Friday, December 25, 2015

Gidakom, my destined place of posting

Life in other place is full of happiness knowing though it will never be to the fullest. It’s wonderful to begin with fresh life, with new companionship, doing new things, even eating new food. It does take some time to adjust to just starting out chimes, but the necessity of living in the present endures any hardships.
I grew up in one of the remotest village with an understanding that everyone has the same value as a human being, including persons with disabilities. As a kid, I have seen many physically disabled people neglected by individuals, families and society as a whole. Being a Buddhist country, disability, as many people consider, a curse of bad deeds in previous life had left many disabled persons unattended years ago. But, with public awareness and social education through CBR and other rehabilitation programmes, disabled persons at least enjoy the right to basic health and education. I had a desire to work with physically challenged persons and help them in promoting their rights after graduating from my college in bachelor’s degree in prosthetics and orthotics in India. On completion of my course, RCSC placed me at Gidakom hospital, the only Centre for Prosthetics & Orthotics as a Prosthetist and Orthotist. I was then exposed to varied orthopaedically disabled Bhutanese people. And it’s indeed my dream come true, helping them stand on their own feet and enjoy every right that other Bhutanese enjoy with whatever the resources available at the P & O unit of Gidakom hospital.
Bhutan is a developing country in South Asia. Though the basic health services are available to all people of Bhutan through its national, regional, district and BHUs, Prosthetic and Orthotic services for the person with physical disabilities are only available at Gidakom hospital at present, which serves as the National Centre of Prosthetics and Orthotics. Apart from rehabilitation professionals, physically disabled persons and their families, not many people know about the prosthetic and orthotic services. Seriously, few might have never heard of it before and some simply might have ignored since they are able person. To the rehabilitation professionals, person with disabilities and their families, prosthetic and orthotic services is their every night dream, every day hope and every time goal of rehabilitating the person with physically challenged to make them stand on their own feet and enjoy the right to equality and non-discrimination, live independently in the community, exercise franchise, stand for opportunities and hold public office, etc. In Bhutan, the services are very recent rehabilitative modality incorporated in to the field of medicine under ministry of health, royal government of Bhutan. A very low percentage of Person with physical disabilities in Bhutan have been receiving marginal amount of prosthetic and orthotic services in Gidakom hospital. The prosthetic and orthotic profession is involved in the manufacture and provision of prosthetic devices for amputees (potential prosthetic users) and persons with other physical impairments, such as weakness or deformity (potential orthotic users). Prosthetic and orthotic services are concerned with physical rehabilitation provided by medical and allied health professionals associated with a prosthetic and orthotic department. This includes patient assessment, prescription and manufacture of devices, fitting, training, follow-up and repairs.
How many of you seriously know about prosthetic and orthotic science? Prosthetics and orthotics is the modern treatment and rehabilitative modality that deals with the orthopaedic and neuromuscular disorders and insufficiencies including congenital loses and accidental or traumatic amputations. Prosthetic and orthotic treatment returns the handicapped individual from his own world of darkness of suffering to the real world as an able individual capable to serve the society and thus achieve the dignity, esteem and self sufficiency. It enables the individual, once again to view the world as it is.
Prosthetic is a specialty within the medical field concerned with the evaluation, fabrication, and custom fitting of artificial limbs, known as "prostheses" that replace the lost body part either congenitally or due to trauma which includes total limbs, figures, partial hand, partial foot, etc. Prostheses enhance the function and lifestyle of persons with limb loss. The prostheses must be a unique combination of appropriate materials, alignment, design, and construction. Prostheses are an artificial device that replaces a missing body part, which may be lost through trauma, disease, or congenital conditions. A Prosthetist is the primary clinician responsible for the prescription, manufacture, and management of prostheses. Other prosthetic professionals include prosthetic technicians and assistants.
Orthotic is a specialty within the medical field concerned with the evaluation, design, fabrication and custom fitting of orthopedic braces, known as "orthoses" which leads to the mechanical correction of orthopaedic deformities by supporting the weaker body parts, preventing unwanted movement, etc. An orthoses is "an externally applied device used to modify the structural and functional characteristics of the neuromuscular and skeletal system". An Orthotist is the primary clinician responsible for the prescription, manufacture, and management of orthoses. Other orthotic professionals include orthotic technicians and assistants.
The discipline of prosthetics and orthotics is indispensible in the field of modern treatment without which the total rehabilitation of the orthopaedically handicapped individual is incomplete. According to the definitions in international standards prosthetic and orthotic service delivery includes; patient ass
Though the exact national figure on disability is not available as no such survey has been conducted so far, but by a rough estimate more than 300 prostheses and orthoses are fitted in Bhutan every year at Gidakom hospital.
There is an enormous need in developing country like Bhutan for prostheses and orthoses. Natural disasters and road traffic accidents had increased amputees and different diseases have left many people disabled. The services for prosthetics and orthotics are limited to a centre at Gidakom hospital. This has resulted in very limited services to people in smaller urban or semi-urban areas. Those who do travel to the centre to obtain P & O services usually receive inadequate services. Prostheses or Orthoses are designed and fabricated quickly and given to the patients without adequate training in how to use them properly.
In the case of prostheses, patient who come to the only centre for services rarely have their stumps prepared properly for the design and fitment of sockets. This results in shrinkage of the stump as soon as the new prostheses are used, so the socket no longer fits. The patient from the rural area discovers this after he has returned home. Few patients can afford to return to the city for designing new socket and prostheses as a whole. This cost both government and patients.
The lack of braces in rural areas is most evident. Families may bring their children with disabilities to the city to obtain a brace. However, children quickly outgrow their braces, which must be adjusted or replaced. Families cannot afford to go to the city each year, so the children stop using the braces and experience the well-known consequences.
These people who do not benefit from the services they seek are perhaps the minority in rural areas. The majority who need services do not seek them, many for economic reasons and some because of lack of awareness about possible services.
In order to provide clinical orthotic and prosthetic services to the people of Bhutan who need them, personnel must be trained to provide the needed services on time.
The national plan for the distribution of prosthetic and orthotic services should begin by establishing services at regional hospitals and, as and when feasible, should plan for further distribution of services to the district hospitals. 
Gidakom is located west of Thimphu with the nearest highway point at Khasadrapchu. It is half an hour drive from the main Thimphu town. The small valley of Gidakom is centered by Bjemina village in the north and Tsendendapsa in the south beautified by Bjemina River and giant hills. The valley blessed with rich minerals under Mewang geog boast of its 7 mining quarries.
On the sloppy hill of Gidakom lies the age old hospital popularly known as Leprosy Mission Hospital. Of course now most of the people call it as TB Hospital of Bhutan. Initially, Gidakom hospital was established in the 1960s as a Leprosy Mission hospital and up until 2001 had medical direction provided by the physicians working from the mission. The 60 bed hospital became the district hospital of Thimphu on 26 July 2011.
The hospital has a general ward and TB/leprosy cottage and OPD apart from a small Prosthetic & Orthotic unit attached with physiotherapy unit that caters the P & O services to the section of physically challenged people. Though not much development was brought, the hospital caters the health facilities through an age old buildings established by the mission. The hospital delivers general health services to the people of nearby villages apart from the specialized treatment of MDR-TB patients referred from other hospitals. The leprosy cottage still has few leprosy infected patient living under the care of Royal mother Azhi Kezang Choden.   
Life has never been as what we all would have desired. But life goes on with the clicks of time and alternate day night. Every happy moment comes with its own share of sadness. After all I look forward to happy days. These lovely place and work, it will remain forever in my memory, but for now, I have got miles to travel, promises to keep, and dreams to fulfill, and achieve my destination, before my eternal sleep. Because you and I can make a difference!

Tuesday, December 22, 2015

The Language of Suicide

Image result for suicide in bhutan

Bhutan, an abode of Gross National Happiness which adheres to Buddhism had transformed through the different phases of modernization embracing every trends of western culture. The global terrorism of suicide had affected millions in the world and became epidemic in a small and landlocked country of perfect bliss, which has become a concern for all the Bhutanese and nation as a whole. But the mere discussion of suicide and the means of tackling it have been generally seen as social taboo amongst most Bhutanese. It is surprising; especially when a Buddhist country-believe that a person who commits suicide will not be reborn as human being and that a person who had committed suicide in previous life takes the same fate of ending life. Suicide is one of the great, baffling phenomena of recent times. No one really knows how to fight it, or even, for that matter, what it is really. Under the Bhutanese law, committing suicide or attempting to commit suicide is not punishable. Punishment for attempted suicide is not in law on the reasoning that a person cannot be forced to enjoy the right to life to his detrimental, disadvantage or dislike. However, abetting a suicide is regarded as a crime.
According to dictionary, Suicide is an act of killing oneself intentionally. But as a matter of fact, is suicide really killing oneself? There must be something that drives the victims to kill themselves. There must be someone or something that takes the victim’s right to live. What’s that last thing you’re supposed to do when you know; you’ve nothing left to do in life? Some people think it as a crazy thing of foolishness. But, in depth, there’s something truth etched to their foolish act of suicide.
Am I overanalyzing the word suicide? I’m not propagating suicide but the fact is not the suicide but the force that drive suicide should be addressed. I know that there are many who preceded me on this topic with far greater experience and with in-depth research on suicide. I am neither an intellect nor a religious saint and I can only bring to this alarming topic my personal thoughts. I can only give a simple answer or if not, a question in itself. Suicide had become embedded in Bhutanese culture since time immortal. But, suicide in Bhutan had begun to rise, steeply and dramatically by leaps and bounds every year. The average annual growth rate of suicide in Bhutan is 9.4 %. Out of a total of 378 cases of suicide in the last five years, 254 are male and 124 are female. By age category, it is highest for youth below the age of 25 years and by occupation the highest is farmer followed by students. There are twice as many deaths due to suicide than HIV/AIDS. According to data, we should be more concerned about youths, the future of nation and farmers who live under poverty line.
To address the problem of suicide, are we going to organize anti-suicide movement? Run extensive public awareness campaign? Broadcast on television, radio and newspapers? Is the key to fighting suicide, educating people about suicide? These approach isn’t very effective. How effective it is to educate people against suicide? Because the more they are being aware of suicide, the more people, paradoxically, will want to try it. Suicides have become a contagious epidemic of self-destruction engaged in by people in the spirit of experimentation, imitation, and rebellion. These are completely a crazy action that somehow, among people, has become an important form of self-expression. Some study shows that, in some places and under some circumstances, the act of one person taking his or her own life can be contagious. Suicides lead to suicides. According to David Phillips, a sociologist at the University of California at San Diego, “suicide stories are a kind of natural advertisement for a particular response to your problems.” When some people who are unhappy and unable to make up their minds because of depression, those suicide stories give permission to die- and it serve as the tipping points in suicide epidemics.
As the number of suicides has grown in the recent years; the idea had fed upon itself, infecting younger and adults, and transforming the act itself so that the unthinkable has somehow been rendered thinkable. And the idea itself acquires a certain familiarity if not fascination to young people, and the lethality of the act seems to be trivialized.
Though the common risk factors of suicide epidemics is a wider concept of perception, the major factors driving the act of suicide are mental illness, drug and alcohol consumption, previous suicide attempts, family history of suicide, terminal illness or chronic pain, unemployment, poor economy, low social support, low self esteem with feeling of hopelessness and recent loss or stressful life event. Until and unless the causes are eradicated from the life of victims, the suicide would rather increase.
But the lesson here is not that we should give up trying to fight suicide. The point is simply the way we have tended to think about the causes of suicide doesn’t make a lot of sense. What’s that invisible social trend that governs suicide? When suicide is an epidemic, how does that change the way we ought to fight the suicide? Suicide notes tend to express not depression but a kind of wounded pride and self-pity, a protest against mistreatment. To address suicide epidemic, the concern authorities, you and I can join in understanding the needs, rights, freedom of living a life that could save someone, your family, your country men.
Parents are powerfully invested in the idea that they can shape their children. And of course, this is a hard fact to believe. Is love and affection in the early years of childhood and the basics of everyday life that children need to be safe and happy enough? Because what parents need to induce is the lasting intellectuality to the personality of your child. Does the specific social environment that we create in our homes make a real difference in the way our children end up as adults?
Is it right for parents to advice not to indulge in alcoholism and substance abuse when parents themselves indulge? Parents can make a change in their children’s way of positive thinking. You and I can make a difference.
Suicide, taking your own life, is a tragic reaction to stressful life situations-and all the more tragic because suicide can be prevented. The people who are planning of suicide show warning signs before they take their own life. And it’s very important to know the early signs of suicide at the earliest. Especially, teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. they may struggle with self-esteem issues, self-doubt, and feeling of alienation. For some, this leads to suicide. The highest suicide rate in adults is depression that is undiagnosed and untreated. The women suicide occurs against the discrimination they face in society, inequalities they are treated and just being a women that men take advantage of their body. The major suicide warning signs are change in eating and sleeping habits, withdrawal from friends, family and regular activities, rebellious behavior, etc.  
When the life deals us with the worst deals, it become hard to handle what life tosses our way. Being deserted by someone we love leave us feeling fragile, devastated, and scared to live. Some end up taking their own life. Suicide is not a final solution to the problems. What’s the use of giving oneself a death sentence when many others fear of death? Unfortunately, there isn’t ever going to be a safer form of suicide, to help save people from escaping the world of misery…is there?
We should know that life itself is sandwiched with the ingredient of happiness and pain, life is tricky and there’s great deal of murky water we need to wade through before we can start enjoying life of happily ever after ending. Finally, when we win from the battle of miserable life, we will think about the guts and the hardness we took to stop suicide, we will be amazed, we had it in us! Because you and I can make a difference!

CHENNAIYIN FC, Champion of Hero ISL 2015

Image result for chennaiyin team

The final was played between Goa and Chennayin on 20 December 2015 at. The much awaited grand finale of 2nd Hero Indian super league 2015 was played on 20th December 2015 at the Fatorda Stadium in Goa, between the Zico’s home team FC GOA and Marco’s CHENNAIYIN FC, and Chennayin were crowned as champions defeating Goa 3-2. The match started with tensed feeling of who-would-win-thoughts, though both the teams proved their own willingness to be the ISL champion of 2015. The game of bit physical at beginning that injured Dudu and Mandar impacted lot on GOA’s play though Mandar continued playing for his team. The first half was heart sinking moment with pressures soaring up from both the teams. Yet, many great opportunities were missed by the teams at the crucial moments. Pelissari’s misses was a great lose for away team CHENNAIYIN FC. It was sure to score opportunity he just couldn’t convert into goal leaving the supporters in deep silence of anger and fear. 
Chennai’s Mendoza almost brought happiness to rather few supporters at the stadium when he narrowed his shot though not on target. The bad misses by FC GOA’s Jofre and poor delivery of corners by GOA blew the supporters and Zico’s dream of winning ISL 2015. Yet, the GOA’s goalie saved Mendoza’s shot on target giving them a courage and hope of challenging their counterpart, Chennai. The half time ended with the extra time of 2 minutes with Jofre’s out of target shot and Wadoo’s long range shot with the score line of 0-0. The first half was not much of spectacular rather a physical game with fouls and injuries, and the time wasting.
The second half started with the same anticipation of who would win the title. The match resumed with Pelissari’s long shot not on target of course. Unlucky for FC GOA, the referee lifted yellow card to GOA defender signaling for first penalty shot. The shot taken by Pelissari was saved by the GOA keeper yet bounced back to the foot of Pelissari who then finished with his simple touch leaving FC GOA in complete disbelief. The roar of crowed diminished and the killing silence ruled the once chaotic stadium. It was already 1 goal for Chennai. The celebration was in air. But, within 4 minutes, substitute for Leo Moura, Thaokip equalized at 58 minutes when Romeo assisted by a perfect cross. Goa’s equalizing happiness has short lived when referee blew whistle against Goa’s goal keeper pointing for second penalty shot. The second penalty shot was taken by Mendoza which was saved by goal keeper taking responsibility for his fault of knocking down Mendoza. There was a little hope when Goa defender Gregory shot but he missed the target. Pelissari and Jeje were substituted by Elano and Jayesh respectively. The game entered into last stage with score line 1-1, Goa’s Jofre netted at 87 minutes making the crowd of 18,477 cheer at the top of their voice, reverberating across the whole stadium. And Jofre was declared the hero of the match. But during the 5 minutes of extra time, Goa goal keeper Kathimani’s own goal and Mendoza’s perfect goal sent the chill of defeat through the veins of home team, FC GOA. The celebration of Mendoza taking off his jersey and running round the pitch was spectacular though he knew the Japanese referee Moto would give him yellow card. After all that doesn’t matter when the team CHENNAIYIN FC won the 2nd ISL 2015. Though it was the last minute win for Chennai, the overall possession, shots, shots on target and fouls were with Chennai. Of course Goa was with more corners that didn’t turn into any single goal for them. The award ceremony was breathtaking, when the champion team took away the cash prize of 8 cores. The 2015 ISL golden boot award and golden glove award were taken by Mendoza and Edele Beta. Jeje, the Indian player from Mizoram took away the award for ISL emerging player of the league.   
The 2015 Indian Super League Season is the second season of the Indian Super League, a professional football league played in India since 2013. The season features eight teams. The regular season kicked-off on 3 October and ended on 6 December, while the finals began on 11 December and concluded with the final match on 20 December. The defending champions Atlético de Kolkata were eliminated in the semi-finals by Chennaiyin. 

Wednesday, December 16, 2015

Quit Smoking Day

Smoking refers to the habit of inhalation and exhalation of smoke resulting from burning tobacco in cigars, cigarettes and pipes. I started smoking when I was in my late teens. Smoking has become a part of my everyday life. Starting to smoke at such a young age, I didn’t really think about the health risks of smoking and I certainly didn’t realize how addictive smoking can be. I’ve spent many times during my last 10 years trying to answer the most perplexing question, ‘Why do I smoke?’ The excitement of experimenting with something that many other people do and just as a mere sensation has spirals me into addiction.
After 10 years of being a smoker, and knowing the health effects and religious sin of smoking, I’ve finally decided to quit and I’m ready to quit smoking. Mark Twain said, “Quitting smoking is easy. I’ve done it a thousand times.” Many of other smokers might have tried to quit, too. I have tried many times and failed many times. It is hard to quit smoking, but I can do it. No matter how much old I’m or how long I’ve smoked, quitting will surely help me live a healthier life. Quitting smoking is difficult, but not impossible. Quitting smoking is a lot like losing weight. It takes a strong commitment over a long time. I know there’s no one right way to quit smoking. Every smokers wish there was a shortcut to let them quit. Unfortunately, there won’t be a safer mode of smoking either.
So, I’ve picked 1st January 2016 (New Year) as my Quit Day. This is a very important step I took and I’m preparing myself with a plan of a strong, personal commitment to quit smoking from New Year.
I’ve started to smoke fewer cigarettes and will continue till my Quit Day and then I’ll quit. I started cutting down on the number of cigarettes I smoke a little bit each day. Now, if you ask me why I’m quitting smoking, I’ve enough reasons to quit. Though lately realized, the deadliest health effects including the lung cancer, chronic obstructive pulmonary disease, emphysema, heart disease, stroke and other cardiovascular diseases had prompted me to quit smoking. And the benefits of quitting smoking that are numerous including the improvement of lung capacity within 9 months by 10%, reduction of heart attack risks to half within a year, lung cancer risk will become like a person who has never smoked within 10 years, etc.
Attending the Buddhist teachings had helped me greatly. Tobacco is regarded as a black food, grown through wrongful prayer and that smokers will go to lower realms. At first it was insane to believe but the Buddhism, itself is a blind faith. There is no history of family smokers and that I wanted to fit once again into the circle of my families without tobacco cravings. Many smokers think they’re cool and consider as a fashion, but in real the society had their own stand. 
This New Year, join me in quitting smoking. You and I were not born with cigarettes in our mouth, and we can go back to being non-smokers. Tobacco cravings will wear us down when we try to quit smoking, but we are not at the mercy of tobacco cravings. There are over one thousand million smokers throughout the world, which is an astonishing number, considering the harm smoking does to our body, which we are all well aware of. By a rough, thousands of Bhutanese smoke though the smoking is prohibited and country is trying to become tobacco free nation.
Like what I did, the decision to quit smoking is one that only you can make. Others may want you to quit, but the real commitment must come from you. Think about why you want to quit smoking. Are you worried that you could get a smoking related disease? Will the benefits of quitting smoking outweigh the benefits of continuing to smoke? Are to ready to make a serious resolution to quit smoking? Nicotine, a poisonous alkaloid which is addictive makes us become physically dependent on and emotionally addicted to it. But you don’t mind, as I said before, quitting smoking is hard but, not impossible. Above all quitting smoking will give us a big boost to our morale and feeling of achievement. Finally, when we win from the battle of tobacco addiction, we will think about the guts and the hardness we took to quit smoking, we will be amazed, we had it in us!
Because you and I can make a difference!

Dzi, the Mythical Jewel

Dzi, the mysterious and one of the most sought after antique in the world had galvanized me to learn more though I’ve seen few times when my parents had them kept at home as a sacred ornament which they believed to bring good luck to our family. Gathered with my friends over a warm Bukhari after tiresome badminton, the beer-bonding session was on the floor. Gradually, we all became debatable and debated on many topics ultimately landing to an elaborative debate on Dzi for long. Though they have their own stories about the origin and its significance, the Dzi bead is one of the most baffling bead of all, known to human being today.
Dzi (pronounced as “zee”) in Tibetan word mean “good retribution, dignity and perfection.” Dzi are found primarily in Tibet, and neighboring Bhutan, Nepal, Ladakh and Sikkim. Although the geographic origin of Dzi is idiopathic, it is accepted as “Tibetan Beads.” Dzi beads are made from agate (a cryptocrystalline variety of silica, chiefly chalcedony, characterized by its fineness of grain and brightness of color), and have decorative symbols composed of circles, ovals, squares, waves or zigzags, stripes, lines, diamonds, dots, and various other archetypal and symbolic patterns.
The authentic “Pure Dzi” and “Chung Dzi” are found primarily in Tibet, and the “Dzi Family” can be found in Bhutan, Sikkim, Ladakh and Nepal. The later are “etched carnelian.”
Colours mainly range from brown to black, with the pattern usually in ivory white. Dzi beads appear in different colors, shapes and sizes; the surface is usually smooth and waxy. The round brown dot surrounded by white circle is the eye of Dzi. The number of “eyes,” is considered significant. The symbolic meaning of these beads is based on the number and arrangement of the dots. The highest number of eyes on ancient Dzi is twelve.
Tibetans believe that Dzi are naturally formed, not man-made. But since the knowledge of the bead is derived from several different oral traditions, the beads have provoked controversy regarding their source, their method of manufacture and their precise definition. Numerous attempts to trace the origin had failed and till now, it is unclear why, when and how the Dzi was manufactured.
Among the many myths and legends describing the origin of the bead, the main belief is that the Gods created them. Tibetans believe the Dzi as precious jewel with supernatural origin.
Some oral traditions of Tibet says that the Dzi were once insect that lived in a kind of nest call “Dzi Tsang” in Tibet. But the insects became petrified in the form of Dzi when unearthed, touched by human hand or woman’s shirt.
Another legend says, the compassionate vajrayana Buddha rescues the severe epidemic of Tibetans by releasing the magical Dzi to bring them good luck, ward off evils and protect wearer from physical harm.
According to Tibetans, there are many criteria to identify authentic Dzi beads such as the Weathering Marks (signs of aging and it represent the age of Dzi. They are tine lines of different thickness running irregularly on the surface of the Dzi bead. However, not every old Dzi bead will have the weathering marks), Cinnabar Dots (the red or black speckles that grow from within the body of Dzi to its surface), Diaphaneity (the transparency of the Dzi body, which is the ability to allow light to pass through. However, not every authentic Dzi are transparent), Circular Dragon Marks (the natural streaks that circulate the body of Dzi), Body Color (the body color of younger bead will have a shinning black and white. While older one varies from dark brown to light brown), Motif (the unusual pattern in the Dzi determines the higher price value than the common patterns), the Dzi with larger size is at higher value.
In Bhutan, the Dzi beads are known as “Cat’s eye.” Dzi has become the most singled out historic jewels among the Bhutanese people and the increasing transaction of Dzi is attributed to the rising Chorten and Lhakhang vandalism in the country.

The origin of Dzi in Bhutan is not documented but elderly Bhutanese believe that the Dzi originated from ocean.

Saturday, December 05, 2015

International Day of Persons with Disabilities

The International Day of Persons with Disabilities (IDPD) has been commemorated since 1992 to promote awareness and mobilize support for the critical issues relating to the inclusion of persons with disabilities in society and development. The 3rd day of December each year aims to promote action to raise awareness about disability issues and draw attention to the rights of an inclusive and accessible society for persons with disabilities.
As per the World Health Organization; Disability is an umbrella term, covering impairments, activity limitations, and participation restrictions. Impairment is a problem in body function or structure; an activity limitation is a difficulty encountered by an individual in executing a task or action; while a participation restriction is a problem experienced by an individual in involvement in life situations. Thus disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.

Disability is not a phenomenon but is a phase. Everyone at one point or the other passes through such phases. The elderly, ill, pregnant, obese, children, persons with fracture or with luggage could all be described as passing through a phase of disability. Even during such phases each one has the right to live in dignity. Accessibility, therefore, cannot be an aspect of sympathy but is very much the right of every individual. Though unintended, most of our buildings today remain inaccessible to many. This is largely due to the lack of conscious efforts, concerns for the disabled and lack of basic information on what constitutes an accessible design. A universal design, not remaining synonymous only with the provision of ramps, involves many more aspects to consider. This neither implies an additional demand nor involves an extra cost, if integrated right from the conception of the design.
This effort aims to bring about awareness of the issues faced by the physically challenged people when using public buildings and spaces. It also incorporates concerns of the elderly, children and of people facing temporary mobility problems. We, as committed and concerned professionals, should take up this responsibility of addressing these issues and demonstrate through our work the benefits of a barrier-free environment. Access to public areas is not only a matter of dignity but also the fundamental right of every person in our country.
Government has been working towards invoking civil society participation to facilitate social inclusion and democratic governance. The aim is to empower the vulnerable sections of our society to enable them to effectively participate in mainstream development and decision-making processes. This includes people with disabilities and issues related to disability. While working on issues of disability in the past 3 years, we realized that, besides social and attitudinal barriers, physical obstacles in the environment pose a major hurdle in inclusion and, together, these barriers result in nonparticipation and exclusion.

There are more than a billion people in the world today who experience disability. People with disabilities have generally poorer health, lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their everyday lives. According to WHO World Bank Report 2011 on disability, less than 15% of disabled persons could obtain aids and appliances. There are more than 20 million people in need of orthopaedic appliances and to this figure about million new disabled people are added every year. Most of the world’s disabled people live in the developing countries. People with physical disabilities in Bhutan live in circumstances of poverty, isolation and social stigma. Their experiences have been exacerbated by the lack of services & facilities and vehement attitudinal barriers in all walks of their life. Disability is significant not only for the disabled person but also for the family and neighbours. The estimated 1 billion people living with disabilities worldwide face many barriers to inclusion in may key aspects of society. As a result, persons with disabilities do not enjoy access to society on an equal basis with others, which includes areas of transportation, employment, and education as well as social and political participation. A very low percentage of Person with disabilities in Bhutan have been receiving marginal amount of services in hospitals.
Bhutan is one of the nation in the world with a long-standing commitment of becoming an inclusive society where People with Disabilities, are able to fully participate in the social, cultural, recreational, economic and political life of the nation. Inclusion is the primary social objective. All citizens should have the opportunity and right to participate without discrimination, attitudinal & environmental or service barriers in all walks of life.
Recognizing the rights and responsibilities, the Government of Bhutan will ensure that every Person with Disabilities in Bhutan achieve full emancipation and self esteem by equalization of opportunities through creation of enabling environment, so that the society is benefited from their untapped talent and contribution. The Government will endeavor to promote community participation in order to generate adequate community response towards the causes of disability. The Government will ensure the promotion of innovative and adaptive technology in order to create and facilitate access to social and economic rehabilitation for Persons with Disabilities.

With the theme “Inclusion matters; access and empowerment for people of all abilities” there is no better time than this to create barrier free environment for person with disabilities and empower them with full rights and optimal social status. Persons with disabilities must be given role in the society and to participate on an equal basis with others. It is important to focus on the ability and not on the disability of an individual.
The sub-themes for IDPD 2015 include:
1.      Making cities inclusive and accessible for all:
For many city-dwellers, today's modern cities and towns may be convenient and fascinating places for working and living, offering a great variety of opportunities and experiences. But for disabled persons, such built environments are full of uncertainties, anxieties and dangers. Disabled persons encounter many obstacles that prevent them from moving about freely and safely. For wheelchair users, steps and stairways are obstacles. Blind people are endangered by the absence of directional and safety features that they can hear and touch.
The way in which the environment is developed and organized contributes to a large extent, to the level of independence and equality that people with disability can enjoy.
In society there are a number of barriers, which prevent disabled people from enjoying equal opportunities with non-disabled people. For example: structural barriers in the built environment; inaccessible service points; inaccessible entrances; poor town planning; and poor interior design etc. It must be emphasized that barriers also include communication barriers i.e. oral language is a barrier for sign & touch tell language users.
Key access concerns in Bhutan are:
1.  Most public as well as private buildings are inaccessible for PwDs (people with disabilities)
2.  Planning professionals need to recognize and act upon the specific details, which are needed in providing a barrier free environment.
3.  Lack of specialists/expertise in the field of barrier free access
4.  Costs are often cited as the reason for the failure to provide a barrier free environment. However, when accessibility is incorporated in the original design, the additional cost does not generally exceed 0.2% of the overall cost of development.
5.  All relevant staff in the central departments and in the local government should attend and complete a course on barrier free access to provide the exposure towards the needs of PwDs. Professionals involved in the construction industry should complete the course as well.

2.      Improving disability data and statistics:
The absence of a common language of disability, including a common understanding of the multidimensional concept of disability, is the principal cause of the lack of agreement on disability data around the globe. Lack of proper data and statistics on disability had hindered the process of priorities for disable persons in the country and are left less concerned though government, NGOs and other organizations had voiced and conducted the social analysis of disability and data collections. Royal government of Bhutan should start a pilot disability survey and encourage a better understanding of people affected by disability, together with helping to make people more aware of the rights, dignity and welfare of disabled persons.  

3.      Including persons with invisible disabilities in society and development:
The government should respect the right to participate in public life and reduce inequalities in the society. Often the societal image of persons with disabilities is impacted by attitudes based on stigma and discrimination, as well as archaic ideas about disability and persons with disabilities that are often the greatest barrier to their full and equal participation in society and development on an equal basis with others.
In the social model, the focus is to the society; undue restrictions on behavior of persons with impairment are seen to be imposed by: a) dominant social, political, and economics ideologies; b) cultural and religious perceptions regarding persons with disabilities; c) paternalism in social welfare systems; d) discriminations by society; e) the inaccessibility of the environment and information; and f) the lack of appropriate institutional and social arrangements. Thus in this model, disability does not lie in individuals, but in the interactions between individuals and society. In the social model, persons with disabilities are right holders, and are entitled to advocate for the removal of institutional, physical, informational and attitudinal barriers in society.
It is important to note that disability is part of the human condition, and that all of us either are or will become disabled to one degree or another during the course of our lives.
“The only disability in the world is BAD ATTITUDE.”

World AIDS Day

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World AIDS Day is celebrated on 1st December each year and is an opportunity for we people worldwide to unite and recommit ourselves to the fight against HIV and achieve AIDS free generation, show our support for the people living with HIV/AIDS and commemorate solidarity with people who have lost their precious life because of HIV/AIDS. World aids day was first ever global health day, held for the first time in 1988.
Despite the virus only being identified in 1984, more than 35 million people have died of HIV/AIDS out of an estimated 36 million people who have the virus globally making it one of the most destructive pandemics in history. Sub-Saharan Africa has the highest rates of HIV in the world and certain areas of the Caribbean, Eastern Europe and South East Asia have high prevalence of HIV.
Today, scientific advances have been made in HIV treatment, there are laws to protect people living with HIV and we understand so much more about the condition. Despite this, 28 new HIV positives were detected in the last five months, totaling the number of HIV cases detected since 1993 in the country today to 460. Of the 460 detected so far, 354 are living with HIV/AIDS in the country, 20 live outside Bhutan and 86 have died.
Still, there are people who don’t know the facts about how to protect themselves and others, and stigma and discrimination remain a reality for many people living with the condition. World aids day is important because it reminds the public and government that HIV has not gone away- there is still a vital need to raise awareness, fight prejudice and improve education.
What are the early symptoms of HIV?
Around a week to ten days after HIV infection takes place, symptoms can occur which is the result of the body reacting to HIV infection clinically referred to as “Seroconversion”. The most common symptoms of recent HIV infection are severe flu-like symptoms, including a sore throat and fever, and a rash on the chest. Other symptoms can include fatigue, nausea and diarrhea. People who experience the above symptoms to do an HIV test if they occur within six weeks of sex without a condom.
The second stage of HIV infection is the “asymptomatic” stage, and there are generally no symptoms, often lasting for as long as ten years. The third stage of HIV infection is the symptomatic stage, where the body’s immune system has become so damaged that it becomes susceptible to a range of “opportunistic” infections that would normally be prevented by the body’s natural defenses. These infections include bacterial diseases such as tuberculosis, pneumonia and blood poisoning, fungal diseases such as oral thrush, and viral diseases.
When should one take an HIV test?
One should get an HIV test if one think she/he have exposed oneself to risk-for example, a sex without a condom with someone whose HIV status is not known or sharing of injecting needles or drug equipment.
If one is a sexually active gay or bisexual man, it is recommended to have an HIV test at least once a year, and more regularly if one have –unprotected anal sex with new or casual partners.
If one has recently had sex without a condom, and one experience early symptoms of HIV, one should get tested as soon as possible.
Even if one don’t have symptoms, one can’t assume one don’t have HIV. It is always advised to get tested for HIV and other STIs.
After a person has been infected with HIV, there is a four week gap-commonly referred to as “window period”-where the virus can’t be detected by a test. After the window period, one can get a reliable test result telling one whether one is HIV+ or HIV-
The mode of HIV transmission
HIV can be transmitted through infected semen, vaginal fluids, rectal secretions, and blood or breast milk. The most common ways HIV is passed on are through sex without a condom, or sharing infected needles, syringes or other injecting drug equipment.
HIV cannot be passed on through casual contact, such as touching, shaking hands or sharing utensils. HIV cannot be passed on through saliva, including spitting or kissing. HIV cannot be passed on through urine or faeces.
How can one protect oneself and others against HIV infection?
Always use a condom when having vaginal or anal sex. You may also want to refrain from giving oral sex if you have cuts, sores or ulcers in your mouth. Avoiding having your partner ejaculate in your mouth also lowers risk although the risk of HIV from oral sex is much lower generally. You should also never share needles, syringes or any other injecting equipment.
HIV/AIDS treatment
HIV and AIDS is not the same thing. When someone is described as living with HIV, they have the HIV virus in their body. A person is considered to have developed AIDS when the immune system is so weak it can no longer fight off a range of diseases with which it would normally cope. An AIDS diagnosis takes place at such a late stage of infection when one or more of the most commonly experienced illness linked to HIV occurs (known as an AIDS-defining illness)
Though there are extremely effective treatments for AIDS which enable people to live a full and active life and live a near normal lifespan, there is still no cure and HIV is a condition you have to live with every day for the rest of your life.
Whilst HIV needn’t be feared the way it was decades ago, it remains a serious, long-term condition with life-limiting consequences. PEP or Post Exposure Prophylaxis is a medical treatment that prevents HIV infection after the virus has entered the body. Highly effective HIV medication reduce the level of HIV in the body (clinically referred to as an “undetectable viral load”) and when this happens, the chance of passing HIV on to a partner are significantly reduced (this doesn’t mean that HIV treatment is a replacement for condoms, but it does give HIV positive people more options for safer sex and reduce overall risk of onward transmission) and will also prevent the HIV infection from damaging the immune system so severely and can stop opportunistic infections (the infections take advantage of the weakened immune system in a way they wouldn’t normally be able to in an otherwise healthy person). Treatment must be taken every day and can cause side-effects and sadly there is still a lot of stigma and discrimination around the condition. So everybody should take all the measures to avoid HIV transmission.