Dr Manju Antil (Counselling Psychologist and Psychotherapist)

World Health Organisation (1978) proposes the assumption of a three-tier classification system including Impairment, Functional limitations and Disability. Impairment leads to functional limitations, and functional limitation leads to disability.

Impairment

 An impairment is permanent or transitory, psychological, or anatomical loss and/or abnormality. For example a missing or effective part, tissue organ or “Mechanism” of the body.Such as an amputated limb, paralysis after polio, myopia, mental retardation etc.

Functional Limitation

Impairment may cause functional limitations which are the partial or total inability to perform activities necessary for motor, sensory, or mental functions within the range and manner of which a human being is normally capable such as walking, lifting loads, seeing, hearing, reading, writing, counting, talking interest in and making contact with surroundings. A functional limitation may last for a short time, a long time permanent or reversible. It should be quantifiable whenever possible. Limitations may be described as “Progressive” or “Regressive”.

Disability

Disability is defined as an existing difficulty in performing one more activity which in accordance with the subject’s age, sex and normative social role, are generally accepted as essential, basic components of daily living, such as self-care, social relations and economic activity. Depending in part on the duration of the functional limitation disability may be short-term, long-term or permanent.

Medically, disability is physical impairment and inability to perform physical functions normally. Legally, disability is a permanent injury to the body for which the Person should or should not be compensated.

The disability can be divided into 3 periods:

1. Temporary total disability is the period in which the affected person is totally unable to work. During this time he may receive orthopaedic, ophthalmological auditory or speech or any other medical treatment.

2. Temporary partial disability is the period when recovery has reached the stage of improvement so that person may begin some kind of gainful occupation.

3.   Permanent disability, applies to permanent damage or loss of use of some part/parts of the body after the stage of maximum improvement from any medical treatment has been reached and the condition is stationary.

 The stark truth that confronts us all, today is the total number of disabled people in the world. WHO puts the figure at 500 million; a figure exceeding the entire population of Africa or that of the United States of America and the USSR combined. 300 million of this staggering number live in developing and under-developed countries. And this is no static figure, every year an additional 15 million handicapped join the ranks of disabled persons. As victims of war, accidents, mal-nutrition and diseases they share the right of all humanity to grow and learn, to work and create, to love and to be loved; but they live in societies that have not yet learned to fully protect such

Rights for disabled citizens; who are, too often, denied the opportunities and responsibilities which should rightfully be theirs

One more stark statistic out of the 500 million disabled, at least one quarter are children. Yes (according to Unicef figures) one child in every ten is born with a disability or acquires it early in life.

THE DISABLED PERSONS IN INDIA

India is a vast country with variable social, cultural, geographical and economic backgrounds. Despite breakthroughs in health services, a number of disabilities continue to appear due to polio, communicable and congenital diseases, increased industrialization and mechanization, and vehicular traffic leading to locomotor disabilities. Vitamin-A deficiency, cataracts and infections, injuries, nutritional deficiencies leading t visual loss, ear infections, external injuries, and noise pollution contributing to hearing loss.

An insight into the magnitude of disability in India can be obtained from the report of the survey done by the National Sample Survey Organisation (NSSO), which has estimated the disabled population in India and about 17 million, constituting about 1.9% of the total population of India. About 10% of disabled persons suffer from more than one disability. It is estimated that 2% to 2.5% of the

The population is mentally disabled. Those with locomotor disabilities, number about 5.4 million, with speech and hearing disorders, 4.8 million, and with visual handicapped, 3.5 million. As 80% of disabled persons live in rural areas, rehabilitation services need to be improved in these areas.

In 1985, the Government launched the District Rehabilitation Centre Scheme (DRCS) in eleven districts of the country. These services include immunization, medical and surgical assistance, education through special schools, vocational training and job placement. Since 1991, these centres have also started training Aanganwadi workers and their instructors. An evaluation of this scheme prompted the formulation of a new scheme, which is to be operated in rural areas through voluntary organisations.

The objective of the new scheme is to provide comprehensive services encompassing medical educational, vocational, social and psychological rehabilitation, to all categories of rural disabled, as far as possible at their doorsteps. This scheme comprises a two-tier programme. It would operate at the district level and at the Primary Health Centre (PHC) level. At the district level, a core team of professionals and specialists would function under

The project coordinator. At the PHCs, there would be a Multi Rehabilitation Assistant (MFA) together with three Community-Based Rehabilitation (CBR) Workers. The scheme would be introduced in a phased manner and the entire district would be covered within a period of 3 to 4 years.

This attempt to adopt the Community-Based Rehabilitation (CBR) approach for rural areas would lead to initiatives from the community to manage welfare activities. This is to be done through the participation of disabled people in all stages of the programme, from planning to implementation. Resources would also be generated from within the community as far as possible.

The Government provides financial assistance to voluntary agencies working in the field. The scheme ‘Assistance to Organisations for Disabled’ has been in operation for the last 30 years. At present about 315 voluntary organisations throughout the country are being assisted to implement rehabilitation programmes. These are in the areas of education, vocational training, placement services, psychological rehabilitation/counselling, awareness generation, early detection and intervention. There are approximately 82 voluntary organisations in the area of orthopedically handicapped, 63 in the area of visually handicapped, 67 in hearing handicapped and 101 in mental retardation.

In 1992-93, Rs. 9.6 crore were given to voluntary organisations, benefiting about 42811 people with disabilities, while in 1993-94, Rs. 10.4 crore were given, benefiting 60161 people with disabilities.