Promoting inclusivity in post-pandemic world

Contributed by Dr Abang Muhammad Fahmy bin Abang Haji Hepnie, Consultant in Rehabilitation Medicine, Head of Rehabilitation Department, Brunei Neuroscience, Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre

The International Day of Persons with Disabilities is observed every year on December 3 to promote the well-being and welfare of people living with disabilities.

The theme for this year’s International Day of Persons with Disabilities is ‘Leadership and participation of persons with disabilities toward an inclusive, accessible and sustainable post-COVID-19 world’.

Since March 2020, there has been major political, social and economic change as a result of domestic and international responses to COVID-19. People with disabilities are among those most affected in this COVID-19 pandemic. Although marginalisation, discrimination, vulnerability and exploitation have been experienced by many people with disabilities even before the pandemic, this has been magnified with the reduced access to routine healthcare and rehabilitation services, more pronounced social isolation, sub-optimal public health messaging, inadequately constructed mental health services, and a lack of emergency preparedness for people with special needs.

Brunei has ratified the United Nations’ Convention on the Rights of People with Disabilities in April 2016 and implemented the Old Age Pensions and Disability Act (Amendment) Order 2021 and Persons with Disabilities Order 2021 from October 1, 2021. These are all the right direction towards ensuring that persons with disabilities in the country are given due recognition and protection.

The Government of His Majesty Sultan Haji Hassanal Bolkiah Mu’izzaddin Waddaulah ibni
Al-Marhum Sultan Haji Omar ‘Ali Saifuddien Sa’adul Khairi Waddien, Sultan and Yang Di-Pertuan of Brunei Darussalam with other stakeholders for disability continue to drive the national effort to improve the well-being, welfare and support system for persons with disabilities.

Disability can be congenital or acquired. Persons with disabilities occupy an essential and ever-growing proportion of the healthcare continuum. Rehabilitation services especially play an important role in the healthcare of persons with disabilities. The rehabilitation teams at Pantai Jerudong Specialist Centre (PJSC) and at the Ministry of Health (MoH) see many people with disabilities among their patients.

Rehabilitation services are consistently among the health services most severely disrupted by the pandemic. PHOTOS: PJSC
Rehabilitation staff have had to be deployed to other areas of need in the fight against COVID-19 and therefore reducing the already small number of staff offering rehabilitation services

At PJSC, the rehabilitation team sees mainly adult patients suffering with cancer, stroke, spinal cord injuries, brain injuries, neurological disorders or trauma, musculoskeletal disorders and maxillofacial conditions. At the MoH, the rehabilitation teams see a variety of adult and children with chronic or acute disabling conditions, which include- but not limited to – patients with cerebral palsies and other congenital conditions; acquired childhood illnesses leading to disabilities, orthopaedic conditions, limb amputations, cardiopulmonary conditions, psychiatric conditions, hearing and visual impairments; and other serious medical and surgical illnesses leading to disabilities.

There are also other rehabilitation professionals working in non-government organisations and the private sector that provide important input to persons with disabilities in Brunei.

Unfortunately, COVID-19 has created significant challenges for rehabilitation services around the world, including Brunei.

Rehabilitation services are consistently among the health services most severely disrupted by the pandemic. This is due to specific characteristics of rehabilitation settings. First of all, rehabilitation services provide a multi-disciplinary treatment.

This means that many different professionals, including doctors, therapists, nursing staff, and psychologists, interact with single patients and as a team on a daily basis. Group therapy (more patients supervised by one or more therapists) is also an integral part of rehabilitation protocols. Secondly, a direct and prolonged contact between patients and rehabilitation healthcare workers is expected, including hands-on or close-distance interventions to support patients in activities such as assisted exercises and ADLs (activities of daily living such as dressing, toileting, and feeding) or mobility (such as transfers or assisted walking).

Rehabilitation staff have had to be deployed to other areas of need in the fight against COVID-19 and therefore reducing the already small number of staff offering rehabilitation services.

The implementation of social distancing and movement restriction strategies in Brunei has resulted in many persons with disabilities with rehabilitation needs not being able to access rehabilitation services, or they may have an adaptive form of rehabilitation (telehealth). The reality is, however, that many people are left with no access to rehabilitation services and this may compromise their health outcomes.

Children with disabilities often receive support from specialised professionals through schools, through the Ministry of Education (MoE) Special Education Department and from the MoH’s Child Development Centre. Families of children with disabilities may find childcare, education and rehabilitation challenging during COVID-19, as school closures and social distancing are implemented. Children with disabilities are also at-risk populations during the pandemic and may experience negative outcomes due to reduced quality of care and rehabilitation.

There have always been transportation barriers for persons with disabilities, but this has worsened in the COVID-19 pandemic. Access to public transportation for persons with disabilities is especially problematic.

A common complaint from those persons with disabilities who have their own private transportation is that there is a lack of universally accessible parking spots in Brunei, and even if there are such spots available, these are often already taken by able-bodied individuals.

Persons with disabilities may be at greater risk of contracting COVID-19 because of several issues. There may be barriers to implementing basic hygiene measures, such as handwashing (handbasins, sinks or water pumps may be physically inaccessible, or a person may have physical difficulty rubbing their hands together thoroughly).

Persons with disabilities may have difficulty in enacting social distancing because of additional support needs with caregivers. They may also need to touch things to obtain information from the environment or for physical support. They may have difficulties accessing public health information regarding COVID-19.

Persons with disabilities and their household members should follow the MoH guidance on basic protection measures during the COVID-19 outbreak, such as hand hygiene, respiratory etiquette and physical distancing.

Ensure that assistive products, if used, are disinfected frequently; these include wheelchairs, walking canes, walkers, transfer boards, white canes, or any other products that are frequently handled and used in public spaces.

While social distancing and movement restrictions are useful strategies in reducing the transmission of COVID-19 in the community, this has taken a toll on the mental health of the population, especially for persons with disabilities due to increasing isolation.

This is where it is important for family members, friends or caregivers to check in regularly to provide emotional and practical support, while respecting social distancing restrictions that are in place. The availability of easily accessible counselling service would be a significant help to isolated persons with disabilities.

As medical doctors, my colleagues and I are often pre-occupied by the routine minutiae of providing the technical and clinical care aspects to our patients. And unfortunately, what is often overlooked is the “human side” of caring, that transcendent sense of seeing life through the eyes of our patients.

One of the biggest lessons that I have learned from my patients living with disability is their unbeatable human spirit to survive and keep going, while facing the daily challenges despite all barriers whether physical, psychological or environmental.

I also have deep admiration and appreciation towards the family members and caregivers of persons with disabilities, as their support are invaluable in helping their loved ones with disabilities improve their quality of life.

PJSC is commemorating the International Day of Persons with Disabilities to highlight our patients and staff with disabilities, as well as their selfless families and caregivers by putting ourselves in their shoes, and how they face the world in this current pandemic. In doing so, we hope to promote their stories, struggles and achievements; and help improve disability awareness to all.

The International Day of Persons with Disabilities should be celebrated by everyone: individuals, organisations, agencies, charities, places of learning – all of whom have a vital role to play in identifying and addressing discrimination, marginalisation, exclusion and inaccessibility that many people living with disabilities face.

The International Day of Persons with Disabilities may be just one day on the calendar, yet it symbolises the actions we should take every day, in order to create diverse and accepting communities.

I urge that we learn from the experiences of persons with disabilities during this COVID-19 pandemic, and promote empathy and kindness, as well as meaningful investments into the socioeconomic building blocks to reduce the barriers faced by persons with disabilities.