STRUGGLING FIELD OF SPEECH-LANGUAGE PATHOLOGY IN PAKISTAN

Abstract

The need of speech and language pathology (SLP) as a specialized field in Pakistan emerged with the education of deaf. Development in education of deaf began in Pakistan by Mr. Siddique Akbar Makhdum in 1949. Later in 1951 College for the Teachers of the Deaf in Lahore was established with the collaboration of USAID and faculty from US to teach speech-language pathology. The basic courses introduced were speech, language and audiology. In the tenure of 6th president of Pakistan General Zia-ul-Haq, many organizations were formed to serve special needs children. In his time special education centers were developed in Islamabad, Lahore and Karachi. One of its kind was Speech and Hearing Centre, Karachi, which was established in 1983 and aimed to advocate Auditory Verbal Therapy (AVT).1 In 1991, Post graduate diploma in speech-language therapy (PGD-SLT) was launched with collaboration of NIRM (formerly called National Institute of Handicapped NIHd), UNDP and National Institute of Psychology (NIP), Quaid-e-Azam University, Islamabad. Ministry of Women Development, Social Welfare and Special education took this initiative. Diane Schaffer from USA and Linda from England were two expert speech therapists who came to Pakistan to teach and train PGD-SLT students in NIRM. Speech and Hearing Association of Pakistan (SHAP) was formed in January 2000.2 On 13th June 2002 SHAP got registered under Sindh Government with registrar of societies Act 21 of 1860. Currently Ms. Amina Siddiqui is President and Dr. Nadeem Mukhtar is Vice President of SHAP. In 2006-2007 Special Education Department of Karachi University launched masters in speech Therapy program. In 2007 Zia-u-Din Hospital started clinical services and collaborated with SHAP to develop the College of Speech Language & Hearing Sciences (CSLHS) where nation’s first 4-year Bachelor’s program in Speech Language Therapy was launched in 2007.2 In 2010 Riphah University Islamabad started MS program in speech-language pathology under supervision of Dr. Ayesha Kamal Butt. In 2013 Isra University Islamabad campus started M.Phil SLP degree program and PhD in Rehabilitation Sciences which opened way to doctoral degree for SLPs as well. In 2019 Riphah International University also launched PhD in Rehabilitation Sciences program. King Edward Medical University also launched BS program in 2008. Currently there are 16 institutes offering BS, 5 institutes offering MS/MPhil and 6 institutes offering diploma in SLP. On 9th October 2019 Pakistan Speech and language pathologist association (PSLPA) was formed by pioneers of field in Pakistan. It is federally registered under the society’s registration act 21 of 1860. Launch day of PSLPA i.e. 9th October was also declared as National Speech Pathology Day. President and Vice President of PSLPA are Dr. Nazia Mumtaz and Ms. Saima Tariq respectively. Although the field of speech-language pathology in Pakistan headed up in 1990 but research in the field began with the commencement of degree programs. The lag between practice and research resulted in the lack of culturally appropriate standardized practices which has yet not been eradicated fully. Despite efforts of existing associations to eliminate malpractice and quackery from the field, it is still going on a huge scale. In fact many practicing SLPs are yet not registered with any association because on legal grounds there is not yet any such compulsion for them on national level. In many states, like other medical professions, it is mandatory for SLPs to be licensed through a state authority in order to practice their speciality.3 The licensing process includes such steps that helps to maintain and establish stringent standards for licensure candidacy and practice. In Pakistan there is a dire need of state’s recognized licensing system that could assure provision of genuine SLPs to public through a standardized vetting process that internationally involves qualifying degree education, supervised clinical experience and examination. Graduate programs are producing culturally consistent researches, even though application of these researches is slow and rare to an extent that out dated traditional practices still dominates. Consequently patients and their families suffer with no or slow pace of progress. There are also centers where patients treated by SLP students are not supervised and guided by senior therapists hence their trial and error learning only benefits them in making stronger clinical record books but at the cost of patient’s wastage of time and student’s malpractice. One reason behind lack of desired clinical supervision is recruitment of less number of SLP clinical supervisors in teaching hospitals as compared to number of students and case load. In many institutes SLP departments are provided with too low budget to equip their clinics with latest assessment and treatment tools due to which students could not get know how of latest practices happening in the field at international level. A huge proportion of clients that take speech therapy sessions are children and adolescents. Regarding pediatric speech therapy, many families raise issues that they are not allowed to observe or stay in sessions. Furthermore, non-provision of appropriate parent training which is contrary to roles and responsibilities of SLPs,4 is also a critical issue that puts parents or guardians in psychological stress when they try to work with their affected family member. Like other countries, in Pakistan the solution of all aforesaid problems can only be found with integration of evidence based practices (EBP). Only with evidence based practices Pakistani SLPs can make informed, evidence based decisions in their practices along with provision of high quality services reflecting the needs, choices, interests and values of target population.