SONIA, 15, from Kamalganj in Sylhet, was first diagnosed with deafness as infant when she did not respond to any sound, but never received therapy afterwards.

This means, she is wholly incapable of lip-reading or understanding sign language.

Being unable to cope up in a normal school, she has also never learnt how to read or write.

She was never given any therapy because there are no services within their area, claimed her father Borhan Miah, a farmer by profession.

"I had taken her to the Sylhet city hoping to find a cure, but they told me that she will have to take therapy for several years. 1 could not afford such a program. Besides, how will a farmer survive in the city?" said Borhan Miah.

For children with hearing impairments, a cochlear implant can cost as much asTk 20 lakh, said Dr Shorifa Shahjadi, Assistant Professor of Physiology Department at Bangabandhu Sheikh Mujib Medical University.

Occupational therapy, directed at rehabilitation, is given to patients with both physical and mental special needs, and can cost up to Tk 300 per session at private organizations, said Shariful Islam, Secretary of Bangladesh Occupational Therapists Association.

"This therapy is important because it acclimatizes the patients to their surroundings, and makes them self-reliant, it focuses on improving both physical capabilities as well as social skills," added Shariful.

Children with other physical impairments also have to go through extensive therapy processes to improve their situation, said Krishno Sen, Monitoring and Evaluation Officer of the Research and Evaluation Division of Centre for the Rehabilitation of Paralysed (CRP).

"In the initial stage, a cerebral palsy patient is given a month-long therapy at a stretch, while spinal cord injury and stroke patients are kept

for three months, but, they require consistent follow-ups and lifelong attention. Many patients have to go through recurring periods of long-term therapy throughout their lives,'1 he

added.

The burden of the costs involved make many drop out of these medical procedures, said Krishno Sen.

A wheelchair would cost around Tk 15,000, stated Shariful Islam.

Children with behavioural or psychiatric illnesses also do not usually get fully treated, and medicine costs may be as much as Tk 2000 per month said Badrul Mannan, General Secretary of Welfare Society for Mental Health and Rehabilitation (WSMHR).

Depending on the severity of the intellectual impairment, the child may be fit for rehabilitation within a couple of years, or may have to take lifelong sessions of therapy and training, said Director of Society for the Welfare of the Intellectually Disabled (SWID), Nurul Islam.

Centre for the Rehabiliation of Paralysed (CRP) in Savar, on the outskirts of the capital, provides medical care at discounted rates, or even free, according to the financial need of the patients, said Sen.

"However such services cannot be delivered to patients all over the country, * he added.

Our primary medical care system consisting of community clinics, are not equipped with such services, although such patients exist everywhere, maintained Badrul Mannan.

"The government run community level clinics are unable to provide medical intervention to patients with special needs, because it is difficult to recruit good doctors in rural areas. At best, patients are referred on to hospitals which can provide such facilities," admitted secretary to the Ministry of Health and Family Welfare, NM Niaj Uddin.

Nevertheless, the ongoing nationwide survey of people with special needs being undertaken by the government will help identify children with developmental problems all over the country, and make it easier to extend medical intervention to them, said Professor Naila Zaman Khan, of Dhaka Shishu Hospital.