Transcript self care in physically challenged people

SELF CARE IN PHYSICALLY
CHALLENGED PEOPLE
By
Dr Chukwukelu B C
(MBBS,FWACP,FIHIMN)
Chief Consultant Family Physician &Director of Training
The Eko Hospitals,Lagos
A Physically Challenged in Nigeria
Outline
• Definition of terms
• Importance of self care
• Conditions needing self care in physically
challenged.
• Self care skills in the physically challenged
• Resources for self care in the physically challenged.
• Occupational therapy for the physically challenged
• The physically challenged social health insurance
scheme
• Conclusion and Recommendations
INTRODUCTION
From the press-punch may 6 2012• The Centre for Citizens with Disabilities, a non-governmental
organisation, has said about 19 million Nigerians have a form of
physical disability.
• It decried the failure of the Nigerian constitution to protect the
rights of those with physical challenges.
• In an interview with SUNDAY PUNCH, the CCD Coordinator, Mr.
David Anyaele, identified poverty as the major cause of disability.
• According to him, lack of access to quality health care, poor
nutrition and environment, insurgency in the North, road accidents
and polio are major causes of disability.
• He said, “At the CCD, we are of the opinion that more than 19
million Nigerians are living with disability. However, the National
Population Commission’s Census of 2006 says 3.2 million Nigerians
are living with disability; 61 per cent of this figure is above 18
years.”
From the press-punch may 6 2012
• He decried discrimination against people with physical
challenges, which he categorised as attitudinal,
environmental, institutional, and constitutional.
• He explained, “People show negative attitude because
some see disability as a curse. He noted thatpeople .
isolate, exclude, and stigmatise the less privileged. The
environment is not friendly because our public buildings,
transport system and academic institutions are hostile to
people with disabilities.
• “Institutionally, the public and private sectors design their
policies, products and services at the exclusion of PWDs. As
at today, Sections 15 and 42 of Nigeria’s constitution are
silent on discrimination against disability and most states
have no disability-sensitive laws.”
Some data
• Disability is very common worldwide. The World Health
Organization (WHO) estimated that about 500 million
people live with disability worldwide, with about 75% living
in the developing countries .
• In Nigeria, WHO estimates put the number
of people with disability at 19 million or approximately
20% of the country’s population .
• There are no credible and robust statistics in Nigeria about
most things, including disability. There is therefore a big
knowledge gap that needs to be bridged.
Definition of Terms
• Self care includes any intentional actions you take
to care for your physical, mental and emotional
health.
• Good self care is a challenge for many people and it
can be especially challenging for the physically
challenged.
• Self care is unique for everyone.
• The physically challenged persons have a problem
with their bodies that makes it difficult for them to do
things that other people can do easily.
• They are one of the excluded populations of the
society and also they face number of problems in
their daily life.
• There are four types of physically challenged
persons-Physically handicapped (amputees, congenital
absence of limbs or other body parts), Blind, Deaf, and
Dump.
Peculiar Problems among the physically
challenged persons
• Physically handicapped
(those with gross anatomic
defects e.g limb loss)
 Mobility
 Feeding if it involves upper
limbs
 Personal groomingtoileting, bathing, etc
 Socialization
• The Blind person
 Independent travelling
 Reading/ education
 Socialization
Peculiar Problems among the physically
challenged persons
• The Deaf person
 Verbal communication
 Independent travelling
 Education
 Socialization
• The dumb person
 Verbal communication
 Independent travelling
 Socialization
 Education
CAUSES OF DISABILITY
Conditions causing disability are classified as:
• inherited (genetically transmitted);
• congenital, meaning caused by a mother's
infection or other disease during pregnancy,
embryonic or fetal developmental
irregularities, or by injury during or soon after
birth;
• acquired, such as conditions caused by illness
or injury; or
• Idiopathic
Physical Disability
• Any impairment which limits the physical
function of limbs, fine bones, or gross motor
ability is a physical disability.
• Other physical disabilities include impairments
which limit other facets of daily living
Importance of Self care
• People with self-care difficulty encounter challenges
in performing activities of daily living (ADL), such as
dressing or bathing.
• Depending on the severity of the disability, people
with a self-care difficulty may require additional
assistance in the home to carry out daily activities.
Areas of wellbeing that need self care
Self care is needed in areas of
 Physical wellness
 Emotional wellness
 Social wellness
 Spiritual wellness, and
 Mental wellness
Self care skills in the physically challenged
• But for their limitations, the physically challenged
persons have needs similar to the general population.
• Self care skills include
Physical self care skills
Emotional self care skills
Spiritual self care skills
Social self care skills
 Mental self care skills
Physical self care
• This is done with the
individuals having a good
insight of their limitations.
1. Food
• Eat regularly.
• Eat healthily
One example of a self care
goal: Even if it’s a small
amount, I will eat something
for each meal
2. Physical activity
This depends on the type of
limitation- brisk walking,
jogging ( on the spot),
swimming. Group
activity enhances motivation.
• It helps combat feelings of
sadness or depression and
prevent chronic health
problems.
Physical self care
3. Sleep - Although
everyone has different needs,
a reasonable guideline is that
most people need between
6-9 hours of sleep per night.
• One example of a self care
goal: I will go to bed by 10 p.m.
during the week so that I can
get enough sleep
4. Medical care -Getting medical
attention when in need of it is an
important form of physical self-care.
• Some individuals as a result of their
limitations put off getting medical care
until problems have become more
complicated .
• One example of a self care goal in a
diabetic person: I will set aside money
in my budget(or seek financial help) so
that I can get my prescriptions filled
every month.
Physical self care
• 5. Rest
How much rest we need is dependent upon our age, how balanced
we feel emotionally, physically, and spiritually, as well as our own
particular needs for our physical bodies. If we can hear and honor
our body's specific rhythms and cycles, we will be able to honor
our need for rest.
6 Medical Attention
Another challenge for some disabled people is being able to seek
and get medical attention when needed.
7 Clothing
Availability of appropriate clothing is an issue for some physically
challenged people
6. Pain management- The need for adequate pain mgt is a concern
for some physically challenged. There is a risk of abuse of
analgesics including the risk of addiction in some of them
We should not discriminate against
them
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How Are They Discriminated against?
Said to be dependant and unable to cope on
their own.
Not given jobs because of there disability
Called humiliating names
‘Second class’ citizens
Meant to be less intelligent
Not All disable people are ‘stupid’
Stephen Hawking
seen as The Worlds smartest man is disabled.( july 1993,
The Smartest Person In the World
Refuses To Be Trapped By Fate
• Stephen William Hawking( CH CBE FRS FRSA) is a British
theoretical physicist, cosmologist, author and Director of
Research at the Centre for Theoretical Cosmology within
the University of Cambridge
• He said ,"Nowadays, muscle power is obsolete.
Machines can provide that. What we need is mind
power, and disabled people are as good at that as
anyone else."
• Hawking, 51, gained fame in 1988 with the publication
of "A Brief History of Time." The book later was made
into a movie of the same name.
• He holds the professorship at Cambridge University once
held by Sir Isaac Newton and did ground-breaking
research on the theory of black holes.
• In 1974' simple terms, Hawking demonstrated
that matter, in the form of radiation, can escape
the gravitational force of a collapsed star.
Hawking radiation was born!
• Stephen Hawking has a new mind-bending
theory about black holes, the bizarre cosmic
objects that cemented his reputation as the
world's most famous living scientist.
• Rather than lecture on theories of astro-physics,
the Cambridge University professor gave a
glimpse of the day-to-day realities of his life - a
life with ALS, or Lou Gehrig's disease. The disease
has cost him his voice and the ability to move all
but a few muscles.
• His many publications include The Large Scale Structure
of Spacetime with G F R Ellis, General Relativity: An
Einstein Centenary Survey, with W Israel, and 300 Years
of Gravity, with W Israel.
• Among the popular books Stephen Hawking has
published are his best seller A Brief History of Time,
Black Holes and Baby Universes and Other Essays, The
Universe in a Nutshell, The Grand Design and My Brief
History.
Professor Hawking has twelve honorary degrees. He was
awarded the CBE in 1982, and was made a Companion
of Honour in 1989. He is the recipient of many awards,
medals and prizes, is a Fellow of The Royal Society and a
Member of the US National Academy of Sciences.
• Stephen was diagnosed with Amyotrophic
Lateral Sclerosis., a form of Motor Neurone
Disease, shortly after his 21st birthday.
• In spite of being wheelchair bound and
dependent on a computerised voice system for
communication’ Stephen Hawking continues
to combine family life (he has three children
and three grandchildren), and his research into
theoretical physics together with an extensive
programme of travel and public lectures.
• He still hopes to make it into space one day.
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Even though he (Hawking) contracted motor neurone
disease and Doctors gave him two and a half years to
live, his determination was not dampened.
Yet he went on to Cambridge to become a brilliant
researcher and Professorial Fellow at Gonville and Caius
College.
From 1979 to 2009 he held the post of Lucasian
Professor at Cambridge, the chair held by Isaac Newton
in 1663.
Professor Hawking has over a dozen honorary degrees
and was awarded the CBE in 1982.
He is a fellow of the Royal Society and a Member of the
US National Academy of Science.
Stephen Hawking is regarded as one of the most
brilliant theoretical physicists since Einstein!
They have their own Olympics!
The past
• In the past Disabled people were made to be
infertile because they believed that they were
not fit to breed and that there children would
also carry on this disability
Emotional self care
• Counseling- This could mean seeing a psychologist,
a clinical social worker, or therapist.
• Keeping a journal- Some physically challenged
persons find that recording their thoughts and
feelings in a journal or diary helps them manage their
emotions after an assault or abusive situation.
• Meditation and relaxation exercises.
• Emotional self care also involves the people around
you- It’s important to make sure that the people in
your life are supportive.
-Nurture relationships with people that make you
feel good about yourself
- Make spending time with friends and family a
priority
-Consideration of joining a support group for the
physically challenged.
• Individuals should be wary of
- Friends or family who only call when they need
something.
- People who always leave them feeling tired or
depressed when they see them.
- Friends who never have the time to listen to them.
Spiritual Self care
Individuals need
• To make time for reflection.
• Spend time with nature.
• Find a spiritual connection or community that is
meaningful for them.
• Cherish their optimism and hope.
• Meditate, pray, and sing.
Social self care
• Intentional building of friendships and investment
in community life.
• Practicing appropriate boundaries with regard to
time, touch, and communication
• Exploring and sharing feelings and needs including
asking for help
• Seeking counseling to address challenges in family
and/or intimate relationships
• Being simultaneously assertive and willing to
negotiate
Mental Self care
• Counseling to explore unresolved issues, and find
support with depression, anxiety, or loss.
• Addressing workaholism, perfectionism,
procrastination, unhealthy competition etc.
• Managing time and money thoughtfully to allow
time and resources for play.
• Building self-esteem by conscious decision-making
and follow through, maintaining a sense of humor,
and practicing forgiveness.
• Developing a range of practices for reducing stress
Resources for self care in the physically
challenged
1. Political will to improve the welfare of the
physically challenged.
2. Self care support networks, social groups of
physically challenged persons that meet to discuss
their goals and evaluate them.
3. Ownership of health insurance
4. Self care information on health and human body
systems, lifestyle and healthy eating.
5. Self care skills and life skills training programmes
and courses for people.
6. Advice from licensed counselors, clinical social
workers, psychotherapists, pharmacists,
physiotherapists and complementary therapists.
7. Library.
8. Community recreation and sport centers.
9. Religious or spiritual centers.
10. Access to occupational therapy
Occupational therapy for the physically
challenged
• Occupational therapy provides the skills for the job
to help physically challenged people lead productive
and satisfying lives.
• Occupational therapists consider occupation to be
everything people do to occupy themselves, including
looking after themselves (physical self care), enjoying
life (leisure- social and emotional self care), and
contributing to the social and economic fabric of their
communities (work/productivity- social self care).
• As a form of self care for the physically challenged
persons, occupational therapy works to break down
the barriers which impede individuals in their
everyday activities.
• Occupational therapists examine not only the
physical effects of an injury or disease, but also
address the psycho-social, community and
environmental factors that influence function.
Occupational therapy checks
 What the individual can and cannot do physically
(this includes strength, coordination, or balance)
 What the individual can and cannot do mentally
(the memory, organization skills, or coping strategies)
 What materials the individual uses to participate in
the occupation (work tools, furniture, cooking utensils
clothes, or other materials)
 The social and emotional support available in the
home, school, work and community
 The physical setup of the house, school, class room,
work place, community, or other environment
Occupational therapy helps
1. The individual to overcome their disability
2. Adapt the material or equipment for their use
3. Recommend changes to the environments where
the individual carries out their occupation.
Overcoming Disability
A. Educating or instructing the individuals on how to do things
with the abilities they have
Some examples:
• how to remember things when the memory is poor
• how to dress or cook using one arm
• how to manage time and money
• how to use public transport when having problems
• how to get around in the community, while using a
wheelchair
• how to manage stressors
• how to advocate for an integrative community
B. Suggesting activities that will help the challenged
individual to improve or maintain the abilities they
have or are weak in.
Some examples:
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improving the coping strategies
increasing the strength
increasing the confidence and belief in oneself
increasing the coordination of the individual
improving the individual’s concentration
minimizing or preventing deformity of the hands after
an injury
Adapting the Materials the individual uses
A. Changes in the things they use around the house
Some examples:
• Large push buttons on their telephones
• Can opener that can be used with only one hand
• Special key holder to make turning keys easier
B. Changes in the things they use at work or school
Some examples:
• A special chair to help them sit up straight
• Self-opening scissors
• Special hammers and other tools that are easier to
use and prevent injury to hands and back
• Writing boards to help keep paper still
C. Changes in the things they use to take care of
themselves
Some examples:
• Built up handles on toothbrushes, forks, spoons, or
knives to help hold them
• Special bath or toilet seats
• Long handled and curved brushes for hair and bath
• Braille paper for reading
• Hearing aids
D. Changes in the things they use to get from place to
place
• Some examples:
• Recommend wheelchairs
• Special seating and positioning for chairs to help sit
right
• Car modifications such as one-handed steering
wheels or hand operated accelerators/brakes
• Bicycles/tricycles modifications such as foot straps
for pedals or seat support
Recommending Changes to the
Environments Where Work is done
A. Recommending changes to the physical layout of
the work place, home, or school of physically
challenged persons.
Some examples:
• Wheelchair ramps. Some banks have them.
• Widening doorways
• Lowering/raising desk tops, counter tops, or
cupboards
• Reorganization of living space
B. Recommending and finding out about the support
in the community
Some examples:
• Self-help groups
• Community recreational programs
• Funding agencies for transportation needs, special
equipment such as wheelchairs, bath seats, or
specialized computer equipment
C. Working with the people in the community by
providing education about a disability to the family,
teachers, parish members, employers, or employees
D. Working with the government to encourage people
to stay healthy
Some examples:
• Request funding for special equipment
• Request funding for programs such as exercise
programs, or a work training program for people
with physical disabilities
• Respond to legislation that may affect health care
The Physically Challenged Social Health
Insurance Scheme
• The National Health Insurance Scheme (NHIS)
through its informal sector programme has designed a
health financing scheme for the physically challenged.
• This will improve the general wellbeing of those
with good knowledge of self care.
• It is called The Physically Challenged Social Health
Insurance Scheme
• VULNERABLE GROUP SOCIAL HEALTH INSURANCE
PROGRAMME
Definition
Vulnerable Group Social Health Insurance Programmes are
programmes designed to provide Healthcare Services to
Persons who due to their physical status (including age)
cannot engage in any meaningful economic activity.
They include the following:
a. Physically Challenged Persons
b. Prisons Inmates
c. Children Under Five
d. Refugees, Victims Of Human Trafficking, Internally Displaced
Persons And Immigrants Social Health Insurance Programme
e. Pregnant Women and orphans
The programme has not commenced due to political
issues.
The NHIS says they are launching the programme in
batches and that they are sorting out the retirees
for now.
That of the Physically Challenged will commence later.
When is the issue?
• Health benefit package- This is as it applies to the
members in the formal public sector package.
1. All primary care diseases are covered irrespective
of the number of outpatient visits.
2. However, the patient pays 10% of the cost of
medications.
3. Secondary and tertiary care are covered only after
authorization has been obtained from the Health
Maintenance Organization (HMO).
4. 21 days of admission are covered in a year etc.
• Administration is through the HMO approved by
NHIS
The Physically challenged in the New
National Health Bill
• The Federal Ministry of Health will manage 5% of the
fund for the provision of basic minimum package of
health facilities.
• The Act is also for the purpose of providing health care
insurance for certain class of people who are actually
deprived.
• The Act also provides that the NHIS would provide
health coverage which will cover pregnant women,
children who are under five years, the elderly and the
physically challenged persons.
• The Act also provides that part of the funds would be
used to train nurses and midwives.
CONCLUSION
• The Physically challenged and all disabled persons in
general also need comprehensive care
• The Family Physician should be at the fore front of
advocacy fore this group of important citizens
• The different countries in the West African Sub region
should ensure that effective health maintenance
/insurance policy is in place to actively cater for this
group. Their health insurance should not be politicised
• Health Education on Self Care for the Physically
challenged should be taken Seriously and implemented
REFERENCES
• Alu Timothy Eliya And Gabi Sunday Tsibi. Recreational Activities for
the Physical Challenged In Nigeria. IOSR Journal of Business and
Management (IOSR-JBM) e-ISSN: 2278-487X, p-ISSN: 2319-7668.
Volume 16, Issue 9.Ver. IV (Sep. 2014), PP 12-16
www.iosrjournals.org
• Leke Baiyewo,19 million Nigerians are physically challenged, The
Punch Newspapers,6th of May 2012
• Wikipedia, Physical Disability
• www.rainn.org/ UK Violence Intervention and Prevention Program
• Godfrey CM, Harrison MB, Lysaght R, Lamb M, Graham ID, Oakley
P.Care of self - care by other - care of other: the meaning of selfcare from research, practice, policy and industry perspectives. Int J
Evid Based Healthc. 2011 Mar;9(1):3-24
• www.desert-alchemy.com/info/article/physical-self-care
REFERENCES
• Amusat, N. Disability Care in Nigeria: The need for professional
advocacy. AJPARS Vol. 1, No. 1, June 2009, pp. 30-36 35
• http://www.washington.edu/doit/smartest-person-world-refusesbe-trapped-fate
• http://www.biography.com/people/stephen-hawking9331710#research-on-black-holes
• NHIS Operational Guidelines ,2012
• Olutobi Konigbagbe.The Plight Of People With Physical Disability
In Nigeria. www.deindefatigables.blogspot.com
Thank you