[Tshering Penjor]

1. What evidence do I have (or need) to identify those factors and levels posing the greatest barriers to rehabilitation in my population?
Ans= Some of the evidences that i would like to have is about the people’s knowledge, attitude and practice of rehabilitation in general so that i can know where the gap is.
2. How does my own professional expertise and organizational access suggest where I might be most be effective in developing and launching an intervention?
Ans= As my work area is at the hospital, it is more appropriate for me to provide the intervention at institutional level. But I can also do it at personal and community level.
3. What formative research might be needed to understand the precise intervention that would be most appropriate and impactful towards overcoming the challenges I identify?
Ans= Research on why people in my community faces less access to rehabilitation services.
4. When considering potential interventions, what factors related to implementation do I need to consider?
Ans= All the possible factors like personal, household, community, institutional and even the policy factors..
5. What implicit biases may be at work in my culture or context and how do those implicit biases impact an individual’s ability to access and benefit from rehabilitation?
Ans= Especially the socioeconomically deprived population. This impacts their accessibility to rehabilitation through affordability and transportation issues.

[Tshering Penjor]

1.Leadership behavior can be taught vs leaders are born: Most of the world leaders are made or taught leaders and seldom are born leaders and inherited leaders. An inherited leader will have an edge over taught or made leaders, but the born leaders must also be subjected to learning and training for leadership to hone their leading role. A combination of both can come as a strong leader. One such example can be cited as Bhutan’s Fourth King, who was abdicated the throne at age 16 when his father the 3rd king passed away. He brought an unprecedented changes and well being to its people through his reign.

2.Post your reflections on your strengths, areas that need attention, and development priorities as identified by the emotional intelligence questionnaire on the discussion board.
Myself as a leader is a middle of the road management. I do not find any strengths of leadership as of now. I usually tend to be gentle and try not to hurt someone’s sentiments and keep everyone happy which is really wrong. After this training i am optimistic I can be a lot better version of myself and be more of a team management leader.

3. Research some vision statements of various organizations. Post at least two such statements on the discussion forum and explain how these may have evolved.
WHO vision statement “all peoples attain the highest possible level of health”
WFP “Hunger should not be an issue in today’s world”

4.Post your reflections on building strong leadership and increasing political support for rehabilitation of your country on the discussion board.
Advocating and making people and political leaders aware of how important and vital can rehabilitation and assistive technology be, will definitely change the perceptions and ideas on these matters. Or someone from rehabilitation background must stand up to become a political leader and spearhead this action.

[Tshering Penjor]

The term rehabilitation to me sounds like finding your own habitat again which you have once lost it.

[Tshering Penjor]

I am Tshering Penjor, working as a Physiotherapist here at national referral hospital, Bhutan. This is my 7th year in the service. The expectations that I have after completing this course would be acquiring some leadership quality and skills to work and involve multidisciplinary teams to work together.

[Tshering Penjor]

We have some SCOs and NGOs that are trying their best to work with health care professionals and help people with disabilities.

[Tshering Penjor]

Soma of the NGOs related to disability and rehabilitation are:
1. Disabled people Organisation
2. Bhutan Stroke Foundation
3 Ability Bhutan Society
4. Draktsho ( Vocational training)

I don’t think so we follow the WHO guide to action

Since I dealt with many people living with disabilities, the main issues is with the financial crises. As years add on, the family members are affected depriving them from working as a full time earner. Though the primary health care is free out here and no issues in availing health care. But there are so many environmental barriers which hinders them in availing rehabilitation services whilst provided with assistive technology.

[Tshering Penjor]

Key findings in Bhutan are as per 2019 report:
1. There has been a 66.6% increased in year lived with disability between 1990 to 2019.
2. 190,000 people experienced conditions that could benefit from rehabilitation.
3. 47,000 people have been affected by LBA
4. Approximately 1 in 4 people could benefit from rehabilitation.

According to the latest Population and Housing Census of Bhutan, 2.1% of the population are categorized as disabled (NSB, 2020).
The country recorded more than 800 motor vehicle accidents in 2020. In 2021 and 2022, more than 700 cases were reported in each year (As per the report/data maintained by the Royal Bhutan Police).

[Tshering Penjor]

Key findings in Bhutan are as per 2019 report:
1. There has been a 66.6% increased in year lived with disability between 1990 to 2019.
2. 190,000 people experienced conditions that could benefit from rehabilitation.
3. 47,000 people have been affected by LBA
4. Approximately 1 in 4 people could benefit from rehabilitation.

According to the latest Population and Housing Census of Bhutan, 2.1% of the population are categorized as disabled (NSB, 2020).
The country recorded more than 800 motor vehicle accidents in 2020. In 2021 and 2022, more than 700 cases were reported in each year (As per the report/data maintained by the Royal Bhutan Police).

[Tshering Penjor]

I second the concept of creating awareness about the models of disability. Over the time it has improved a lot in viewing the disabilities through many angles Thus bringing new changes and opportunities to enhance the lives of persons with disabilities.

[Tshering Penjor]

The national policy for persons with disability, Bhutan 2019 have cited everything including from the health and education coverage to the transportation and socioeconomic security, protection and access to justice and to the environmental modification. The aforementioned things are in place in one or another way but one things i would like to really change is to enhance environmental modification which quite poor in our settings. SO many physical barriers.

[Tshering Penjor]

Currently in Bhutan, it is generally the medical and social model of disability. Medical model because people think everything can be fixed or mended by surgery or medicines and that concept is even at the level of health care professionals. Due to this the rehabilitation usually gets delayed and ignored.

The public structures and buildings are not so disable friendly and accessible. Even the footpaths and ramps are built inappropriately. But the place where i was born and brought up still adheres with the traditional model and ignores the peoples with disabilities.

[Tshering Penjor]

Here at the apex hospital in our country, Bhutan, some of the rehabilitation services include physiotherapy interventions. occupational therapy interventions, SLP interventions and prosthesis and orthosis. But in the districts it is usually the PT services available, the rest of the professionals do not exist there.

Another scenario is once the patient is discharged from the ward they will be referred to continue the rehab at the opd settings. If need be OT,SLPs and PNOs referrals are also made. Those families who can afford the home service on monetary basis, hires the rehab professionals to come at their house and do the necessaries. A palliative care at its infancy stage is also trying to cater the rehabilitation services to those families who are financially deprived and can not afford to bring the patient to the daily opd services.

[Tshering Penjor]

Some of the rehabilitation approaches we use here in Bhutan are institute based and community based rehabilitation. From department of physiotherapy, the services provided related to rehabilitation encompasses issuing Wheelchair services and walking aids. In districts a community based rehabilitation covers and facilitates the peoples with physical difficulties stranded at homes. An occupational therapy services are available at national referral and regional referral hospitals. Only one orthosis and prothesis center in the entire country.

Even an eye surgery and ENT related surgeries camp happens here with the expertise from the ex-countries.

[Author]

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