This is a guest post by Habeeb Tunji Ololade, currently a Senior Physiotherapist with the Medical Rehabilitation Therapist (Registration) Board of  Nigeria. He is engaged in the academic training and curriculum activities that have to do with the training of physiotherapists and occupational therapists in Nigeria. He is @habeeb011 on Twitter.

While I was travelling on a public bus sometime in 2016, there was a fellow traveller on the bus who sat on the seat next to where I sat. During the course of the journey she did not utter any word but as we were approaching the end of the journey, she had the need to communicate with the bus driver, it was at that point that it dawned on me that this lady had hearing impairment and as such didn’t hear any of the discussions that other people on the journey have been having. The sight of this young lady that was full of hope and independence just like any other young adult of her age initially aroused an emotional feeling of pity and sympathy towards her from me after I realised her situation of being hearing impaired. It was the sort of emotional pity that perhaps she has had to cope with for years in her young life and I guess leaves her in a state of discomfort and frustration at how the rest of society refuse to acknowledge and accept her for who she is, just like the same way she probably has accepted and adapted to acknowledge the rest of the mainstream society for what it is.
I realised that she didn’t need society’s patronising sympathy for her physical condition, rather, just like everyone else in the society she would be happier if everyone around her make her feel normal, part of the mainstream society in an inclusive manner and not looked at as an unfortunate individual with unsolicited pity. I had to work on my state of my mind of feeling pity towards her and stopped looking at her like she is not part of the mainstream society. This experience made me to realise that in as much as it’s necessary to empathise with other people in whatever situation they find themselves in, it is more important to:

Never show pity towards a disabled individual (this hurts them), and if there is the desire to help an individual with any form of disability to overcome a barrier, one should do so with empathy and not with a look of pity, sympathy or any sort of unusual look on one’s face, to the extent that the person being helped will feel as if he/she is a burden to the person that has chosen to provide the support that the individual with the disability needs. It is important to provide supports that are inclusive and that give power and agency to the individual with the disability. It is important to realise that individuals with disability issues are just like any other person in the society. After all, we all seek for support or assistance for things we struggle with and we do not look at such requests as irrational, diminishing, or belittling.

After that experience it dawned on me that for the past few years that I’ve worked in hospitals, I have never come across a patient with hearing impairment. I wondered: is it that they don’t experience the conditions I treat? Could there be somewhere else they go to for treatment? Is it possible that there are many barriers in hospitals, such that they are not able to seek help and they just prefer to die silently in pain?

On daily basis people with disabilities in Nigeria face many barriers in their everyday life, from institutional to social barriers. These barriers in most cases start from families to the neighbourhood in which they live, and unfortunately, these are the people that should understand them more and be more inclusive in their engagements with them, however in most cases the reverse is usually the case.

A lot has been said through advocacy and campaign on some of these barriers but little or nothing has so far been done in tackling and eliminating such barriers in the society.
Court they say is the last hope for the common man, likewise, hospital should be the last hope of a sick man, either: common or uncommon, rich or poor, able or disabled. The hospital is a place that should be designed to accommodate all humans: able/disable, sick/well, rich/poor.

For instance, in Nigeria people with physical disabilities are not able to easily access most of the public health facilities in the country due to the non-inclusive nature of the design of most of these health facilities. Unlike other people in the society, disabled individuals are faced with several multi-layered restrictions and barriers. The presence of these barriers can easily be interpreted as discrimination against them.
Until about 10 years ago in Nigeria there was no voice given to issues that relate to disabilities in the country. And despite the increased advocacy for disability related issues in the mainstream media in the country, most public buildings (private/government) don’t have the basic facilities to accommodate people with disabilities.
It’s more saddening to note that our health sector that should be at the forefront of disability advocacy is also guilty of lack of providing an inclusive and disable friendly environment. If hospitals won’t make individuals with disabilities function independently, then, where is the hope for a disable inclusive society?
Lagos state is one of the few states in Nigeria that have passed disability rights law. The state government makes it mandatory that all public buildings (including banks) must construct or reconstruct their buildings in order for them to be accessible to physical challenged individuals within the period of 5 years from the year the bill was passed into law, however, the law is yet to be enforced (a law without enforcement should have never been made). Maybe the lack of the political will to enforce the law on the part of the government is because the government itself is guilty of not implementing the law on its own buildings.

Many Hospitals are yet to build ramps around staircases to accommodate wheelchairs. The availability of ramps in public buildings and public spaces will significantly increase access to public spaces by individuals who are wheelchair users.

My questions on the issue of disability in Nigeria as a medical practitioner with regards to the hearing impaired passenger on the bus are:
What if she needs to seek medical assistance, how will she express herself in confidentiality to the doctor?
What if she needs health counselling, how will she go about it?
How will she get treatment at the hospital without stigmatisation?
How will she communicate in confidentiality with the doctor in these hospitals?
I am sure you will agree with me that Communication is very critical to medical providers and individuals accessing medical assistance. Attention is being given to improvements in our health care service delivery day in day out but little do the health innovators consider with regards to people with disability issues and this group are supposed to benefit from these services like the rest of the society.

A partially deaf and dumb woman was recently at a government hospital in Surulere area of Lagos where, for over five hours, she was completely ignored and help did not come to her. In tears, she recounts her ordeal. “I became deaf accidentally. I was not born deaf. When I have health challenges, I go to the hospital, mostly the general hospital. When I get there, I would greet them (health workers) and they will just say, ‘Go and sit down’. I will stay there for long and no help will come. I can’t hear my name when they call. There’s nobody to help me. Even if I say that I am deaf, it does not make any dense. So, in the hospital, we don’t enjoy the experience.

Disability includes physical disability and mental disability, some are primary (from birth) while others are secondary (acquired through accidents or diseases). Many disabled individuals attend clinics with the support of a care giver who often experience loss of economy time in order to support their loved ones at the hospital, instead of going to work. At times when families run out of means to feed their disabled family members, the disabled persons are left at home with no attention. Many disabled individuals have died of depression and other curable diseases due to lack of access to medical care and facilities, after living a deprived life ‘because society doesn’t care about them’. Such instances would have been eliminated if hospital environments are more inclusive.

My point in all this is that our hospitals should be structured and designed in ways that they will accommodate all the special friends around us, such that they will be able to access healthcare independently and confidentially without having to wait or employ a third person’s support.

Disability is not restricted to those who are confined to wheelchairs alone, there are other forms of disabled people who can walk but with other challenges, considerations must be given to them when setting up government hospitals.

A hearing impaired individual should be confident of getting a sign language interpreter while on a doctor’s visit while confidentiality will still be maintained. Hospitals must provide effective means of communication for patients, family members, and hospital visitors who are deaf or hard of hearing. The services of an interpreter should be easily accessible in emergency room care, inpatient and outpatient services, surgery, clinics, and educational classes. Whenever patients, their family members, companions, or members of the public are interacting with hospital staff, the hospital should be obligated to provide inclusive and effective communication means to everyone.

Effective communication is particularly critical in health care settings, where miscommunication may lead to misdiagnosis and improper or delayed medical treatment.

A visually impaired individual who wish to access a government health facility should be able to access such a facility, an individual on crutches should be able to rent a wheelchair at the entrance or at the car park of hospitals.
I once had a patient with pelvic hip fracture on frame, she was placed on Zeeman’s frame (walking frame), she chartered a taxi to the hospital, the taxi driver did his own part of the deal and when she alight from the car, of course you know the terrain of our hospitals in Nigeria are very difficult to navigate for a patient on frame, but a ramp at the entrance would have saved her from the pains she went through in order to get to my department. Perhaps, she might have achieved little or nothing from her rehabilitation on that particular appointment.
My appeal to government is that they should make it mandatory that every major hospital in the country should set up SPECIAL unit and policy to address the challenges faced by disabled individuals while accessing their medical care and facilities, with the dignity and confidentiality of their disabled service users preserved and protected.