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ACQ
Volume 11, Number 2 2009
ACQ
uiring knowledge in speech, language and hearing
the Bangladesh Health Professions Institute, the academic arm
of the reputed Centre for the Rehabilitation of the Paralysed
(for more information see
www.crp-bangladesh.org). It is
located in the medical faculty of the University of Dhaka and
was developed with support from University College London.
The first batch of students began their studies on 3
July 2004 and this date is now celebrated annually as the
anniversary of speech and language therapy in Bangladesh.
There are currently 51 students over four year levels studying
to become speech and language therapists. The first batch
of students will complete their internships by the end of
2009. These graduates will be the first ever fully qualified
speech and language therapists educated in Bangladesh.
At present the Bangladeshi speech and language therapy
students are being trained and supervised by overseas trained
therapists, mostly from Australia, UK and Canada. Links with
neighbouring India are also being explored. This has been a
necessary step until some local speech and language therapists
are suitably qualified to take on training roles themselves.
There has also been significant involvement of local teaching
staff in teaching modules in linguistics, psychology, anatomy
and physiology, community-based rehabilitation, and training
and management. Supervision of students in some clinical
placements has involved not just speech and language
therapists but special educators, occupational and
physiotherapists and developmental therapists.
Scope of practice
The Bangladeshi speech and language therapy students
have been involved in clinical placements in a number of
settings in which it is planned they will work in the future.
Some of these are quite similar to Australia, such as
hospitals and schools (especially schools for children with
autism). It is also envisaged that speech and language
therapists will work in other disability organisations and will
have a strong training role. Differing from most Australian
courses, final year students participate in cleft palate surgical
camps and complete placements in community-based
rehabilitation.
Community-based rehabilitation (CBR) is “a strategy for
rehabilitation, equalisation of opportunities, poverty reduction
and social inclusion of people with disabilities” (WHO, 2004,
p. 2). In the developing country context and in a situation
where the majority of services are only accessible in cities
and to those able to pay, CBR has been extremely important
and is becoming increasingly widespread. Involvement of
the profession in CBR is essential both for making sure that
those with communication and swallowing difficulties are
included in development initiatives, and for ensuring that
services are accessible to the majority of the population. For
centre-based therapy, follow-up is a significant issue, with a
history of many clients being unable to return for subsequent
appointments. For this reason also, working through CBR is
more practical.
Further public awareness-raising about the role of
speech and language therapy and the services available
will be very important for the future development of the
profession. Although there have been a large number of
referrals for services through student placements, these
have primarily consisted of speech difficulties in adults and
language difficulties in children. There has been limited
public knowledge to date of the role of speech and language
therapists in the areas of swallowing, voice and fluency.
Awareness-raising among other professions will also be
essential to generate appropriate referrals.
Education, health and disability
in Bangladesh
Education rates are increasing significantly in Bangladesh
with 94% of children enrolled in primary education in 2004.
This has not always been the case as demonstrated by the
adult literacy rates in 2005 – 41% for women and 54% for
men in 2005 (UNDP, 2007). A history of education being for
the wealthy, and pressure for all available family members to
be contributing to household income have been limiting
factors on participation in education.
Three levels of government health care services are
provided in Bangladesh. At the primary level, preventive care
is provided for all including those in remote areas. Secondary
health care includes curative care for upazilla (subdistricts)
and at the tertiary level there are fourteen medical colleges
which provide services to the people at district level. Some
city-based non-governmental organisations (NGOs) provide
specialised care in areas such as cardiology, oncology,
neurology, diabetes and leprosy care.
Persons with disabilities within Bangladesh however are
marginalised, receiving the lowest priority in service provision
within the country (JICA, 2002). Studies suggest that only 1–2%
of children with a disability who live in a developing country
receive an education and only 2% of people with disabilities
in developing countries have access to rehabilitation and
health services (Inclusion International, n.d.).
History of the speech pathology
profession in Bangladesh
It is an exciting time for the speech pathology (locally referred
to as speech and language therapy) profession in Bangladesh
as it is in the very initial stages of becoming a recognised
profession. There is a history of a number of individuals and
organisations working with people with communication
difficulties in Bangladesh. These people, however, have often
needed to rely on short courses from overseas therapists
and have expressed concern about gaps in their knowledge.
In order to address the need for more comprehensive
training and a broader local knowledge base, a degree
course in speech and language therapy was started in 2004.
This four-year bachelor degree course followed by a one-
year internship is the first formal training program in speech
and language therapy in Bangladesh. The course is based at
First batch of speech pathology students with teachers