Kunho Kim was worried about his travel home to South Korea from the US. Beyond the usual complexities of travel during Covid-19, he had to worry about some other things: the microbes catching on the wheels of his wheelchair, and the availability of aisle chairs for boarding the airplane.
He is an experienced traveler and wheelchair user. As an undergraduate at Harvard, he wrote the book ‘20 States On Wheels’, based on his cross-country trip in the US. He later went to Saigon, Vietnam, where he worked on creating accessibility guides in video format.
As such, he’s no stranger to airports – and was taking all the precautions recommended. “I wear masks, gloves and social distance but because I use a wheelchair, I’m more cautious as my wheels literally sweep the ground everywhere I go.”
Kunho had been mitigating this risk by limiting movement in New York, but as more and more of the city shut down, he decided to return to family in South Korea. “As a person in a wheelchair, if the city gets shut down, it would be difficult for me to get daily necessities.”
The UN Human Rights High Commission points out that measures such as social distancing and self-isolation may be difficult for those with physical disabilities.
In Thailand, most people with physical disabilities have helpers – making social distancing and self-isolation near impossible. According to the ILO, most disabled persons are concentrated in rural areas. Few can afford the kind of self-propelled wheelchairs that Kunho uses for his travel. For this population, Covid-19 has presented surprising conveniences and additional challenges.
Dr. Nisarat Opartkiattikul, Assistant Professor of Clinical Pathology at Mahidol University and Director of the University’s Sirindhorn School of Prosthetics and Orthotics, highlights the nuances of this experience. She mainly works with two groups of patients: those with missing limbs (who require prosthetic limbs) or those with limbs that don’t function well (possibly due to problems with the nervous or muscle system i.e. stroke patients).
“Now with Covid-19, those who do not urgently need to come to the hospital don’t come in, so those with physical disabilities are able to travel more conveniently – there’s less traffic, and they have space to be more socially distant from others because it’s less crowded, even in our clinic.”
At the same time, many are traveling to hospitals from rural areas, bringing with them multiple relatives.
“At Sririraj, we have a policy that requests they only bring one relative, to reduce crowding – but from my observation, most people with physical disabilities have more than person supporting them – if they’re children, then the parents and grandparents will come.”
With a strict filtering system, hospitals in Thailand are trying to limit the number of people coming through their doors, Sririraj hospital calls its patients in advance to make sure they are fully briefed on the one-relative policy. Dr. Nisarat acknowledges that this may not be possible for everyone, but there are separate waiting rooms provided. If patients register a fever, they are asked not to come in.
For Dr. Nisarat, however, the Covid-19 situation is a minor change to the pre-existing, widespread difficulties faced by those with disabilities in Thailand.
In general, those with physical disabilities have access to the healthcare system which operates on the basis of the ’30 Baht Healthcare’ system. It is rather the longstanding economic barriers that Dr. Nisarat points to as the key problem. The unemployment statistics are shocking: according to the National Statistics Office, approximately 60 – 70 percent of those with disabilities over the age of fifteen are unemployed, compared to a 2019 national average of 0.7 percent.
While the 1991 Rehabilitation of Disabled Persons Act (updated in 2010) prevents discrimination on the basis of disability, the International Disability Rights Monitor estimates that non-compliance rates in Thailand range from 20-90%. An anecdote in Chiang Mai City Life relates the story of a university graduate who is turned the moment a potential employer sees her polio brace.
But many don’t even make it to school, let alone university, in an underfunded education system that lacks accessibility. Although the Thai government funds K-12 education for those with physical disabilities, according to the 2008 Education Provisions for Persons with Disabilities Act, very basic physical barriers can prevent students from getting to school.
“There are many problems in the education system,” said Dr. Nisarat, speaking of a fourteen-year-old patient whose legs were amputated in his first year of secondary school. “After three years he was still looking for a school because originally his school had been on the fifth floor. Now that he has to wear a prosthetic leg, it’s very difficult for him to climb stairs like that.”
These physical barriers are not just in the schools themselves, but in travel from home to school. In general, Thai public transit is not kind to those with physical disabilities.
“Most public transportation in our country is still not universally designed [design that meets the needs of people with and without physical disabilities].”
“They need more space than others, and helpers for their wheelchairs, but the stairs required to get up to our buses don’t support wheelchairs, roads and walkways also don’t support people with physical disabilities.”
Thus, those with disabilities in Thailand face the double burden of economic and physical constraints.
Ultimately, what is required for those with disabilities goes beyond better access to medical care during an epidemic. For this crisis, economic solutions are critical. Many Thais are temporarily jobless because of the Bangkok shutdown and streaming back home to rural provinces. Some have called for a Universal Basic Income policy that will provide low-income people with support – it is important to simultaneously advocate for even more aggressive welfare policies relating to those with physical disabilities.
Currently, the government welfare program provides registered disabled persons a 500 baht per month allowance. However, many will lose income amid the current economic slowdown or will lose support from family members who no longer have income from work in metropolitan areas. The welfare program needs to be expanded far beyond a meagre 500 baht for low-income people with disabilities.
“Access to additional financial aid is…vital to reduce the risk of people with disabilities and their families falling into greater vulnerability or poverty,” a UNHR expert explains. Kunho agrees – as the US floats a $1000 per person stimulus package, he points out that those with disabilities will need more, as many have pre-existing conditions, so will be taking more care, and facing more constraints, than those without disabilities.
The UNHR report emphasizes: “States have a heightened responsibility towards this population due to the structural discrimination they experience.”
In Thailand, structural programs – such as establishing a stricter monitoring system for non-discrimination in employment or ensuring better accessible infrastructure in schools – must follow.
As Dr. Nisarat says, “People with disabilities don’t need pity – they need opportunities to enter society on an equal footing to everyone else.”
Photo credit: Kacha Mahadumrongkul