Disability Medical Care 1

Disability Medical Care in Developing Countries Heather Gammon

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Introduction According to the World Health Organization, 15% of the worlds population, or more than one billion people are living with disabilities and consequently, 25% of the worlds population is affected by disabilities. Of that 15% of people with disabilities, two-thirds of the disabled population lives in developing or low-income countries (WHO). Due to the poverty level of these countries, proper medical care is not available for people living with disabilities. Unfortunately, the global disability rate is increasing rapidly and is expected to double by the year 2025 (WHO). Specifically in Africa, the quality of health care is declining, limiting the access to proper medical care for disabled people even further. In response to these startling statistics, the improvement of medical care for people living with disabilities in developing countries in Africa will be explored and the following literature reviews will discuss the cited reasons for inadequate medical care for people with disabilities in developing countries as well as steps that could be taken for improvement. Disability and Poverty Poverty is a major issue within developing countries that people are working to improve. However, people often ignore health concerns within developing countries, overlooking the correlation between poverty and disability. According to Lygnegrd, Donohue, Bornman, Granlund, and Huus, (2013), poverty is both a cause and consequence of disability(297). Within developing countries, poverty and disability create a cycle, reinforcing each other and contributing to increased vulnerability and exclusion of disabled people (Department for International Development, 2000,2). Within a setting of poverty, the heightened exposure to risks and environmental hazards related to poverty can increase the likelihood for congenital or acquired disabilities, while disability can reinforce poverty through its negative association with education and employment(Lygnegrd, Donohue, Bornman, Granlund, and Huus, 2013, 297). Disability is often viewed as purely a medical issue but is much more complicated than that. The Department for International Development (2000) states that disability is the outcome of complex interactions between functional limitations arising from a persons physical, intellectual or mental condition and the social and physical environment(2). Additionally, the DFID (2000) mentions that the needs...cannot be fully addressed unless the underlying causes of poverty are tackled (2) Therefore, the treatment of disabilities needs to be improved in conjunction with the poverty level of a developing country. Abuse and Discrimination In every culture, a stigma is associated with a disability but this stigma is even stronger in developing countries due to the poverty level of the country and the burden of disabled people. Specifically in Nigeria, the belief is held that if a child is born with a mental disability, the family has come under a curse by the gods and is being punished for evil doing (Omigbodun, 2008, 230). Often times, families try to escape the stigma by either abandoning their disabled child or by locking up children with mental disabilities...often with the child having to endure slow starvation (Omigbodun, 2008, 230). In addition to neglect and abandonment, children with disabilities are deprived of opportunities to participate in society and are prone to violence and abuse (Parnes, 2009, 1176). According to Parnes (2009), current research indicates that violence against disabled children occurs at annual rates at least 1.7 times greater than their non-disabled peers, showing the difference in the treatment of disabled and nondisabled people (1175).

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Unfortunately, women with disabilities experience stigma due to both gender and disability, and consequently, they face more discrimination and violence than disabled men. As a result of the negative views associated with disabled women, now women with disabilities represent one of the most marginalised groups in society (Parnes, 2009, 1174). In fact, according to a 2004 survey in Orissa, India, 100% of the women and girls with disabilities were physically abused at home (Parnes, 2009, 1174). Parnes (2009) also states: It is not unknown for children born with congenital disabilities to be killed or left to die. This is far more likely to happen in the case of a girl-child. If allowed to survive, the girl-child is likely to continue to face discrimination within the family, receive less care and food, and be excluded from family interactions and activities. She will have less access to health care and rehabilitation services, fewer educational and employment opportunities, and little hope of marriage. She will also be more vulnerable to physical and mental abuse. (1174) Even though disabled women experience more hardship than disabled men, the quality of life for both women and men with disabilities is very low. In order to decrease the prevalence of violence and discrimination toward people with disabilities and to increase the quality of their lifestyle, measures should be taken to improve the opportunities and medical care available for disabled people living in low-income countries. Decline of Healthcare in Africa While it is important to improve healthcare in all developing countries, the low-income countries in Africa should be an area of focus. Out of every continent, Africa has the poorest health services and those health services are currently declining (Grut, Mji, Braathen, Ingstad, 2012, 2). In his article, Omigbodun notes that resource poor countries in Africa...continue to face marked deterioration in health care which presents an even greater obstacle for the provision of medical care to people with disabilities (2008, 226). In addition, Maseru states that the governmental health services that have previously provided public health care in Lesotho have referred patients to private clinics and pharmacies in response to the decline of public medical care in Africa (2011). According to Omigbodun the decline has been in the sparse but adequate medical infrastructure as well as in the status and stability of healthcare workers (2008, 226). In order to see improvement in the medical care for people with disabilities, lowincome countries in Africa need to see an increase specifically in their stability of their medical workers as well as in the overall structure of the healthcare system. Barriers to Receiving Health Care Accessing general health care is difficult in developing countries in Africa but greater barriers exist for disabled people, making it more difficult to receive special needs medical care. Through his interviews with Somali mothers, Beatson (2013) recognized two themes among the obstacles preventing people, specifically parents, from accessing adequate health care for children with disabilities: not understanding their childs condition and managing a child with special needs (144). After interviewing Mthunzi (a boy with epilepsy in South Africa), Grut, Mji, Braathen, and Ingstad (2012) concluded that many people in developing countries lack knowledge on how to acquire and sustain good health as well as knowledge about training and

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rehabilitation[and] on how medical treatment works(5). In addition, parents also have to choose between high costs - use of scarce money, effort and energy - weighed against their daily chores and responsibilities (Grut, Mji, Braathen, and Ingstad, 2012, 5). Within low-income countries, maintaining a job and responsibilities is necessary for survival and often overrides the necessity to attempt to gain access to medical care for a stigmatized person, presenting another barrier to receiving adequate health care. According to Grut, Mji, Braathen, and Ingstad, (2012) Among the factors which reduce access to health services for poor people with disabilities are unavailability and inaccessibility of the health services, combined with financial constraints and ignorance of available services, inadequate and inaccessible transport (2). Of these factors, the direct and indirect financial costs involved in visiting a health facility[have been] described as the greatest barrier to access (Kleintz, Mannava, Nimul, Vichetra, Walji, 2012, 5). Finances are not only required to be seen by a health provider but are also necessary for transportation to the medical facility due to the distance and difficulty of walking to a clinic. Kleintz, Mannava, Nimul, Vichetra, Walji (2012) stated that the physical distance to a health centre was reported on a number of occasions as a barrier to access, mainly due to people with disabilities requiring reliable, physically accessible and affordable transport (4). Finally, the quality of services offered at the health facilit[ies] was deemed as the second most important barrier to seeking health services (Kleintz, Mannava, Nimul, Vichetra, Walji, 2012, 5). Kleintz, Mannava, Nimul, Vichetra, and Walji (2012) reported that uncaring attitudes and inadequate knowledge and skills of health professionals when dealing with people with disabilities contributed to patients declining to visit medical facilities (6). It was also reported that within developing countries there are numerous accounts of people with disabilities having to wait longer for services, experiencing uncaring attitudes or even being denied treatment due to inability to pay the unofficial fees posing another barrier rather than encouraging disabled people to attempt to access disability health care when it is available (Kleintz, Mannava, Nimul, Vichetra, and Walji, 2012, 5). Improving Medical Care Developing Countries Before designing and implementing strategies to improve disability medical care within developing countries, it is important to take into consideration the needs as well as the resources and abilities of the family group that will be affected by the strategies (Grut, Mji, Braathen, and Ingstad, 2012, 5).Through their assessment of health services in Africa, Grut, Mji, Braathen, and Ingstad (2012) also recognized the necessity to understand the rationale for the persons actions and priorities in regards to their decision of whether or not to use the health care that may be available to them (5). By gaining a better understanding of the personal views and abilities of the families and individuals affected by disabilities, health care services can be designed to better cater to the needs and desires of the patients. Due to the data found that many disabled people in developing countries are uninformed of their condition and unaware of health services that can help them, it is also important to promote better understanding of health issues among people with disabilities (Kleintz, Mannava, Nimul, Vichetra, Walji, 2012, 10). After understanding the opinions and abilities of people with disabilities and their families and informing disabled individuals of health care that is available for them, health services can be designed to best meet the needs of disabled people in low-income countries.

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In conjunction with determining the needs and abilities of disabled people and their family members, within a developing country it is necessary to provide outreach options for the provision of medical care. Grut, Mji, Braathen, and Ingstad (2012) suggest: focus on bringing medical services and treatment out to the disabled person and the families; with a stronger emphasis on involving skilled and specialised medical and health professionals higher up in the hierarchy in outreach and homebased services. In cases where this is not possible, there is a need to strengthen accessible transport facilities in order to bring the patient to the hospital. (5) In areas where it is difficult for a patient to travel to a clinic or hospital, health care would be much more beneficial if it was provided directly in homes and within the community. Additionally, the provision of medical care could be strengthened by namely raising awareness among health service providers on how to address the needs of and engage with people with disabilities (Kleintz, Mannava, Nimul, Vichetra, Walji, 2012, 8) and through the development of the training and the tasks of the local, often unskilled, health workers accordingly (Grut, Mji, Braathen, and Ingstad, 2012, 5). Finally, Community Based Rehabilitation is a strategy that could be beneficial treatment for disabled people in a setting of poverty. According to Chatterjee, John, and Thara (2013), CBR is a program that was initially promoted as a strategy to improve access to rehabilitation services for people with physical disabilities in low- and middle-income countries by making optimum use of local resources (78). Through their research on schizophrenia in India, Chatterjee, John, and Thara (2013) found that in addition to providing medical treatment, CBR services have an explicit focus on developmental needs, social exclusion due to discrimination, and promoting the human rights of the individual (78). The nature of CBR services involves the entire community, including neighbors as well as family members, and therefore presents a strategy for both the provision of disability medical care and the prevention of discrimination toward disabled individuals. Conclusion Based on the research presented in this literature review, the improvement of medical care for people with disabilities in developing countries is complex and requires many steps. In conclusion, in order to improve the medical care for people living with disabilities in developing countries in Africa, it is necessary to understand the culture and its impact on the provision of medical care as well as create a more accessible system of providing medical care that includes community based rehabilitation and outreach.

Disability Medical Care 6 Works Cited Beatson, J. E. (2013). Supporting Refugee Somali Bantu Mothers with Children with Disabilities. Pediatric Nursing, 39(3), 142. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/ pdfviewer?sid=72a53f4a-c2a4-4433-8ac6c03e2facd1aa%40sessionmgr4005&vid=7&hid =4205 Chatterjee, S., John S., Thara R. (2013). Comprehensive care for patients in the developing world. International journal of mental health. 42, 1, 77-90. Retrieved from http://eds.b. ebscohost.com/eds/pdfviewer/pdfviewer?sid=80a022bc-15be-449c-b27e-11e098b67d93 %40sessionmgr198&vid=10&hid=110

Department for International Development (2000). Disability, poverty and development. Retrieved from http://www.handicap-international.fr/bibliographie-handicap/4 PolitiqueHandicap/hand_pauvrete/DFID_disability.pdf

Grut, L., Mji, G., Braathen, S.H., Ingstad, B., (2012) Accessing community health services: challenges faced by poor people with disabilities in a rural community in South Africa, African Journal of Disability 1(1), Art. #19, 7 pages.http://dx.doi.org/10.4102/ajod.v1i1.19

Kleintz, P., Mannava, P., Nimul, O., Vichetra, K.,Walji, F. (2012). Barriers to and facilitators of health services for people with disabilities in cambodia. The nossal institute for global health. Retrieved from http://data.biitbook.com/Barriers-to-and-facilitators-of-healthservices-for-people-with-disabilities-in-Cambodia-(WP20).pdf

Lygnegrd, F., Donohue, D., Bornman, J., Granlund, M., & Huus, K. (2013). A Systematic

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Review of Generic and Special Needs of Children with Disabilities Living in Poverty Settings in Low- and Middle-Income Countries. Journal Of Policy Practice, 12(4), 296-315. Retrieved from http://eds.b.ebscohost.com/eds/detail?vid=3&sid=f43cfb c3-bfca-4f42-a491-fd39de3d13b2%40sessionmgr198&hid=106&bdata=JnNpdGU9Z WRzLWxpdmU%3d#db=asx&AN=90147523

Maseru (2011). Lesotho: public health services in decline. Retrieved from http://www.irinnews.or g/report/93873/Lesotho-public-health-services-in-decline

Omigbodun, O. (2008). Developing child mental health services in resource-poor countries. International review of psychiatry. 20, 3, 225-235. Retrieved from http://eds.b.ebscohost. com/eds/pdfviewer/pdfviewer?sid=80a022bc-15be-449c-b27e11e098b67d93%40sessio nmgr198&vid=9&hid=110 Parnes, P. (2009). Disability in low-income countries: Issues and implications. Disability & Rehabilitation, 31(14), 1170. http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid= 72a53f4a-c2a4-4433-8ac6-c03e2facd1aa%40sessionmgr4005&vid=17&hid=4205

World Health Organization (2013). Disability and health. Retrieved from http://www.who.int/medi acentre/factsheets/fs352/en