Empowering the person with disability should be the main focus and bringing about different management strategies could be the corner stone for working effectively with this segment of our society. But the need of a culturally competent model is an essential part and should be seen as a best practice approach

Health is a significant indicator of development of our society where disability plays an important role. Disability is often perceived as limitations on an individual's life resulting in experiences of marginalization and restriction on their lives in different ways. It is mostly evident that demographic and epidemiological perspectives of health are the popular thrust areas while disability, a major part of health issues, remains unrecognized.

Disability: The Word Beyond it

Impairment, disability and handicap are related terms and carry special meanings; yet there is a degree of overlapping among them. According to the WHO Manual, an impairment is 'concerned with abnormalities of body structure and appearance and with organ or system function resulting from any cause; in principle, impairments represent disturbances at the organ level,' and disability is 'reflecting the consequences of impairment in terms of functional performance and activity by the individual; disabilities thus, represent disturbances at the level of the person'. On the other hand, the term handicap is 'concerned with the disadvantages experienced by the individual as a result of impairments and disabilities; handicap thus reflects interaction with and adaptation to the individual's surroundings.' (World Health Organization, 1980)

Prevalence of the Problem

Table-1 presents two sets of data from 2001 and 2011 Census in regard to the place of residence and includes both sexes of population with disability in India. It clearly signifies that the percentage of persons with disability in India has increased both in rural and urban areas during the last decade (2001-2011). Yet another part shows that the proportion of the population with disability is higher in rural areas than urban areas, whereas, the decadal increase in proportion is significant in urban areas. The table also explains that there is a slight increase in disability among both sexes over the decade. The proportion of disabled population is higher among males and there is a decadal increase in proportion which is higher among females than males.

Culture and Disability

Another way to explain disability is the way we look at people with the problem, describe and present them. Disability is professed as a challenge no matter where the person is born. The challenge is magnified when they belong to a developing country, like India. Understanding the cultural background and following a cultural competent model is a critical part for the person to be served as well as the person serving these people. Sharing similar values and perspectives keep the task smooth for both the segments as perceptions are often influenced by the culture (Stone, 2005). Moreover, language forms the way people look at society and the existing social phenomena; it influences community attitudes and impacts the lives of individuals in the society. Therefore, special attention is underlined while addressing the issue of disability because it can have a profound effect on the way they are viewed by the community as well as by themselves. Few expressions, by their very nature, degrade and diminish people with disability and perpetuate inaccurate stereotypes. Thus, the People with Disability (PwD) Act, 1995, ensures human dignity and includes referring to 'people with disability', 'people with learning disability', 'person living with depression' etc.

Need for Professional Intervention

It is to be mentioned that the unique perspective of culture, when analyzed from a different view point, adds an in-depth meaning to disability. A competent and meaningful level of understanding disability may be quite helpful for the service providers. In addition, society labels people with different terms and at various situations. As a result, the stigma associated with disability can never be ignored. The appearance of disability in an individual exerts a strong negative influence on the functioning of the family. The situation also impairs the family relations within the family and causes emotional distress, frustrations and disturbs the relationship between the parents and individual or with other family members. If all these are not taken care of, the family stays in a state of permanent crisis which may lead to an eventual breakdown of the family and create a negative home environment. The financial and social status of the family is degraded along with the low expectations of the family members of the disabled. Parents' educational level and their previous experience with disability also play an important role in epitomizing the situation. The response of the rest of the extended family, friends, neighbours and other people to the disability of the individual characterizes the social system and regulates the social behavior of the individuals within it. The different circumstances arising out of these situations call for professional intervention and validate the role of social workers working with this segment of population.

Disability and Care Givers: Possibilities and Challenges

Dealing with people with disability is a challenging task by itself. The care givers here can be categorized into two types, namely, the primary or the informal care givers which includes typically family members or friends, and the secondary or the formal care givers which include the physicians, nurses or any other professionals who help out the person with disability. In this context, the 'culture brokering' model can be of prime interest. This concept is mainly used by the health care researchers to describe how the health care professionals from the patient's community often help the patient to understand how health services operate and how to obtain services from it. The care giver who works in the setting of disability treatment, also promotes a system of best practices and utilizes the culture brokering model to incorporate cultural values. This model marks variability of treatment among care givers keeping in mind the cultural aspects of society. For example, religious affiliation, education, mass media, occupation, income are found to be the important factors that affect people's attitudes, outlook and understanding of disability. This allows the care giver to function as a 'cultural bridge' between diverse communities and main stream services. This model can be seen as a conceptual framework that can order the thinking of the 'culture broker' in analyzing problems and devising culturally appropriate solutions. Thus, the model allows us to look at different factors not only at an individual level, but also at various other levels that link a person to the family, community and the broader service system.

According to 'cultural brokering' model, the intervention strategies include establishing trust and rapport, and also maintaining connections. As Sotnik and Jezewski clearly point out, the specific elements of these culture- brokering strategies are, advocating, mediating, networking, negotiating, innovating, intervening, and sensitizing. Regardless of what it means, disability providers must incorporate these intervening conditions as they move through the three stages of culture brokering, specifically, stages of problem identification, intervening strategies and evaluating outcomes (Sotnik & Jezewski, 2005). Therefore, a cultural broker should be willing to take risk and be able to tolerate ambiguous roles, should have trust and respect for the community, has to be comfortable in functioning at the margins of various systems (person's cultural system and service delivery system) and above all, should have good communication skills. The professional focusing on disability should be a cultural broker who can.

·       Act as a catalyst for change;

·       Provide a variety of support services for families dealing with the problem of disability;

·       Encourage the family and community to work with the individual with disability;

·       Assist the individual as well as the family to cope up with different unwanted situations;

·       Encourage transparency in inter-cultural communication;

·       Provide support to both of the parties;

·       Help to link the family with supportive resources, like-providing psychological support and if necessary cognitive behavioral therapy (CBT) and psychiatric intervention, raising of knowledge and competencies of parents in different forms like briefing, teaching, workshops, seminars etc, toy and book library, rehabilitation equipment and aids rental, long and short term respite care, social help and aid, information, counseling, guidance services, transport and forming mutual support groups for the families with similar problems;

·       Facilitate a cultural competent environment; and

·       Support participatory development of the individuals with disability.

Also, other functions of the professional may include-early, multidisciplinary, continuous and complex therapy according to the individual needs, constant evaluation by monitoring development and progress of an individual and modifying a therapy programme accordingly, psychological support and raising of knowledge and competencies of parents, concerning the specific needs of their disabled individuals. Considering the Indian scenario, people try to center around their roles and responsibilities and prefer prevention over promotion (Uskul, 2010). The form of professional help for the disabled individual includes all forms of support for the families by referring to all of the life's spheres and enable access to:

Considering the Indian scenario, people try to center around their roles and responsibilities and prefer prevention over promotion (Uskul, 2010). The form of professional help for the disabled individual includes all forms of support for the families

·       Health care, education, social benefits and housing;

·       Special aids and rehabilitation equipment;

·       Social rehabilitation and daily activity for those who cannot work;

·       Vocational rehabilitation and training, employment and support in job placement;

·       Advocacy, personal assistance and legal protection;

·       Meaningful and active leisure time activities, services in the community, participation in culture, sports and recreation respite care.

Hence, the worker dealing with this issue should have the ability to network, have effective problem solving skills and flexibility and willingness to learn and act mostly perfectly in the culture brokering role.

Conclusion

Empowering the person with disability should be the main focus and bringing about different management strategies could be the corner stone for working effectively with this segment of our society. But the need of a culturally competent model is an essential part and should be seen as a best practice approach. This would definitely bring about positive changes in dealing with this segment of population. Moreover, there is generally no agreed or preferred professional method of managing disability issues and defining the role of caregivers. However, it is recommended that understanding the situation as it arises and using integrated approach based on the individual need and circumstances should be the only concern at the moment.