Monthly Archives: May 2015
Krishna Gautam is a Past-President of the Mid-Western Chapter of ‘National Federation of the Disabled Nepal’ (NFDN) and founder member of ‘Centre for Independent Living’ (CIL) in Kathmandu. Presently, he works with the CIL as the General Secretary. He lives with his wife and two children in Kathmandu.
In this interview with CBM’s Ashok Shah, Krishna Gautam talks about his experience during the earthquake on 25th April and the work CIL plans to do in the aftermath for the rights of people with disabilities.
When did you start CIL? What’s the idea behind starting this organization?
“We started CIL in Kathmandu in 2006. We were a group of ten people with disabilities who believed it’s important to work with rights-based approach in disability sector. Earlier, whatever we did mostly centred around charity based approach… What CIL wants is that the disability movement must be led by people with severe and profound disabilities; and their issues must be addressed and resolved by persons with severe disabilities themselves. That’s the reason we started CIL.”
Where were you during the 25th April earthquake? What did you experience on that fateful day?
“I was in Nepalgunj [a town about 500km west of Kathmandu]… I was invited at a friend’s place for lunch. At the entrance, two persons carried my wheelchair and helped me get inside the house. After lunch, we were just watching TV and talking to each other when the ground began to shake, making such a terrible noise. Before I could make sense of what was happening, the hosts had left the house and reached the garden outside…
The ground continued to shake and I thought I’ll fall off the wheelchair. Later, the hosts came back and helped me get out of the house. The earth was shaking even when we reached outside. It was such a horrifying experience. Luckily, it was a single-storey house…”
When did you return to Kathmandu? How difficult was it to reach the capital after the quake?
“Actually, I was to take a flight back to capital that Saturday evening. But due to the earthquake, all flights were cancelled. Even telephone connections were down. An hour later, I could finally speak to my family in Kathmandu and got to know that my daughter was slightly injured… Later, I somehow boarded an overnight bus from Nepalgunj to Kathmandu to be with my family. On 26 th April, I could finally meet my wife and children. But a few hours later there was another massive aftershock. I was so worried about my family…”
What are you doing for fellow persons with disabilities who are affected by the earthquake?
“For the first few days, we were so scared that we could not leave our families. The aftershocks kept coming and we couldn’t do anything at all. Meanwhile, we have been calling our Disabled Person’s Organisations (DPOs) in the affected districts to know about the damage caused to persons with disabilities. Also, we have set up some tents in an open ground in Jawalakhel as temporary shelter for people with severe disabilities whose shelters have collapsed and have nowhere to go. At the moment there are about 15 persons in the tents here, most of them wheelchair user and severe spinal conditions. We are expecting some more persons with severe disabilities from worst hit districts like Kavre and Sindhupalchowk. They can stay here up to 3 months, or till the time they have no other alternative… In the coming days, we’re also trying to provide peer counseling and assistive devices in this shelter.”
Tomorrow, you’re going to attend the Protection cluster meeting. How do you plan to advocate for the rights of persons with disabilities?
“I believe, persons with disabilities are the first casualties during the earthquake. They are also most likely to be left behind and forgotten during the immediate rescue and relief work. So, we’re planning to organize as many persons with disabilities and attend the cluster meeting tomorrow. We’ll put forward that access to relief supplies and temporary shelter must be inclusive of persons with disabilities. For that I think we need to organize, make our presence felt in such meetings, only then our voices will be heard. Most importantly, we’re going to advocate that the earthquake will result in many more people with injuries and disabilities who will need to be looked at seriously. The government needs to look into the issues of their recovery and rehabilitation, and later the issue of employment as well.”
Why do you think disability issues needs to be advocated in such cluster meetings? Why is disability forgotten?
I think that’s because we haven’t been able to raise our issues effectively, or mainstream our issues at the national level. The reasons for this could be that we aren’t yet organized among ourselves, we lack coordination and we’re yet to demonstrate our strength and impact as a group and community. We are still inside our houses. Time has come that we leave our houses and fight for our rights.”
As well as providing medical care and emergency support to people with disabilities and injuries in Nepal, CBM is working closely with Nepalese Disabled People’s Organisations to help ensure that all relief and reconstruction efforts are disability-inclusive.
As we watch the events unfold in Nepal since April 25, we are reminded of the extra challenges that people with disabilities experience during disasters. Those with physical disabilities may struggle to flee to safety or travel long distances for essentials like food and water. The methods used to communicate an approaching disaster may not consider the needs of people who live with blindness, deafness or learning disabilities. Temporary shelter facilities, as well as other relief and longer-term recovery services, may not be accessible. And suddenly there is an influx of people experiencing new disabilities within the population; physical trauma caused by an earthquake, for example, may lead to the amputation of limbs or spinal cord injuries.
At the same time, people with disabilities show incredible amounts of resilience in emergencies. There are countless stories of people with disabilities helping their own community members. I think back to working in Haiti with CBM after the 2010 earthquake. Key members of our community rehabilitation team had disabilities themselves, yet refused to let disability equal inability. They worked hard within our teams to ensure that the needs of their whole society were being met.
This week, in the UK, we celebrate Mental Health Awareness Week- a perfect time to talk about the importance of mental health in disasters. People with psychosocial disabilities (those living with disabilities caused by mental illness) are often left behind during a disaster. In the Philippines after Typhoon Haiyan, we heard stories of people living with mental illness who had been chained in their homes and were unable to flee to safety when the typhoon was approaching. In addition, access to mental health care – and psychotropic medicines in low and middle income countries is an ongoing issue. During a disaster, the ability to access care and medication often shifts from challenging to virtually impossible.
The World Health Organization (WHO) estimates that after an emergency, the number of people experiencing mental disorders can as much as double within the population. At the same time, normal signs of distress within a population increase greatly. This information highlights something very important. First, there is a great need to continue to care for people with psychosocial disabilities after a disaster. In fact, the need has now doubled. But secondly, suddenly there is a large amount of psychosocial stress being experienced within the general population. This stress is a normal reaction to loss and to exposure to distressing events. Many will recover from these experiences, however a number of those who need psychosocial support can benefit from simple, cost-effective approaches such as Psychological First Aid.
CBM recognizes the importance of mental health and psychosocial support during emergencies. We also place a high value on the knowledge and understanding that our local partners have during emergencies within their countries. This is why CBM works hand in hand with our partners during and after emergencies.
In Sierra Leone, for example, our Enabling Access to Mental Health programme had already established an active mental health advocacy group, the Mental Health Coalition – Sierra Leone. The Coalition had become a focal point for mental health system development, in collaboration with the Government of Sierra Leone. When the Ebola outbreak started in West Africa, the Coalition was in the perfect position to support the coordination of mental health and psychosocial actors in Sierra Leone. They were able to advocate for better psychosocial support for health care workers. They also pushed to have mental health professionals (trained under the Enabling Access to Mental Health Programme) placed strategically throughout the country to offer support for those experiencing signs of distress and ongoing care for people with psychosocial disabilities. The Coalition supported the adaptation of training and activities to the local context, and advised on the development of strategies, policies and basic packages. Because we had a trusted partner already engaged on the ground, CBM was able to mobilize financial support so that they could continue their impressive work.
Now, looking to Nepal, CBM is currently implementing response work, again with strong partners, to offer mental health and psychosocial support. Already, CBM is a partner with a national level mental health group- KOSHISH. Our emergency response unit based in Kathmandu has been liaising with them since the earthquake struck, as part of our overall response, and we are now at the stage of providing them with support to be able to meet immediate psychosocial needs of people affected by the earthquake, and to improve access to basic relief aid as well as to specialise services for persons with psychosocial disabilities. In addition, we will draw on the knowledge and experience of our partners doing Community Based Rehabilitation work throughout Nepal. They are in the perfect position to provide their communities with psychosocial support, and we are already working to ensure that relevant staff members are also trained in Psychological First Aid.
People with Epilepsy often face similar stigma and discrimination in their communities as those with psychosocial disabilities. For this reason, we encourage our partners to also include people with Epilepsy into our mental health and psychosocial support programmes.
Addressing mental health and psychosocial needs is essential for complete and effective disaster response. I hope that by highlighting the work of CBM in emergencies, the experience, rights and needs of people with psychosocial disabilities, are clear. But more importantly, I hope to have shown a way to approach these challenges – not only will this strategy improve the situation for many individuals affected by the current emergency, but will build their resilience for the future, and therefore that of their families, communities and society as a whole.
CBM is working to bring urgent relief to people with disabilities in Nepal after the earthquake on 25th April, and provide vitally needed healthcare for both physical and mental health needs.
In March, I visited Ivory Coast in West Africa to monitor the progress of our project to scale up the prevention of blindness in the country. This is one of several CBM projects co-funded by Standard Chartered’s Seeing is Believing Programme.
The aim of our programme in Ivory Coast is to increase the number of people who receive cataract surgery to restore their sight. The catchment area of the project includes 7 hospitals, covering a population of around 5.4 million. In that area, an estimated 31,500 are blind due to cataract, according to Ivory Coast’s Eye Health Strategic Plan 2013-16. Cataracts can be easily treated with a simple surgical procedure – but for most Ivorians, sight saving treatment is out of reach because there aren’t enough suitable facilities or trained doctors.
In a poor country like Ivory Coast, where nearly 1 in 4 people lives on less than $1.25 a day, losing your sight is a terrifying prospect. At the COMB hospital in Dabou, I met Seydou, who was waiting to undergo cataract surgery. Seydou was forced to give up his job as a minibus taxi driver three months ago, when sight loss in one eye meant that he couldn’t judge the distance between his taxi and other cars. With little or no support available from the state, he had to rely on family and friends to support him, his wife and his seven children. For him, the surgery was life-changing – very soon he will be working again, regaining his independence and the chance to escape poverty.
Another patient I met at COMB hospital was Ndri Kouassi. In his 70s, the former draughtsman became completely blind due to cataract four years ago. It was a traumatic experience; he became completely dependent on family members. In hospital, before surgery, he seemed vulnerable and lost; his wife held his arm to guide him but he often stumbled. A few days later I met him at his home. With his sight restored, he was a changed man, laughing and confident. Now he could see his children and grandchildren, he explained, he was no longer in the wilderness.
CBM has been working with COMB hospital for many years and the hospital is playing a key role in our programme, hosting a training programme for eye-specialists in carrying out cataract surgery. Once they’ve completed their 6 month training programme, these doctors will work at one of four new cataract surgery facilities that CBM is setting up and equipping at regional hospitals. By the end of the four year programme, we expect to have trained 42 ophthalmologists and increased the number of cataract surgeries by 200%.
Currently many patients have to travel miles to get the surgery they need. I met one elderly lady who was staying with relatives so that she could get to hospital for surgery. I was struck by the dedication of her daughters, who had made the long, difficult journey with her so that their mother could have her sight restored. But for many people who have lost much of their sight, such a journey would be impossible. Equipping regional hospitals and training doctors to work in them is vital if eyecare services are to be accessible to those that need them most.