Living with disability

10 World Health • 48th Yem, No. 5, September-October 1995 living with disability Volker Krause The writer, who has impairments of a// limbs, describes how a person with the same impairment may encounter handicap in one country but be independent, mobile, self-sufficient, integrated and free in another. Because of a congenital skeletal impairment of my limbs, I wear two lower leg prostheses and am limited in my handling abilities. Over the years I have been able to compensate for my upper limb impairments by using my elbows and occasionally my mouth. My level of functional mobility depends on the use of lower leg prostheses. However, the level of handicap encountered depends on the society in which one lives. The International Classification of Impairments, Disabilities and Handicaps (ICIDH) (see box on page 4) devised its codes as a tool for measuring the effectiveness of policies for people with disabilities; but they also serve to assess cross- national differences. Up to the age of 21 I lived in Germany. I left that country six years ago for the United States. Handicaps of several kinds were an everyday experience in Germany, and only after my arrival in the USA did those handicaps largely disap- pear. Ramps, elevators, accessible public transport and adapted public facilities are mostly absent in Germany but fairly widespread in the United States where, further- more, I was not barred from taking driving lessons and driving a car. I still remember my driving instructor in Mississippi saying, "Show me In spite of having two artificial legs, Vofker Krause was encouraged to drive in the USA that you can do it." I had never previously been allowed the chance of showing that I could do it. Experts in my native country, who did not have any disabilities, declared that I could on ly drive a car that was specifically equipped for my needs. Their ruling that special equipment would have to be in- stalled at a cost of US$18-20 000 put an end to my hopes of acquiring a driving licence there. In fact their report itself cost more than all the driving lessons I subsequently took in the United States. For almost six years now, I have been driving a regular car with automatic transmis- sion but no extra equipment. The rush-hour traffic in Chicago, Detroit and Washington D.C. has given me no problems. A matter of legislation These experiences suggest that eliminating handicaps in the areas of jobs, social integration and economic self-sufficiency is largely a matter of disability legislation, political culture and social attitudes towards people with difficulties. These vary widely from country to country. In the USA, fundamental pieces of legislation such as the Americans with Disabilities Act (ADA) provide disabled people with legal recourse against discrimina- tion , while public attitudes tend to emphasize accessibility and integra- tion rather than segregation and confinement in isolated rehabilita- tion centres. In most countries there is no legislation equivalent to the ADA, and indeed some institutions may even side with those who discrimi- nate against people with disabilities. In 1993, in the north German town of Flensburg, for example, a court supported the claim of a vacationing couple that their holiday had been spoilt by the presence of disabled people in their hotel. The political culture tends to emphasize segrega- tion rather than encouraging inde- pendence and integration into society. My experience shows that a person with an impairment may encounter handicap in one country but may be helped to be mobile and self-sufficient in another. • Mr Volker Krause is o doctoral candidate in political science. His address is Department of Political Science, University of Michigan , 560 I Haven Hall, Ann Arbor, M/ 48 I 09- 1045, USA