Category Archives: Poverty
Nepal is not Haiti. The scale of the earthquake is of course very different. Around 8,800 people were killed in the first quake of 25 April, and a further hundred in the second quake in May. In Haiti the numbers reached 200,000 including many senior civil servants which effectively meant that large parts of the government became dysfunctional or non-existent. This is not at all the case in Nepal where the government is clearly structured and very active in the earthquake response, working alongside agencies such as CBM to distribute emergency relief as well as post-emergency non-food items such as tarpaulins, sanitary kits and corrugated iron sheeting. However, people with disabilities are disproportionately affected at times of crisis and my time spent in Nepal demonstrates clearly how the often sporadic and uneven response often fails to reach those who need it most.
I am wandering through the rubble strewn streets of Bhaktapur with social worker Pramita. We pass a line of people waiting for government relief who have been standing in the sun for several hours. At the front of the queue, the crowd at the kiosk window is 3 people thick and I try to imagine how someone with reduced mobility or a wheelchair user would be able to get to the front. “What happens if someone can’t come to collect relief supplies themselves?” I ask, thinking of others in more remote rural areas who may live several hours walk from anywhere accessible by road. “They ask a relative or neighbour to come for them, “ Pramita replies. “What happens if the relative or neighbour was killed or injured themselves, or is unable to spare so much time?” I ask. She sighs. “Then they might miss out,” she admits.
I learn more about the reality of this when I visit CBM partner, the National Federation of the Disabled Nepal (NFDN), an umbrella organisation representing a network of disability-specific bodies. The National President, Shudarson Subedi, describes story after story from these member organisations describing people with disabilities who were often just not aware of relief opportunities available, or unable to reach the distribution points which were many hours down steep hillsides.
NFDN has responded to this in a range of ways, including a project to introduce radio and SMS alerts to ensure those with hearing or sight impairment are aware of all rehabilitation opportunities. However, their most powerful approach has been in finding a stronger voice in the country’s rehabilitation efforts, working closely with the government to ensure that the “building back better” efforts are inclusive not only of people with disabilities but are inclusive of all those with specific and needs. In addition, they are helping to increase the extent to which people with disabilities are active participants in the decision making about reconstruction of health, education and livelihood systems and structures.
The next day I visit new CBM partner, the Spinal Injury Rehabilitation Centre in Kavre, which normally caters to around 40 patients with spinal cord injuries but is currently housing 110. To cope with this dramatic increase in numbers, CBM is supporting the hospital with emergency wheelchairs and anti-pressure sore cushions for earthquake affected patients. SIRC Director, Esha Thapa, explains that they might normally expect a patient to spend 3-6 months with them undergoing surgery and then extensive therapy and rehabilitation. However, with only 10 occupational therapists in the whole country, the rehabilitation phase is likely to take longer for so many new patients. SIRC would also expect to carry out around 50 home modifications in a year, but 90% of the patients who have been admitted with earthquake injuries have lost their homes.
We visit the stepdown facilities – huge tents erected in the hospital grounds – which allow those who have received surgery and rehabilitation at the hospital but who are not quite ready to leave the hospital. They can spend two weeks staying in the tents, being observed as they learn new ways of coping with daily tasks. The burden of this sudden physical trauma and the aftercare is a heavy burden not only on the injured person but also on their family or friends who stay with them at the hospital as primary carer. Esha describes one patient brought in by her neighbour who was forced to discharge herself far too early because the neighbour’s husband wanted her at home. Another left hospital before receiving any of her physical therapy treatment plan because she was frightened of missing out on the relief materials being distributed in her village.
But some are there for the longer term. One young boy was carried by his neighbours from the ruins of his collapsed house in which his parents were killed. But with no family and no home to return him to, they were unwilling to take him back once his treatment had been completed. Another man, having seen the photographs of his own destroyed house and the devastation of most of his village, had no desire at all to go home.
CBM has been working with local partners in Nepal for 30 years and the CBM country office and emergency response unit were able to respond within hours of the earthquake starting. CBM will be there not just for the weeks and months that follow the earthquake but, continuing to work through local partners and influence the government, for the years that will be needed to ensure that the post-emergency response and the rebuilding of the country’s structures and systems are 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.
As the UK celebrates Mothering Sunday this weekend, 15th March, we’d like to tell you about one very special mother. Roy is 26 years old and has four children. She lives with her husband Ronald and four children in a remote village in Uganda, East Africa, about 100km northeast of the capital, Kampala.
Like millions of mothers around the world, Roy works hard to support and care for her children. It’s not easy to bring in enough money for the day-to-day essentials and school fees for her two older children – primary education is not free in Uganda. She and Ronald eke out a living growing sweet potatoes, maize and beans and making bricks.
But what makes Roy particularly amazing is that one of her four children – Denis, aged 8 – is actually her half-brother. He came to live with Roy and Ronald just a year ago. We’ve been sharing Denis’ story recently as thanks to CBM supporters, he is currently being treated for Blount’s Disease, which causes his legs to bend and makes walking slow and painful.
Denis had been abandoned by his biological mother and was living with his father. But he was not treated well.“While all other children at my father’s place were sent to school, Denis was neglected. He didn’t bring the boy to a doctor or send him to school. Instead the father gave him funny and abusive names because of his disability. He has even beaten the boy”, explains Roy.
Sadly, due to the stigma attached to disability and the lack of support and education for parents, this story is all too common. But Roy looked at Denis and saw a boy who needed love and care. She took him in and is now mother to him, along with her three other children.
Without treatment, Roy knows that Denis’ future would probably be bleak. “If he remains with this condition he will face very difficult times in future. He may never be independent. He may need help at all times. He will have a lot of pain and his mobility will always be limited. And he might never find a woman who wants to marry him”.
But the treatment for Blounts’ Disease is far from easy for an 8 year-old to go through. Denis spent a tearful night in hospital before his surgery, a long way from home. Since initial surgery to straighten his leg, he has to wear a metal brace or “fixator” on his leg, with daily physiotherapy exercises that often cause him pain.
It’s hard to imagine how a child could go through treatment like Denis’ without a mother’s love and support. Roy is with him every step of the way. At hospital, hers was the first face he saw when waking up from surgery, encouraging him to drink some tea and then have a rest. Before travelling home with him, she learned about the exercises he must do to ensure that his leg heals strong. Every day, she encourages him to do his exercises, encouraging him to persevere in spite of the pain. She must also work hard to help Denis keep his wound clean to prevent infection – not easy when you live in a dusty environment with no electricity or running water at home.
CBM supporters, outreach workers and doctors are all playing a vital role in helping Denis on his treatment journey, which is vital for him to build a better future. But without Roy by his side, showing him a true mother’s love and care, none of this would be possible.
Even in a ‘developed’ country like the UK, disabled people are more likely to be poor than the able-bodied. Government figures show that about 20% of British families with at least one disabled member live in relative poverty compared to only 15% of other families.
There are two key reasons for this. Firstly, disability is an expensive business. Most significantly disabled people face extra costs due to their impairment. They may need to buy specialist equipment, they may have to carry out more laundry, they may need to use taxis because of inaccessible public transport or they may require an extra room to accommodate a personal assistant.
Secondly, it can be hard for disabled people to find paid work. Although there has been some progress, disabled people are still more likely to be unemployed than their non-disabled counterparts. While more than three-quarters of the British working-age non-disabled population are in employment, less than 50% of working-age disabled people have a job. As a result, many disabled people have to rely on benefits and, not surprisingly, have difficulty making ends meet.
I know from personal experience how difficult it can be to obtain employment. After graduating, I spent six months out of work and had to apply for more than 40 jobs before I managed to persuade an employer to recruit me. This was despite having a degree from Cambridge University and a postgraduate diploma. Fifteen years later, I have a rewarding, well-paid job. Like millions of other people, I have to cope with the daily challenges of living with a disability. However, I’m one of the lucky ones. At least I don’t have to cope with poverty as well.