Monday, 21 June 2021 | Dr BKS Sanjay
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Dr BKS Sanjay
Disability is any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them. According to WHO, disability has many dimensions, such as impairment (loss of body part), limitation of activity (walking) and restrictions in participation (any kind of social restriction).Over one billion of the 7.8 billion world’s population- about 15 per cent have some form of disability. The National Sample Survey conducted by the Government of India from July to December 2018 showed that about 2.1 per cent of the total population is disabled in our country.
Being an orthopaedic surgeon, I will confine myself to orthopaedic disabilities which are defined as loss of motion in which there is disability of the bones, joints or muscles leading to substantial restriction of movement of the limbs.People with disabilities have the same health needs as physically fit people. Disability is thus, not just a health problem but rather a complex phenomenon, reflecting the interaction between disabled person and the society in which he or she lives.
Locomotor disability means problem in moving from one place to another, that is, disability in the legs.According to the 2011 census, 26.8 million population was disabled and 20.3 per cent had movement disability. I believe health of the limbs is as important as that of the health of the heart and the lungs. Whatever mankind has achieved so far is mainly due to locomotion, be it in war or in peace, on earth or beyond. Our ancient Indian scriptures state that, if there is birth, there is development, degeneration, disease and death. If we analyse the causes of disability, then all these stages of life are vulnerable to disabilities depending upon the age of the individual.
Polio, cerebral palsy (CP) and club foot in childhood are the main causes of disability in India. India is polio free since March 2014 that means there are no new cases of polio. But there are lakhs of old polio cases which are causing major social and other problems to the patients and the nation. The main cause of disability in polio is due to muscular paralysis which has to be corrected during surgery.Cerebral palsy is one disability which can be prevented with timely intervention of medical advice during the perinatal period.
The road traffic accidents have become an epidemic in our country, causing havoc and producing significant disability in the society. Almost five lakh people are encountering road traffic accidents in which more than a fourth are dying and at least a fourth are being disabled for their whole life in spite of the best available treatment in the current scenario in our country. Nowadays, these road traffic accidents are high energy injuries which are fatal and involve multiple bones and sometimes multiple organs. In such a scenario, it is very difficult in general to give functional results which match the pre-injury status.
The fracture of the shaft of the long bones are not as dangerous as the fracture of the joints because invariably they result in premature degenerative arthritis. The back bone is considered to be the benchmark of anything. If the back bone is injured then the body below that injury becomes paralysed.There has been a lot of progress in surgical tools, technology and techniques but even then, once the spinal cord is transected then there is no possibility of repair, regeneration and recovery.This usually leads to serious lifelong permanent disability. Lakhs of people suffering from paralysis of all four limbs (quadriplegic) or of both lower limbs (paraplegic) are living in a pathetic situation on the bed with no or limited mobility in our country. This problem is more accentuated with poor people, especially in remote areas.
Another common cause of disability is bacterial infection which is mostly preventable. Infection can occur at any age. The incidence of infection of bone and joint like septic arthritis or tubercular arthritis is getting reduced but the incidence of post operative infection in patients with fractures after road traffic accidents is increasing proportionately in spite of taking all precautions before and after surgery including generous use of antibiotics. The management of open fracture is a challenging problem. These fractures may get complicated after surgery resulting in early infection, mal union or non-union. People in general in our country are underestimating the consequences of infection. The bone infection is such a deep seated infection that it takes years to control. If it is not controlled in time then these non-healing discharging sinuses can also have cancerous transformation in select group of patients which is usually treated with amputation.
The incidence of amputation has significantly reduced and is nearly negligible in road traffic accident related amputations.But the numbers of amputations in diabetic foot, Buerger’s disease, atherosclerosis (narrowing of arteries) and other peripheral vascular disease have increased tremendously in recent times. This can be avoided if we become health conscious because most of these diseases are a result of a sedentary lifestyle. The awareness about late stage complications of obesity, diabetes, hypertension, hypercholesterolemia, smoking and alcohol abuse too should be spread among the general public.
Anything which causes irreparable damage to bone, muscle, nerve, artery, even skin can lead to amputation which can give rise to serious disability. Impact of disability depends upon the age of the individual for example if the child is affected or disabled then his educational development will suffer while if an adult is affected then his employment is affected and if older people are affected then they usually suffer from social and mental problems.
Any disability, not only results in physical loss but mental, financial and social loss as well. Disability caused due to deformity can be reduced significantly with exercise, manipulation and orthosis and/or after undergoing various surgeries. I strongly believe that surgery has played an important role in the lives of persons with disabilities. Only an hour long, well done surgery in these disabled people has changed their lives significantly and they are not only developing or improving themselves but also contributing to the growth of society and nation.
The impact of disability increases proportionately with the time laps of correction. Governments, non-governmental organisations and society should strive to prevent disability of any kind and if it happens then it should be treated as early as possible. Therefore, like government and non-governmental organisations, me and my organisation are also doing our bit to spread awareness by organising free health camps, public awareness lectures and by writing such articles to reduce the disabilities and to make disabled people able through prompt surgical interventions. The deformities and disabilities caused due to any reason whatsoever should be corrected at the earliest. Hence, this author always advises the patient with deformity and the patient’s family members that if surgery is needed, then, it should be done at the earliest as a plant can be straightened, but not a fully grown tree.
(A Padma Shri recipient, the author is an orthopaedic surgeon & member of HNB Uttarakhand Medical Education University executive council. Views expressed are personal)
