Ecosystem and its link with physiotherapy

In very simple form, ecosystem can be defined as the interaction between organism and their environment. Here the interaction refers to exchange of energy between organism and environment to keep them living and sustainable. In scientific term, organisms are called the biotic component and nonliving goods are called abiotic component, both components are interrelated. Human being falls under the biotic component of ecosystem having dominant control on whole system. The ecosystem are life support system from where organism receives the food, water shelter and others basics. Over population and increasing industrialization is the main factor that compromises the synergistic relationship with both biotic and abiotic component. The disturbance on ecosystem directly compromises the health and livelihood of human beings as they also depends on other component within the same system.

Let’s discuss how the human beings are affected with the change in ecosystem services. 

Food: Damage to ecosystem reduces the production of food which is basic need for every living creature. Decrease supply of food results malnutrition that may predispose the population to developmental delays (in children) leading to the disability. Under nutrition also downsizes the responsiveness of body immune system which predisposes creatures to diseases and finally to the death(if not managed properly). The state of children report published by UNICEF-2013 highlighted malnutrition as one of the leading causative factors for disability. Developmental delays and cerebral palsy are the common disability marked when there is a poor or under nutrition. These sort of disability are often associated with problem in eating and swallowing due to the weakness or impairment in body parts like hands, trunk and swallowing mechanism. The problem in posture after the cerebral palsy or the developmental delays is also one of the factor that hamper the adequate nutrition  (even though availability of food is sufficient) thus predisposing them for the further impairment. The further impairment on such populations makes them weak and more sedentary which reduces their contributions to the ecosystem.

The physiotherapist has major roles to support people with disability to make their life more functional and mobile. Exercises and the facilitation to improve the hand, trunk function and posture are designed by physiotherapist. For some people with disability, only exercises may not assist to be more independent on feeding, at such instances prescriptions of assistive devices could be done. Only prescription of devices without the follow up may not work, the physiotherapist has role to train on how to have the proper and wise use of such devices. United nation convention for the rights of people with disability article 20 also focuses on the user and family training after the prescription of any devices- proper training directs towards the proper use of devices without the harm.

Water and sanitation: Some findings of global ecosystem assessment suggests that about 1 billion people in the world lack the access to safe water supply, while 2.6 billion lack access to sanitation. Globally it is often said and postulated that investment on the safe drinking water and improvement in sanitation directly relates to promotion of human health and ecosystem productivity. Let’s link the discussion with the physiotherapy and disability.  According to the world report of disability 15% of the world population comprises the people with disability. Similarly, WHO guideline on the provision of manual wheelchairs says that 1.5% of the total population needs the wheelchair services. Likewise, World report on the disability says 0.5 % of the total populations need prosthetic/ orthotic devices. WHO also states that out of the total needy population with disability, only 5-15% of the populations have access to the rehabilitation services that includes physiotherapy, assistive devices and other specialized services.

The physiotherapy facilitated by qualified physiotherapist to the person with disability before and after getting the assistive devices increase the mobility of person with disability. The increased mobility facilitates the increased access to water resources and toilet. Access to toilet promotes its usage. Proper use of toilet reduces the possibility of spreading the infections originating from the fecal maters. Experts say that Nepal has still 96% of the rehabilitation needs that is to be addressed. The physiotherapy and the provision of the assistive devices is also one of the major activities that falls under the rehabilitation need. But the physical accessibility of the water resources and toilet is also one of the factors that could obstruct the access even after receiving the physiotherapy and mobility aids. The ministry of women children and social welfare has already developed the accessibility guideline. The proper implementation of this guideline while constructing the water resources and toilets would simply wonders a lot.

Participation: Participation is also one of the facilitating factors to promote the access to the services like health, education, livelihood, empowerment, social opportunity ( as suggested by WHO CBR guideline). The increased mobility and the participation promote the social contribution of people with disability. For example afforestation could be one of the attempts to protect the environment where the person with disability also participate directly if she or he has adequate mobility.

As stated above people with the disability constitute the 15% of the world population. The ecosystem conservation and strengthening initiative will not be participative and complete if this huge group is missed. The increased participation due to increased mobility after the rehabilitation (for the people who need it) promotes their contribution for the ecosystem. The physiotherapist has the very dominant role on facilitating the activity of the daily living and mobility of the person with disability to or closest to the independent level.