As with all cultures around the world, the ways and means of managing people and their disabilities has a varied and colourful history. In Bhutan, the provision of services specific to people who have a disability has been dependent upon the caring of members of the family, and extended family, based on a belief in Karma, which enables family members and the community to look at people with disability with compassion and concern. The support provided by families has been of immense benefit to people who have a disability, notwithstanding the sometimes use of ineffective support activities, such as the use of traditional medicines and ‘lay doctors’ prescribing cures.
The supportive Buddhist culture has also allowed for the maintenance of people with a disability within their culture and community. In many countries, with the growth of large urban populations, it has been necessary to provide services specifically for people with a disability as families became less able to provide the care themselves. The industrialisation of communities has often forced parents to seek paid employment, to leave the family home, thus creating situations where caring for people with a disability became a ‘burden’. In the hustle and bustle of urban life more and more people with a disability became segregated and in many western countries the people with disabilities who needed most care were placed in large institutions [institutionalised] and effectively excluded from their families and society in general. This ‘westernisation’ history has not established itself fully in the Bhutanese way of life and so the provision of services for people who have a disability has only recently become a ‘national’ issue for deliberation and planning at a governmental level.
Within Bhutan there is lack of clear data regarding incidence of disability and a clarity about the definition. The general opinion is that the persons with disability are the responsibility of the society and their needs should be taken care of by the society.
The Royal Government of Bhutan provides health, prevention, medical rehabilitation and social services free of cost to all the citizens. Childhood care practices have always existed in the cultural context and institutionalisation of care is a new concept in Bhutan. The needs of education of children with disabilities have been met through institutional care in two residential National Institutions for the hearing and visually impaired, but the current focus of the government is to provide inclusive education and promote the learning of all children together in ordinary schools.
Non-formal education policy provides all Bhutanese citizens with community-based opportunities to become literate but these are being used by the disabled children and adults in almost an ad-hoc manner. There is a lack of strong advocacy for education of children with disabilities, particularly when physical and geographical barriers affect accessibility and services available for the education of children with disabilities are an unmet need.