Posted July 1997

Special: Empowering the rural disabled in Asia and the Pacific Blind disabled people and the Thai rural economy Prayat Punong-ong President, Christian Foundation for the Blind P.O. Box 88, Khon Kaen 40000, Thailand

Introduction

The country and its administration

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.

Socio-economics

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 [2]. Most (87%) disabled live in rural areas. The Health and Welfare Survey, 1991 [3], 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 institution [4].

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.

Evaluating the needs of the disabled

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:

1. The traditional viewpoint, which regards the disabled as a burden who cannot cope with life by themselves, and therefore must be over-protected or discarded must be altered. Recommendation: teach the general society to recognize the capabilities of the disabled so private citizens effect changes in their hiring methods. Only by permitting the disabled to exercise their basic human dignity and responsibility can their quality of life be improved. Thus, in educating of the disabled, the focus must be on preparedness of the individual to make progress for themselves when changes in society allow them.

2. Another obstacle the disabled face in society is architectural and infrastructural. There are thousands of construction projects all over Thailand. It has become difficult to navigate our communities. In the case of the disabled in wheelchairs it is even harder than for the blind, since there are few ramps in public buildings such as banks, libraries, and markets, and toilet facilities are non-existent. Roughly-surfaced roads are unsafe for wheelchair users. Even mailing a letter becomes impossible. Transportation for the disabled in general is made so difficult they can scarcely get around. A blind man with a guide dog is not permitted to take his place on a bus with his dog; and odds are that few Thais have ever seen or heard of a person in a wheelchair bus. A wheelchair-bound person, who had a car adapted and drove as well as anyone else on the street, was denied a license because of his wheelchair: not on the basis of a test drive. Though dejected, he submitted to the law and returned to his rural home by air. To add insult to injury: he was forgotten on the plane until the cleaning staff found him waiting to be deboarded.

3. A third obstacle is the laws and regulations which discriminate against the disabled. In 1994, five blind students from rural Thailand applied to take the entrance exam for a rural university but were denied because of their blindness: revealing the prevailing social attitude as well as the feelings of those in authority over such institutions. Recommendation: The problem could be avoided by integrating the disabled into mainstream schools and society.

4. A further obstacle is in accessibility of information. In Thailand, there are 40,000 schools for children. However, many children on crutches or in wheelchairs find it practically impossible to attend class or go to the library, as no consideration is taken for their mobility. The blind can obtain reading materials only with great difficulty - if at all. Information is a necessary tool enabling the individual to make proper decisions affecting the quality of their life. A mechanic is not expected to repair a vehicle without tools - yet the inaccessibility of learning materials for the disabled places them in exactly that situation. They find themselves with a critical job to do, but without tools.

Redress for the disabled

The law

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.

Education

The Ministry of Education is responsible for the administration of fourteen departments. The education of the disabled is affected by:

• the Department of Teacher's Training. This Department has 36 colleges, eight having training programs for the education of the disabled.

• the Primary Education Department, which administers 35,000 schools and kindergartens.

• the General Education Department, which is responsible for 2,100 secondary schools.

• Under the direction of the General Education Department is the Special Education Division, which is responsible for:
  • 13 government schools for the deaf
  • 2 government and 5 private schools for the blind
  • 1 special school for the physically disabled
  • 6 government and 5 private schools for the mentally disabled

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.

Health support

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.

Adult programming

In 1994, the government began a new small loans program whereby the disabled can start up small businesses.

Non-governmental programs
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:

1. School for the Blind - a special school comprising grades Kindergarten to Grade 9.
2. Skill Development Centre - teaching orientation and mobility (O&M), massage
3. Lighthouse - a wood-working training center producing furniture and preparing students for factory jobs. (Has about 40 students.)
4. Caulfield Memorial Library. Provides material production for recreational reading, as well as textbooks.

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:

1. Integrated Education (IE)
2. Community Based Rehabilitation (CBR)
3. Material Production
4. Personnel Development (teacher training, education of cmmunity leaders, parents, etc.)
5. To act as a stimulus for government action.

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:

1. the Chiang Mai School for the Blind in the North, now government-run, was privately founded in 1961. This school has recently converted to IE, and handles 90 special and 46 integrated students.
2. the government-run Surat Thani School for the Blind in the South recently converted to IE. This school has approximately 100 students in special programs and 14 students in IE.
3. the Bangkok School for the Blind is a Roman Catholic-run special school for grades kindergarten to 9, and serves ~80 special students.
4. the Caulfield Foundation, founded by Miss Caulfield's adopted blind daughter, a Thai, Mrs. Sribuaphan, runs a training centre in traditional Thai massage, and a special school for about 80 special students in Pattaya.
5. the Association for the Blind in Thailand is an informal education cooperative to help the blind.
6. the Foundation for the Employment Promotion of the Blind was established in 1993 by Mr. Pecharat Techavachara, a Thai businessman and president of the Thai Blind Union. The foundation provides training in computer and other high technology skills.
7. the National Council for the Disabled consists of the Disabled Association of Thailand, and is active in stimulating the government sector to work for the disabled.
8. the Foundation for Handicapped Children runs comprehensive CBR projects in the North and Northeast.
9. the international NGO Save the Children has a comprehensive CBR project in the Bangkok slums, and supports other education projects for the handicapped.
10. Daughters of Charity, a Roman Catholic work, runs CBR and PBL programs in the rural Northeast.

Employment opportunities

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.

Rural employment opportunities

Agricultural industry opportunities

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.

Funding for reaching goals

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.

Footnotes

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.