disability competence, Indian medical graduates, physical medicine & Rehabilitation, sjmch Puri

1. DISABILITY & CULTURAL
COMPETENCIES
DR. SUSHIL KUMAR NAYAK
ASSISTANT PROFESSOR
PHYSICAL MEDICINE & REHABILITATION (PMR)
SJMCH, PURI

2. Induct disability as a component for all education
courses for schools, colleges and University
teachers, doctors, nurses, para-medical personnel,
social welfare officers, rural development officers,
asha workers, anganwadi workers, engineers,
architects, other professionals and community
workers.
Sec 47 (1)(b) of the Rights of Persons with Disabilities Act
2016 -Chapter -8, Duties & Responsibilities of Appropriate
Government

3. The WHO’s world report on disability states that
people with disabilities have the same general
healthcare needs as others but they are
two-times more likely to find healthcare
providers’ skills and facilities inadequate,
three-times more likely to be denied healthcare,
and four-times more likely to be treated badly in
the healthcare system.
http://whqlibdoc.who.int/publications/2011/9789240685215_eng.
pdf?ua=1.

4. Consequently, Parliament of India enacted the
CRPD-compliant Rights of Persons with
Disabilities Act (RPDA), 2016 and the Mental
Healthcare Act (MHCA) in 2017.

5. Foundation Course (FC) for the
Undergraduate Medical Education Program
4- Professional Development and Ethics Module
(P&E)
4E. (P&E): Disability competencies

6. As newly joined medical students, you need to
recognize the importance of various deviations
from majority that are happening in human life.
Disability is part of human diversity.
Differently-abled individuals need to be
understood and recognized by any stream that
deals with human life.

7. The roles of Indian Medical Graduate
4.5.1- (Clinician) Description disability as per
United Nations Convention on the Rights of
Persons with Disabilities

8. The United Nations Convention on the Rights of
Persons with Disabilities (CRPD), was the first legally
binding instrument on the issue of disability, and
Aimed to “promote, protect, and ensure the full and
equal enjoyment of all human rights and
fundamental freedoms by all persons with
disabilities and to promote respect for their
inherent dignity.

9. 4.5.2-[Clinician]- Compare and contrast medical and
social model of disability.
Medical model of disability
 The medical model of disability says people
are disabled by their impairments or differences.
 Under the medical model, these impairments or
differences should be ‘fixed’ or changed by medical
and other treatments, even when the impairment or
difference does not cause pain or illness.
 The medical model looks at what is ‘wrong’ with the
person and not what the person needs.
 It creates low expectations and leads to people losing
independence, choice and control in their own lives.

10. Social model of disability
 The social model of disability says that disability is caused by
the way society is organised, rather than by a person’s
impairment or difference.
 It looks at ways of removing barriers that restrict life choices for
disabled people. When barriers are removed, disabled people
can be independent and equal in society, with choice and
control over their own lives.
 Disabled people developed the social model of disability
because the traditional medical model did not explain their
personal experience of disability or help to develop more
inclusive ways of living.
 Barriers are not just physical, Attitudes found in society, based
on prejudice or stereotype also disable people from having
equal opportunities to be part of society.

11. 4.5.4- [Lifelong Learner]- Awareness of the disabilities included
in the Rights of Persons with Disabilities Act, 2016.
(a) promote values of inclusion, tolerance, empathy and respect for diversity;
(b) advance recognition of the skills, merits and abilities of persons with
disabilities and of their contributions to the workforce, labour market and
professional fee;
(c) foster respect for the decisions made by persons with disabilities on all matters
related to family life, relationships, bearing and raising children;
(d) provide orientation and sensitization at the school, college, University and
professional training level on the human condition of disability and the rights
of persons with disabilities;
(e) provide orientation and sensitization on disabling conditions and rights of
persons with disabilities to employers, administrators and co-workers;
(f) ensure that the rights of persons with disabilities are included in the curriculum
in Universities, colleges and schools.
Sec 39 (2)of the Rights of Persons with Disabilities Act 2016
Chapter 8, Duties & Responsibilities of Appropriate Government (Awareness
campaigns)

12. The 21 disabilities are:-
1. Blindness
2. Low-vision
3. Leprosy Cured persons
4. Hearing Impairment (deaf and hard of hearing)
5. Locomotor Disability
6. Dwarfism
7. Intellectual Disability
8. Mental Illness
9. Autism Spectrum Disorder
10. Cerebral Palsy
11. Muscular Dystrophy
12. Chronic Neurological conditions
13. Specific Learning Disabilities
14. Multiple Sclerosis
15. Speech and Language disability
16. Thalassemia
17. Hemophilia
18. Sickle Cell disease
19. Multiple Disabilities including deafblindness
20. Acid Attack victim
21. Parkinson's disease

13. FC 4.5.3- [Communicator] Build an understanding on the
disability etiquettes while addressing people with disabilities.
The Basics of Disability Etiquettes
Speak Directly with the Disabled Person. At
times, especially in case of disabled kids, people
tend to talk about them with their companion.
Ask Before You Help.
Avoid Touching Crutches, Wheelchair or Cane
etc.
Be Sensitive while Speaking.
Do Not Assume.

14. FC 4.5.5- [Communicator]- The use of verbal and
nonverbal empathetic communication
techniques while communicating with people
with disabilities

15. • Use a normal tone of voice—do not raise your
voice unless asked to
• Be polite and patient—do not rush the
conversation
• Speak directly to the person rather than the
person with them
• Ask the person what will help with
communication—there are different ways to
communicate
• Don't pretend to understand—let the person
know you are having difficulty; try asking yes or
no questions

16. • Be flexible—reword rather than repeat anything
that is not understood
• Only refer to the person's disability if necessary
or relevant
• Offer assistance if it appears necessary, but
respect the person's wishes if they don't accept
your offer
• Avoid saying anything that implies the person
with disability is superhuman, courageous or
special
• Relax—everyone makes mistakes; apologise if
you believe you have embarrassed someone.

17. • FC 4.5.7 [Lifelong learner]- An understanding
of accessible healthcare setting for patients
with disabilities, including Universal design.

18. • Healthcare Accessibility Standards framed by
Govt. of India on recommendation of
committee by CPWD, Min. of Urban
Development and CCPD, Department of
Disability Affairs, Ministry of Social Justice and
Empowerment.

24. Roles..
• FC 4.5.6 [Professional]-Should have non-
discriminatory behavior towards patients or
caregivers with disabilities.

25. It’s vital to remember that not all disabilities
are visible, so the first step to having a positive
attitude towards disability is not to judge.
In order to advance our communities and
society as a whole, we must all have a more
accepting outlook towards one another,
especially when it comes to disability.

26. Of course, disability is not only physical and
visible. A disability can also affect someone’s
mental capacity.
Displaying empathy, patience and positivity
towards disability of any form promotes
inclusion and openness for the affected
individual.

27. FC 4.5.8 [Leader]- Advocate social inclusion by
raising awareness of the human rights of
persons with disabilities.

28. Defined as including individuals with
disabilities in everyday activities and ensuring
they have access to resources and
opportunities in ways that are similar to their
non-disabled peers.
It involves designing buildings, products, or
environments in a way that
secures accessibility and usability to the
greatest extent possible.

29. CULTURAL COMPETENCE

30. What is cultural competence?
The integration and transformation of
knowledge about individuals and groups
of people into specific standards,
policies, practices, and attitudes used in
appropriate cultural settings to increase
the quality of services,
thereby producing better outcomes.
National Technical Assistance Center for State Mental Health Planning

31. The ability to think, feel, and act in ways that
acknowledge, respect, and build upon ethnic,
socio-cultural, and linguistic diversity
The awareness, knowledge, and skills needed
to work with others who are culturally
different from self in meaningful, relevant,
and productive ways.

32. This is relevant for the medical students as they
are joining MBBS in medical colleges
throughout all states in India and students
from outside India are also joining medical
colleges in India. Therefore, the cross cultural
component will help students a lot as the
cultural diversity is unique and vast in the
country.

33. Foundation Course- 4.6
Understanding and respect of cultural diversities
and interact with those with different cultural
values

34. With cultural competence…
One can be able to gain a broadening of
perspective that acknowledges the simultaneous
existence of differing realities that requires
neither comparison nor judgment.
One can be aware of likely areas of potential
cross‐cultural-miscommunication,
misinterpretation, and misjudgment; anticipate
their occurrence (knowing what can go wrong);
and have the skills to set them right.

35. Pedersen’s Developmental Model
 Awareness – consciousness of one’s own attitudes and
biases as well as the sociopolitical issues that confront
culturally different youngsters.
 Knowledge – accumulation of factual information about
different cultural groups.
 Skills – integration of awareness competencies to positively
impact children from culturally distinct groups.
 Attitude – belief that differences are valuable and change is
necessary and positive.
Each domain builds successively on the previous one such
that mastery of an earlier domain is necessary before
proceeding to subsequent domains.

36. Cultural Competence includes
Self-awareness
 Cultural understanding
 Multiple perspectives
 Intercultural communication
 Relationship building
 Flexibility/adaptability
 Intercultural facilitation/conflict resolution skills
 Multicultural organizational development skills

37. Cultural Competence
http://www.getceusnow.com/portal/file/crisis-intervention-ceus-bbs_clip_image001.jpg

38. CULTURAL COMPETENCE: UNDERSTANDING EACH
LEVEL

39. Cultural Destructiveness
• Cultural Destructiveness - The
dehumanization of specific cultures or
individuals signifying an underlying bias
toward the superiority of the dominant or
majority group.
• There is an intention to ignore issues
affecting minorities and promote policies and
standards that have an adverse impact on
them.

40. Cultural Incapacity
• The inability to work with diverse populations.
• There is not an intention to ignore issues or
promote policies and standards that have an
adverse impact on minorities; instead, their
practices are based on a lack of understanding
and ignorance.

41. Cultural Blindness
Approaches used by and for the majority are
perceived as relevant for all others. Practices are
adopted for "the greater good”, which is generally
the majority perspective.
This level is characterized by inability to examine
or even recognize existing biases in approaches to
practices, education, and research that
perpetuates the continued existence and
development of models that support stereotypes
of diverse populations and thus further promotes
prejudice.

42. Cultural Pre-Competence
Recognition of potential weaknesses and
biases within practices and a decision to take
action to address the problem.
Although this phase is a positive movement,
false "comfort" may set in after making only
minimal efforts to be responsive to diverse
populations. The efforts may only be
peripheral and not sufficient to truly address
cultural issues.

43. Cultural Competence
A demonstrated commitment to diverse
populations in all aspects of the structure and
functions of the organization.
The commitment is characterized by a
sustained, systematic integration and
evaluation at all levels of significant
collaboration from diverse populations into
the infrastructure of the organization.

44. Cultural Proficiency
Is demonstrated by the centrality of an
organization's commitment to diversity and by
its external expertise, leadership, and
proactive advocacy in promoting appropriate
care for diverse populations.

45. The Cultural Competency Continuum
• Progress along the cultural competency continuum
requires a continual assessment of an organization's
/one’s ability to address diversity, celebrating
successes, learning from mistakes, and identifying
opportunities for rediscovery.
• An important point to remember is that actions taken
at one point in time may not be sufficient to address
diversity issues at another point in time. Today's
changing environment demands that efforts to move
toward cultural proficiency are more than the "right"
and "good" thing to do - they are the essential
component of effective service/care.

46. Collectivism/Individualism
Individualism refers to the attitude of valuing
the self as a separate individual with
responsibility for one’s own destiny or actions
(e.g., taking care of own one’s needs over the
group’s, self-interest is an appropriate goal).
Collectivism emphasizes common interests,
conformity, cooperation and interdependence
(e.g., taking care of the group’s needs over one’s
individual needs).

47. Defining Cultural Quotient (CQ)
• It is one’s ability to function effectively in a
variety of cultural contexts.
• In addition to understanding different
cultures, it focuses on problem solving and
effective adaptations for various cultural
settings.
• It is an overall capability you can take with you
anywhere.

48. CQ Knowledge
• The extent to which you understand the role
of culture in how people think and behave and
your level of familiarity with how cultures are
similar and different.

49. Why CQ?
 There is widespread globalization― People of different
cultures today live together everywhere in the world.
 There are more opportunities to interact with foreigners
in many aspects (e.g., domestically, business, and work).
 One would need to know the customs of other cultures,
especially the taboos or risk offending people.
 People with higher CQ would be able to interact with
people from other cultures easily and more effectively.

50. THANK YOU