Health Inequalities Among Challenges Facing People With Special Needs

When Mdm Jothi Marimuthu’s son, who has special needs, suffered a hairline crack on his left leg two years ago, the doctor at the accident and emergency department tried to explain his medical condition to the 22-year-old man.

Kiran Raj S Vanu has global developmental delay, an intellectual disability due to epilepsy. “(But) he was giving all these medical terms, and Kiran just stared (at the doctor),” recalled Mdm Jothi, 47.

“He doesn’t know about special-needs (persons), he’s a normal A&E doctor. So he tried to talk to Kiran like a normal person, and I told him ‘Sorry, he can’t understand what you’re trying to tell him’,” added the housewife.

Apart from a difficulty in understanding what the doctor was saying, some persons with special needs, such as Kiran, might also face difficulties expressing their pain or discomfort. Others are more susceptible to certain health conditions.

As such, providing healthcare for this group of people requires specialised training, something special-needs experts and caregivers feel is lacking here.

Mdm Jothi said the A&E doctor had also insisted that Kiran, who was later fitted with a cast, try using a pair of crutches to move around.

However, her son did not know how to hold the crutches, and continued to walk on his injured leg while carrying the mobility aid.

While Kiran — who is a trainee at the Movement for the Intellectually Disabled of Singapore (Minds) Employment Development Centre — is able to tell his parents he is in pain, Mdm Jothi added that he will not be able to point out exactly where he is hurting.

Speaking to TODAY, Minds deputy chief executive officer Jeffrey Chan said that some persons with special needs have communication difficulties, especially if they are unable to verbally express their health concerns.

Others take on more personal health risks when they are unable to care for themselves properly, including in areas such as weight management and dental care.

Apart from these problems, persons with special needs also face “health inequalities”. Citing international findings, Dr Chan noted that certain medical conditions are more commonly found in persons with special needs due to genetics, for instance. They include certain types of cancer, such as stomach cancer, respiratory diseases, diabetes and osteoporosis among persons with intellectual disabilities.

They are also more likely to have mental health conditions. A higher prevalence of dementia has been found among the intellectually disabled elderly.

Other preventable medical conditions, such as constipation and unhealthy gums and teeth, are also more commonly found in persons with intellectual and developmental disabilities.

A 2013 study by Minds and local practitioners here found that 17.6 per cent of the 227 participants had high cholesterol, 15.9 per cent had hypertension and 10.6 per cent had epilepsy.

When Minds screened its adult clients for Hepatitis B in 2005 and 2006, 70 per cent of the 1,107 people tested had no immunity against the disease.

Some of the basic health screening tests that the general population receives are also not provided to those with special needs, said Dr Chan.

“There are some things that you should be doing for the typical population, so if you are a woman of a certain age, you are always advised to go for a mammogram test, and so the same standard should apply to those with intellectual and developmental disabilities,” he added.

To provide more help on this front, Minds, a voluntary welfare organisation (VWO), is opening a clinic to provide specialised medical consultations, reviews and refers its clients to polyclinics, for instance.

The patients at the clinic will not receive a diagnosis, but will receive a health booklet to track their medical conditions.

Located at the VWO’s Eunos Training and Development Centre, the clinic will operate on Mondays and Wednesdays, and be staffed by three volunteer doctors. It is expected to officially open next month.

A spokesperson from St Andrew’s Autism Centre noted that medical practitioners should also be aware of the high incidence of certain conditions, such as epilepsy and behavioural issues, among autistic patients.

As patients with autism may not be able to communicate their symptoms as easily, doctors have to detect signs of their discomfort through their body language or by speaking to their caregivers, she added.

Although there are medical professionals willing to walk the extra mile to understand and treat persons with special needs, Ms Denise Phua, Member of Parliament for Jalan Besar GRC, said “access to them is not assured”.

“We need clusters of GPs, dentists and other medical professionals who can be trained in and/or specialise in the major disabilities; and their whereabouts and availability made known,” added Ms Phua, who is also the President of the Autism Resource Centre (ARC).

Similar to the Appropriate Adult Scheme for persons with mental disabilities, a group of volunteers can also be trained to accompany persons with special needs and facilitate communication between them and healthcare workers during routine health-screening and urgent medical treatment sessions, said Ms Phua.

VWOs dealing with clients with disabilities can also provide training and support to medical professionals.

For example, ARC, St Andrew’s and other autism partners have worked with Duke-NUS Graduate Medical School to engage caregivers and healthcare professionals on various topics relating to autism diagnosis, medical issues, among others.

Mr Timothy Chua, senior lecturer with the Social Work Programme at the Singapore University of Social Sciences, said more attention should be given to special-needs adults in their 30s to late 50s.

These adults are likely to stay with their older parents, where the latter’s advanced age might put a strain on them while managing their child’s health conditions.

With most health services being provided for at health institutions, Mr Chua suggested having more home-based outreach initiatives, such as befriending programmes, given that many adults with special needs spend most of their time at home or around their neighbourhoods.

Despite the many challenges, caregivers such as Mdm Jothi feel that all it takes is for medical professionals to show more patience when dealing with patients with special needs.

There is no need for all doctors to go for special-needs training, she believes.

“They (just need) to be more compassionate and more patient with them (persons with special needs). Try to find a way to mingle with them and get their trust, to make them feel safe,” she added.

Link to original article: http://www.todayonline.com

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