Rural Bhutan home of majority living with physical and mental disabilities

ABS in Zhemgang. pic: Ability Bhutan Society

About 70 percent of persons with disabilities are concentrated in rural parts of communities

KARMA CHIMI | Thimphu

According to the Population and Housing Census of Bhutan, 2017 about 16,567 persons with disabilities (PWDs) have been recorded in the country. Of that total, 12,512 resides in rural communities.

In light of this glaring statistics, it is said that the prevalence of PWDs is significantly higher in rural accounting to 70 percent than in urban areas.

Additionally, rural areas lack the necessary facilities and services for PWDs and children with disabilities (CWDs) while stigmatization is also much more pervasive there.

With support from the Federal Ministry for Economic Cooperation and Development, Germany, Ability Bhutan Society (ABS) is piloting the second phase of its project for rural communities. This phase will span the three dzongkhags of Samtse, Tsirang, and Zhemgang from 2022 to 2024.

ABS has revealed that Samtse had the largest number of PWDs for the year 2022 with 1332, followed by Tsirang with 900 and Zhemgang with 305.

According to Namgay Dorji, project manager at ABS, the project was able to produce great results and could educate and inform rural communities about PWDs and their needs for services, medication and therapy.

Additionally, Namgay said these differently-abled individuals are receiving training in agriculture, weaving, and tailoring.

In Punakha, Chhukha, Dagana, Trashigang and Sarpang, similar pilot projects were carried out between 2018 and 2021. About 3,226 PWDs were reported for the initial three-year program of which more than 50 in the five districts received skill development to support their daily sustenance.

The project activities cover the five domains of health, education, livelihood, social and empowerment.

Namgay said disability medical camps are also being provided in collaboration with Ministry of Health (MoH) in rural communities.

All stakeholders, including dzongkhag heads and local leaders are also being provided awareness, training and workshops on the services by the MoH and different NGOs when it comes to PWDs.

In rural communities, similar services, trainings and seminars on early intervention and identification, as well as inclusive education, are also made available to teachers, ECCD facilitators, and health personals.

Namgay said it is challenging to go to the most isolated locations in these dzongkhags while the challenging geographical terrain only made the matter daunting.

Meanwhile, families and guardians expressed their need for an instant improvement while using the services, which according to ABS is not achievable. According to Namgay, PWDs require longer times for therapy and improvement.

Pema Deki, dzongkhag project coordinator for ABS in Tsirang, said PWDs and their guardians still face some difficulties to avail the services as most facilities are not designed in an inclusive manner.

She added that social conventions and cultural norms are other obstacles that contribute to the widespread stigmatization of people with disabilities. People become hesitant as a result of these obstacles and stop thinking about the actual reasons and because of their disabilities.

“Such believes and tradition makes it harder for the health assistant and non-governmental organizations (NGOs) to convince the people,” Pema said, addding there are some positive changes and decline in such issues over the time.

Another significant problem, according to Pema, is getting parents and communities to accept CWDs and PWDs.

The significance of early identification and intervention is still not understood by individuals and communities. She believes that prompt intervention is possible if early detection is achieved.

Pema emphasized that while everyone should take ownership and responsibility, parents and people with disabilities should put more effort. She said they need to speak for themselves which would make a much higher difference and that it is time for them to voice their opinions.

It has also been observed that individuals with disabilities encounter challenges to commute even when travelling from their village to the dzongkhag centre for diagnosis and treatment. In addition, they encounter problems on proper accommodation and meals despite being sent to dzongkhag and regional hospitals.

“We do our best to offer transportation, lodging and meals,” said Namgay Dorji. He, however, claimed that due to financial limitations they are not always able to offer such services.

Kelzang Choden, coordinator for Zhemgang district, said that while she was working in Punakha during the first project, it was easy for them as Punakha had better reach and access to transportation and road. However, for Zhemgang it is difficult as the gewogs and villages are scattered and that they are not able to reach the concerned PWDs and provide necessary services.

“In order to deliver our services, we have had to travel to gewog for the past year. However, people often assume that we will come to their doorstep, which is something we are unable to accomplish,” Kelzang said, adding that at times they travel to the villages to render their services.

Dechen Tshomo, an occupational therapist at JDWNH, stated that whatever measures are in place should be appropriately channelled so that PWDs and CWDs in remote regions can also access the required services and facilities.

She added that rather than operating independently, MoH and pertinent disability-related organizations should cooperate and coordinate their efforts to help and educate the rural communities

Along with numerous initiatives and assistance offered by MoH, Care for Child Development Plus (C4CD+) and Bhutan Child Development Screening Tool (BCDST) training is also provided to health assistants in rural communities in order to facilitate early intervention.

Along with the MoH and other ministries, there are currently more than five NGOs working for PWDs and CWDs throughout the nation. These agencies strive to improve the environment for the differently-abled and also reduce the numbers in both urban and rural areas.