Category Archives: poverty

BADD: Why I Write

(This was originally posted as a BADD contribution at my tumblr.)

I spend a lot of time blogging about and against ableism, about being a person with a mental illness, about the way policies and cultural attitudes and assumptions act to disadvantage people with disabilities. But for some reason, I was having a lot of trouble coming up with a topic for[BADD] . I got some good suggestions – issues of ableist language (and I’ve written in the past about the words ‘retarded’ and ‘hysterical’ and their ableist roots and effects), issues about the enormous intersection between poverty and disability (poverty leads to bad health outcomes and disability often leads to poverty, making a self-reinforcing cycle), and disability tropes in pop culture (I don’t watch family guy but have talked about 90210!).

I thought of some other topics I could address – why I see today’s immigration protests and related activism as a disability-related issues and the importance of intersectionality issues in meaningful social justice work, or even an info piece on how PWDs should take steps to prepare for emergencies such as natural disasters. but I didn’t feel excited about any of those.

So I’m going to go back to the beginning, and talk a little about why I identify as a person with a disability, why I talk about disability issues, why I’m a contributor to a blog about feminist and disabilities, why I spend so much time and emotional energy on these topics. (Which are, frankly, often personally distressing, what with all the info about how I’m going to die poor and alone.)

I write because I want things to change. I’m not always sure the writing helps me individually – it is hard to focus on these issues, to perpetually remind myself of the limitations caused by my disabilities, of the societal attitudes that assume that I am lazy and worthless and dangerous to be around, of the innumerable policies and laws that reinforce and ensure the unequal status of PWDs. And while I see the value of creating a space where other PWDs can discuss their personal circumstances and struggle and receive support instead of judgment and blame, the internet is a big enough place that I think that role is being filled, well, by lots of blogs and LiveJournal/Dreamwidth communities.

I write because I want people – both PWDs and TABs – to recognize the larger cultural and political forces that create and maintain societies that use disability as a punchline, as an insult, as a reason to keep people unemployed, poor, disempowered, and sometimes leading directly to their deaths. I want PWDs in the US, Canada, UK, Australia, and other “first world” countries to understand that lobbying their governments to abandon use of land mines can directly affect the prevalence of disabilities in poorer countries like Cambodia (thanks to s.e. smith for that great post!). I want people to think about how recovery efforts in disaster-affected areas like Haiti need to include specific focus and attention on the unique and disproportionate needs of PWDs.

But for me, it’s not enough to just help people understand. I desperately want them to act. To get involved in the political process to advocate for the rights and needs of PWDs. To get involved in social justice issues as a whole, because issues affecting immigrants are going to fall heavy on immigrants with disabilities. To tease out how a national policy can and will affect PWDs in other, poorer, countries. To vote, to talk to their elected representatives, to encourage others to act.

I believe that change is possible. And I blog to facilitate, encourage, and promote that change.

Why SF’s Proposed Sit/Lie Laws Are a Terrible Idea

In San Francisco currently, there is something of a debate brewing about Mayor Newsom’s proposed sit/lie laws, which would make it illegal for anyone to sit or lie on any public curb or street in San Francisco (with a couple of exceptions).

The intersections with disability here are rather clear. For one thing, there are some intersections between homelessness and disability, because some homeless people are, for example, mentally ill or have disabling physical problems. Do either of these things make them unworthy of compassion, or not human? Of course not, but from the way this proposed ordinance is designed, it is, on a very basic level, criminalizing homelessness even more than it is already criminalized (not to mention socially stigmatized), while taking extra “common sense” steps to avoid citing non-homeless people for an offense. Observe the following response to concerns that SF police would begin to crack down on non-homeless people were the laws to go into effect:

During a heated, five-hour Board of Supervisors public safety committee hearing on the issue Monday, Adachi showed photographs of behavior that would be illegal under Newsom’s proposed law: a well-heeled tourist sitting on her luggage as she waits for a cab, a little boy sitting on a sidewalk clutching his skateboard, and tourists sitting on a curb and gazing up at the sights.

Assistant Police Chief Kevin Cashman said all of those people would be warned first to move and that none of them would probably receive a citation.

“Obviously common sense is going to be part of the training with enforcement of this statute,” he said at the hearing.

Ah, yes, “common sense.” Common sense, apparently, still makes the further stigmatization of homeless people de rigeur. Because apparently, they don’t deserve to sit down in public, unlike “well-heeled” tourists and neighborhood residents. I wonder what the response to a person with disabilities — tourist or not — needing to sit down on a public street might be? Someone waiting for an ambulance? While that is approaching a bit of a slippery slope argument (which I generally like to avoid), it is worth considering, simply because “common sense” will mean different things to different people — those whose job it is to enforce the statute included.

Also interesting is the framing of this ordinance in terms of concern for children. From one of the SF Gate articles:

Newsom, who bought a home in the Haight recently, was convinced to support an ordinance after walking along Haight Street with his infant daughter and seeing someone smoking crack and blocking the entrance of a business.

Certainly, children need to be protected from dangerous situations or potentially dangerous situations, but is an ordinance that criminalizes the poor and homeless — not all of whom are recreational drug users or addicts — really the way to do it?

Additionally, nowhere have I seen any plan to increase the number of homeless shelters or services for homeless people attached to this ordinance. The implicit message behind these proposed sit/lie laws seems clear: It’s too bad you’re homeless, but don’t you dare be homeless on our streets, because it might make our city look bad. Oh, and you certainly shouldn’t expect the city to help you not be homeless — even after it cites you for breaking the sit/lie law.

(Cross-posted to ham blog)

Happy Cesar Chavez Day!

Here in California, today is an official State holiday to celebrate the life and work of Cesar Chavez. Chavez worked to promote and enforce the civil rights of farm workers and, with Dolores Huerta, was cofounder of the United Farm Workers of America, or UFW – still one of the United States’ two major union umbrellas. While his work is usually viewed through the lens of organizing for Latinos, there is a significant disability component to his work.

Migrant farm workers are affected by a number of intersecting a complex factors which negatively affect their health and put them at risk of becoming permanently disabled through their work. They are likely to be exposed to harmful chemicals or dangerous work situations and because they often live on the farm under the control of the farm owner, they have little access to health care. This is all complicated by the immigration status – or lack of – of the workers. Here’s a brief overview of the occupational hazards, from the National Center for Farmworker Health:

The agriculture industry is one of the most dangerous occupations in the United States. While farmworkers face workplace hazards similar to those found in other industrial settings, such as working with heavy machinery and hard physical labor, they also face unique occupational hazards including pesticide exposure, skin disorders, infectious diseases, lung problems, hearing and vision disorders, and strained muscles and bones. Lack of access to quality medical care makes these risks even greater for the three million migrant and seasonal farmworkers who work in the fields every year.

In 2007, for every 100,000 agricultural workers in the U.S. there were 25.7 occupational deaths in agriculture. This compares to an average rate of 3.7 deaths for every 100,000 workers in all other industries during this same year. The Centers for Disease Control and Prevention label agriculture the most dangerous industry for young workers in the United States, accounting for 42 percent of all work-related fatalities of young workers between 1992 and 2000. Fifty percent of these victims were younger than 15 years old.

During their daily work, farmworkers are often exposed to pesticides. A 2002 study examined take-home organophosphorus pesticide exposure among agricultural workers and found pesticides in dust samples from 85% of farmworkers’ homes and 87% of farmworkers had pesticides in dust samples in their vehicles. In addition, 88% of farmworker children had organophosphate metabolites in their urine.

Infectious diseases among the farmworker population are caused by poor sanitation and crowded conditions at work and housing sites, including inadequate washing and drinking water. Farmworkers are six times more likely to develop tuberculosis when compared with other workers, and rates of positive TB results between 17% and 50% have been reported throughout the United States.

Because farm labor consists of constant bending, twisting, carrying heavy items, and repetitive motions during long work hours, farmworkers often experience musculoskeletal injuries. Furthermore, workers are often paid piece-rate, which provides an incentive to work at high speed and to skip recommended breaks. From 1999 to 2004, almost 20 percent of farmworkers reported musculoskeletal injuries.

Another complicating factor is the prevalence of child labor on these farms. It is obviously difficult to quantify this phenomenon, but worldwide, approximately 132 million kids between the ages of 5 and 14 work in agriculture. In the United States, somewhere between 300,000 and 800,000 children do agricultural work, sometimes working 12 or even 14 hour days. Environmental pollutants like pesticides have greater effects on children and their growing bodies are often at greater risk of harm from musculoskeletal and other injuries.

The punishing nature of this work is well known and acknowledged by government agencies. The Social Security Administration, which provides cash benefits and medical coverage to individuals it determines are “permanently disabled,” has a special category for “the worn-out worker.” This is a provision specifically for someone with less than a 6th grade education who, after 35+ years of arduous manual labor, can no longer return to that previous employment. The most common example of someone who fits this category is a migrant farm worker – someone who worked in orange orchards, climbing ladders, carrying heavy boxes of fruit, whose body has simply broken down and can no longer sustain that arduous labor.

There are three million workers currently in the fields, including a significant number of children, for whom this is the expected outcome – if they manage to sustain their labor for thirty five years. Cesar Chavez fought for those people and fought to protect them from outcomes and conditions that were, in his time, even worse and more damaging than what I’ve described above. We now must continue his fight.

Si Se Puede!

Mental Health Care in Post-Quake Haiti

An excerpt from a New York Times article – click through for the whole piece.

Inside this city’s earthquake-cracked psychiatric hospital, a schizophrenic man lay naked on a concrete floor, caked in dust. Other patients, padlocked in tiny concrete cells, clutched the bars and howled for attention. Feces clotted the gutter outside a ward where urine pooled under metal cots without mattresses.

Walking through the dilapidated public hospital, Dr. Franklin Normil, the acting director, who has worked there for five months without pay, shook his head in despair.

“I want you to bear witness,” he told a reporter. “Clearly, mental health has never been a priority in this country. We have the desire and the ability, but they do not give us the means to be professional and humane.”

As disasters often do in poor countries, Haiti’s earthquake has exposed the extreme inadequacies of its mental health services just at the moment when they are most needed. Appalled by the Mars and Kline Psychiatric Center, the country’s only hospital for acute mental illness, foreign psychiatrists here have vowed to help the Haitian government create a mental health care system that is more than just an underfinanced institution in the capital city.

The Community First Choice Option

So it looks like here in the United States, after what seems like a full century of arguing and revising and protesting and name calling, our legislature may actually pass a health care reform bill today. This is far from an unqualified victory – the bill is a very mixed bag from a number of viewpoints, and PWDs have both reasons to be happy and reasons to be upset. In other words, there’s not one “right” way to look at the bill from a disability rights perspective and people can still be committed to disability advocacy whether they love or hate this bill. (You’ll notice I cagily haven’t taken a position on the overall bill.)

There is one aspect of it that is very exciting, though, and has been the result of strong advocacy from ADAPT and the National Council on Independent Living: the Community First Choice Option. The CFC Option would give states the option to request federal funding to provide in-home assistance and support to PWDs. The goal of these programs is to facilitate PWDs staying in a community-based setting – living independently, with a partner, family, or other arrangement – rather than moving to a full-time care institution such as a nursing home.

PWDs would be able to access a variety of types of assistance, as ADAPT describes:

Services under this option would include services to assist individuals with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related tasks through hands-on assistance, supervision, or cueing. ADLs include eating, toileting, grooming, dressing, bathing, and transferring. IADLs include meal planning and preparation; managing finances; shopping for food, clothing, and other essential items; performing essential household chores; communicating by phone and other media; and traveling around and participating in the community. Health-related tasks are defined as those tasks that can be delegated or assigned by licensed health-care professionals under state law to be performed by an attendant. Services also include assistance in learning the skills necessary for the individual to accomplish these tasks him/herself; back-up systems; and voluntary training on selection and management of attendants. Certain expenditures would be excluded, including room and board; services provided under IDEA and the Rehabilitation Act; assistive technology devices and services; durable medical equipment; and home modifications.

There is a similar program, In-Home Supportive Services (IHSS) currently existing in California that is based primarily on state funds that has proved a win for both PWDs and for state budgets. The benefits for PWDs are clear – they are allowed the dignity and independence of a community-based setting rather than needing to move to an institution for support. It has also benefited the state, however, because the average yearly cost per IHSS consumer is $10,000, compared to the $60,000-80,000 it would cost to institutionalize that person. Since Medicaid, the state and federally funded health insurance program for low-income folks, would bear the bulk of the cost of institutionalization, IHSS provides a significant cost savings. These are programs that do the right and moral thing by allowing a PWD to remain in the community while saving the state money at the same time – a win-win. For yet another win, family members of the PWD can sometimes be paid to serve as a caregiver, increasing income to the household to ameliorate the poverty disproportionately experienced by PWDs and their families.

Here are a couple of stories from IHSS consumers about how the program affects their lives:

Jill has had back surgery and 3 knee surgeries and is unable to stand for more than 20 minutes at a time. Her 11-year-old daughter has ADHD and needs to be watched at all times. The combination of dealing with knee and back pain, migraines one to three times a week and caring for her daughter Courtney leaves Jill unable to take care of certain household needs such as cooking and cleaning her home. Without IHSS services Child Protective Services might have placed her daughter Courtney in foster care.

Christie Ritter: On October 1st, 2002, I was stopped at a traffic light. It was my day off from being a respiratory care therapist in a hospital. I worked neonatal and pediatric specialty. I was sitting at the light, waiting for it to turn green, heard some screeching tires. Next thing you know, I have a car coming through my driver’s side door. Broke my neck and my lights went out. So when I woke up, found out my neck was broken and I’m a quadriplegic.
Ritter has some movement in her arms and legs, but she can’t grip or hold things and she can’t hold herself up well enough to walk. Ritter fought for in-home care. And with therapy and assistance, she holds down a full time job and lives in her own home.

There are problems even with this portion of the bill – the availability of the optional federal funding has been delayed a year, and individual states can still opt not to administer the program. It is, however, a good and positive step in the right direction.

Photos from Mental Health Institutions in Indonesia

The Big Picture, one of my very favorite photo blogs, in which the Boston Globe collects a set of stunning photos on a single topic or theme, recently had a series on Indonesia. Two of the photos especially caught my eye, as they depicted scenes from mental health institutions in the country.

In a room with vivid green walls and white tiled floor, a person is seen from the knees down is chained to a wooden pole with a metal link chain. The person is barefoot, wearing dingy jeans with a tear in the knee.

The leg of a patient is chained to a post at the Galuh foundation for people with mental health conditions on February 10, 2010 in Bekasi, Indonesia. Belief in black magic is commonplace in Indonesia, where there is much ignorance over mental health issues, with traditional healers instead consulted for apparent sufferers. 2007 figures suggested that 4.6% of the nation suffered from serious mental disorders in a country whose population now stands at around 230 million, with only around 700 psychiatrists across 48 psychiatric hospitals available to help treat those affected. (Ulet Ifansasti/Getty Images) #

A shirtless boy, thin with protruding ribs, turns his head to the side as he is sprayed with a water hose. Behind him are walls of broken concrete.
A shirtless boy, thin with protruding ribs, turns his head to the side as he is sprayed with a water hose. Behind him are walls of broken concrete.

A patient named Yoyo is bathed at the Galuh foundation for mental patients in East Bekasi near Jakarta on February 11, 2010 in Bekasi, Indonesia. With limited mental heatlth care available in Indonesia, sufferers usually turn to black magic and are taken to “dukuns” or healers who are believed to have magical powers. (Ulet Ifansasti/Getty Images) #

Black, Hispanic, Poor people wait longer for breast cancer treatment, experience more recurrences

In the USA, Black women have the highest mortality from breast cancer of any other group, despite the rate of diagnosis of breast cancer being highest in White women. Hispanic women have a lower breast cancer diagnosis incidence than either, but mortality rates are disproportionately high in Hispanic women also. Here are the CDC incidence and mortality statistics over time:

“Incidence rate” means how many women out of a given number get the disease each year. The graph below shows how many women out of 100,000 got breast cancer each year during the years 1975–2005. The year 2005 is the most recent year for which numbers have been reported. The breast cancer incidence rate is grouped by race and ethnicity.

For example, you can see that white women had the highest incidence rate for breast cancer. Black women had the second highest incidence of getting breast cancer, followed by American Indian/Alaska Native, Asian/Pacific Islander, and Hispanic women.

Breast ca incidence stats showing White women at highest risk

The graph below shows that in 2005, black women were more likely to die of breast cancer than any other group. White women had the second highest rate of deaths from breast cancer, followed by women who are American Indian/Alaska Native, Hispanic, and Asian/Pacific Islander.

Breast ca mortality stats showing Black women at greatest risk

A number of contributors to this disproportionate mortality have been proposed, including environmental toxin and pesticide exposure, more aggressive tumours, and later diagnosis. Most alarmingly, the mortality gap seems to be widening.

This week’s British Medical Journal (BMJ) has an important article today demonstrating one of the consequences of healthcare racism in the USA:

Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis[1]

The researchers analysed national cancer records for 18,050 US women, aged 65 or older and otherwise non-disabled, who were diagnosed with early stage breast cancer during an eleven year period to 2002, and who received breast conserving surgery and radiotherapy, but not chemotherapy.

30% of the women in this study had to wait more than six weeks after their surgery before they could have radiotherapy. Delays greater than six weeks were associated with a modest but significant increase in local recurrence of the breast cancer.

The study also showed that there was a continuous relationship between radiotherapy delays and local recurrence; the sooner radiotherapy was started, the lower the risk of cancer recurrence, and this relationship was strong. This is concordant with previous studies.

So who was subject to these long, risky delays in treatment?

Sadly, the answer will not surprise you: Black women, Hispanic women, and poor women. Black women were almost 50% more likely to experience a longer than six week gap before radiotherapy treatment, and Hispanic women experienced a 30% increase in risk of delay.

The followup was only five years long in this study, and breast cancer tends to be a cancer that bides its time; the increase in risk (and in consequence mortality) may be greater, even much greater, with longer followup. In addition, as local recurrence risk tends to more common in younger women and this study focused on older women, the effect could be more pronounced in the total population of those with breast cancer. In addition, the study studied mostly White women, as Black women tend to get their cancers younger and have a decreased likelihood of receiving breast-conserving surgery and radiotherapy. In other words, this study was set up in a way that made it, in some ways, particularly difficult to find a significant difference in the effect they were looking at; the fact that they still found one means that the effect is likely to be really quite pronounced.

The accompanying BMJ editorial by Ruth H Jack and Lars Holmberg[2] goes on to suggest one possible model of healthcare delivery that might alleviate these delays:

One good example of how practices can be improved is the Rapid Response Radiotherapy programme in Ontario. This programme has drastically shortened waiting times for patients having palliative radiotherapy by restructuring the referral process so that many patients are treated on the same day as their consultation.9 Countries where disconnected systems are responsible for different aspects of treatment will find it more difficult to ensure that diagnosis, referral, and treatment are not subject to delay.


[1] Impact of interval from breast conserving surgery to radiotherapy on local recurrence in older women with breast cancer: retrospective cohort analysis
Rinaa S Punglia, Akiko M Saito, Bridget A Neville, Craig C Earle, Jane C Weeks.
BMJ 2010;340:c845; Published 2 March 2010,

[2] Waiting times for radiotherapy after breast cancer
BMJ 2010;340:c1007
Published 2 March 2010,

Newsflash: Poverty is Bad for Your Health

A recent study from Columbia University found that of all the health factors they measured, poverty had the greatest negative impact on health. The other factors they looked at included smoking, obesity, lack of health insurance, and binge drinking, all of which had a less significant impact on health outcomes than living in poverty. Poverty, defined as living below 200% of the United Stated Federal Poverty Level, was determined to take away 8.2 years of health, meaning poor people have 8.2 fewer years in which they are healthy than someone above 200% of the FPL (This is a standard measure of health burden, used by the WHO.) We should also be explicit that when we talk about poverty we talk about race – over 50% of black and Latino young adults live in poverty, compared to less than 30% of white young adults.

To which I respond, well, YES, clearly. But you would never know these things from the way we talk about health. Think about how many public health programs are focused directly on the spectre of obesity. There’s PE programs and school activity policies, public education campaigns (usually involving TV ads) to tell people to spend less time watching TV, there’s calorie labeling requirements and scolding people to go to their farmer’s markets and taxes on soda or foods with trans fat. Some of those policies may have worth, but their goal of eliminating TEH FAT ZOMG and thereby solving the health crisis is clearly misdirected. Even worse are the articles and attitudes engendered by this focus on obesity as a health issue, like this recent article in the LA Times, because they imply that a systemic issue like the health care problem can be resolved by individuals changing their lifestyles, rather than by systemic change on a much broader level.

The effect of poverty on health has been clearly documented. People who live in poverty are more likely to have asthma and diabetes. They’re way more likely to be exposed to parasites like toxocariasis, cysticercosis, and toxoplasmosis, which can have significant physical and neurological effects including seizures and developmental delays. They’re five times more likely to be exposed to lead paint as children. They’re twice as likely to have untreated cavities, which can lead to heart disease or infection and even death. This all means that from the beginning, even from birth, people living in poverty are more likely to develop or acquire a disability or chronic health condition.

It would seem, then, that addressing poverty in order to prevent those negative health outcomes would be a public health priority. But it really isn’t – poverty programs are rarely described as health programs. When a politician starts talking about welfare, they’re talking about cash payments to help parents raise their kids, to preserve and support families. They don’t talk about how assisting a family out of poverty will make that whole family healthier, and less in need of health care. And addressing the negative health effects of poverty – safely removing all the lead paint, preventing slum housing conditions like cockroach infestations and mold that contribute to asthma, get them some access to dental care – would have an enormously beneficial effect on hundreds of thousands of individuals and on the health care system as a whole. However, addressing the systemic effects of poverty isn’t nearly as easy as shaming “the fatties” and slapping some calorie numbers on menus.

This is especially galling because there is so much overlap between the community of PWDs and people in poverty. A recent study found that almost half of working-age adults who experience poverty for at least a 12-month period have one or more disabilities. People with disabilities account for a larger share of those experiencing poverty than people in all other minority, ethnic and racial groups combined and are even a larger group than single parents. Families with more than one member with a disability are even more likely to be living in poverty. There are two things going on here. First, people who live in poverty are more likely to be or become PWDs, partly because of the health factors discussed above. But also,  PWDs are more likely to live in poverty, partly because of the cost of health care.

All of this suggests that our conversations about health care need to include ideas about addressing poverty and that our work on poverty issues has special effects on health and disability. Hurrah for intersectionality!

Disability in Rwanda

Nobody knows how many people with disabilities there are in the world. In doing some basic research, I saw estimates ranging from 300 to 600 million. This is partly a definitional issue – it’s hard to get people to agree what “disabled” means – but mostly is because nobody has ever tried to figure it out. What is clear is that most people with disabilities live in poverty. According to the UN, two-thirds of people with moderate to severe disabilities live below the poverty line. Only two percent of people with disabilities in developing countries have access to basic services.

Take, for example, Rwanda, where poverty is both a cause and an effect of disability. It’s a gorgeous country and home to the rare mountain gorillas. It also had a massive genocide in 1994 during which an estimated 800,000 people were killed – an eighth of the population. Currently, organizations estimate that about 300,000 of the 10 million residents have disabilities. Nearly ten percent of the disabled population has had one or more limbs removed – either hacked off by machete or destroyed by mines, bombs, and bullets during the genocide. The genocide also caused resources like food to be diverted and scarce, resulting in malnutrition, which in turn has caused disability. Despite all that, the genocide is not the major cause of disability in the country – poverty, disease, accidents, lack of medical care and congenital causes are more common.

It’s also one of the poorest countries in Africa. “In 2006, 56.9% of the total population were living below the poverty line and 37.9% were extremely poor. In rural areas about 64.7% of the population were living in poverty… 28% of the rural population was food-insecure and 24% was highly vulnerable to food insecurity.” Poverty is more likely in households headed by females (which are more common after many men were killed during the genocide) and especially in households headed by individuals with HIV/AIDS.

Unfortunately, attitudes towards people with disabilities in Rwanda are not positive. From a report on disability policy in Rwanda:

‘Social exclusion’ is not a concept that is widely used in Rwanda, but disabled people are both actively and passively excluded in Rwandan society. Rwandans do not value disabled people. Disabled people are seen as objects of charity. They are underestimated and overprotected, and their potential and abilities are not recognised. Disabled children are seen as a source of shame and often hidden away. Name-calling is common. Disabled women find it difficult to get married. Disabled people suffer discrimination in employment.
Disabled family members are sometimes passed over in matters of inheritance. Land and assets are given to others who are deemed to be able to make better use of them, thus leaving the disabled person dependant on family to support them and removing the opportunity for them to lead independent lives. Negative attitudes are particularly strong towards those with severe disabilities, people with intellectual and learning disabilities, blind and deaf people.

Another organization reports that “disabled people are commonly addressed by their disability rather than their real name.”

Rwanda is making significant economic progress since the genocide, with yearly economic growth twice as high as what’s usually expected for a developing nation. It is described by Fortune Magazine as “a business-friendly nation that wants to become a model of private sector development in Africa.” The United Nations awarded Kigali, the capitol city, “the Habitat Scroll of Honour Award for many innovations in building a model, modern city symbolized by zero tolerance for plastics, improved garbage collection and a substantial reduction in crime.”

But it’s unlikely that this economic development will benefit Rwandans with disabilities. The country’s first Economic Development and Poverty Reduction Strategy Plan “had no specific reference to disability or how to include people with disabilities in the process.” While there has been significant foreign investment in the country, that impacts only the urban corporate portion of Rwanda. When nine of every ten adults are subsistence farmers in rural areas, those incoming dollars are extremely unlikely to reach the hands of most of the country’s inhabitants. The countryside isn’t appealing to private investment, especially when there’s no health stability. Any job development programs in rural areas are run by NGOs operating on donations and the products they create ($85 silk-mohair knitted scarves for Whitney Port from MTV!) are marketed based on pity for Rwandans. Those are not sustainable jobs or industries and will not create long term employment for those in rural areas. The most viable avenue for rural economic development has been through microloans through organizations such as Kiva.

Even these limited opportunities for work are unlikely to be available to people with disabilities. PWDs are unlikely to be awarded microloans to run their own businesses and are rarely employed by the NGO projects. As one research report observed:

Disabled people are generally excluded from development activities. They are often extremely poor and are continually in ‘survival mode’, so they literally cannot contribute to development activities, either materially or in terms of their time. They are largely excluded from micro-credit programmes because they lack assets as collateral and are seen as a bad risk. Disabled informants for this study said that they were often not told about development activities in their communities in the first place and when they tried to get involved, they were deliberately excluded.

It’s clear that colonization and ongoing meddling from the Western world has done nothing but contribute to and exacerbate problems like the genocide, so the solution isn’t to charge in there and tell Rwanda what policies it should have and how to run things. They were colonized by Belgium until 1960, for goodness sake. So I can’t say I know what the solution is, and the only advocacy action I can think to take is to encourage/pressure NGOs to be inclusive of PWDs when designing and implementing development projects. There’s a number of disability organizations in Rwanda and I think we’ll have to rely on them to do this work. Some lists of the organizations can be found in this report and in a project report from Handicap International.