The Bhutanese Leading the way.
This only includes ages 5 and above
The National Health Survey in the most detailed survey of its kind till date found that there are 48,325 persons with disabilities in Bhutan out of 710,667 people. This is 6.8 percent of the total population.
The figures are only for those who are five years and older, and it is also only for self-reported disability during the health survey in 20 Dzongkhags. So, the actual numbers could even be higher.
The prevalence of disability in self care is at 2.4 percent, hearing at 2.0 percent, mobility at 2.0 percent, vision at 1.8 percent, cognition at 1.5 percent and communication at 0.8 percent.
This survey is eye opening, as it is the first time that such a large number and percentage has come to the fore.
The numbers above also show that the various stakeholder agencies need to put in resources and manpower into the issue.
EECD coverage and inclusive education
The Executive Director of Ability Bhutan Society (ABS), Kuenzang N. Tshering, said, “The government should not totally depend upon us, but they should also start taking care. We are not proposing a special center, but the ECCD coverage is good and people with disability should be accepted there, but acceptability is low, and we cannot blame them as they do not have trained teachers. They should be initiating enrolling students and ensure care giving as the ECCD coverage is good.”
He said most of the people with disabilities are in the rural areas who are not reached out to by CSOs and the government. He said these people are vulnerable and disadvantaged among the community, as they are neglected since it is thought they cannot contribute productively as citizens.
He said the communities and people should speak up for these people instead of just one or two CSOs, and so the government can take care of them and the people with disabilities should be given the opportunity to contribute to the economic development of the country as exclusion will cost much more.
Kuenzang said they have been requesting that all schools should be SEN schools. He said making this possible will increase coverage across the country.
Policies need to be implemented
The Executive Director of the Disabled People’s Organization (DPO) of Bhutan, Kinley Wangchuk, when asked what the government and society can do about the issue gave some recommendations.
Kinley said there are multiple levels of disability broken largely into three categories of mild, moderate and severe.
He said the mild and moderate levels need maximum inclusion giving them equal education and more inclusivity, not just infrastructure wise, but even in terms of technology, enhancing skills, etc.
Giving an example, he said there are certain children with disability who are very good in math and score 98 and 95 and cannot cope up in other subjects due to their disability, and so here ,the education policy should not force these brilliant minds in math to pass other subjects, like Dzongkha, and should instead be more accommodative.
He said for the mild and moderate people with disabilities if the National Policy for Persons with Disabilities of 2019 is implemented, there are several provisions.
He said the approved policy has provisions for the private sector to get tax rebate incentives for hiring persons with disability and others provisions.
This well written policy has policy interventions in education, health, economic security, caregivers, families and communities, protection and access to justice, disaster mitigation, built environment, transport, ICT, participation in sports, culture and leisure, policy and planning, finance, political participation, HR development, CSOs and data and information.
However, most of the above remains on paper, with no implementation on the ground except in a few sectors, like Education, Health and Elections where some effort is being made but there is a long way to go, but for other sectors not even a start has been made.
He said apart from the 2019 Policy above the National Council this year passed many recommendations in education, economy, health, access and de-stigmatization for a more inclusive society to include and help Persons with Disabilities (PWD).
Separate help for the severe cases
Kinley said the worse hit of the categories are the severe cases where there is cognitive capabilities, and so they cannot work and earn, and so are going to be poor.
He said even if their parents are Dashos or tycoons, they will suffer from poverty and low self-esteem.
Kinley said that in the severe cases, the government needs to do something, as the CSOs can only do so much. He said there are a lot of cases where the persons with severe disabilities do not have both parents, and have to depend on their siblings, and in some cases nobody is there for them. He said there are cases where old mothers who have given birth to a single child with severe disability die and there is no one to look after the child.
He said, “Who will take care here? There are no disability care facilities and even aged care facilities. These are the realities.”
He said the traditional concept is that children will take care of their parents when they get old, but these days people have only one or two kids and what happens when the kid or kids are disabled?
He said the Ministry of Health should screen and certify mild, moderate and severe cases, and then after the certification, for severe cases, the government should give monthly remunerations even if its is as low as Nu 1,000 or Nu 2,000 as it will still help.
Human Rights and Social Cluster
He said the voices of the marginalized and voiceless disabled community should be heard, and they have certain rights, which should not be looked at negatively, but as simple human rights and basic human dignity.
Kinley said that a lot of other sectors also need to come together for PWD as if one looks at the 13th Plan, there are four clusters of which the social cluster is only health and education.
He said it is pertinent that the social cluster covers the needs of the differently abled other than just health and education.
Disability can happen to anyone
Kinley said that people may think that PWD is a separate category, but what people do not realize is that ability is very short lived, and disability can happen to anyone.
He said the JDWNRH, itself, reports 500 to 600 stroke cases a year, there are a lot of motor vehicle accidents a year, there are kidney failures and the victims of Non Communicable Diseases are only going up. He said ability is short lived, and anyone or any family can go through disability at any time, but there is no mechanism to help, and this is when it hits hard on society, as a whole.
Kinley said that these days due to migration, the children are all migrating and old parents are left behind. He said the kids may send money to the parents, but it is difficult to get workers to help them and so it is not just about money too.
Pilot program
The DPO in association with the Royal Society for Senior Citizens is piloting a voluntary program in Paro where volunteers from the Paro College of Education provide weekly service to 19 people with disabilities in 3 Gewogs by going to their homes to wash, clean and do other chores.
The initiative will be launched on 13 October 2024 coinciding with the Royal Wedding and it can be replicated in other colleges.
He said, “The RCSC in 30 minutes judges a candidate based on manner, form and disposition but three years of such voluntary service with a certificate should speak more about the candidates, and if RCSC agrees then we can get more volunteers.”
Hidden economic cost of exclusion
There is also a huge hidden economic and productivity cost to the system not being inclusive, supportive and disabled- friendly.
In the case of many children with disabilities, one of the two parents resign from work which takes away workers from an economy already suffering from a small population, lower fertility rate and large scale migration.
The lack of an inclusive system also ensures that the child with disability cannot get the necessary help, barring the child from contributing economically when she or he grows up, and thus taking away yet another worker from the economy. This is two per family or more, and adds up when it happens in thousands of families.
Kinley shared a story where a mother was staying with a child at the Wangsel Deaf Institute and the father worked in Thimphu. However, with the distance the father found another wife depriving the non-working mother and the deaf child with their only source of income and financial security.
Education Minister says all schools to be inclusive in 13th plan
When the Minister for Education and Skills Development, Yeezang De Thapa was asked about what her ministry is doing to help persons with disabilities, she said, “We have inclusive education programs in schools for children with disabilities across Bhutan, like inclusive schools in 20 Dzongkhags. In 2024 we have 1,253 disabled children enrolled in 44 schools. In the 13th Plan, all schools will be made inclusive friendly.”
Meaning of the Disabilities surveyed
The survey has followed the Washington Group questions and definitions which follows an accepted international criteria.
‘Seeing’ and ‘Hearing’ disabilities are not just to do with the eyes and ears, but also difficulties in seeing or hearing which can also be caused by problems in other body systems such as in the brain.
‘Mobility’ is walking without assistance of any device or human. If such assistance is needed, the person has difficulty walking. Furthermore, difficulties in mobility can arise from wide-ranging impairments, such as paralysis, cerebral palsy, amputation, middle-ear issues, and significant cardio-pulmonary difficulties, among others.
‘Cognition’ is to do with remembering and concentration. Remembering refers to individuals using their memory capacity to recall facts, events, experiences or what has happened in their immediate surroundings. Individuals can recall or think again about something that has taken place in the past (either the recent past or further back). With younger people, remembering is often associated with storing facts learned in school and being able to retrieve them when needed.
‘Concentrating’ refers to individuals using their mental ability to accomplish such tasks as reading, calculating or learning something new, and focusing on the task at hand in order to complete it. Concentrating is the act of directing one’s full attention on one subject or focusing without distraction on one thing.
‘Cognition’ also includes decision‐making, understanding spoken and written language, finding one’s way or following a map, reading and thinking.
Cognition is significant difficulties, and not common everyday problems like forgetting where keys have been placed or getting to the end of a task that was considered boring or unpleasant.
‘Self-care’ refers to ‘washing all over’ and represents the process of self-cleaning the entire body (usually with soap and water) in a culture-specific manner. The activity includes washing hair and feet, and gathering the items necessary for bathing, such as soap or shampoo, a washcloth or water.
‘Self-care’ also refers to ‘dressing’ and represents all aspects of putting clothing or garments on the upper and lower body, including the feet if culturally appropriate. Gathering clothing from storage areas (i.e. closet, dressers), securing buttons, tying knots, and zipping, among others, should be considered part of the dressing activity.
Communication can be interrupted at numerous places within the exchange process. It may, for example, involve mechanical problems like hearing or speech impairment. It may also be related to the ability of the mind to interpret the sounds that the auditory system is gathering and to recognize the words that are being used. The intention is not to include communication problems due to issues relating to non-native or unfamiliar language.
