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Supporting AAC Users in Pakistan

February 2, 2017

I was very fortunate to be invited to visit both Pakistan and parts of the Middle East in the last year. Looking back it is interesting to consider the common challenges and opportunities faced in providing services and assistive technologies that we encountered. In this blog, I reflect upon my time in Islamabad and Rawalpindi

In discussing how to meet AAC needs in Pakistan it is important to understand the size of the country, much larger than most of us from the west anticipate. That has significant implications for how services can be delivered. In a country where the rights of people with a disability are recognized, but where there are major barriers to delivering upon that commitment the need to share best practices across the country is a constant challenge. People do rise to that challenge, after it was announced that both EA Draffan and would I be in Pakistan, a number of people thought nothing of driving for four hours to engage and discuss ideas despite fog and crowded roads. There was a passion and interest in the work - a half day public event on disability and communication drew 1500 people to an events marquee in Islamabad. They heard from those of us from the west about best practices and examples of the impact of technology, but also listened intently to politicians and religious leaders share perspectives and ideas. Above all the theme emerged that we must, and can do more.

Outside of the large public event, we delivered some in depth training on aspects of AAC provision to Speech and Language therapists locally. EA explored the concepts of AAC, investigating how assessment can take place and I added to this by exploring the continuum of technology devices and how we can use those devices to stimulate communication in a purposeful manner. From those discussions we identified some common issues to consider.

1 The delivery of AAC services needs to be integrated into the wider experience of the user

One of the issues we discussed at length was how speech and language therapists could integrate their knowledge and expertise with other members of a multidisciplinary team. The therapists I met recognized the limitations of working on a withdrawal method to deliver AAC training and assessment. We began to explore what drove the maintenance of that model and what could be done about that. Some of the themes that emerged were   

  • The baseline of knowledge and experience among other professionals including teachers
  • The availability of equipment for use outside of the therapy session
  • Time management challenges to meet the levels of demand

We recognized that addressing these challenges not only required a commitment by all members of the team, but also policy and actions from service managers to incentivise team members to apply AAC programs with the therapist was not present.   

2 Technology availability in Pakistan needs to be stimulated

The availability of technology with which learners could develop,practice and generalize their communication skills was a real barrier to uptake of AAC in Pakistan. Much of the equipment was based around simple hardware devices such as a big mack or gotalk. These were easy to use, reliable and used digitised speech making recording and speaking messages in Urdu easier. There was a great deal of interest in the availability of low cost AAC apps, especially for Android platforms which are far more pervasive than Windows Phone or iPads. As we spoke, it seemed unlikely that the market in Pakistan was large enough to attract the interest of western AAC manufacturers, especially as there were some technical limitations to localising apps to support Urdu. As a result, it was clear to us that the challenge of providing AAC apps in Pakistan had to be met from within Pakistan. Relationships between therapists, services, researchers and developers needed to be nurtured to bring products to market. Who would lead that effort needed to be clarified and acceptable to all.     

3 AAC products need to be available to support local language and culture

The challenge of producing new products for Urdu, that could be available at a price point that was accessible in Pakistan is significant. We all felt that there were some significant building blocks that needed to be created, which could be integrated into new products by innovators and entrepreneurs. The most significant of these were

  • Urdu Text to Speech
  • Urdu work prediction
  • Graphic symbols reflecting the culture and values of Pakistan

To develop the technologies required to meet the first two needs, it was clear that researchers needed to be encouraged to enage with the issue. There was great consensus that this could best be done by the government funding the development of the technology under open source licence to support developers of AAC solutions and reduce the cost of the final products.

On the third point, there was considerable discussion about taking the Tawasol Arabic/Islamic symbol set and modifying the symbols for the culture of Pakistan. Pakistan is an immensely rich culture, I was taken to see hugely colorful locations, and clothing worn by many women was bright whilst modest. Similarly the clothing of men was different to those we had depicted in the Arabic symbol set. But despite this, many felt that the symbols provided a much firmer starting point for the creation of a Pakistani symbol dictionary than western symbols and that the availability of the Tawasol set under a very broad creative commons licence was welcomed.         

These themes were reflected when I had the opportunity to visit a child development center in Rawalpindi. Whilst meeting members of the teams delivering AAC and discussing how it was being provided for individual children, the limitations we had discussed the day before were apparent. There is no lack of commitment or passion in Pakistan and there was evidence of a strong foundation of knowledge in Islamabad, the challenge is to provide the resources and technology which unlocks that potential.

On a personal note, I should describe how welcome I felt in Pakistan. I had great pleasure in meeting people, there was a willingness to debate the way ahead and everyone that I met took time to help educate me about the culture of the country and the experience was personally fulfilling. If others get a chance to visit, take some pleasure in it, enjoy the beautiful mosques, but visit the preserved sites sacred to Buddhists, Sikhs and others, prepare to be challenged and to engage in debate with both men and women. Take pleasure in the beauty of the country, and try to understand the economics and culture to help bring access and inclusion to all.

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