ACQ Vol 11 no 2 2009

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.

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.

First batch of speech pathology students with teachers

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

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ACQ Volume 11, Number 2 2009

ACQ uiring knowledge in speech, language and hearing