THE medical model of disability rehabilitation sees disability as a problem and not a situation.  Therefore, using the medical model as a standard in rehabilitation of persons with disabilities is in itself discriminatory.
This model, by which illness or disability is as a result of a physical condition intrinsic to the individual (part of that individual’s own body), may reduce the individual’s quality of life, and cause clear disadvantages to the individual.
The medical model tends to believe that curing or at least managing illness or disability mostly or completely revolves around identifying the illness or disability from an in-depth clinical perspective (in the sense of the scientific understanding undertaken by trained healthcare providers), understanding it, and learning to control and or alter its course.
By extension, the medical model also believes that a “compassionate” or just society invests resources in healthcare and related services in an attempt to cure disabilities medically, to expand functionality and or improve functioning, and to allow disabled persons a more “normal” life. The medical profession’s responsibility and potential in this area should be to see ability and not disability.
There are a number of ‘models’ of disability which have been defined over the last few years. The two most frequently mentioned are the ‘social’ and ‘medical’ models of disability.
The medical model of disability views disability as a ‘problem’ that belongs to the disabled individual. It is not seen as an issue to concern anyone other than the individual affected.
For example, if a wheelchair-using person is unable to get into a building because of some steps, the medical model would suggest that this is because of the wheelchair, rather than the steps.
The social model of disability, in contrast, would see the steps as the disabling barrier. This model draws on the idea that it is society that disables people, through designing everything to meet the needs of the majority of people who are not disabled.
There is a recognition within the social model that there is a great deal that society can do to reduce, and ultimately remove, some of these disabling barriers, and that this task is the responsibility of society, rather than the disabled person.
Some examples of a medical model approach might be:
*  A course leader who refuses to produce a hand-out in a larger font for a visually impaired student. The student cannot therefore participate in the class discussion;
*  A member of staff who refuses to make available a copy of a PowerPoint presentation before a lecture. This creates a barrier to learning for the dyslexic students in the group who are likely to have a slower processing and writing speed and who will struggle to understand and record the key points;
*  A Students’ Union society that organises an event that is not accessible to disabled members.
This medical model approach is based on a belief that the difficulties associated with the disability should be borne wholly by the disabled person, and that the disabled person should make extra effort (perhaps in time and or money) to ensure that they do not inconvenience anyone else.
The social model is more inclusive in approach. Pro-active thought is given to how disabled people can participate in activities on an equal footing with non-disabled people. Certain adjustments are made, even where this involves time or money, to ensure disabled people are not excluded. The onus is on the organiser of the event or activity to make sure that their activity is accessible. Examples might be:
*  A course leader who meets with a visually impaired member of the group before the beginning of a course to find out how hand-outs can be adapted so that the student can read them;
*  A member of staff who makes PowerPoint presentations available on Blackboard to all members of the group before a lecture. This allows dyslexic students to look up unfamiliar terminology before the lecture, and gives them an idea of the structure that will be followed. This ‘framing’ helps students to understand and retain the information;
*  A Students’ Union society that consults with disabled members before organising an event in order to make sure that the venue is accessible.
Many people around the world are willing to adopt the social model and to make adjustments for students who have a visible disability and Zambia should not be left behind. However, they are not as accommodating with people who have a hidden disability, or a disability that is not clearly understood.
An important principle of the social model is that the individual is the expert on their requirements in a particular situation, and that this should be respected, regardless of whether the disability is obvious or not.
In 1980, the WHO introduced a framework for working with disability, publishing the “International Classification of Impairments, Disabilities and Handicaps”.
The framework they proposed approached disability using the terms Impairment, Handicap and Disability.
Impairment is a loss or abnormality of physical bodily structure or function, of logic-psychic origin, or physiological or anatomical origin, while
Disability is any limitation or function loss deriving from impairment that prevents the performance of an activity in the time-lapse considered normal for a human being and Handicap is the disadvantaged condition deriving from impairment or disability limiting a person performing a role considered normal in respect of their age, sex, social and cultural factors.
The International Classification of Functioning, Disability and Health (ICF) defines disability as an umbrella term for impairments, activity limitations and participation restrictions. Disability is the interaction between individuals with a health condition (for instance, cerebral palsy, Down syndrome and depression) and personal and environmental factors such as negative attitudes, inaccessible transportation and public buildings, and limited social supports.
The altered language and words used show a marked change in emphasis from talking in terms of disease or impairment, to talking in terms of levels of health and functioning. This change is consistent with widespread acceptance of the social model of disability.
The Medical Model of Disability focuses on the individual’s limitations and ways to reduce those impairments or using adaptive technology to adapt them to society. Current definitions of disability accept biomedical assistance but focus more on factors causing environmental and social exclusion. Uncritical reliance on the Medical Model produces unwanted consequences.
Among advocates of disability rights, who tend to subscribe to the social model instead, the medical model of disability is often cited as the basis of an unintended social degradation of disabled people, further, resources are seen as excessively misdirected towards an almost-exclusively medical focus when those same resources could be used towards things like universal design and societal inclusionary practices.
This includes the monetary and the societal costs and benefits of various interventions, be they medical, surgical, social or occupational, from prosthetics, drug-based and other “cures”, and medical tests such as genetic screening or pre-implantation genetic diagnosis.
Often, a medical model of disability is used to justify large investment in these procedures, technologies and research, when adaptation of the disabled person’s environment might ultimately be more beneficial to the society at large, as well as financially cheaper and physically more attainable.
Further, some disability rights groups see the medical model of disability as a civil rights issue, and criticise charitable or medical initiatives that use it in their portrayal of disabled people because it promotes a pitiable, essentially negative, largely disempowered image of people with disabilities, rather than casting disability as a political, social and environmental problem with socio-cultural aspects of “normalcy” and the pressure it exerts on individuals to conform.
Therefore it is very important that disabled people in Zambia are helped through the use of social model and not the medical approach which is being promoted now and view disabled people as sick people who need a medical doctor instead of disability rehabilitation experts.
(The author is regional disability policy analyst for SADC and inclusive development advisor for Centre for Disability Development Research, Law and Policy, Johannesburg. Project office, P.O Box 1981 New Castle, 2940, South Africa. For your letters please send to us on P.O Box 34490 Lusaka, Zambia or use our South African Address. Tell: +27343127894 Fax: +27343127894 Mobile: +27733453663; E-mail: cm@cddrlp.net Website: ww.cddrlp.net;   Mobile +260966-755461)