Posted July 1997
|Special: Empowering the rural disabled in Asia and the Pacific|
Blind disabled people and the Thai rural economy
President, Christian Foundation for the Blind
P.O. Box 88, Khon Kaen 40000, Thailand
Thailand is governed by a constitutional monarchy with the King as Head of State. Administratively, Thailand is divided into Central, Provincial, and Local Administration. Fourteen ministries represent the Central Administration. Each ministry is divided into departments, divisions and sections.
Provincial Administration is the system of decentralization in which a hierarchical unit is administered and staffed by the Central Administration. There are 76 provinces, each headed by a governor appointed by the Ministry of Interior - except for the Bangkok Metropolis where the governor is elected. A province consists of districts, sub-districts, and villages. Local administration is composed of the Provincial Administration, the Municipality, the Semi-urban District, and Villages.
Thailand enjoys agricultural self-sufficiency, and has had a diversified economy since the 1960's. Today, manufacturing constitutes the second largest income generating sector after agriculture.
Throughout the Kingdom, the average household income is 7,062 Baht/month (cv=0.12, 50 Percentile at 4,015 Baht/month). In contrast, Bangkokians are paid nearly double the national average: 15,951 Baht (cv=0.01, 50 Percentile at 10,040 Baht/month). The disparity in incomes is definitely a regional vs Bangkok or rural versus urban split. Household incomes outside Bangkok averaged: 4,717 Baht/month (cv=0.09, 50 Percentile at 4,094 Baht/month) for rural areas; and, 7,466 Baht (cv=0.02, 50 ;Percentile at 5,029 Baht/month) for semi-urban areas; while urban centres rose to 11,912 Baht/month (cv=0.01, 50 Percentile at 7,079). Regional household incomes are comparable to rural incomes (i.e. the average ranging from 4,500-6,999 Baht/month). By way of corroboration, Figure 4 presents a comparison of 1988 and 1992 incomes and expenditures by region. Despite the fact that there was a national average 176% increase in incomes over the four year reporting period, the regions outside Bangkok rose only 160%. Thus gains in the capital region were nearly 20% more than the rest of the country.
Thus Thai society has three "worlds". The first is made up of the very well-to-do in the booming urban areas (mostly Bangkok). Although the "first world" represents only 8.9% of the households, it earns ~50% of the country's income. The second is the up-and-coming middle class who work in government positions or for private enterprises. Finally, there is the third world - the subsistence farmers, the disabled, the lepers, the outcasts - these live primarily in rural areas, and represent the 18% of the households whose income is less than 2,000 Baht/month.
The disabled, who are part of this "third world" of Thai society represent 1.85% of the total population . Most (87%) disabled live in rural areas. The Health and Welfare Survey, 1991 , indicates that throughout all age groups except the elderly, males are more frequently found disabled than females. As the population ages, and males die, the frequency of disability in the surviving female population equals that of males. Figure 6 presents the frequency of the five major types of disability: the most (45%) being physical disabilities, followed by 21% Aural/Oral, 15% Mental, 14% Visual, and 10% Others. As the population reaches past sixty years of age disabilies increase except for Mental disabilities, which appear to have tapered off by that age. Considering both age and gender frequency of each disabled grouping separately (Figures 7-11), it is evident that males outnumber females in: Physical (67%), Mental (62%), and Other (67%) categories. For Visual and Aural/Oral disabilities there is on average an even split between genders. The reason why males have more disabilities is an unstudied phenomenom, but could be the result of less female participation in the workforce, motor vehicle registration and military roles.
Of the total 1,081,996 disabled persons, 238,039 (22%) were school-aged
but the vast majority were under-educated. The Ministry of Education, 1993,
indicated that only 7,242 school-aged children are attending an educational
|Level||#s in Special schools||#s integrated||Total|
|Secondary school||Primary school||Others||Total|
As our medical services grow more sophisticated, many of our disabled may be healed. Otherwise we are faced with the sombre forecast that the number of people with disabilities in Thailand will double within the next two decades thus overtaxing existing facilities. Under present circumstances, it will be necessary for certain types of disabled, especially those with multiple disabilities, to be kept in institutions where staff and facilities are concentrated. However, the better way to go is integration of the disabled into mainstream society.
The sense of hearing was once looked upon as a very important sensory channel, but with the advent of industry, exacerbated by television, the primary sense became sight. As economic and technological development continues at a great pace, sight becomes ever more important.
Though Miss Caulfield established a School for the Blind in Thailand in 1939, it was an incredible 20 years later that the Ministry of Education gave a recommendation that graduates of this school receive certificates upon graduation. This long delay bespeaks of an underlying belief that only 'whole' or 'naturally strong' persons are able to contribute to society: nevertheless, the weak or powerless are made pawns or labourers for that society. Many people would like to donate food and shelter to care for the disabled, but what the disabled really need is their independence and education so they can become entrepreneurs or employable.
In Thailand, all citizens must carry an ID card: however, the disabled are exempted - supposedly a special privilege. However, when any Thai goes to the bank, to register property, or to vote, an ID card is required: no exceptions.
Imagine the blind farmer, Sawaeng, leading his buffalo along. When asked, "Where have you been, Uncle?", he replies, "The buffalo is sick, so I took him to the vet." Asked further, "Did the doctor check him for you?", he replies, "No, my buffalo is not yet registered so I cannot receive any service." The Thais think it very ugly to be compared to a water buffalo, but here blind Sawaeng has no ID card so he cannot register his buffalo. His buffalo CANNOT be registered because Sawaeng has no ID himself. Sawaeng's is a hard life, and has little to recommend it. Thus the lack of an ID-card becomes an added handicap: it segregates the disabled from the rest of society. Recommendation: treat the disabled like others in all aspects of life. They want to be named at birth and be registered with the family: they want their ID cards. They want to be considered people not animals.
So far, Thailand's economic development plans are based on the assumption that economic growth will have spin-off benefits to all parts of society. To a certain degree it appears to be successful but the growth of the GNP has also widened the gap between the rich and the poor, the rural and the urban. Some are gaining, but the powerless and especially the disabled, remain in a vicious circle of poverty, ignorance and sickness. If we allow the disabled to become responsible and contributing citizens, the whole nation will benefit. Recommendation: decentralize government services so that rural peoples (including the disabled) can be responsible for determining their life's path.
Obstacles still defy the advance of the disabled through society:
The Bill of Rehabilitation was enacted November 1, 1994: it guarantees the right of medical access, educational opportunities, vocational training, and social rehabilitation to the disabled. In order to receive service or subsidies, however, the disabled are required to register with the Department of Public Welfare.
This Law is a major provision for the disabled, and yet the government (not only the elected body, but also its ministries, departments and divisions) must follow-up with constructive sufficient action. Non-government organizations (NGOs) of and for the disabled are lobbying the government to fulfill its self-confessed responsibility.
The Ministry of Education is responsible for the administration of fourteen departments. The education of the disabled is affected by:
Special schools for the disabled teach their pupils the national curriculum. However, these schools consistently fail to effect integration of students with society: the pupils lack social skills.
In a nutshell, the problem encountered by the rural disabled is no access to schooling. For this reason, and because Thailand's governments are beginning to respond, the focus of NGO and International NGO (INGO) activity is to encouraging the government to integrate the disabled.
The primary health care programme in Thailand, which was introduced in the late 1970s, can be conceptualized as public health services of the community by the community and for the community. The objectives of the program are to expand the coverage of health services (particularly among the underserved rural population) utilize community resources and encourage participation of rural population to solve individual health problems and eventually to establish self-help programmes at the village level. An innovative approach rests with the training of key village health resources, primarily the Village Health Communicator responsible for health education and dissemination of health information, and the Village Health Volunteer having the responsibilities beyond that of the VHC to include the simple curative aspect of health.
Through the Departments of Health, Medical Services, and Communicable Diseases Control, the Ministry renders medical services and rehabilitation to the disabled people. Attempts have been made to integrate curative and preventive measures for the physically and mentally disables\d in most of the general hospitals.
Medical rehabilitation has been developed in Thailand to the extent that medical rehabilitation departments or units are set up in hospitals throughout the country (including the urban provincial cities). Of these, 99 hospitals are under the jurisdiction of the Ministry of Public Health and the remaining are attached to state enterprises, different ministries, Bangkok Metropolis Administration, and universities (including private hospitals).
The numbers of rehabilitation personnel of the Ministry of Public Health is far behind the disabled population. Thus the Ministry has launched a project to produce more medical personnel. Before 1982, doctors in the field of rehabilitation medicine actually graduated from abroad. Later, training courses for doctors of this field were arranged in Thailand. At present, there are five medical schools providing doctors of this field. It is expected that 15-20 doctors will graduate each year. The rural population is served to the extent that they are able to get to provincial hospitals. NGOs in cooperation with INGOs are working to provide rural based rehabilitation programs.
Previously, the programs of organizations working for the welfare of the disabled dictated what the lives of the disabled would be like: everything was done on their behalf. Today the better social policy trend is toward government organizations and NGOs working together with the disabled helping them to help themselves. Globally, the World Council for the Welfare of the Blind and the International Federation of the Blind have merged into one to share resources and improve their effectiveness. In 1982, the Thai National Council of Disabled Persons was established and included: The Association of the Blind, the Association of the Deaf, the Association of the Disabled, and the Association of Parents of the Mentally Retarded. In unity there is strength.
In 1994, the government began a new small loans program whereby the disabled can start up small businesses.
The family, relatives, and communities have traditionally been a cornerstone in looking after the welfare of their disabled members. However, in the past few decades various NGOs are serving the growing needs of the disabled. Some agencies initiated rehabilitative programs long before the government assumed such duties.
There are currently over 60 well-established NGOs whose primary objective is to render services to the blind, the hearing impaired, the physically disabled, the mentally handicapped, the lepers, and the mental patients.
As for the visually disabled the works are based primarily on NGOs whose funding is primarily from international charities. As already stated, the first school for the blind in Thailand was established in 1939 by an American blind lady, Miss Caulfield. This facility is now known as the Bangkok School for the Blind, and is undertaken by the Thai Foundation for the Blind, a private sector organization. This foundation has four units:
A second foundation, the Christian Foundation for the Blind in Thailand (CFBT), was started in 1978 by a Thai blind man, Mr. Prayat Punong-ong. The CFBT serves the blind from almost entirely rural origins. This foundation has five programs to serve the rural blind:
The Education Center for the Blind, Khon Kaen, includes a preparatory program, hostel for orphans and live-in students, teacher consultation forum, and a material resource production centre serving 700 students. It is also the centre for promoting IE to new rural schools.
The Home for Multiply Disabled Blind Children, Pakkred (Central region), provides shelter and rehabilitation for blind children with additional disabilities as well as encouraging social integration of the blind in primary schools. The Extension Center for the Blind, Nakornratchasima, includes a preparatory and IE program as well as skill development of teaching personnel. Annual capacity is approximately 200 students. The Center for Community Based Rehabilitation, Roi Et, runs CBR and prevention of blindness (PBL) programs. The Lamphang Skill Development Center (Northern region) offers CBR and IE programs.
Other institutions working for the rehabilitation of the blind:
Once the disabled emerge from non-integrated special schools, charity stops and society looks askance. Adjustment to the 'real' world is a serious problem. A number of disabled persons have entered university: their classmates and professors are skeptical but nothing compared to what they face once they have completed their degrees and try to find work. Then they are like specters - invisible to employers. They feel worthless and frustrated. Some organize themselves into militant groups (music bands on the streets) and make wild demands. Asked to take the initiative and go into self-employment, they may shy away, so many of them begin and end their working lives as beggars. The result is a brain drain.
The brain drain, whereby well-trained and capable Thais flee for the 'good life in the West' is a common term. When civil servants go to better paying positions in the private sector is another brain drain - though the country isn't losing as the services of these types are still available. The brain drain in the streets occurs as 100s of people (60,000 in 1993) involved in serious accidents are disabled and left vegetating. Most tragic, however, is the brain drain caused by the eschewance from society of the disabled.
There are success stories, however, and these include those blind who work as: telephone operators, computer operators, masseurs in Traditional Thai massage, school teachers, and cottage industry entrepreneurs. Unfortunately the numbers of gainfully employed disabled persons are a minute fraction of the total number of employable disabled people.
Surveys indicate that the majority of disabled do not seek employment because of a perception of the "severity" of their disability (Figure 12). Other reasons include: "family support" making work unnecessary, "unavailability of work", and "others". Ironically, very few indicated "No support" as a reason. This finding did not vary according to urban or rural respondents: though the majority were rural. The response between men and women showed little difference. Interestingly, 72% of disabled have "never known" that assistance from NGOs or GOs was available. Women are less informed than men about the availability of help (Figure 13). Consequently, 64% of able-aged and able-minded disabled are likely out of work due to lack of awareness of or access to programing.
Experience of the CFBT's CBR programs in the rural areas of the country has found the disabled, who, though living in a subsistence environment, are highly motivated and willing to work hard to achieve independence. Therefore, the key to employing the disabled is finding them and including them in education of available programing, and connecting them to NGO/INGO funding in their own setting. In this regard, it has been the hallmark of the CFBT to go out and find the disabled so that they can be rehabilitated. The 'going out' is achieved in two ways: 1) by literally mounting a motorcycle and heading out to the villages to conduct surveys; and, 2) by involving the government's own network of health care workers (doctors and nurses in rural areas) and school health teachers (in rural schools) to conduct surveys. Such work has already been started by the CFBT - the numbers of people so far surveyed is about 500,000. This is a very successful program albeit tedious, and low profile for fundraising.
Recommendation: Continue looking for and rehabilitating the disabled. Funding to Thai NGOs, like the CFBT, involved in such surveys should be continued because they are indeed: 1) reaching the disabled; and, 2) stimulating the government to take on a share of the responsibility for the cost of the search... thus effecting a more equitable distribution of wealth within the country.
So who will take up the slack caused by departing international aid? "The poor must come first," states our former PM Chuan and advertisements showcase the benevolence of politicians towards the "third world" people. However, contrary to appearance, these "gifts" actually come from taxes paid by fellow Thai citizens. Although there are democratic methods of obtaining government project aid, it is usually the "first and second world" people who have the communication gadgets and the connections to tap these resources
With respect to the disabled a middle ground needs to be taken whereby government takes fiscal responsibility for educating the disabled while allowing NGOs to administer projects, because what the disabled seek is an economical and sensitive opening up of opportunities.
To insure this happens, the government needs to provide some important things. One of the foremost is equitable distribution of wealth and broad popular participation in the decision making process. These are part of the many social dimensions involved in bridging the gap between the disparate elements of our society and giving people a sense of belonging in the place of their birth. Being P.A.R.T. of the project includes:
Participation in project formulation to solve problems at the village level. For some years now the intellectuals who sit in air-conditioned rooms in Bangkok identified the programs - handing the structure down to the people without their consultation or participation. The result is that some people in the villages end up receiving training five times a year from various ministries on such subjects as birth control, new agricultural methods, cloth making etc. Rural people and the disabled need to be involved in deciding what areas need to be developed.
Attitude or fundamental beliefs to work in the villages. Outsiders should not act as the experts who tell the poor folk what to do. The better attitude is one of joining in a task together with both politicians and representatives from the village or the disabled taking part. The culture of petty kingdoms built on vote-buying must give way to the grassroots implementer.
Responsibility to seek long term results. The development process must become the responsibility of the local citizens. Only then will there be an end to the need to flee an inhospitable environment and uncontrollable destiny. When local people feel that they bear responsibility for their development, and that they have sufficient power to exercise this responsibility, they will have the potential to take joy in changing, rather than fleeing their situation or just giving up.
Technology applied appropriately to meet local needs. Through this method government efforts to reach the predetermined objectives acceptable to the rural population will bear fruit. New technology will become the blessing it is intended to be when local people learn to make it work for them, not when it is used to overthrow their intelligence and understanding.
Unless we adopt these concepts social migration and displacement will not halt. Although our per capita income is high, inequity has increased. Economic and social elements of Thai society must be brought into alignment.
2. Based on the preceeding footnote, the total population in 1992 was ( 58, 486, 295.4. Thus 1.9% disabled persons is a totla number of 1,081,996.
3. Produced by the Social Statistics Section, the Education and Social Statistics Branch, National Statistics Office, Office of the Prime Minister.
4. Statistics from the previous academic year (i.e. 1992) thus compatible with the other statistics in the paper.