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    Towards equitable healthcare and rehabilitation

    Dr Abang Muhd Fahmy bin Abang Hj Hepnie, Head of Rehabilitation Department, The Brunei Neuroscience, Stroke and Rehabilitation Centre (BNSRC), Pantai Jerudong Specialist Centre (PJSC) International Day of Persons with Disabilities (IDPWD) is celebrated every December 3 to promote the rights and well-being of persons with disabilities at every level of society and development and to raise awareness of the situation of persons with disabilities in all aspects of political, social, economic, and cultural life.

    The theme for this year’s IDPWDis ‘Transformative Solutions for Inclusive Development: the Role of Innovation in Fuelling an Accessible and Equitable World’.

    This theme focusses on creating innovation and transformative olutions for inclusive development in three different thematic topics – 1) to provide disability inclusiveness in employment; 2) to provide disability inclusiveness in reducing inequality; and 3) to develop disability inclusiveness, with sports as an exemplar case. The United Nations’ Convention on the Rights of Persons with Disabilities (CRPD) of 2007 describes disability as an “evolving concept” and said that “persons with disabilities include those who have long-term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others”.

    Disability is an outcome of an interaction between health conditions (such as cerebral palsy, depression or lung disease), and environmental factors (such as inaccessible transportation, limited social support or air pollution).

    Disability is a matter of degree, because mental and physical impairments range in severity, from minor to severe. The experience of disability over the life course is a universal human experience since everyone will experience some limitation in bodily or mental function at some point. The experience of disability can be temporary, chronic or progressive.

    It is also diverse not only in extent but also in type. There are many different types of disability, some may not always be visible.

    A therapist supporting a patient during a rehabilitation session. PHOTOS: PJSC
    Patient undergoing rehabilitation while a therapist looks on

    Some people live with severe sensory, mobility, communication or cognitive impairments (eg, people who are blind or deaf, wheelchair users, or children with intellectual disabilities) but there are also people with mild and moderate impairments who need help to keep these impairments from worsening.

    Finally, as we age, we experience multiple morbidities in which several, mild or moderate impairments across many body functions occur together, producing relatively high levels of overall disability.

    It is estimated that 15 per cent of the global adult population experiences disability and two to four per cent experience very significant difficulties in functioning. The right to health is one of the fundamental rights of every human being.

    Persons with disabilities have the right to the highest attainable standard of health as enshrined in the CRPD. Persons with disabilities occupy an essential and ever-growing proportion of the healthcare continuum.

    While some health conditions associated with disability result in extensive healthcare needs, others do not. All persons with disabilities have the same general healthcare needs as everybody else and hence require access to mainstream health services.

    Barriers to health care are often experienced by all people, however, persons with disabilities experience them even more.

    For example, persons with disabilities face greater challenges getting to health centres and hospitals as many are dependent on others for transportation.

    Rehabilitation can help reduce the impact of a broad range of health conditions. It can also assist those who experience or are likely to experience disability to achieve and maintain optimal functioning. Rehabilitation is an essential health strategy and core component of universal health coverage, along with health promotion, prevention, treatment and palliation.

    Rehabilitation services are primarily composed of rehabilitation medicine, therapy and assistive device provision and the health personnel required to deliver these come from broad professional categories. Rehabilitation takes place within multiple levels of health services, from primary to tertiary services. In Brunei, medical rehabilitation services are mainly offered in the major government hospitals, specialised centres such as Pantai Jerudong Specialist Centre (PJSC) as well as some bigger health clinics.

    There are also other rehabilitation professionals offering rehabilitation services in non-government organisations and the private sector in Brunei.

    Access to rehabilitation services is often a prerequisite for many people recovering from illness or injury, those managing chronic illness, older people and in particular people with disability, to be able to work, participate in community life and obtain an education.

    At PJSC, the rehabilitation services mainly see adult patients suffering from cancer, stroke, spinal cord injuries, brain injuries, neurological disorders or trauma, musculoskeletal and orthopaedic conditions and maxillofacial conditions.

    At the Ministry of Health (MoH), the rehabilitation teams see a variety of adults and children with chronic or acute disabling conditions, which include – but are 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.

    People with chronic illnesses or disabilities are more vulnerable to being unemployed.

    This is the situation globally including in Brunei. Disadvantaged socio-economic groups are more likely to develop chronic illnesses and disabilities, which may cause them to become unemployed.

    This increases their risk of poverty and further exacerbates health inequities. Interventions are needed, at the organisational and personal levels, to enable a return to work and prevent further exclusion of these vulnerable groups.

    Adaptations of the workplace to accommodate persons with disabilities have been proven to improve employment chances for them.

    Rehabilitation services in PJSC and MoH can assess and rehabilitate some patients who have sustained disabilities to return to work or return to school so that they don’t become unemployed or have their formal education stopped as a result of their disabilities.

    This however requires full commitment from the relevant multiple stakeholders for a satisfactory outcome.

    The rehabilitation services at PJSC include specialised equipment that can objectively measure, track and evaluate patients’ functional capacity to do work as well as help stimulate the action taken when doing tasks at their workplace as well as helping them practise these actions.

    PJSC also has certified disability management professionals (CDMP) who can facilitate patients’ physical recovery, rehabilitation, and return-to-work process while seeking to control the escalating costs of injury or impairment, disability, and absence from work.

    PJSC is a specialist hospital treating conditions that commonly leads to disabilities.

    This year, PJSC commemorated the IDPWD by holding an exhibition at their hospital lobby on December 6 promoting awareness of disability issues and mobilising support for the dignity, rights and well-being of persons with disability, especially from the healthcare and rehabilitation perspective.

    Persons with disabilities experience health disparities and greater unmet needs in comparison to the general population.

    As a nation, we need to strive towards removing barriers and making our existing healthcare system more inclusive and accessible to persons with disabilities.

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