Chapter 16
Exercises for further thought and research[15-1] Find out about injuries common among children in Cambodia, and discuss what to do to preventthem.

Disability and special education needs[15-2] Assuming an injury that is likely to happen to children, such as an abrasion or cut, discuss possible
ways to teach children how to treat it.
[15-3] Concerning first aid procedures that are actually performed in daily life, discuss what kinds ofLearning objectives

scientific evidence form a basis for the procedures, and whether there is anything that can be done

You will be able to gain a proper understanding and explain:

to improve on them.

- The deﬁnition of disease, impairment, disability, and handicap using speciﬁc examples.

[15-4] Look back on experiences of your own or someone close to you of injuries or illnesses in the past,and reflect on what care was given, what action was taken in response, and what you/they were
and were not able to do. Discuss what issues Cambodia has.

- The medical model of disability, the social model of disability, and the integrated model ofdisability (International Classiﬁcation of Functioning, Disability and Health: ICF).
- Challenges in education of children with disabilities in Cambodia.
This chapter ﬁrst provides basic knowledge necessary to understand disease, impairment, disability, andhandicap. Secondly, we explain the medical model of disability, the social model of disability, and theInternational Classiﬁcation of Functioning, Disability and Health (ICF) as an integrated model ofdisability. Finally, we describe the present situation of special education needs for children withdisabilities in Cambodia.
Note that in this chapter health is mainly treated as a factor of disability; that is, in terms of healthconditions such as disease or injury. This differs from the broad meaning ascribed to health in theprevious chapter (e.g. Chapter 1).

1. Aspects of disease, impairment, disability, andhandicap
1) Disease
References

Disease results from abnormalities in all or part of the physiological state of living creatures. Someone

1

The International Federation of Red Cross and Red Crescent Societies. International first aid and resuscitation guidelines 2016.

suffering from a disease is incapable of fulﬁlling normal functions, and generally experiences various

https://www.ifrc.org/Global/Publications/Health/First-Aid-2016-Guidelines_EN.pdf
2

Jain S, Iverson LM. Glasgow Coma Scale. https://www.ncbi.nlm.nih.gov/books/NBK513298/

types of pain. However, some diseases such as diabetes produce no sense of pain before growing severe.

3

Foundation for Ambulance Service Development: Report of the committee for the criteria for determining levels of severity andurgency during an emergency medical evacuation. 2004. https://www.mhlw.go.jp/shingi/2009/08/dl/s0825-6c.pdf

4WHO. Hypertension. https://www.who.int/news-room/fact-sheets/detail/hypertension

5

Pasteur Institute in Cambodia. Rabies Prevention Centers – Pasteur Institute in Cambodia (pasteur-kh.org). https://www.pasteur-kh.
org/rabies-prevention-centers/

6WHO. The benefits and risks of self-medication. WHO Drug Information. 14:1-2. 2000. https://apps.who.int/iris/bitstream/
handle/10665/57617/WDI_2000_14_n1_p1-2_eng.pdf?sequence=1&isAllowed=y7

A disease can be deﬁned as a condition in which cells suffer damage for some reason and fail to function
normally.
Diseases recognized as resulting from morphological abnormalities in cells are referred to as“organic diseases.” They contrast with “functional diseases,” in which current medical knowledge
cannot identify any cellular abnormalities. Cancer, diabetes, cerebrovascular disease, and heart disease
are considered organic diseases, while mental illnesses are placed in the functional disease category.

Bennadi D. Self-medication: A current challenge. Journal of Basic and Clinical Pharmacy. 5.19-23. 2014. https://www.ncbi.nlm.nih.
gov/pmc/articles/PMC4012703/

8

American Heart Association: Hands-only CPR. https://international.heart.org/en/hands-only-cpr

9Larsen MP, Eisenberg MS, Cummins RO, et al. Predicting survival from out-of hospital cardiac arrest: a graphic model. Annals ofEmergency Medicine. 22:1652–1658. 1993. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600120/pdf/649.pdf

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3052) Impairment, disability, and handicap

by wearing artificial limbs or using a wheelchair. In such cases, the physical loss of a leg cannot bedirectly linked to a decline in capacity or suffering social disadvantage.

(1) Definition of impairment, disability, and handicap

What happens, however, if Cambodian society is unable to supply artificial legs or wheelchairs? Or
1,2,3

Impairment

if roads, homes, and workplace environments are not altered to provide proper wheelchair access? In

is physical or mental dysfunction, which may be either permanent or temporary, due to a loss of mental

such cases, the view is that the social environment is the cause of the disability. That is the basic idea ofor physical structure or function. Disability, meanwhile, is any restriction or lack of ability (resulting

the social model.

The WHO (1980) provided definitions of impairment, disability, and handicap as follows:from an impairment) to perform an activity in the manner or within the range considered normal for a

Look at the following illustration and consider where the disability exists (Figure 16.2).

human being. Handicap is a disadvantage for a given individual that limits or prevents the fulfillmentof a role that is normal.
Views on disability, however, are more complicated and can broadly be divided into two basicmodels: the medical model and the social model.

2. Models of disability
1) The medical model of disability
Under the medical model, disability is defined as conditions in which the body fails to function normally
due to disease or injury (Figure 16.1). This causes a decline in the capacities necessary for everyday life,
placing afflicted persons in socially disadvantageous circumstances. Suffering a stroke, for example,
may cause brain damage (i.e., disease) that permanently impairs numerous physical functions. This can
include paralysis in the hands and feet, speech disorders, and other problems (i.e., impairment).

Figure 16.2 A person with a disability in a wheelchair faces stairs. Where is the disability?

Numbness in the hands and feet can adversely affect mobility, the ability to grasp objects, and othereveryday life skills (i.e., disability). Victims can lose the ability to work, perform housework, and fulfill
other social roles (i.e., suffer social disadvantage or handicap).

Disease or injury

Impairment

Disability

Social disadvantage,
handicap3) International Classification of Functioning, Disability, and Health(ICF) as an integrated model of disability
The ICF is a classification of health and health-related conditions for children and adults that wasdeveloped by the WHO and published in 2001. The integrated model of disability is an attempt tomerge, or at least bring together, the medical and social perspectives.4 This model allows for people with

Cerebrovasculardisease or stroke

Partial paralysis

Difficulty walking
and other mobility
problems

Inability to work,
unemployment

Figure 16.1 The medical model of disability

disabilities to fill a number of different roles “including citizen and patient, among many others.”4,5 An
important point to note is that this model was created to be applicable to all people under any conditions,
not just persons with disabilities.
As shown in Figure 16.3, the ICF model regards disability as a state of dysfunction or disturbance ofdaily human life. Daily life is categorized into three parts: physical and mental function and structure,
activity, and social participation. For example, dysfunction or disturbance of physical and mental

2) The social model of disability

function and structure means impairment, indicating abnormality of mental function, motor nerve
function, sensory functions such as vision and hearing, vocal organs, digestive and circulatory systems,
immune system, endocrine system, or reproductive system. Limitation of activity refers to difficulty in

In contrast, under the social model, the causes of disability are considered to lie in the social environment.

performing activities such as walking, eating, taking transport, or counting money. Restriction of social

For example, even if people lose legs after stepping on unexploded land mines, they may regain mobility

participation refers to limitation or lack of involvement in any area of life such as education, gainful

306

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307employment, or leisure pursuits. Relationships between health conditions, daily activity, and6environmental and personal factors are indicated by double arrows, denoting interaction.

The three types of dysfunction of daily life are influenced and affected in turn by environmental

4. Special education needs for disabled children in
Cambodiafactors (e.g., products and technology, the natural environment and human-made changes to the

According to the Policy on Education for Children with Disabilities of the Cambodian Ministry ofenvironment, services, systems, and policies), and by personal factors (e.g., age, gender, ethnicity,

Education, Youth and Sport, 68% of all children with disabilities suffer from vision-, hearing-, or

outlook on life, and lifestyle). Moreover, this figure shows that these functions of daily life interact withmobility-related issues.8 In the 5-17 age group, 2.6% of boys and 2.9% of girls do not attend school due

health conditions such as disease and injury.

to their disabilities. Unfortunately, Cambodia has a shortage of experts that specialize in educating
disabled children. As a result, the introduction of inclusive education has not progressed smoothly.
This creates challenges to guaranteeing education for children with disabilities through the

Health Condition

framework of the child-friendly school adopted in the policy. One objective of this policy is to raise(disorder or disease)awareness of the situations of persons with disabilities throughout the community, and to promote
acceptance of such individuals into society among all concerned parties.

Daily Life

Body Functions
and Structures

Activities

Participation

Column: Inclusive education for children

All children have the right to access and benefit from quality education, based on the principle of“Education for All.” Guaranteeing education is the key to sustainable development, peace, andstability among countries; thus it is an urgent issue. However, due to various conditions there arechildren who have difficulty accessing education, and are excluded from education. What kinds ofEnvironmental
Factors

Contextual Factors

children are hampered in their right to education? For example, children with disabilities, girls,

Personal
Factors

children living in remote areas, street children, child laborers, children in poor families, and childrenof minorities. These children have special needs for education. Inclusive education not only includes

Source: World Health Organization. How to use the ICF: A practical manual for using the International Classificationof Functioning, Disability and Health (ICF). Exposure draft for comment. October 2013. Geneva: WHO.3

Figure 16.3 The ICF Model: Interaction between ICF components

3. How does Cambodian society view disease anddisability?

children with these special needs in school education, but also transforms the whole school so thatchildren with diverse traits can learn equally.
Resources: Disability Action Council. Inclusive education training in Cambodia. https://www.eenet.org.uk/resources/docs/cambodia.pdf,
Education World Forum. The Darkar Framework For Action. UNESCO 2000. https://sustainabledevelopment.un.org/content/
documents/1681Dakar%20Framework%20for%20Action.pdf

Column: Child-friendly schools

All social systems and agencies that affect children should be based on the principles of the

Disease and disability can lead to prejudice, stigma, and discrimination. In Cambodia, however, aConvention on the Rights of the Child. Based on this principle, UNICEF developed the framework ofrecent report based on a survey of people living with HIV reveals interesting results. For example,

the child-friendly school, which is characterized as “inclusive, healthy and protective for all children,

instances of job discrimination or income loss due to AIDS declined from 46% in 2010 to 2% in 2019.

effective with children, and involved with families and communities - and children.”7

Those experiencing verbal harassment fell from 14% to 3% during the same period. The report also

Cited from https://www.unicef.org/french/lifeskills/index_7260.html

notes, however, that despite the decreases in such stigmas and discrimination from others, “self-stigma”(resulting from personal shame, guilt, and self-blame) had declined only slightly.
How and why have such changes occurred in Cambodia, and what types of prejudice, stigmas, anddiscrimination are directed toward other types of diseases and disabilities, for example, mental illness,blindness, or hearing loss?

308

Chapter 16

Disability and special education needs309◆ INDEX ◆Column: What is UNICEF?

The United Nations Children’s Fund (UNICEF) is an international organization established in 1946 toprovide emergency assistance to children suffering in the aftermath of World War II. UNICEF’s
missions are to save children’s lives, to defend their rights, and to help them fulfil their potential, from

28-day cycle ►194

American School Health Association ►26amino acids ►84, 105early childhood through adolescence. UNICEF staff work in over 190 countries and territories.

6 food types ►87

amounts of invading pathogens ►114

basic eye care services ►157
basic health services / basic healthcare
services ►28, 29

70_80% alcohol ►128

anaphylactic shock ►84, 296
anatomy of the human body ►32

basic human right ►204
basic lifestyle habits ►80Aabdominal pain ►300

anemia ►79, 103

Battambang ►258
bee stings ►296

abduction ►269

angina ►98

ability to predict and avoid danger ►275,
283
abortion ►200

animal bites ►296
anniversary reaction ►281

behaving safely ►264
behavioral addiction ►238
behavioral influences ►62

anorexia ►102

best-before ►67, 68

antagonist muscles / antagonistic muscles►35
anthelminthic ►126

betel quid ►181
bioaccumulation ►247

antibodies ►46, 118
antibody-producing cell (plasma cells) ►118

biofeedback ►106
biological clocks ►81, 107

achieve a self-identity ►196

anti-drugs campaign ►183

biological defense mechanisms ►114

acoustic deafness ►159

antigen ►118

biological diversity ►255

acquired immune system ►116

antigen presentation ►118

biological influences ►62

acquired immunodeficiency syndrome(AIDS) ►205

antigen-antibody reaction ►118
anus ►41

biosphere ►245, 246
birthlength ►198

Cited from https://www.unicef.org/ and https://www.unicef.org/eca/press-releases/unicefcommemorates-70-years

Exercises for further thought and research[16-1] Think about what disability and the conditions of being disabled mean to you.
[16-2] Consider why special education programs need to teach children with disabilities, reflecting on
your own experiences.
[16-3] Examine how Cambodian society views disabilities.

References
1

World Health Organization. International Classification of Impairments, Disabilities, and Handicaps. 1980. Geneva: WHO.
https://apps.who.int/iris/bitstream/handle/10665/41003/9241541261_eng.pdf?sequence=1&isAllowed=y20-20-20 rule ►138

abrasions ►293
absence ►175
absence of a health insurance system ►199
access to health and nutrition services ►28
accident ►262

Ang Pleung ►199

biochemical and physiological tests ►82

activities of the immune system ►114

anxiety ►235

birthweight ►198

acute alcohol intoxication ►174

appraisal support ►229

Acute Stress Disorder (ASD) ►280

arrhythmia ►102

adaptive immune system ►117

arteriosclerosis ►99

bites ►293
bladder ►42
blood glucose concentration ►84

adaptive immunity / acquired immunity ►46

ascending neurons ►38

adolescence /adolescent ►78, 79, 195, 222,

Asian mind ►230

223
adolescent growth spurt ►190

aspects of health ►21

bloodborne transmission ►205

assessment ►291

blue light ►92

adolescent’s mental development ►195
adrenal glands ►42

astigmatism ►134, 135
asymptomatic HIV infection ►206

BMI-mortality relationship ►101body balance ►79

adrenaline ►228
advertisements ►181

atriums ►36

body clock ►92

autoimmune diseases ►46, 119

AED ►302, 303

autologous ►117

body growth ►79
body mass index (BMI) ►101, 102, 152

aerobic exercise ►90

automated external defibrillator ►303

body strength ►79

afferent nerves ►43

autonomic function ►108
autonomic nervous system ►39, 40

bone marrow ►46

blood pressure ►37, 287, 289
blood sugar levels ►43

body temperature ►287, 290

2World Health Organization. Towards a Common Language for Functioning, Disability and Health ICF. 2002. Geneva: WHO.

3

World Health Organization. How to use the ICF: A practical manual for using the International Classification of Functioning,

aging ►23
AIDS ►206, 308

autonomy ►196
available carbohydrates ►83

brain ►39
brain hemorrhage ►98

Disability and Health (ICF). Exposure draft for comment. October 2013. Geneva: WHO. https://www.who.int/classifications/

air quality ►69

awareness of compliance with laws ►268

brain size ►219

axial length of the eye ►132
axillary temperature ►290

brain stem ►39
brain weight ►219

https://www.who.int/classifications/icf/icfbeginnersguide.pdf?ua=1

4
5

drafticfpracticalmanual2.pdf?ua=1

airborne transmission ►65, 114

Anderberg P. Making both ends meet. Disability Studies Quarterly. 25:3, 2005. https://dsq-sds.org/article/

Al-Anon ►178

view/585/762#:~:text=The%20integrated%20model%20of%20disability,%22%20(Seelman%2C%202003).

alcohol ►174

Seelman, K. D. Trends in rehabilitation and disability: transition from a medical model to an integrative model. National
Rehabilitation Conference Keynote. Tokorozawa, Japan: National Center for Persons with Disabilities. 2003. https://www.normanet.
ne.jp/~rehab/2003/seelman.pdf

6

Fitzgerald D. People living with disabilities. https://slideplayer.com/slide/13222050/

7

Cambodia sees decline in stigma, discrimination against HIV carriers: new survey. Asia & Pacific. 2019-08-28.

8brightness ►69, 137
Buddhism ►230

alcohol dependence ►238

B
B cells ►46, 116, 117, 118

built environment ►259, 260

alcohol use ►93, 97
alcoholic hepatitis ►175

bacteria ►113
bacterial food poisoning ►127

bulimia ►102
bullying ►233
burn ►299
bystander ►286

alcohol consumption ►182

Alcoholics Anonymous (AA) ►179

bacteriolytic activity ►116

Ministry of Education, Youth and Sport. Policy on Education for Children with disabilities. http://www.moeys.gov.kh/en/press-

allergens ►84
alveolis ►38
ambivalence ►196

bad breath ►142
balanced diet ►105
banana plantations ►252

releases/policy-on-education-for-children-with-disabilities.html#.XvB1EWj7SUk

amenorrhea ►102, 194

Bangkok Charter for Health Promotion ►25

http://www.xinhuanet.com/english/2019-08/28/c_138344792.htm

310

agent ►113

311