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It is indeed heartbreaking for parents when they find out that their child is intellectually disabled. The initial reactions are of denial, despondence, anger, frustration etc. But what we fail to realise that they are the special creations of the universe. We hardly try to recognise their potential and talent and very often fail to judge their value as a human being. One such special girl once told me, ‘You need to take time to get us know; we are all different’. This is it — they are all different and special ones.
   ‘Intellectual disability’ — the term is synonymous with ‘learning disability’, mental sub-normality, mental handicap and mental retardation though the last three terms have derogatory connotation. International Classification of Diseases of World Health Organisation (ICD-10) and Diagnostic and Statistical Manual Of Mental Disorders (DSM-IV) of American Psychiatric Association (APA) still use the term mental retardation for scientific nomenclature, hopefully which would be changed very soon.
   Intellectual disability is a condition, in which there is delay or deficiency in all aspects of development, i.e., there is global and significant deficiency in development of motor, cognitive, social and language function. This is the commonest form of developmental disability which manifests at early childhood, usually before the age of 18 years and it is a lifelong condition. It is usually ascertained by Intelligence Quotient (IQ) assessment and assessment of adaptive functioning and behaviour in respect of areas such as, communication, self care, home living, social or interpersonal skills, use of community resources, self direction, functional academic skills, work, leisure, health and safety. It is a condition of antiquity. Description of this condition can be found in the ancient medical literature and fiction like Kashyapa Samhita and Ayurvedic treatise and even in Holy Quran. In the South Asian region it is referred to different names such as ‘buddhyi protibondhi’ in our country, ‘manda buddhyi’ in India and ‘manda manasika’ in Sri Lanka.
   This is a global and national public health problem. The lifetime prevalence of intellectual disability in any age is 1-3 per cent globally. National Survey on Mental Health in Bangladesh among adult population revealed that prevalence of mental retardation was 0.1 per cent though no national figure is available regarding prevalence rate among children. From different sample survey it was estimated that the prevalence rate among children in Bangladesh was around two per cent (WHO 2001), which was nearer to the South East Asian Regional figure. According to the severity of the conditions, it varies from mild and moderate to severe and profound categories.
   Intellectual disability is a condition of mutli-factorial origin. Combination of genetic and environmental factors like specific genetic syndromes (Down Syndrome, Fragile-X-Syndrome etc.), lower socio-economic class, malnutrition, poor living conditions are important risk factors. Besides, birth complications like perinatal birth injury and postnatal hypothyroidism, infection, trauma and toxicity are the factors which are very pertinent to the socio-cultural context in Bangladesh.
   Children with intellectual disability face a lot of familial and social discrimination, neglect and humiliation in our country. The parents and family members are ashamed of them and try to hide them from other family members and social gatherings. Very often they are placed in an inhuman condition, lack proper nutrition and denied the basic demands of life. Often they are physically, mentally and verbally abused — at home as well as outside. The discriminations towards them are immense especially towards the female children. The mothers of such children are blamed and harassed by family members for giving birth to children like them. Occasionally, female children are sexually abused by their relatives or strangers.
   Parents of intellectually disabled children are almost ostracised in our society. They even face difficulty in finding a house for rent! There is government quota for admission of the intellectually disabled children in the mainstream schools. But they are deprived of that opportunity in the face of opposition from the school committee and from other guardians. The problem lies behind our attitude towards them. We, the so-called normal and educated people have such meanness and incapacity to overcome this attitude of injustice and inequality to them.
   United Nations Declaration on The Rights of the Disabled Persons (UN 1975) stated that ‘Disabled people whatever the origin, nature and seriousness of their handicaps and disabilities, have same fundamental rights as their fellow citizens of the same age, which implies first and foremost right to enjoy a decent life, as normal and full as possible’. We are far away from creating justice and equality for disabled persons even after three to four decades of passing the UN resolution. We have to realise that children with intellectual disability have every right to live a life with full potentials and opportunities with dignity and justice. For that, we need to show empathetic and helping attitude towards them.
   Most of the children with intellectual disability have multi-dimensional physical, mental and behavioural problems. Recent evidences have suggested that they are three to four times more risk prone to develop child psychiatric disorders. Among them extreme form of restlessness is called Attention Deficit Hyperactivity Disorders (ADHD), violent and aggressive behaviour, emotional disorder, psychotic disorder, eating disorder, sleep disorder, adjustment problem are common. Besides, self injurious behaviour and inappropriate sexual behaviour sometimes become very difficult to manage. Sensory and motor disabilities (stereotypes, mannerism etc.), incontinence of bowel and bladder are the most common physical problem of children with intellectual disability. Sensory disorders add an additional obstacle to normal cognitive development. A significant proportion (25-50 per cent) of them has co-morbid epilepsy. The organisations and persons, those who are working for the children with intellectual disability, they have to address these issues very carefully.
   Physical and psychiatric assessments are the integral parts of management issue for children with intellectual disability. There must be a comprehensive assessment in collaboration with psychiatrists, paediatricians, clinical psychologists and paediatric neurologists. It is regrettable that there is no universal IQ assessment instrument available in our country. Most of the IQ scales from Europe and America are translated into Bangla and then used here. Those who urged that their scale is validated and standardised, they have done it among 200-300 or more intellectually disabled children in Dhaka city which is not at all the representative sample of such population of our country. For this reason, the government has to take initiative from respected ministries (education ministry, ministry of health and family welfare and social welfare ministry etc.) to develop a universal IQ assessment tool so that everybody could use that uniform instrument. The issue is very sensitive and specific from scientific point of view.
   Early detection and interventions are vital to prevent intellectual disability among children and to enhance maximum functional outcome. In Western countries, some physical screening and blood sampling for preventable conditions (thyroid function tests, Kariotyping etc.) are done to detect the risk. Then measures are taken accordingly. It is established from national and international studies that, birth complications like antenatal, perinatal and postnatal birth injuries are important risk factors for developing intellectual disability among children in our country. So, incorporation of these services should be done to our Reproductive Healthcare Package, Maternal and Child Health Care (MCH) and Emergency Obstetric Care (EOC) services.
   The care of intellectually disabled children starts from within his or her home. They need comfortable family environment neither under stimulating nor over-stimulating with love and affection. Parents and guardians have to understand the issue thoroughly and may require training programme and to know how to rear and handle their children. They have to learn about the ABC (A= Antecedent, B=Behaviour, C=Consequences) of the Functional Analysis of Behaviour of their children and applications of Behaviour Modifications Techniques for managing and controlling undesired behaviour. The Basic Life Skill Training is to be applied so that they can achieve the skill such as eating, dressing, bathing, toilet training and other personal care gradually. The children with intellectual disability should be provided with different educational, vocational, social and cultural and other group activities so that they could learn the social, educational and cognitive skills. The parents have to keep one thing in their mind, they don’t have to sacrifice their personal life, career, leisure and social life. If they do not lead their near normal life they would be burned out very soon and no energy would be left for giving efforts to their special kid. All the family members should share the responsibilities rather than overburden one especially the mother. It will promote a congenial environment for the children within the family and enhance family bondage.
   The concerted efforts of persons concerned such as psychiatrists, psychologists, paediatricians, occupational therapists, social workers, speech therapist, physiotherapists, counsellors, volunteers, policymakers and other persons working in government and NGO level are needed for the best interest of the children with intellectual disability. Collaboration is the key to success.
   The initiatives taken by the present government for the welfare of the disabled persons are praiseworthy. Recently, the honourable social welfare minister Enamul Huq Mostafa Shaheed declared that disabled person will be provided with special identity card and would be regarded as Golden Citizen of our country. The card holder will get special concession from different government services such as transport, medical service and other services cost. In the 5th National Convention on Disability, the prime minister declared that her government will enact law for the protection of rights of the person with disability so that they could contribute to social and economic development as a competent citizen, and could get the opportunity to involve themselves in the mainstream developmental activities. This will certainly encourage the children and guardians of the intellectually disabled children. Besides, provision of educational scholarship, preservation of quota in government services including civil services will give tremendous hope and aspiration among them.
   We have to work together to build up a better future for the children with intellectual disability so that they can lead a socially and economically productive life with dignity and justice in our society.
   Reference: World Health Organization. Mental Retardation. Regional Office of the South-East Asia Region.2001. WHO, New Delhi, India.
   The writer is a mental health physician, department of psychiatry, Dhaka Medical College Hospital

Without a doubt the end of the war has brought great relief to the general population who do not have to fear bomb attacks in public places and to read and listen to media reports of dozens of casualties on a daily basis. Even Tamil people on whose behalf the LTTE lay claim to be the sole representative, and on whose behalf they sought to fight, are relieved at the enhancement of their personal security. When I was in Jaffna a month ago many people told me that they feel a lot safer now that the period of killings, abductions and forcible conscription is ended, despite the daily difficulties that Tamils are vulnerable to at military checkpoints.
   Even in Colombo, where a spate of extrajudicial killings and abductions once took place, the feeling is one of greater security of life. There is also a popular feeling that the end of the LTTE has brought about peace, and what needs to be done is to repair the damage done by the war, which would include resettling the internally displaced persons as a first priority. The government is itself acting as if there is no ethnic conflict anymore, with President Mahinda Rajapaksa’s assertion that there will be no more minorities taken by many of his admirers as the height of statesmanship.
   There is also a strong argument put forward by Sinhalese nationalist parties that control over the north and east taken back from the LTTE by dint of military sacrifice ought not to be yielded by the government ever again. This is seemingly deterring the major political parties from even raising the issue of an ongoing ethnic problem in the current pre-election period. With decisive elections around the corner, the issue that has surged to the political centre stage is that of the executive presidency, its merits and demerits. The opposition has begun focusing on its abolition as the best part of the solution to the country’s many ills.
   There is also pragmatic thinking behind the decision to focus on the issue of the abolition or reform of the institution of the executive presidency. This is the fact that it can enable the two largest opposition parties, the UNP and JVP, to work together despite their fundamental differences on other key issues, such as the economy and attitude towards ethnic minorities. Much of the efforts of these two parties have been to try and identify a common presidential candidate who can rival the incumbent president in charisma and nationalism that will make a powerful appeal to the majority Sinhalese electorate.
   
   Non issue
   Unfortunately, the imminent general and presidential elections coupled with the comprehensive military defeat of the LTTE have effectively put the discussions about a political solution to the ethnic conflict on hold. The vexed issue of the devolution of power as a solution to the ethnic conflict that has existed for over half a century seems to have receded from the centre stage of politics as never before. The current political debate indicates a belief that the defeat of the LTTE, which had controlled large chunks of the north and east, has relegated the devolution of power to that of a non-issue.
   On the other hand, the defeat of the LTTE and the end of the war has not ended the problems that are special to Tamils, and which Tamils feel they are powerless to address. This includes their distress at the way that the internally displaced people of the Vanni have been detained, and are now being released with barely any support for them to get resettled. It is unconscionable that people who have lost all their property, and been effectively incarcerated for over half a year should be released, as they are, with the government only providing for a Rs 25,000 resettlement allowance at the outset. This miniscule amount of money is not going to help them rebuild their shattered lives after the ravages of war.
   Indeed, the Tamil sense of being disempowered, disregarded and unfairly treated goes much deeper than their anxiety at being specially targeted during the government’s post-war security operations. The bottom line is that if there had been an effective Tamil-controlled administration in the north and east, which is what the devolution of power is meant to obtain, displaced Tamils would not be resettled in the way that is being done today. Therefore the effective devolution of power to the provinces, particularly to the north and east, remains an article of faith in the Tamil consciousness. This became apparent to me when a civic organisation of which I am a member conducted a public forum on the issue of non-devolutionary constitutional reforms.
   The idea behind the forum was a reasonable and legitimate one, as I saw it. Any political solution if it is to be lasting will need to be composed of both the devolution of power to some degree, as well as some non-devolution based reforms, such as a more comprehensive set of legally protected human rights, equal status to Tamil language, provincial representation at the centre, economic development that benefits the regions and so on. The idea behind the public forum was to bring together a range of speakers from different political backgrounds to discuss at least one aspect of the political solution to the ethnic conflict at a time when such discussion appears to have died out.
   
   Minority concerns
   At the forum on non-devolutionary constitutional reforms there were sharply contrasting views expressed by the Sinhalese speakers and by the Tamil and Muslim ones. The Sinhalese speakers took an essentially positive approach, on the basis that constitutional reform needed to go beyond resolving the ethnic conflict. Multicultural and pluralistic principles are inherently important in guaranteeing the rights of the citizen of the state, both as ethnic minorities and as individual citizens. The reforms suggested included the abolition or reform of the executive presidency, which has become perverted into an instrument of over-centralisation of power.
   Other reforms proposed included the implementation of the 17th Amendment to the constitution which seeks the de-politicisation of public institutions, not least the elections commissions to prepare for the forthcoming general and presidential elections. If this key constitutional amendment had been functional, Sri Lanka might have had a police force that was more independent of the political authorities who seek to misuse it for their own purposes. This has ramifications for democracy in the country. The election commissioner himself has publicly stated that unless his instructions are followed by agencies such as the police, he is helpless when conducting elections.
   Despite their good intentions, the organisers of the public forum on non-devolutionary constitutional reform misread the present mindset of the ethnic minorities. The Tamil and Muslim speakers, as well as members of the audience, expressed their strong displeasure that the issue of the devolution of powers was not being considered at the forum. They seemed to have an apprehension that the discussion of non-devolutionary constitutional reforms signified a tacit abandonment of the concept of devolution of powers. This is in fact the reality at the present time, with the two largest political parties dodging the issue now that elections are round the corner. Indeed, the Tamil and Muslim participants at the discussion were so negative about non-devolutionary constitutional reforms that they did not make a single constructive suggestion with regards to them.
   The outcome of the public forum on non-devolutionary constitutional reforms clearly indicates that the devolution of powers is crucial to the sense of political justice of the Tamil and Muslim ethnic minorities. Therefore it will have to be at the centre of efforts at conflict resolution and inter-ethnic reconciliation if ethnic minority support is to be forthcoming. Proposals for non-devolutionary constitutional reforms can at best be only a supplement to the devolution of powers, if the support and consensus of the ethnic minorities is to be obtained. With general and presidential elections on the horizon, political parties that seek the votes of the ethnic minorities will need to address their aspiration that the devolution of powers to the provinces will soon become a reality.

Population growth and
women’s education

The higher is the rate of women education the lower is the rate of population growth and vice versa. This should be a part of the development strategy of the government.
   Less health education, high fertility rate, population boom, and poverty are pertinent issues knotted with each other.
   2. Education, particularly female education, can create awareness about child health, child education, and economic development lessening poverty and birth rate.
   3. Female education is more effective than distribution of contraceptives toward controlling population boom, increasing economic growth, overall development, and eliminating poverty.
   Sonia
   Dhaka

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