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In the context of Nepal, Audiology and Speech-language Pathology (ASLP) is a noble profession. The history of audiology and speech-language pathology is not very old globally, either. The concept of audiology and speech-language pathology started rising soon after World War II, when young military personnel who were involved in war as the pillar started developing hearing loss due to loud noises, and many others got aphasia due to brain injury. Therefore, the history of ASLP around the world is not as old as that of many other medical professions.
Audiology and speech-language pathology services in Nepal started in 1987 as the Speech and Hearing Aid Clinic at Tribhuvan University Teaching Hospital in the Department of ENT-HNS. Those days, there were no qualified professionals or people with a degree to practice audiology and speech-language pathology, and the service providers who were practicing it were only qualified at a higher secondary level. The whole speech and hearing unit was established as a part to assist ENTs. Later, considering the needs of the professionals, the same individuals were sent to India to take bachelors and master’s degrees in this field with the help of Impact Nepal. By 2008, four individuals were upgraded to professionals and were part of the Speech and Hearing Unit at the Department of ENT TUTH. Similarly, the service at Bir Hospital started in 1991, Shree Birendra Sainik Hospital in 1992, and Patan Hospital in 2016.
The rise of BASLP course in Nepal
The Bachelor in Audiology and Speech-language Pathology (BASLP) course in Nepal started in 2009 at Maharajgunj Medical Campus (MMC), Institute of Medicine (IOM), Tribhuvan University. It is the first and only institute in Nepal that runs BASLP courses in Nepal till date. The first draft of the BALP curriculum was submitted to the Medical Education Commission in 2008 and implemented in 2009. Later, in January 2014, the curriculum underwent its first major revision. In the beginning, the number of students who could enroll in the program was four, of which three were full-scholarship students and one was a fee-paying student. The BASLP course has gone through many ups and downs. The institute was not able to accept new students for the years 2016 and 2017 due to a lack of faculty. The course underwent a great revolution in 2018. The institute hired more faculty and the number of seats was increased to six for the enrollment of the BASLP course. Out of six students, four or five get a scholarship and one or two are fee-paying students. Till 2022, the 7th batch has come out, which means 25 students have graduated from IOM, and currently, 16 students are enrolled in the program.
About BASLP course
The aim of the course is to generate competent manpower that can deliver international standard service. It is a four-year course. It is one of the many allied health courses that run in Nepal. The student must be a science student with 50% marks in Physics, Chemistry, and Biology to appear in the entrance examination conducted by the Medical Education Commission (MEC), and must be listed on the merit list.
Professional development and its expansion
To work as a professional, one must obtain a license from the Nepal Health Professional Council, which was established in 1997. Till date, there are 92 registered professionals in NHPC. The Nepali professionals in this field also have their own association, which is called the Speech and Hearing Association of Nepal (SHAN). It was established in 1999. There are altogether 78 registered professionals in this association. There are currently 53 professionals working in Nepal, out of which 35 are working in Kathmandu and 18 are working outside Kathmandu. The major hospitals that provide speech and hearing services in Nepal are Tribhuvan University Teaching Hospital, Bir Hospital, Shree Birendra Sainik Hospital, and Patan Hospital. Some of the areas where these services are provided in Kathmandu are Baneshwor, Tripureshwor, Chakrapath, Basundhara, Baluwatar, Thapathali, Jawalakhel, Kirtipur, and Madhyapur-Thimi. The service has been able to expand all over the country. It is now available in some major cities like Chitwan, Butwal, Pokhara, Dharan, Biratnagar, Janakpur, and Dhanghadi.
Its scope in Nepal
It is a dual degree—Audiology and Speech-language Pathology—that has immense scope globally. Since it is one of the noble professions all over the world, we can say that it’s emerging and trying to take a lead in the field of rehabilitation. Audiologists are experts who practice in the area of hearing and balance and rehabilitation. They provide patient-oriented service and work in the wide dimension of prevention of hearing-related disorders, their identification, diagnosis, evidence-based diagnosis, and treatment of hearing and balance-related disorders among all age groups.
Similarly, speech-language pathologists are experts who practice in the area of speech, language, communication, and swallowing-related disorders. They provide services to all age groups. As a part of their service delivery, they have a wide range of scope from collaboration, prevention, screening, and assessment to treatment. The different disorders they provide services for are autism, intellectual disorders, hearing impairment, apraxia, aphasia, dysarthria, voice disorders, fluency disorders, stuttering, swallowing, and feeding-related issues.
The best part of this profession even in Nepal is you can choose and decide to work either as an audiologist or as a speech-language pathologist. And, further to this, you can also choose disorder-specific or age-specific specialties, e.g. you can work as a pediatric speech-language pathologist or audiologist, or just work in the area of swallowing disorder or balance disorder. The various settings to work in Nepal are hospitals, private clinics, rehabilitation homes, research centers, and institutes (as an academician).
The ratio between professionals and disorders in Nepal is very difficult to comment on. However, increasing awareness about speech and hearing-related disorders has increased the necessity for these professionals. The gap between service delivery and the number of patients is high due to a lack of professionals. Every hospital needs this professional for a better quality of service. In the present scenario, the frequency of vacancy announcements for this professional is increasing, but many vacancies get lapsed because there are no professionals to apply for the job.
In terms of salary, as soon as you start working as a professional after your bachelors, the average salary is NRs.50, 000, which means it is one of the best professions to get a fair salary. The increasing demand for professionals and jobs and the fair amount of salary indicates it is one of the best emerging professions in Nepal.
Why BASLP in present context of Nepal?
To study BASLP in Nepal, it costs NRs.750, 000, whereas to study MBBS it costs 40 lakhs-44 lakhs, for BDS around 20 lakhs, and for BSc. Nursing, 10 lakhs. So, it can be one of the best medical courses, requiring lesser fees. The total duration of the course is only four years, whereas for BDS and MBBS it is five and half years. Therefore, one can complete this course in a shorter time frame than BDS and MBBS.
Every year, the number of MBBS graduates is 1,835, BDS graduates 565, and B.Sc. Nursing 1,280, which is very high in comparison to BASLP graduates, which is only six. As we know, the number of professionals is in high demand, so the chances of getting a job after graduation are more for BASLP in comparison to MBBS, BDS, and B.Sc. Nursing.
After graduation if someone wants to do a private job, the salary of BASLP graduates is higher than MBBS, BDS, and B.Sc. Nursing in the current context of Nepal. The course is not gender-specific like nursing, so both genders are given equal priority. The job is always 9-4, so there are no hectic night duties during student life and as a professional, also.
Currently, while there are fewer posts generated at the government level in comparison to MBBS, BDS, and B.Sc. Nursing, many are now working on a policy to make Audiology and Speech-language Pathology compulsory in every hospital. Hopefully, in the future, we will have more government posts coming up for ASLPs. Having said all that, all professions have their own importance and identity. MBBS and BDS practitioners perform surgery and prescribe medicines, whereas audiologist and speech-language pathologists provide related rehabilitation.
