrative parts to create the sixth region. I was also part of this administrative board. "

The creation of courses in speech therapy of upper level was a breakthrough for the training of more professionals able to treat people with disorders of voice, speech, language and hearing. The Universidade de São Paulo - USP (University of São Paulo) in 1960, and the Pontifícia Universidade Católica de São Paulo - PUC-SP (Pontifical Catholic University of São Paulo) in 1961, pioneered the creation of these courses. Then it was time for Santa Maria (RS) in 1970, and the Universidade Federal do Rio de Janeiro - UFRJ (Federal University of Rio de Janeiro). In Paraíba, the first course took place in 1998 in the Centro Universitário de João Pessoa - UNIPÊ (University Center of João Pessoa) and the state of Bahia, the courses in speech pathology at the Universidade do Estado da Bahia - UNEB (University of the state of Bahia) and Universidade Federal da Bahia - UFBA (Federal University of Bahia) were created in 1999^29-31.

The first courses were created, the supporters of Speech Therapy throughout Brazil. In Belo Horizonte, the first one was founded by Faculdades Metodistas Izabela Hendrix and represented a significant advance for speech therapy in Minas Gerais. In 2000, it has begun a course of speech therapy at UFMG.

"... at first the course in speech therapy was linked to the department of otolaryngology ... the creation of a course is too bureaucratic, we had to go through several steps, such as the creation of the curriculum, which is documented in the Medical School (UFMG)..."

The professionals who worked here also had a desire to see the class organized, which led to the necessity of creating a responsible body, as presented in the vignette below on the implementation of the Union, a body responsible for the creation of instruments of controlling professional practice.

"... we started to gather and improved the idea of founding a Union ... there were many meetings, so that in September 2001 it was founded the Speech Therapists Union of Minas Gerais - Sinfemg. "

Prospects of Speech Therapy

The oldest statistics found on the number of speech therapists in Brazil is from 1998. This year, there were 15,804 active speech therapists in Brazil and there are now 32,426. The region that has grown the most was the 5th Region (Acre, Amapá, Amazonas, Goias, Para, Roraima, Rondônia, Tocantins, and Distrito Federal) which now rely on the state of Goiás from 1998 previously part of the 6th Region. The sixth region, which includes Minas Gerais, had 1730 speech therapists in 1998 and today has over 4659, which, 3420 are in Minas Gerais16, 32.33.

Respondents reported (43.15%), with satisfaction, to have seen the profession gaining ground and growing during the past 20 years, yet they also show concern for the market (53.85%).

"... market can not absorb the professionals they train, so in general, for health professionals ... the Brazilian health system is not ready for it "

"... the more you improve the knowledge of a profession, the better you prepare these individuals to suit this market."

"... Speech Therapy has grown a lot... but we have to have a more professional maturity... we have to have a maturity to know how you enter the market. I think those are the two things that the speech therapy still has to work on, and I think they are too close together..."

"... we do not know many details about our profession and this will be discovered working on it"

Assessment of the historical study

The rescue of a history is based on research, registration of deeds and finding people who represent the actors of a certain history. It is important to consider the social context of the time, the individuals composing the society as well as their needs and desires, as it is through this that these individuals build their history, mobilizing efforts to generate change and seek for solutions to problems that afflict them.

Each respondent presented their view on the relevance of the study, through their perceptions and their own involvement in history. Much of professionals (80.95%) understood the importance of this survey for the Science Speech Therapy.

"... The record is the best way for us to understand the trajectory of a profession ... it is something we also see ... which was positive in terms of action of a particular profession, which it suddenly missed. It is when you look at your reality and you do an analysis, a reflection on the path you have followed the same life that is their profession and understand this course is that you understand what you still need to do…"

Others emphasized the importance of the first Speech Therapy recognition (19.05%).

"...The professionals who brought knowledge from outside Minas Gerais deserve the honor"

"...it's important to remember never to forget the pioneers of our profession, that they can always be in the minds of the young"

The knowledge about the history of Speech Therapy in Minas Gerais provides grants and safety so that students and professional speech therapists can participate in future changes that will enable the improvement of that science. Understanding the importance of Speech Therapy in the health field values the origins of this practice, the purpose and process of its establishment. Understanding this pathway is essential for any healthcare professional who understands what happens in the present and fights for improvements in the future, helping to maximize the profession in the various environments that it manages³⁰.

It is believed that this study reflects the historical aspects of Speech Therapy in other states and in Brazil, especially regarding the attraction of professionals to the state due to the promising market, followed by the creation of courses and increasing number of professionals in the State from the region itself, which had their training in these courses. It also presents peculiarities that differ from other states, like Sao Paulo, Rio de Janeiro and Rio Grande do Sul, where the graduation of the first professionals occurred in similar areas and courses were created before the regulation of the profession¹⁹.

CONCLUSIONS

The beginning of Speech Therapy in Minas Gerais was in the 70's and the main way of entering the labor market was in private practice or accreditation by the LBA.

The class organizations began in the 70's. During that same period, clinics which were accredited by the LBA were created and the first manifestation of class organization, the Núcleo Mineiro de Fonoaudiologia. In the 80's, the profession was legislated and the 1st course of speech therapy in Minas Gerais created, leading to the significant increase of practitioners in this state. In the 90's, the 1st public course in Speech Therapy in Minas Gerais and the Speech Therapy Regional Council were created, culminating with the creation of the Speech Therapists Union of Minas Gerais in 2001.

The first contact of study participants with speech therapy occurred in various ways: in the academic period, by indication of other professionals in health sciences and education and working in other occupations through subjects who had communication disorders. In turn, the motivation for choosing the profession was due mainly to the rehabilitation role of this science and the ability to complement other areas such as Education and Music. It is likely that these are still important drivers for the professionals who started their training recently.

The reports allowed us to visualize the efforts of professionals to carry out the profession in the state and still know the changes that this science has gone through, which, consequently, serve as a tool for current and future speech therapists strive for improvement of the profession. These pioneer professionals are highlighted by the effort made in promoting lectures, symposia, courses and even in the publication of articles in newspapers and on television news reports.

The performance of this historical review is of great matter for the recognition and appreciation of the pioneers interviewed, who also report satisfaction with the growth of the profession.

Given the above, it was possible to describe some aspects of the course that the Speech Therapy outlined in Minas Gerais since the arrival of the first speech therapists to this day. It is believed that memory biases have been minimized by the concordance of facts, reported by more than one participant. Unfortunately, due to the scarcity of documents about the topic, it was not possible to ensure that all steps have been documented. We suggest the development of new research in the area, in order to fill any gaps that may have occurred, and further studies for the detail and historical comparison of Speech Therapy in the Brazilian states. However, this study is considered valid for recording the history of speech therapy in Minas Gerais. It's important to note that this work does not describe the history of speech therapy in Brazil as a whole; nevertheless, it reflects an important part of this story.

Finally, it must be reminded that history is still being built, since it is a dynamic process involving all its students and professionals.

REFERENCES

Received in: 09/22/2010

Accepted in: 02/08/2011

Conflict of interest: non-existent

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Publication Dates

• Publication in this collection
  19 Aug 2011
• Date of issue
  Apr 2012

History

• Received
  22 Sept 2010
• Accepted
  08 Feb 2011