A Thesis Entitled Disability in Ghana by Solomon Sackey Amoatey

A Thesis

entitled

Disability in Ghana

Solomon Sackey Amoatey

Submitted to the Graduate Faculty as partial fulfillment of the requirements for the

Master of Arts Degree in Sociology

______Dr. Karie Peralta, Committee Chair

______Dr. Shahna Arps, Committee Member

______Dr. Jim Ferris, Committee Member

______Dr. Amanda C. Bryant-Friedrich, Dean College of Graduate Studies

The University of Toledo

May 2020

This document is copyrighted material. Under copyright law, no parts of this document may be reproduced without the expressed permission of the author.

An Abstract of

Disability in Ghana

Solomon Sackey Amoatey

Submitted to the Graduate Faculty as partial fulfillment of the requirements for the Master of Arts Degree in Sociology

The University of Toledo May 2020

The study focused on the general situation of disability in Ghana. The objectives of the study were to explore the social experiences of people with disabilities and to examine how the Social Model of Disability apply to the experiences of people with disabilities in Ghana. Using qualitative data from 24 interviews conducted, the Social

Model of Disability is applied to analyze the issues that disability leaders face in their everyday lives.

Findings from the study reveal that in Ghana, disability is seen as a curse and as atonement or punishment for sins committed, which may result in banishment from society and difficulty in finding a romantic partner. In general, disability is linked to evil spirits. Most participants asserted that this cultural belief impedes their social integration, and they expressed frustration with how this notion adversely affects every aspect of their social life.

There are challenges with the DACF such as insufficient amount of funds disbursed, delay in disbursement of funds, bureaucratic process in accessing funds and alleged discrimination and corruption by government officials in the disbursement of funds. Unemployment among disabled people is high. This is because most employers

iii are not willing to employ a disabled person, due to the perception that a disabled worker would not be productive.

The study found that inaccessible buildings and roads, lack of disability equipment, inaccessible vehicles and discrimination in transport vehicles, restrict the independence of disabled people. Specifically, these issues prevent disabled Ghanaians from exhibiting self-determination and making contributions to society in more meaningful ways.

Based on these findings, it is recommended that the amount disbursed from the

DACF should be increased as well as ensuring that funds are disbursed in a timely manner. Authorities should ensure that public buildings and government offices are disability friendly, level bumps and slopes, and remove potential mobility impediments.

The government should encourage disability awareness by lobbying prominent persons in the Ghanaian society, such as chiefs, politicians, religious leaders, and entertainers to promote inclusive attitude toward disabled people, since they wield much influence on the populace.

Key words: Disability, Ghana, Social Model, DACF, Global South.

To all disabled Ghanaians.

v Acknowledgements

Many thanks to God for the health and strength granted me to complete this piece of work. I am very thankful to my supervisor, Dr. Karie Peralta for accepting to supervise my work, when I needed a supervisor, halfway through this work; and for her mentorship, suggestions and encouragement, which have made this work a success. I am grateful to my thesis committee members, Dr. Shahna Arps and Dr. Jim Ferris, for their insightful comments and suggestions, which contributed to the success of this work. I am also thankful to Dr. Mark Sherry for his contributions towards this research.

I am most grateful to my parents, Pastor S.K. Amoatey, and Mrs. Sarah Amoatey, and my siblings, Elizabeth and Esther for their prayers, support and encouragement during my period of studies at the University of Toledo. I extend my heartfelt appreciation to Elizabeth Borteley Angenu also for her prayers, support and encouragement during my period of study.

My profound gratitude goes to Dr. Jerry Van Hoy and Dr. Thomas Zych for their valuable contributions and support during the period of this research. Also, I am thankful to Nicole Lederer, who assisted me in various stages of my IRB application. Many thanks to my colleagues, Edelweiss, Angela and Krista. You made this academic journey exciting.

My sincerest thanks go to the Department of Sociology and Anthropology for fully funding my master’s program and providing me with funds for my upkeep. Finally,

I am very grateful to my participants who contributed to the success of this research.

vi Table of Contents

Abstract iii

Acknowledgements vi

Table of Contents vii

List of Abbreviations xi

1. Introduction 1

1.1. Background to the Research 1

1.2. Disability in the Ghanaian Context 2

1.3. District Assembly Common Fund (DACF) 3

1.4. Rationale of the Present Study 4

1.5. Organization of Study 5

2. Literature Review and Theoretical Framework 6

2.1.1. Introduction 6

2.1.2. United Nations CRPD 6

2.1.3. Ghana’s Initial Report on the UNCRPD 7

2.1.4. The Impact of Coloniality 8

2.1.5. Global South Disability Studies 8

2.1.6. Disability Issues in Ghana 15

2.1.7. Explanatory Models of Disability in Ghana 17

2.1.8. Advocacy by Disability Organizations in Ghana 18

2.2.0. Theoretical Perspective and Model of the Study 20

2.2.1. Social Model of Disability Theory 20

2.2.2. Union of Physically Impaired Against Segregation 21

vii 3. Methods of Data Collection 24

3.1. Philosophical Underpinnings 24

3.2. Reflexivity of the Researcher 24

3.3. Study Area 25

3.4. Data Collection and Procedure 26

3.5. Instruments 27

3.6. Sample Participants 27

3.7. Data Analysis and Transcription 28

3.8. Ethical issues 28

4. Results and Discussion 30

4.1. Cultural Beliefs Impede Social Integration 30

4.1.1. Disability Seen as a Curse 30

4.1.2. Disability Seen as Atonement or Punishment for Sins Committed 34

4.1.3. Divine Healing 35

4.1.4. “Fake” Pastors 36

4.1.5. Banishment from Society 38

4.1.6. Difficulty in Finding Romantic Partner 39

4.2. Government Structures Perpetuate Disability Injustice 45

4.2.1. Insufficient Amount Disbursed from the Common Fund 46

4.2.2. Delay in Disbursement of Common Fund 47

4.2.3. Monitoring 48

4.2.4. Alleged Corruption in Disbursement of Funds 50

4.3. Institutional Barriers Violate Human Rights 51

viii 4.3.1. Employment Barriers 51

4.3.2. Accessing Healthcare 57

4.3.3. Educational Barriers 62

4.4. Mobility Issues Restrict Independence 67

4.4.1. Inaccessible Buildings 67

4.4.2. Lack of Disability Equipment 71

4.4.3. Transport Minibuses 71

4.4.4. Discrimination in Transport Vehicles 72

4.5. Lack of Family and Community Exclusion 77

4.5.1. Lack of Family Support and Connection 77

4.5.2. Community Isolation 81

4.5.3. Conclusion 83

5. Summary, Conclusions and Recommendations 84

5.1. Perceptions About the Causes of Disability 84

5.2. Building Romantic Relationships 85

5.3. Societal Exclusion 86

5.4. Family Support and Welfare 86

5.5. District Assembly Common Fund 87

5.6. Barriers in Society 88

5.7. Mobility 90

5.8. The Social Model of Disability and Ghana 91

5.8.1. Applicability of the Social Model to the Ghanaian Context 92

5.8.2. Perspectives on Disability 95

ix 5.9. Advancing Global South Disability Studies 96

5.10. Participant Recommendations 97

5.11. Policy Suggestions 98

5.12. Limitations and Avenues for Future Research 99

References 102

Appendices 111

A. Email Recruitment Script 111

B. Informed Consent Form 113

C. Semi-structured Interview Guide 117

x List of Abbreviations

DACF ...... District Assembly Common Fund

NHIS ...... National Health Insurance Scheme

UNCRPD ...... United Nations Conventions on the Rights of Persons with Disabilities

WHO ...... World Health Organization

xi Chapter One

Introduction

1.1. Background to the research

According to the Ghana Statistical Service, the 2010 Population and Housing

Census revealed that there are 737,743 disabled people in Ghana (3% of the population).

Of these individuals, there are slightly more women than men, who are disabled (3.1% -

2.9%). There are 50,904 disabled children and 54% of people with disabilities live in rural areas. The most common types were sight/visual impairment (40.1%) and physical disabilities (25.4%). Persons with disabilities were more likely to be illiterate and have a lower level of education than those who were not disabled (Service, 2013).

The World Health Organization (WHO) defines “disability” as a condition or function judged to be significantly impaired relative to the usual standard of an individual or group” (WHO, 2001). Persons with disabilities are the world’s largest minority group.

It is estimated that more than one billion people, about 15 per cent of the world’s population, have some form of disability. Between 2.2 per cent and 3.8 per cent of persons aged 15 years and older have significant difficulties in functioning (WHO, 2015).

Although disabled people in Ghana legally have the same rights to social and economic participation as all others in the country, in practice they are often denied these rights because of disabling barriers in education, employment, and social inclusion (Grischow,

2015).

Mike Oliver, (1996) from England developed the social model of disability in

1983. It highlights the barriers that disabled people experience and demands that they have equal rights, by changing the physical environment or prejudicial attitudes. The 1

question that has been raised by some scholars such as Grech, (2015) is how much this theory that was constructed in the Global North applies to the Global South.

Based on the need to assess how Global North disability theories apply in the Global

South, this research was guided by the following research questions:

1). What are the social experiences of people with disabilities in Ghana?

2). How does the social model of disability apply to the experiences of people with disabilities in Ghana?

Using data from 24 interviews conducted from May-August 2019, I apply the

Social Model of Disability to analyze the issues that disability leaders face in their everyday lives. The objective is to advance an understanding of the everyday experiences of disability leaders in Ghana. It is necessary to develop culturally specific understandings of disability and culturally sensitive responses to the problems disabled people face (Botts & Evans, 2010; Grischow, 2015). This thesis is therefore important because it will provide a basis of local knowledge of disability experiences in Ghana from the lens of leaders of disability organizations, who are disabled. Thus, this study will contribute a perspective on disability in Ghana informed by disability leaders’ insight into personal experiences with disability and their broader viewpoint on the challenges that the average disabled person encounters in their daily lives.

1.2. Disability in the Ghanaian Context

Chronic poverty in Ghana, combined with large-scale prejudice and exclusion, result in very few career options, high unemployment, isolation from families and lead to a high rate of begging by disabled people (Grech, 2011; Kassah, 2008; Naami, 2010).

Currently more and more disabled people in Accra engage in begging on the streets as a

means of livelihood, and begging has been justified by some disabled Ghanaians as full- time work (Sayibu, 2013). Begging is also practiced by some non-disabled Ghanaians and refugees from neighboring countries (Kassah, 2008).

An example of the way that the chronic poverty of the Global South affects disabled people can be found by looking at the advocacy by the Ghana Blind Union. The poverty of the Global South means many disabled people lack the most basic equipment that could address their impairment needs (McClain-Nhlapo, 2007; Mitra et al., 2013).

The lack of white canes for blind people is one example of the unique barriers that people in Ghana experience because of chronic poverty (Opoku et al., 2018). The Ghana Blind

Union has a “White Canes for All” campaign because its research has shown that in greater Accra alone, 55% of its members do not have mobility canes and in the eastern region 58.4% do not have canes (Ghana Blind Union, 2019).

Disability organizations have had to confront the problem of insufficient numbers of trained professionals. For example, there were only 10 trained Speech Language

Pathologists in Ghana in the year 2013 (Crowley et al., 2013). Research also found that there is a lack of trained special educators who are qualified to work with disabled children in schools (Opoku et al., 2017).

1.3. District Assembly Common Fund (DACF)

District Assemblies were established through Article 252:2 of the 1992 constitution of the republic of Ghana. The Article mandates Parliament to “annually make provision of not less than five per cent of the total revenues of Ghana to the District

Assemblies for development; and the amount shall be paid into District assemblies

Common Fund in quarterly installments” (NCPD/GFD, 2010). Currently, Persons with disability are allocated 3% of the District Assembly Common Fund.

According to the National Council on Persons with Disability (NCPD), the aims of the District Assembly Common Fund (DACF) are to minimize poverty among all persons with disabilities, particularly those outside the formal sector of employment, and the enhancement of their social image through dignified labor (NCPD, 2010). The objectives of the DACF are:

• To support the income generating activities of individual persons with disabilities as a means of economic empowerment.

• To provide educational support for children, students and trainees with disabilities.

• To build the capacity of Organizations of Persons with Disabilities (OPWD) in the districts to enable them to advocate and assert their rights and undertake awareness raising and sensitization on disability issues.

• To support persons with disabilities to have access to technical aids and other assistive devices and equipment.

1.4. Rationale of the Present Study

Existing literature shows that researchers have primarily focused on experiences of disabled people, with little attention on the unique perspectives of disability organization leaders. Also, there is little information on how disability issues in Ghana, a

Global South country, relate to Global North theories. The justification for this study is to contribute to this research area. This study therefore fills this gap in literature by demonstrating how disability issues in Ghana relate to the Social Model of Disability.

1.5. Organization of Study

The present study is organized into five chapters. After this introduction to the study, Chapter Two presents the literature review and theoretical framework. Chapter

Three outlines the methods of data collection. Chapter Four presents the data analysis and interpretation. And last, Chapter Five, summarizes the study’s findings, provides a discussion of the findings in relation to past literature, notes limitations of the study, identifies areas for future research, and provides policy and practical recommendations.

Chapter Two

Literature Review and Theoretical Framework

2.1.1. Introduction

This chapter reviews existing literature on disability in Ghana. The chapter covers seven main areas, namely, 1). United Nations CRPD, 2). Ghana’s Initial Report on the

UNCRPD, 3). The Impact of Coloniality, 4). Global South Disability Studies, 5).

Disability Issues in Ghana, 6). Explanatory Models of Disability in Ghana, and 7).

Advocacy by Disability Organizations in Ghana. The chapter also includes the theoretical framework and model of the present study.

2.1.2. United Nations CRPD

The 2008 United Nations Convention on the Rights of Persons with Disabilities

(CRPD,) is the major international human rights treaty concerning disability. There is also an Optional Protocol to the Convention on the Rights of Persons with Disabilities which further protects such rights. Article 1 of the CRPD states that the purpose of the

UNCRPD is “to promote, protect and ensure the full and equal enjoyment of all human rights and fundamental freedoms by all persons with disabilities, and to promote respect for their inherent dignity.” The Parliament of Ghana ratified the UNCRPD on March 12th

2012. The eight guiding principles that underlie the Convention demands that persons living with disability are shown respect for inherent dignity and not discriminated against. Persons with disability are also entitled to the full and effective participation and inclusion in society. Another principle of the convention is that countries must ensure respect for difference and acceptance of persons with disabilities and the creation of equal opportunity. Inaccessible environments prevent people with mobility impairments

from fully participating in society. An inaccessible environment reflects the ‘social model of disability’ (Oliver, 1990). Ensuring accessibility in member countries is another principle of the convention as well as equality between men and women and the respect for the rights of children with disabilities.

2.1.3. Ghana’s Initial Report on the UNCRPD

Ghana’s initial report under the UNCRPD should have been submitted on August

22nd, 2014 but was instead submitted on June 5th, 2018 (Ministry of Gender, Children and Social Protection, 2008). Despite the emphasis on gender equality in the convention, findings from Ghana’s report showed that there are no specific measures taken for women with disabilities. There are unique disadvantages experienced by disabled women

(Naami, 2014) and they face obstacles because of notions of dependency, exclusion from certain types of work, limited educational opportunities, and being denied valued social roles (Geurts & Komabu-Pomeyie, 2016). Included in the initial report is also the lack of ease of accessibility faced by disabled Ghanaians. Most buildings and most transportation vehicles are physically inaccessible. Also, social forces created barriers to inclusion and participation. For example, people with albinism were seen as cursed or a bad omen because of cultural and religious beliefs, which resulted in them being banished from some communities or receiving death threats. Dehumanizing language was often directed at persons with disabilities, and some experience physical, mental, emotional, psychological, sexual and other forms of abuse without any access to justice. They also found that some children with disabilities were denied the right to movement because they are abandoned or hidden in homes. Because of this dynamic, they are prevented

from playing with other children. Additionally, parents sometimes discriminate against their own children (Ministry of Gender, Children and Social Protection, 2008)

2.1.4. The Impact of Coloniality

What is missing in the UNCRPD, and in the responses to it by Ghana, is a recognition of the ongoing importance of coloniality. Soldatic, (2019) suggests that responses framed by coloniality tend to focus on “disparity, deprivation, disadvantage, dysfunction, and difference” within a national context and in doing so, pathologize the oppressed, reduce their concerns to merely economic/policy issues, and fail to consider the ways state policies can reproduce inequality” (p. 98). But the key issue, from the point of view of this thesis, is the way the CRPD avoids any demand that the Global

North change its neoliberal macroeconomic policies that maintain and reproduce coloniality and the impoverishment of the Global South. As Grech, (2011) has argued, the Global South is forced to “accommodate the neoliberal development project, the history and practices of which remain largely unquestioned” (p.87). It is imperative to state that colonialism caused adverse effects on the economic development of African countries (Heldring & Robinson 2012; Settles, 1996) This contributes to the inability of the Ghanaian government to fully and successfully implement socioeconomic policies to help the disabled. For example, according to Settles, (1996), “colonialism and its economic demands irrevocably altered the social structure of many African societies and set the stage for later problems in African economic development” (p.11).

2.1.5. Global South Disability Studies

Theories of disability studies cannot simply be exported from the Global North to the Global South. Chataika, (2012) argues that practices and theories of disability are

defined by the Global North’s epistemologies and the story of the Global South must be primarily told by researchers from the Global South. The knowledge of the people from the Global South is critical and significant because it challenges oppression, voicelessness, and stereotyping. Therefore, it must not be disregarded. In the case of

Ghana, there are specific cultural dynamics and disability issues that might not be present in the Global North or even other Global South countries.

Geurts & Komabu-Pomeyie, (2016) note that disability rights organizations have a long history in Ghana, with the Ghana Association of the Blind and Ghana National

Association of the Deaf tracing back to the 1960s. They interviewed disability rights activists from organizations such as the Ghana Blind Union and the Ghana Federation of the Disabled. Their participants, who had sensory or physical impairments, discussed disabling physical and cultural barriers. Intellectually disabled people were not included.

Disabled people were seen as an object of pity, charity-seeking, dependent, and vulnerable. Interpersonal barriers and disrespect were common as a result of cultural stereotypes and because people were often wrongly assumed to have other secondary impairments. For instance, some physical and sensory impaired people were assumed to have mental illness, and some mobility impaired people were also assumed to be deaf.

They conclude by stressing the need for Disability Studies to take far more interest in the

Global South.

Opoku et al., (2018) focused on how the sustainable development goals of the UN and donor agencies had done little to improve the overall situation of disabled people in

Ghana. Major barriers continued to prevent them from achieving equality in education, training and employment, and contributed to chronic poverty. Even those disabled

people, who were working were often underpaid or underemployed. Inaccessible environments, such as schools with physically inaccessible learning environments, limit the opportunities for disabled Ghanaians. Specific cultural beliefs and superstitions about disability also mean that social interactions often involve stigmatization, labelling and public shaming (Agbenyega, 2003). Although some disabled people are able to receive income support from their families, most do not and there seems to be little government support for these impoverished disabled people. Poverty also mean that many disabled people cannot afford to go to school. Begging is a common response to this poverty, though it has been widely criticized, even by other disabled people (Opoku et al., 2017).

Grischow, (2015) offers insight into another unique cultural dynamic in Ghana.

Specifically, he discusses the power of “big men,” which suggests that the support of powerful people or groups can be even more important than the formal legal protections offered by laws such as the CRPD and the PWDA. “In Ghana, the system of patronage is historically rooted in patrimonial relations between chiefs and their subjects. Under this system, clients (subjects) provide tributes in cash or in kind to the patrons (‘big men’) in return for protection and resources” (p. 9). Grischow’s, (2015) research on this issue is limited, however, in that it only tells the life story of one man’s experience encountering disability-related obstacles. Therefore, its applicability to other contexts needs verification. Nevertheless, the story of one person’s experience of barriers in accessing resources does resonate with the wider literature from social model theorists on the effects of disabling barriers in the lives of disabled people (Naami, 2014; Opoku et al.,

2017, 2018; Singal et al., 2015).

Naami et al., (2012) highlight the unique disadvantages experienced by disabled women in Ghana. In particular, they stress that disabled women are more likely to be unemployed, socially excluded, and in poverty. Poverty limits family life, opportunities for social interactions, leisure activities, and their mobility, due to the cost of transport.

These high levels of poverty and the lack of government support mean that many disabled women resort to begging. Lower levels of social participation are also related to poverty and contribute to a cycle where women are not able to access information about potential opportunities, such as educational or employment opportunities, which would enable them to escape from their poverty.

According to Naami et al., (2012), “Low societal expectations of their capabilities combined with architectural barriers, lack of access to transportation, lack of information, inadequate education and educational facilities, inadequate medical systems, negative cultural beliefs and practices, and few social welfare benefits propel persons with disabilities into poverty” (p.6). For instance, regarding cultural beliefs, Naami, (2014) emphasize that Ghanaians also attribute disability to being cursed by God. Additionally, they found that despite formal government policies requiring local governments to spend certain amounts of their budgets on disability, these requirements were often ignored.

Instead, disabled people were often shunned when they sought government assistance at the local level. The government is mandated by law to provide job training and employment opportunities for disabled citizens, but these opportunities are almost non- existent (Sackey, 2015).

Agbenyega, (2003) confirms that disability is widely regarded in Ghanaian culture as a curse or punishment for the disabled person or their family and can also be

attributed to “witchcraft, sorcery, juju and magic” (p.4). Because they are often considered bewitched, disabled people are commonly sent to charismatic churches, and if they are not “healed,” they are thrown out by their family, with few options other than begging. The terms used to refer to disabled people such as “idiots” and “fools” are also demeaning. The labelling as well as the stigma and exclusion that accompanies it, often leaves lifelong psychological scars on disabled people. Agbenyega, (2003) stresses that labelling people who are disabled begins at birth and can lead to divorce or family disintegration. It continues throughout the life-course and greatly influences educational practices. Due to these negative attitudes that disabled people face in society, many of them feel negative about themselves. Disabled people are not confident about their capabilities, due to unfair treatments, and are often shy to interact with non-disabled people (Slikker, 2009). The labelling practices of schools reinforce these negative attitudes and prevent disabled children from getting proper educational opportunities.

Often schools focus on labelling the students, rather than educating them. They are often maltreated, neglected and excluded by educational institutions, such as in segregated schools. Those with intellectual disabilities never actually ‘graduate’ from school

(Agbenyega, 2003). Agbenyega, (2003) describes this phenomenon, “there is no completion, they simply continue to exist there”. Because of these prejudicial cultural practices in Ghana, little attention is paid to the ways in which schools fail to properly educate disabled students and prepare them for a successful life.

Anwar, (2017) highlights the importance of cultural barriers, particularly beliefs about disabled people being cursed by God or associated with witchcraft as major sources of stigma, discrimination and exclusion for disabled people. However, it is imperative to

note that in Ghana, the belief in a spiritual world and supernatural consequences is present in the whole society and is not unique to disability (Slikker, 2009). Fears about contagion also reinforce cultural prejudice and promote segregation. Disabled children face low expectations, discrimination, and negative labels. These attitudinal barriers to inclusion exist throughout the life course. Anwar, (2017) focuses on such barriers in schools but highlights their lifelong effects as well. For instance, people are more likely to be reduced to begging if they lack proper education and are denied employment opportunities. Disabled people are often denied a job due to negative attitudes of employers. Many employers think that the disabled person is incapable of working or being productive. Some employers also believe that they may lose customers when having an employee with a disability (Slikker, 2009).

Disabled people are faced with barriers to education. A major barrier is inaccessible school education. The needs of disabled people are not considered during the construction of school buildings. Facilities such as the library, laboratories and many classrooms are only accessible by stairs. For example, the rough terrain, lack of ramps, pavements and rails are environmental factors that negatively affect learning of disabled students (Morley & Croft 2011; Opoku et al., 2017). According to Morley & Croft,

(2011), “most disabled students are in Higher Education as a result of their individual and collective agency in the face of structures that seemed likely to determine different educational outcomes for them” (p. 9). In other words, disabled students counter powerful societal effects that often hinder their educational progress through their personal effort.

The extreme poverty that disabled people experience further magnifies their marginalization. Many disabled children are in poor families that cannot afford proper medical treatment. “Exclusion and marginalization make them uniquely vulnerable, affecting their dignity, individuality, and chances to have a normal life. Inequality and discrimination are the most pressing issues to be solved…” (Anwar, 2017, p.6). Anwar,

(2017) also stressed the importance of inclusion and participation in affirming the human dignity of disabled people and ensuring their rights are respected. He also revealed that disabled girls face more exclusion than disabled boys, including increased risk of sexual abuse. Some families hide their children with disabilities from public view. Children with disabilities may be kept in the house by their parents, due to fear of negative attitudes directed towards them in the community (Opoku et al., 2015; Slikker, 2009).

Baffoe, (2013) highlights prejudices and superstitions that deny disabled people access to resources, such as the belief that disabled people are needy, abnormal or the children of evil spirits. He locates the source of such beliefs in the following factors:

“superstition/ignorance, lack of knowledge and empathy, old belief systems and a tendency to fear and exclude people who are perceived as different” (p.193). The effects of such attitudes include bullying, exclusion, insults and ridicule.

A study by Opoku et al., (2017), employed a single-participant approach to investigate the resilience of persons with disabilities in the face of discrimination and marginalization. The story of the female participant highlights the various barriers disabled Ghanaians face, in their attempt to earn a living. Her story reveals obstacles to education, healthcare, employment, and the lack of societal support. The participant recounted that she had to drop out from school due to the long distance she had to crawl

to school in the hot sun. According to her, even though she receives support from her parents, her health needs are not met due to lack of money. Employers had refused employing her because of the perception that a disabled worker is unproductive. Also, they found that people perceive disabled individuals as objects of pity and dependent on the kindness of others. The woman recounted that she declines accepting money from anyone who offers to give her money, because she is disabled. This implies that persons with disabilities are reduced to individuals who depend on the benevolence of society.

According to the participant, this issue was a major factor that drove her to work harder to overcome this erroneous notion.

2.1.6. Disability Issues in Ghana

Previous studies emphasize the significance of disabling barriers in Ghana. A study by Opoku et al., (2108) highlighted barriers in education, training, employment and the physical environment. Basically, people with disabilities are not getting proper education, are not being trained for proper jobs, and have a hard time getting employed.

Additionally, the physical environment has many disabling barriers, such as steps, which impedes the mobility of wheelchair users.

Along these lines, Naami, (2014) highlighted architectural, transportation, information, and medical barriers. People with disabilities are also denied access to social activities, decision making, and leadership positions (Takyi, 2013). For instance, when Dr. Henry Seidu Danaa, a disabled lawyer, was nominated for a government position as minister for the Ministry for Chieftaincy and Religious Affairs, some local chiefs protested against his appointment, due to his disability (Sackey, 2015).

Barriers in healthcare are also a problem. For instance, people with communication disabilities are not going to learn about HIV because there are no HIV materials in accessible formats such as Braille for blind people or captioned videos in local languages for Deaf people (Evans, Adjei-Amoako, & Atim, 2016). Disability organizations have had to confront the problem of insufficient numbers of trained professionals. This problem has been confirmed in the literature, for example, by a study by Crowley et al., (2013) who found that there were only ten trained Speech Language

Pathologists in Ghana in 2013. There is also a lack of trained special educators who can work with disabled children in schools. The 2013 report of “Inclusion Ghana” reported a

“lack of awareness among policy makers and professionals and a lack of professional knowledge about intellectual disability, which resulted in increased risk of delayed diagnoses, secondary co-morbidities, persistent abuse, depleted social capital, and isolation.” (Inclusion Ghana 2013, p. 11). According to Inclusion Ghana, it provided training for self-advocates with intellectual disabilities and also training for over 300 health professionals on how to provide understandable and accessible services for people with intellectual disabilities, as a means to respond to this challenge.

Amenyedzi, (2016) found that negative cultural attitudes about disability are widespread in Ghana, including in Christian churches. These attitudes often suggest that disabled people are cursed and need healing either through an exorcism or by faith healers. If they are not healed, these people are further stigmatized and excluded.

Public health in Ghana has been formed, shaped and reproduced by the dynamics of colonialism. While poverty shapes access to healthcare and the provision of public health infrastructure more broadly (Badu, Agyei-Baffour, & Opoku, 2016), it also creates

impairment. For instance, many of the muscular skeletal impairments in Ghana are caused by carrying water (Geere et al., 2018). Accessing skilled care is often impossible, a problem which is even worse for disabled people (Barlow & Reynolds, 2018; Crowley et al., 2013; Ganle et al., 2016).

Negative cultural attitudes are widespread. Disabled people are often exposed to cultural practices intended to heal them of their disability. If not healed, they are stigmatized, excluded, bullied, insulted, and ridiculed (Anwar, 2017). Agbenyega, (2003) stresses that cultural attitudes attribute disability to “witchcraft, sorcery, juju and magic”

(p.4). Geurts & Komabu-Pomeyie, (2016) highlight oppressive cultural attitudes and stereotypes about disabled people and found that disrespect was common. Also, people with physical impairments, such as wheelchair users or amputees, and people with sensory impairments including blindness or deafness, are often assumed to have other impairments (e.g. mental illness or intellectual disability).

There is lack of support from family members. Families are unwilling to provide for the needs of disabled relatives. Apart from parents, who may cater for the needs of their disabled children, other family members do not provide support. This leaves the disabled person with no option than to fend for themselves, in the case where their parents are poor. With the lack of support from family, most persons with disabilities are dependent on the larger society for their daily bread. (Opoku et al., 2017).

2.1.7. Explanatory Models of Disability in Ghana

Explanatory models are beliefs about the nature, causes, and recommended treatment of illness and/or disability (Kleinman, 1980). In Ghana, common explanations focus on supernatural forces and beings as causes of disability. Many parents, healers,

and lay people believe that disability is caused by spiritual machinations. For example, when a child is born with a disability, then it must be as a result of a curse that ran through the family. The view that evil spirits could be used to inflict disability on a person, are common, especially among some pastors, and traditional healers (Kpobi, et al., 2018; Kpobi, L., & Swartz, 2019). Explanations about the causes of disability influence decisions about seeking assistance or therapy related to impairments.

Results from a study by Wylie et al., (2017), reveal that people are likely to seek religious help in response to communication disability. Help-seeking (advice, prayer, healing etc.) in the religious sector is common as pastors, priests and churches were frequently identified as source of help. Herbalists and spiritualists were also reported to be a source of help within the traditional medicine sector.

A child born with a visible disability is traditionally believed to be the embodiment of a spirit seeking to come to earth for a short while and, therefore, must be

"returned to the spirit world" (Botts & Evans, 2010). Results from a study by Botts &

Evans, (2010) revealed varied ways in which the visibly disabled child is returned to the spirit world. A participant, for example, “ascribed the birth of the infant with disabilities to the secondary god of the village” (p.35). The study illustrated the belief that “if a nearby stream brought life giving water to the village, the disabled child may be viewed as a child of water and should be returned to the water from whence it came (i.e., drowned)” (p. 35).

2.1.8. Advocacy by Disability Organizations in Ghana

Disability organizations such as BasicNeeds-Ghana, Mental Health Society of

Ghana and the Ghana Mental Health Coalition work to remove the attitudinal barriers

about mental health in Ghana. BasicNeeds-Ghana develops programs for groups of various ages, including young people and women of reproductive age. Its programs include school-based mental health initiatives, peer-support, and medical treatment, including counselling services. The Ghana Alliance for Mental Health and Development, composed of 128 civil society organizations and individuals demands, adequately funded mental health services and policies, as well as specialist services for young people.

Inaccessible environments prevent people with mobility impairments from fully participating in society. The Ghana Society of the Physically Disabled took legal action in 2014 over the construction of Madina-Adentan footbridges because of its many steps.

By late 2018, it appeared that they would have to sue the government for contempt of court because it was ignoring court rulings to require disability accessibility. This campaign has reflected a ‘social model of disability’ (Oliver, 1990). In this model, barriers in society (and not the disabled individual) are the locus of the problem (Mallett

& Runswick Cole, 2014). As Shakespeare, (2014) notes, the social model is crucial to the disability movement for two reasons: 1). it identifies a political strategy (barrier removal); and 2). it emphasizes to disabled people that society, not disabled people, are at fault.

Campaigns by the Ghana National Association of the Deaf also aim to break down disabling barriers. For instance, they have stressed the ways stigma and communication barriers prevent Deaf people from accessing healthcare. Prejudice and ignorance about being Deaf (and assumptions that lack of hearing equals intellectual disability) are also the focus of their advocacy. They have responded to this problem by providing training for health workers.

While the obstacles that people with disabilities in Ghana face are well- documented, there lacks a unique perspective of disabled people who are also leaders in disability organizations is lacking. This study explores the perspectives of disability leaders about the key issues for disabled Ghanaians. Disabled people are often denied legal rights to social and economic participation due to disabling barriers in education, employment, and social inclusion (Grischow, 2015). The study will highlight economic and cultural dynamics within Ghana such as chronic poverty, and unique cultural beliefs that disabled people are cursed. It will demonstrate how these issues relate to the Social

Model of Disability.

2.2.0. Theoretical Perspective and Model of the Study

2.2.1. Social Model of Disability Theory

The social model of disability is a theoretical approach which developed out of

Marxist social theories about the ways in which people who are not working are oppressed in capitalist societies (Oliver, 1990; Shakespeare, 2014). One of its main originators, the Union of Physically Impaired Against Segregation (UPIAS), a group of disabled people in the community believed it was important to separate what they called

“impairments” (medical conditions) from “disability” (negative social reactions to impairments) (UPIAS, 1970).

Mallett & Runswick-Cole, (2014) discuss how disability can be studied through national and international perspectives, policies, culture and history. In particular, they explained how the Social Model of Disability emphasizes that society and not the disabled individual is the locus of the problem. It locates disability within the environment and not the person. According to Oliver, (1996), WHO and OPCS schemes

while acknowledging that there are social dimensions to disability do not see disability as arising from social causes. The objectives of the Social Model are identifying the need for barrier removal (Shakespeare, 2014), improving the ways disabled people see themselves individually and collectively by undoing social processes that blame individuals for their social exclusion, and shifting discussion about disability from medical sociology towards a study of disability that explores social and cultural processes

(Oliver, 1996).

The social model perspective explains disability as resulting from disabling social, environmental and attitudinal barriers rather than lack of ability (Ansell, 2016;

Crow, 1996; Oliver, 1996; Shakespeare, 2014). This then demands for the removal of physical, attitudinal, institutional or legal barriers to the participation of disabled persons

(Oliver, 1990), since persons with similar impairments, but in different societies may not experience same barriers.

2.2.2. Union of Physically Impaired Against Segregation

The Union of Physically Impaired Against Segregation (UPIAS) was a groundbreaking grassroots disability organization in the UK. Its publication of “The

Fundamental Principles of Disability” in 1976 brought to birth the social model. One of the most significant contributions which it made is separating “impairment” from

“disability”: It stated that: “In our view it is society which disables physically impaired people. Disability is something imposed on top of our impairments by the way we are unnecessarily isolated and excluded from full participation in society” (UPIAS, 1976 p.14). To understand this, it is necessary to grasp the distinction between the physical impairment and the social situation, called 'disability', of people with such impairment.

UPIAS define impairment as lacking part of or all of a limb, or having a defective limb, organ or mechanism of the body and disability as the disadvantage or restriction of activity caused by a contemporary social organization which takes no or little account of people who have physical impairments and thus excludes them from participation in the mainstream of social activities (UPIAS, 1976). Physical disability is therefore a particular form of social oppression (Oliver, 1996).

This distinction between impairment and disability has been used by many disability studies scholars and disability activists (Mallett & Runswick-Cole, 2014;

Oliver, 1990, 1996). It is promoted by many disability agencies and accepted in government policies in some countries in Europe such as the UK (Priestley, 1999).

Shakespeare, (2014) believes that one reason why the social model became so popular among disabled people is that it not only explained their lived experiences of oppression, but it also gave them an immediate political strategy, a demand for barrier removal, which would increase the rights and inclusion of disabled people. He summarized this argument by saying that if the problem is not that people have impairments, but that they are disabled by society, then the immediate demand must be the transformation of society in order to remove these barriers. He also stressed that this insight is liberating for many disabled people who had blamed themselves and internalized their oppression. “Suddenly, people were able to understand that it was society that was at fault, not them” (Shakespeare, 2014, p. 13). He also said that the social model helped move disability research away from individual issues such as how people cope with their impairments onto wider issues such as the discrimination they experience, and the social and cultural practices which affect their lives.

The present study applies the Social Model of Disability to the experiences and views of leaders of disability organizations. Recognizing that the Social Model of

Disability was created originally by scholars using a Global North perspective, this research is sensitive to this theory’s applicability to the Ghanaian context. The next chapter describes the qualitative method used to make meaning of disability experiences in Ghana.

Chapter Three

Methods of Data Collection

Introduction

This chapter presents the methods used in the present study as well as ethical issues. To gain an in-depth understanding of the experiences of Ghanaian people with disabilities, I employed a qualitative approach. Specifically, I collected data through interviews, given this method’s ability to facilitate the exploration of participants’ experiences and the meanings that they give to them.

3.1. Philosophical Underpinnings

The methods of this study are guided by the interpretivist paradigm, which is concerned with understanding the world from the subjective experiences of individuals.

A main goal is understanding the meanings that people give to their experiences

(Schwandt, 1994). Based on this framework, the present study sought to explore the general situation of disability in Ghana through the subjective experiences of the participants of the study.

3.2. Reflexivity of the Researcher

I was motivated to conduct this study by my personal interest in the lives of my disabled friends. I decided to conduct research that has the potential to inform viable policies that could better the lives of disabled people in Ghana and global south countries, in general. Also, I believe it is necessary to develop culturally specific understandings of disability and culturally-specific responses to the problems disabled people in Ghana face. During the period of data collection, I was actively involved with one of the disability organizations, and I was invited to their general quarterly meeting. I intend to

present results and policy recommendations from this study to the Department of Social

Welfare (DSW) and other appropriate agencies.

Because of my background, I felt an obligation to ensure that participants’ experiences were adequately represented in the study. During the fieldwork, I recognized and acknowledged my privilege as a graduate student in the United States, but I was able to relate to participants’ responses in line with the interview guide. Being able to understand the Ghanaian culture and the contextual aspects of the experiences of some of the participants helped in the data collection, analysis, and results of the present study.

For example, I understood Ghanaian parlance expressed by participants, during interviews and had no difficulty during coding and analyzing of such expressions respectively.

3.3. Study Area

This study was conducted in Accra, Ghana. Accra is the capital of Ghana and also the capital of the Greater Accra Region, one of the sixteen regions in Ghana. Accra has ten districts and it is the Greater Accra Region’s economic and administrative hub. The local languages widely spoken are Akan and Ga. Rural-urban migration has led to high population growth and congestion in Accra. Accra has a total population of 4,010,054 as at September 2010 (Ghana Statistical Service, 2012). Accra has a youthful population, with 56% of the population being under the age of 24. Fifty-one percent (51%) of the population is female with 49% being male. The 2010 Population Census found that the

Greater Accra Region has 14.1% of persons with disabilities in Ghana (Ghana Statistical

Service, 2013). The study site was at the offices of the Ghana Federation of Disability

Organizations (GFD) located at Barnes Road, Accra. GFD is a civil society organization

which brings together the key organizations of persons with disabilities in Ghana. The work of the GFD is geared towards ensuring that persons with disabilities have access to education, health, employment, recreation, the built environment, justice, information and governance.

3.4. Data Collection and Procedure

To recruit participants, I obtained e-mail addresses from the various disability organization websites associated with the GFD and sent an e-mail to leaders, explaining the purpose of the study. Only individuals who were 18 years and older and held a leadership position in a disability organization under the GFD were recruited. I collected data through face-to-face interviews with disability organization leaders. Given that all but one of my participants were disabled, I interviewed them in ways that accounted for their disability accommodation needs. For example, a sign language interpreter was used with deaf participants. I conducted a total of 24 interviews that lasted from 40 to 60 minutes.

Prior to beginning the interviews, I explained the aims of the study to the participants and informed them that agreeing to participate, or not, would not attract any financial rewards or punishments. Additionally, I informed the participants that they could stop participating at any time during the interview, and there would not be any consequence. Only individuals who provided their informed consent were included in the study. The languages used in conducting the interviews were English and Ga, which was possible because I am fluent in both languages. Ga is a Ghanaian local language widely spoken in the study area. As previously mentioned, sign language interpreter, who was an instructor at a school for the deaf, interpreted interviews with deaf participants.

3.5. Instruments

A semi-structured interview guide was used for the study. The guide had 19 questions. However, I asked additional follow up and probing questions when appropriate, in order to obtain in-depth insight and clarifications. The questions focused on exploring the general situation of disability in Ghana, including the disability organization that the participants were involved in, and personal experiences of participant, as a person with a disability. I used a digital voice recorder to capture interviews for analysis, as well as a notepad and pen for notetaking.

3.6. Sample Participants

The participants were selected through purposeful sampling (Patton, 1990), which means that based on the objectives of the study, I relied on my judgment in selecting participants. The main criteria were that for an individual to be selected to participate, they must be 18 years and above and hold a leadership position in a disability organization under the GFD. The participants in this study were 24 disability organization leaders, which included 15 males and 9 females between the ages of 25 and

60. The participants were recruited from various associations under the Ghana Federation of Disability Organizations (GFD) via e-mail. These associations are the Ghana Society of the Physically Disabled (GSPD), the Ghana Blind Union (GBU) and the Ghana

National Association of the Deaf (GNAD). The sampling strategy used for selection was a purposive one. I was able to recruit participants of various ages, genders, and in different leadership positions, to provide a range of different experiences and perspectives.

3.7. Data Analysis and Transcription

First, I transcribed the audio recorded interviews verbatim. Since the participants were assured of their identities being confidential, I used pseudonyms to replace the real names of the participants. I read through each transcribed interview from the beginning to the end to get the main idea. Then, I reread each transcribed interview to increase familiarity with data. With each reading, I paid attention to keywords and highlighted texts that indicate significant instances of social experiences of persons with disabilities. I then generated initial codes and organized them into potential themes. Next, I re-coded some preliminary codes as the analysis process proceeded. After coding all transcribed interviews, I associated quotes with the codes, merged similar codes, and grouped them into broader themes. I put other codes into sub-categories depending on their themes. The next step was to ensure that responses coded into a theme represented a coherent pattern.

Therefore, I analyzed the data to be sure important ideas are not missing and that the themes connected.

3.8. Ethical issues

Ethical considerations are a major part of any research involving the use of human subjects. There are often specific ethical issues dealing with disabled people, particularly those who have experienced mental illness or those with intellectual disabilities. In line with the regulations and guidelines of The University of Toledo, I completed the CITI training and have received ethical approval from the Internal Review Board (IRB).

Approval was also received from the Ghana Federation of Disability Organizations

(GFD).

For the purpose of obtaining informed consent, I explained the specific aims and procedures involved in the study and the roles to be played by participants. I assured potential participants that they reserved the right not to answer any question, if they felt uncomfortable, and that they could also withdraw from participating in the process at any time. I also made known my identity to the participants. To some participants, I read this informed consent in the Ghanaian local language prior to conducting interviews, after which written consent was signed. Even though, generally, participants were enthusiastic about participating in the study, some of them welcomed me with reproof. Their reason being that they have granted many such interviews regarding their concerns and experiences in the past and promises were made to address these concerns, yet nothing has been done. Again, I had to assert that the work was meant for academic purposes only.

Chapter Four

Results and Discussion

Introduction

This chapter analyzes data from qualitative interviews with Ghanaian people with disabilities to explore their social experiences and conditions in Ghana. The analysis produced five major themes. They are the following: 1.) Cultural beliefs impede social integration, 2.) Government structures perpetuate disability injustice, 3.) Institutional barriers violate human rights, 4.) Mobility issues restrict independence, and 5.) Family and community exclusion.

4.1. Cultural Beliefs Impede Social Integration

In Ghana, disability is seen as a curse and as atonement or punishment for sins committed, which may result in banishment from society and difficulty in finding a romantic partner. In general, participants seemed unhappy with disability explanatory models that link disability to evil spirits. Most participants asserted that this cultural belief impedes their social integration, and they expressed frustration with how this notion adversely affects every aspect of their social life.

4.1.1. Disability Seen as a Curse

Many participants discussed their displeasure about the popular belief that they are disabled because they have been cursed. They revealed that most people that they meet perceive that they are cursed. This finding is consistent with a study by Amenyedzi,

(2016), which revealed that negative cultural attitudes about disability are widespread in

Ghana and disabled people are seen as cursed. When asked about the overall situation of disability in Ghana, Dan said:

So, it is like when you are disabled in Ghana, you are a curse and people tend to forget that an ‘abled’ man is the one who becomes disabled tomorrow, so if you look at how they treat us, it is unfair.

Gina also added:

And they regard disabled persons as a curse and relating disability to spiritual. But there is a little awareness and so I think these things are going down. So, our cultural beliefs have negative effects on disability.

Participants seemed to suggest that these negative cultural attitudes towards disabled people are caused by the traditional and the religious institutions in Ghana.

According to participants, some traditional leaders refuse to meet disabled people and deny them access to the chief’s palace due to negative cultural belief about disability. The chief’s palace is the traditional political office and official residence of the chief. One of the major roles of the palace is the settling of disputes among its people. For example, according to Diawuo & Issifu (2016), the Manhyia Palace has been successful in resolving 80 percent of the traditional land conflicts in the Ashanti Region. Denying disabled people access to the chief’s palace reinforces negative cultural attitude about disability. For example, Kwashi said:

There are some chiefs who don’t want to see a disabled person in the morning and also some palaces that do not allow disabled people access in that palace.

Similarly, Amos stated:

Most chiefs in Ghana believe that disability is spiritual or associated with bad spirit and these chiefs do not allow or entertain disabled people in their palaces. It is also a belief that disability is a curse.

However, not all participants agreed that this cultural belief prevents access to the chief’s palace. For example, Adjei, a linguist (spokesperson for a chief) at a traditional palace, who also serves as a patron to a disability organization asserted that there are no such negative cultural attitudes against disabled people as far as his community is concerned. He said:

There are no traditions that prevent disabled people from access to the chief’s palace. No! Then maybe other places but not here in my traditional area. If anyone tells you disabled people are not allowed in the palace, tell the person it is not true. We love them and we are living peacefully together with them. So, if you have any help then you make us aware then we see how to go about it. I am very happy that you are carrying out this research here.

Adjei further added that a new palace is being constructed and it is disability friendly. He stated:

That is why we made sure that the new chief’s palace we are building is disability friendly. We are aware that they have difficulties walking and climbing a lot, so we have reserved a column (space) for them.

Participants stated that disability is also linked to witchcraft. This appears to support findings in a study by Agbenyega, (2003), specifically that cultural attitudes attribute disability to “witchcraft, sorcery, juju and magic”. Most of the participants recounted experiences of being accused of witchcraft. According to participants, among the disabled, blind people are more likely to be accused of witchcraft. Kwame said, for example:

Even the ladies, within a short time they are told that they are ‘baayifuor’ (witch).

When a blind woman does something by herself, people will say she is a witch because a blind person could not do that. Because for some of them, they pound their fufu, make banku, okro stew, they make everything. They wash, iron clothes, do everything. So, they say you are a wizard because they see you doing these. But it is about calculations.

Another participant said:

As for that, it happens most of the time. Someone in this neighborhood even insulted a friend with that assumption. The person said my friend is a wizard, and something was used to chuck (pierce) his eyes in an attempt to chew ‘meat’ at their

(wizards) meeting. I was really sad when the person insulted my colleague that way. So, me I have seen it personally.

Abigail, a deaf participant also shared a similar experience:

People think if you are deaf you are a witch or you are deaf because a witch made you to be deaf, so it is true that people associate deafness to witchcraft. It is not true, but many people believe it.

Disability is also associated with bad luck and people may avoid meeting a disabled person due to this perception. Adam, a physically disabled man shared his experience:

Me I have worked, and I am working with a lot of people, but I clearly see it, how they react. Some even feel that when they meet you, they will get bad luck for the day, disability is associated to bad luck.

Adam’s statement testifies to the overtness of abled people avoiding disabled people. In other words, this discriminatory response is often blatant and appears to be the norm.

4.1.2. Disability Seen as Atonement or Punishment for Sins Committed

Many participants said another cultural belief that hinders social integration of the disabled is the fact that disability is seen as punishment for sins committed either by parents of the disabled person or by the disabled person themselves. They believe that people have the perception of disability being as a result of punishment for sins committed.

Araba and John recounted a more personal experiences related to this issue.

Araba said, for example:

Oh, they say it is because of sins my mother committed and that is why I was born disabled. Personally, some people use that to insult me.

To be noted in Araba’s case is how this belief is used as a put down.

Along these lines, John recognized the discrimination that stems from this notion. He said:

People say that I am disabled as a result of my evil deed. There is a lot of discrimination against we disabled people.

Here again, the participants express that the discrimination that they experience is influenced by cultural beliefs, particularly those that are religious in nature. What became evident is that religion serves as the main cultural frame for explaining disability. From a religious perspective, sinning is a causal factor of disability. Because sinning is considered negative, the consequence, disability, is also viewed undesirably.

4.1.3. Divine Healing

According to deaf participants, their parents appeared to rely on their Christian faith for divine healing. They recounted experiences of being taken to pastors in other to be cured of their impairment. This implies that their disability was believed to be caused by evil spirits and that by prayer, they could be exorcized. In other words, explanatory models that emphasized supernatural causation likely influenced beliefs about treatment and help-seeking behaviors. Narratives from participants are similar to what Anwar,

(2017) has noted that disabled people are taken to religious places for healing. Yet, participants did not share the same explanatory models as their relatives and religious specialists. Deaf participants reiterated that they believe deafness is not caused by evil spirits or witchcraft and therefore cannot be cured with prayer.

Prisca said:

We all have the experience of being sent to a pastor and forced to become hearing and it does not work, it is not anything that can happen. When it started, I was taken to a pastor and they tried to force me to become hearing, but I was like I am happy deaf, I don’t need to become hearing.

In a similar way, Ken explained:

When I became deaf, my parents took me to a Pastor and he was trying to change me to become a hearing person, no one likes to stay deaf. Being deaf is fine but the government has to improve because if you are deaf, you are totally normal, it just depends on how much the government is willing to support you.

Important to note is how the participants expressed that they are often confronted with social pressure to become able-bodied. Nevertheless, they sustain personal acceptance of their disability. Mavis stated, for example:

I like to be deaf. I am free, I don’t have to hear anything, I sleep freely, no one disturbs me, so I am happy to be deaf.

As Mavis noted, she is “happy” to be deaf. What became clear is that many participants are comfortable with their disability even though they experience society telling them that they should not be.

4.1.4. “Fake” Pastors

In a follow-up question as to why they do not believe in the act of healing, deaf participants described the pastors who claim to cure them of deafness as ‘fake’.

According to them, they deceive parents of deaf people to extort them. According to Ato, the alleged pastors present hearing people as deaf and later claim to cure them by praying:

They (pastors) show fake miracles, that is how we see them. They will bring in a hearing person pretending to be deaf, so everybody will be watching and they will be like yes, I am deaf, I am deaf and then all of a sudden the pastor will pray and then he will start speaking. But they were hearing all along, just pretending to deceive people. I have never before seen a deaf person become a hearing person in my life and now until forever, I will never see one. How can a deaf person become hearing? It is just not possible.

From participants’ descriptions, they seemed to point out the physical pain one may endure during this process for divine healing. Abigail, for example, shared her experience during one of these prayer sessions for divine healing:

My parents were worried that I was deaf and they were praying and I said my ears are swelled and that it is okay, it is fine and my parents were still forcing me and I was like I am deaf, just accept it. I was like I am tired, so these pastors deceive people.

Mavis also added:

Some people think you have an evil spirit inside you and that is the reason why they take you to the pastor. So, they think you became deaf because you have the evil spirit, so they take you to the pastor for the evil spirit to be taken out of you and deaf peoples’ parents are like okay, that makes sense so let’s do it. We go and the pastor just screams at you for a while and we are still deaf. The pastors deceive our parents because they pay them money to do it and we still remain deaf.

Abigail and Mavis’ use of the phrases “just scream at you,” and, “my ears are swelled,” seemed to suggest that excessive noise is made during these prayer sessions.

This may have physical and psychological implications on deaf people who go through this activity.

Deaf participants from time to time reiterated their position that deafness cannot be cured. In line with this finding, a research by Kpobi, & Swartz, (2019), also revealed that none of the participants, who were medicine men and pastors, claimed to be able to cure intellectual disability. To deaf participants, the government must support them by helping to break the communication barrier that they face in society.

4.1.5. Banishment from Society

The spiritual dimension of these cultural beliefs associated with disability can have extreme consequences for disabled people and may lead to banishment from society and infanticide. According to several participants, a disabled infant may be banished from society at birth. Below is a short story told by Selina, a physically disabled woman. She summarizes the depth of the issue of banishment that happens in some communities:

Yes, just around, just around where I live there was this young girl who was pregnant, I heard she gave birth and then the next 3 to 4 months I saw her walking alone so I asked that where is her child? They said ‘) y3 nsuo ba nti )mu ak) gya nu kwan” ( the child is a river child so they went to see her off or banish her), you understand. They said the child only cries at night, the child was behaving funny and all that so per their description, we realized that probably the child was suffering from cerebral palsy. But because of how our culture or society perceive the disabled, they said )y3 nsuo b anti )mu ak) gya nu kwan” ( the child is a river child so they went to see her off or banish her). So, she also went to ‘gya the baby kwan’ (Banish the baby).

This story is similar to what was revealed in a research by Avoke, (2002) which reported that children born with intellectual disabilities were generally believed to be

‘children of the rivers and forest’ in many communities in Ghana. Such children are sent back to the rivers or to the forest with the belief of helping them ‘to go back to where they came from’ (p.773). In Ghana, a child born with intellectual disabilities or cerebral palsy is mainly described as a river child.

Some participants, while admitting that banishment of children with disability exist in some communities in Ghana, added that it is now a thing of the past. For

example, according to Kwashi, a physically disabled man, this is due to awareness of disability.

In past times disabled people are not regarded as persons but now disabled people are regarded in society. Sometimes past children born disabled were regarded as animals or from evil spirits and so were banished from the society but now due to awareness on disability, that practice no longer exists in Ghana.

In this research, the narratives of banishment involved only children born with cerebral palsy. Persons with cerebral palsy are regarded as coming from an evil spirit

‘nsuo ba’ and therefore, the belief that they must not live among humans. For this reason, they are “escorted out of the community,” as one participant stated.

4.1.6. Difficulty in Finding Romantic Partner.

Finding a romantic partner is a major concern for people with disabilities, because the general belief is that no one wants to marry someone with a disability. Afia described this situation in detail:

Yes, that is one of the major problems with living with disability because as a disabled person, to get a partner in life unless you get someone who will understand your situation, who is willing to be with you. So, getting a partner as a disabled person is very difficult because it is not everybody who will understand your situation to be with you and help you at home so getting a partner is one of our major problems.

The issue of finding a romantic partner is due to the difficulty in finding someone who will accept one’s disability status and be willing to live in solidarity with a disabled person. The reason for the issue, according to most participants, is the belief that disability is linked with evil spirits. The perception of disability being a curse and caused

by evil spirit makes it difficult for disabled people to build loving relationships or get marriage partners who are non-disabled. Based on the participants’ perception, individuals are not willing to associate with disabled people, let alone to choose them as partners.

Amos seemed to suggest that able-bodied people do not associate with disabled people because of the fear of being stigmatized by society. He said:

I have observed something. That the person will feel that moving with someone like me, the people will ask, so they have not seen anyone to walk with and this is the person you want to walk with. So, perception from the society, the perception that what will the society say about me, seeing me moving with this disabled person, what will the society say? So discrimination is there.

According to the participants’ views few people decide to choose a disabled person as a partner, and they are very likely to face objection from family and sometimes the society at large. In other words, it is a common practice that the family of a non- disabled person, rejects his or her decision to marry a disabled person. For example, Kofi, a physically disabled man, recounted how the family of a non-disabled woman he planned to marry rejected him. According to him, he was described with the Akan word

“musuo” (which literally means an abomination as an abomination). The use of the word

“musuo” to describe a disabled person is hate speech and reveals there is disrespect for disabled people.

There was one time a lady took me to her house and the family said, ‘wo di musuo aba fie’ (you have brought abomination home). When a lady decides to marry a disabled man, the family will object and tell her that upon all the men in town, she could

not choose any than a disabled man and what at all has she brought home. That is the situation, and also, the ladies who are blind face challenge.

This finding is similar to one in a study by Geurts & Komabu-Pomeyie, (2016) which highlighted oppressive cultural attitudes and stereotypes. This study also shows the unique cultural beliefs that disabled people are cursed, affect how families strongly discourage a person from choosing a disabled person as a partner.

Disabled people therefore are uncertain of being accepted by the family of the partner. Gina stated:

I feel that the man will even be anxious whether his family will be happy with his choice of marrying me but even we the disabled are dignifying than the ‘abled’.

Her use of the phrase “but even we the disabled are dignifying than the ‘abled’” may imply that people perceive disabled people as not living a life of dignity.

When participants were asked why people with disabilities have difficulty with finding romantic partners, they gave varied responses. But according to most participants, disabled men are shy to approach non-disabled women to express their interest in them.

They explained that this feeling is because there is the fear of being rejected by women and so they tend not to try at all. Joe described his experience as the following:

But at first, I was scared of approaching girls I admired, when I was a teenager. I felt the girls may turn my proposal down and so to avoid any insult or embarrassment, I did not propose love. There is a lady I loved but I was shy to tell her my feelings so we have been friends but she later realized I loved her and she said why didn’t I tell her because there is no harm in asking her out even if she declined the proposal.

According to Joe, people believe he uses ‘juju’ (magical powers) to get non- disabled women to love him. This perception is depicting how disability is linked with evil spirits. It is in tandem with Agbenyega’s, (2003), study which found out that cultural attitudes attribute disability to witchcraft, sorcery, juju and magic.

Sometimes people ask if I am using ‘juju’ to get these ladies to love me but no. It is because I firstly become friends with the lady, and she gets to know me better. When the ladies get close to me, they realize I am hardworking and with a vision. So, when I propose love, she will accept. But you don’t propose love to the lady at an early stage when she does not really know you. I have been trying to convince my friend to use this trick to get a partner but still he is not able to do that because he is shy.

It is common that disabled women have children with more than one partner. The situation of disabled women with children but no husband is widespread. From their accounts, this seemed to suggest two main things. Firstly, that the men did not love and understand them and/or they refuse to perform responsibilities as a husband and more importantly a father. Disabled men also experience the situation of their non-disabled partners leaving them as Selina explained:

Some men also run away from their wives because they are disabled, they don’t understand your needs as a disabled and are not ready to understand. It is difficult if you don’t get someone who really understands you. Sometimes this makes it difficult in terms of marriage because when you look at disabled women in Ghana, only a few have husbands. Most of them have given birth to children whose fathers are nowhere to be found. The disabled men too, have children with women who have subsequently left

them so if the person does not really love and understand you, they will leave you after childbirth.

Kofi attributed the situation of single parenting to sexual exploitation of disabled women by some non-disabled men. He said:

Most of the ladies with disability always look pretty, so what the sighted men do is that if they get to them and are able to convince them (disabled ladies) to accept their love proposal, they impregnate them and run away. And I have been hearing it on the radio.

Participants explained that many marriages between disabled and non-disabled people do not last. They seemed to hold the belief that romantic love relationships between two disabled people are more sustainable and common. The quotes below express the trouble perceived in relationships between a disabled and non-disabled person.

Deaf people and hearing people don’t really fit together. If it is deaf and deaf person, it is no problem but if it is deaf and hearing person, then it is a serious problem. If the hearing person is serious, then it (relationship) can work. (Prisca).

I have dated 5 hearing people in the past. They are very handsome. If the hearing person can sign, we can marry but they cannot sign and that is a problem. (Mavis)

If it is between two deaf people then it is not difficult, but if it is between a deaf and a hearing person, then it is very difficult. It is because of the communication barrier, maybe if you want to say something but the hearing person cannot hear. I had an experience with a hearing girlfriend. One week it was fine, two weeks, three weeks it was fine and then I saw something changing. All hearing people have the same purpose, their

purpose is like they want to hear you and hear your voice. But you cannot say anything, you can only sign but they want to be hearing you. (Ken).

Yet, it also appeared that participants believe that disabled people prefer non- disabled partners. This could perhaps be that disabled people have internalized the social stigma against them. The response below perhaps means that, from their perspective, the ideal partner is a non-disabled person, and one only “settles” on a disabled person after an unfruitful search for a non-disabled partner. Freda explained:

It is only a few disabled people that are able to find partners that are ‘abled’. If you try for so long and you are not getting an ‘abled’ partner, then you have to settle for a fellow disabled for partner. Unless you are a lucky person before you can get an ‘abled’ partner.

Most participants believed that it is easier for disabled men who are working and have some money to find romantic partners. Joe explained:

It was initially that I thought it is impossible for a disabled man to find love but now I have realized that if you work hard and have job to do, you will find love. But if you go on the streets begging then the ladies will not mind you when you propose love to them. Even if you are selling iced water the lady knows you are working but if you are begging she would not accept because she would feel shy marrying a beggar. It is all about confidence, don’t think you are a disabled man so when you ask a lady out, they will decline your proposal. If you always feel shy to approach a lady because of your disability, you will remain single. If not for lack of money, I can choose to marry any type of lady I want anytime.

The theme, cultural beliefs impede social integration, can be understood in terms of explanatory models of disability in Ghana, (i.e. beliefs about the nature, causes, and recommended treatment of disability) which create barriers to social inclusion. A study by Kpobi, & Swartz, (2019), also emphasized the importance of explanatory models in

Ghana. The authors found that some participants believed intellectual disability could be caused by spiritual machinations. The participants in the study, who were medicine men and pastors, suggested that a child may be born with intellectual disability, as a result of a curse that ran through the family. According to this study, a few participants believed that the child’s intellectual capacity may have been traded for wealth and/or status by their unscrupulous parents. There is also the belief that evil spirits, Jinn,

and curses could be used to inflict epilepsy on a person, and these views were common among pastors, and traditional healers (Kpobi et al., 2018). These beliefs marginalize disabled people by fueling social stigma; and as participants described in this study, put them at risk of abusive treatments and banishment from society.

4.2. Government Structures Perpetuate Disability Injustice

There are disabling barriers that deny disabled people’s legal rights to full social and economic participation. Participants seemed to express their dissatisfaction on how government structures fail to work efficiently. The major governmental policy that was of concern to participants was the three per cent of the District Assembly Common Fund

(DACF) allocated to persons with disabilities. The issues to be discussed under this theme are the insufficient amount of funds disbursed, delay in disbursement of funds, the bureaucratic process in accessing funds and alleged discrimination and corruption by government officials in the disbursement of funds.

4.2.1. Insufficient Amount Disbursed from the Common Fund

All the participants considered the amount disbursed from the common fund not enough to adequately support them. The common fund is purposely disbursed for disabled people to establish a small business to financially support themselves. Most disabled people are unable to use the fund for its purpose and added that it should be increased. The procedure requires disabled people who apply for funding to prove that they are disabled and state for what they need the funding. The amount disbursed to each successful applicant varies, depending on how much the individual requested and how it is going to be spent when granted. The participants reported to have received between

200 cedis ($38) to 1,000 cedis ($200). Even though the fund disbursed is not enough, most disabled people depend on it for financial cushioning. This is because most of them are unemployed and have no other source of income. Afia shared her view on the common fund policy:

Even when common fund is disbursed, you are not given the amount you requested so that you can do something small to support your family. The money you are given is not enough. Now when you even want to buy a table to be used for selling, it is over 200 cedis and you receive a common fund of 200, 400 or 600 cedis. What can you do with it? So, they should give us enough money so that one can even purchase a small container (store) and sell takeaway rubber packs or buy a fridge and sell pure water, so that we can also get enough to support our children in school.

Participants suggested an upward adjustment in the amount paid to them from the common fund. Joe for example said:

If they give us at least 1,000 cedis it can help us to establish something sustainable but 300 and 400 cedis is not enough.

Participants gave the impression that most disabled people intend to use the fund for its purpose of disbursement, that is, to establish a small business to financially support themselves.

4.2.2. Delay in Disbursement of Common Fund

The fund is supposed to be disbursed quarterly but there is often delay in the disbursements. According to participants, it may take a year or longer. Participants commonly expressed that their experience in receiving funds involves a long waiting process. For example, Nii revealed that he has waited over a year;

The challenge is funding; the common fund is disbursed once in a whole year instead of quarterly disbursement. This year we have seen nothing. We have seen nothing, and the days are going but we are waiting.

The delay in disbursement of funds occurs in two stages. First, there may be a delay in the quarterly payment of the five per cent of the total revenues of Ghana to the

District Assemblies for development. In this case, there would be no funds to be disbursed to disabled people within that period. The second stage of delay in disbursement is not as a result of unavailability of funds but, seemingly, due to a principle adopted by a monitoring committee that reviews applications for funding by the disabled. From their accounts, they explained that because there are not enough funds to be disbursed to all documented disabled people, an applicant who received funds during a period of disbursement may be ineligible for funding the following period. The purpose of this criterion is to make sure most disabled people get access to the funds. However, as

participants expressed, this criterion also means that may have to wait several years until they receive funding again. Regarding this issue, Jonathan said:

The last time I received was 4 years ago. No, I think it would get up to 5 years, yes. The money is not given to you every period of disbursement and it does not come in time.

The money received from the common fund no matter how little, is very crucial to providing an economic safety net to disabled people. Therefore, the delay in its disbursement causes a lot of financial and social discomfort. Araba, narrated how the delay in disbursement adversely affects her:

The delay in common fund disbursement is too much. I have 3 children; one is in senior high school and the two are in junior high school. They are all at home now because all were sacked for non-payment of school fees. So, if the common fund was disbursed, I would have gotten some money to do some business but for a year now, we have not received the common fund.

In Araba’s case, the delay in disbursement had a domino effect in that the lack of funding resulted in additional school fees, due to non-payment. Had there not been a delay, Araba may not have had to carry this extra economic burden.

4.2.3. Monitoring

Successful applicants who receive funds are subject to accounting for how the money was used. The Disability Fund Management Committee made up of some disability organization leaders and officials of the district assembly undertake monitoring of beneficiaries. The committee undertakes this activity to get information on how the fund is being managed by the beneficiaries. Most beneficiaries of the fund use money to

establish a start-up business. They mainly open small shops to sell sachet water and other basic items.

During this exercise, they visit beneficiaries mainly at their workplaces and assess how the fund has been used. This is to regulate and make sure disabled people are using the funds appropriately. From their responses, participants seemed to be against providing receipts of purchases as part of the monitoring process not because they do not want to but because doing so is not always possible. The reason is that they are not always given receipts from vendors for their purchases. Moreover, when they submit the receipts that they have, the Fund Management Committee is likely to deem receipts as fake. Fred explained:

Now they said we should provide receipt for any purchase we made with the common fund money given us, but when you submit the receipts, they say it is fake.

Brother if you look at me, can I forge a receipt? No I cannot.

These issues, could, perhaps be a result of beneficiaries indeed forging and presenting fake receipts of purchases. One participant revealed that some beneficiaries sit in front of someone else’s shop pretending that it is theirs during the monitoring process.

Participants shared that there is a new policy in which the government is considering providing disabled people with in kind support for start-up business instead of cash. With this policy, disabled people who apply for funds are given the goods and services that they requested, instead of cash. Notably, most applicants said that they apply to use the funds to make a purchase (e.g., a fridge). while a few said that they apply to use the money to pay for a service (e.g. school fees and/or medical bills). The participants

also disagree with this policy. According to them, they prefer to be given the money, so that they have the opportunity to decide how to manage it. For example, Afia said:

Now, government is bringing a new policy that they buy us what we need instead of giving us the money, but how will government know what exactly I need? So, they must give us the money so that we ourselves buy what we need.

Participants seemed to suggest that regardless of what they have been given by the government, they would still need more funds to make their business fully operational.

4.2.4. Alleged Corruption in Disbursement of Funds

Some participants alleged that some government officials at the district assembly engage in discriminatory and corrupt practices in the disbursement of funds. They seem to imply that there is delay in disbursement of funds, because some leaders in charge of disbursement withhold the fund for their own interests. According to them, they invest the funds intended to be given to disabled people in their own businesses. Participants who made this allegation when asked if they could share evidence, if they had any, declined, stating that they want to desist “mentioning names”. For example, Mavis said:

As for me what I have observed and seen is that when the fund is released, those leaders use it to do their business, they use it to do their business for a very long time until they see that you the disabled becomes serious and confronts them before they disburse.

Mensah also explained:

The government may have released the funds in January but will be disbursed to us in say, June, July, August or September, but meanwhile it was announced that the

money was released by the government. So, the money will be released, and they will use it for their business until the time they feel like disbursing to us.

Likewise, Adam said:

But what the state will use to support people with disability does not get to the ground, when even it goes, it does not go down quickly or at the time in need because a lot of hindrances and big man wants his people to benefit and others want to benefit.

Adam’s quote implies that aside from the alleged corruption by some officials, there is also discrimination during the disbursement of funds. His use of the phrase “big man wants his people to benefit,” suggests that some officials may want funds to be disbursed to their favorites.

4.3. Institutional Barriers Violate Human Rights

The findings of this section relate to how participants experience institutional barriers that violate their human rights. According to the United Nation’s

Universal Declaration of Human Rights, articles 23, 24, and 26 identify that everyone has the right to work, health care, and education respectively (May, 2017). These articles serve as the basis for the following subsections.

4.3.1. Employment Barriers

Unemployment was one of the most common concerns among the participants interviewed. Most of the participants were unemployed because, as they argued, most employers are not willing to employ a disabled person, due to the perception that a disabled worker would not be productive. This may be the case even if the disabled worker is physically capable of doing the job. For example, John said:

I am fit, but when you get to the work field the employer will look at you and say you are not fit for that particular job so you will be declined the job offer. You will be dismissed.

John’s experience reflects how the disabled worker is considered physically unfit or lacking the strength to do any physical activity and, therefore, overlooked by employers. Kwame expressed a similar scenario. He said:

When they look at you, they think you have no strength to do the work so they will dismiss you from the work.

Participants also described how disabled applicants often get denied employment, even when they meet job requirements such as education level. According to Ken, a deaf participant, employers use disability as an excuse for not hiring:

So, if there is a good job and even you have all the qualifications, they won’t vet that person. They always use the excuse of communication. For example, if I want to be a banker and I have the perfect qualifications more than a hearing person but they will just say oh sorry, how are you going to communicate with people and so they use that same excuse of communication in denying me. So, mostly there is discrimination.

According to some participants, disabled people compete with non-disabled people for jobs, and employers always hire the non-disabled. Kwame explained, for instance:

Sometimes when you go, and they see your condition they will just not mind you.

They will take your letter and then just tell you they will call you later. Because we are competing with the ‘abled’ so definitely the ‘abled’ will be picked.

What is shared by these participants is a sense of discrimination and unjust rejection from potential employers. However, participants recognized that there are barriers to employment no matter one’s disability status, such as not having required educational qualification for the job.

Disabled people, who are employed encounter a variety of workplace challenges such as lack of disability accommodations. They are faced with inaccessible office buildings and do not have access to mobility enhancement equipment like wheelchairs and white canes. Disabled participants also expressed how they are discriminated against at the workplace, including by their co-workers. For example, Abigail mentioned:

I will go to work but then they will be like oh, keep resting, keep resting and they end up not making you work. So, there is the issue of getting work and once you get employed, they don’t trust you with anything because they think oh, you are deaf, and you cannot do anything.

In a similar vein, Adam revealed how he is looked down upon by his co-workers:

People even discriminate when you are working with them. They assume that whatever fit people can do, disabled people cannot. I per se, I don’t see where you will put a fit person to school or to do something when it comes to academics that I cannot match that person but because of the disability, people undermine your intelligence and people link you to superstition like you are cursed and that made you become.

As described earlier, there is the public perception that all disabled people are cursed. In addition to this prejudice, disabled people experience stigmatization and stereotyping as described by Ken:

For jobs, if a deaf person steals something at the workplace and the person responsible catches them and kicks them out and later another deaf person comes (for employment), they are like ‘oh another deaf person that stole something?’ They say all deaf people are exactly the same, they are all thieves. They are forgetting that hearing people steal all the time, are all hearing people thieves? One deaf person steals something and that means all deaf people be labeled as thieves?

Participants also recounted inequitable treatment by their employers, who did not provide them with the accommodations that they needed. Below is a brief experience shared by Mary, who quit her job as a teacher to become self-employed, due to a lack of accommodations. According to her, she was not granted the time off of work that she needed to tend to her leg pain.

The time I was teaching, when I felt pains in my leg and ask for permission to be absent at work, then the head teacher will ask me that whom do I want to come and teach my class for me to me paid? Have you seen the question he asks me? And I ask him that, so should I come and teach whiles I am sick too? So, does it mean if you are working and you are sick you should not stay home? So, I have experienced a lot and even because of that the owner of the school came and fought with me and exchanged words with me.

That very day I did not give up with her, I exchanged a lot of words with her and after that I left the place. So, as I went to a different school too, and was treated same way, I decided that it is better I stopped and employ myself.

What Mary’s case shows is not only a lack of individual understanding of disability but also a lack of structural support that takes into account the needs of people with disabilities.

Most of the disabled participants, who were working, were self-employed due to their difficulty in finding jobs. They mainly engaged in vocational jobs or petty trading.

James and Selina, study participants, who are members of the Disability Fund Committee observed that disabled people are mostly engaged in the informal work sector.

Mostly, the way they get employed is more of being self-employed where they have a skill that people think that that service is needed for them then they go to them or they do trade. But when it comes to formal employment, it is very difficult to get employed. (James).

Selina also explained that there is lack of financial assistance for disabled people to be self-employed. She stated:

Most of them engaged themselves in trading, which they are very good at so if you are sampling them for research and you take about 100, you realize that about 80 do well when they are into skill training. When they are self-employed, they do well on that.

Also, there is lack of financial support to enable them to even start a business on their own, like selling something. They need employment so it will be helpful if there is a scheme to help them.

According to some participants the nature of the job determines the employability of the disabled person. They explained that disability may prevent one from being able to engage in certain kinds of jobs and that also accounts to the lack of employment. For example, James explained:

And then there are certain jobs also, that due to its nature they cannot be employed. Let’s say a job where you need to listen to the sound of a machine to take a decision, a deaf person cannot work there. So their employment issues are a bit difficult.

Participants said that the government was not making efforts to ensure that disabled people are employed. They said there is lack of willingness by the government to enforce acts and policies it developed regarding this issue. One of such policies is ensuring that 50 per cent of people, who work at road toll booths, are disabled. With respect to this policy, Amos described the following:

In terms of employment, government announced that 50 per cent of workers to be employed at the toll booths will be disabled people. So, when you calculate, the disabled people working at the toll booths should be about 300 plus. But the people working currently at the toll booths are 83, less than 100 so it is woefully inadequate. It is with reference to the Ghana law, the act 715. Because the minister of labor and employment is supposed to get names of disabled people so that when the names remain on the job search list for a period of time, you take them off, train them and give them the working tool. Is that done in Ghana?

Unemployment among the disabled may perhaps be a force that drives some disabled people to resort to begging. Along these lines, Nii said:

Our living condition is very tough. One thing we want the government to do for us is being employed. Because those begging on the streets can be easily knocked down by a car. But even if you get a small table and start selling something in front of your house, you are safe from being knocked down by a car.

As Nii mentioned, safety is a serious issue for those who beg in the street. He believes the government has the power to ensure that disabled people have jobs and, therefore, do not have to beg.

4.3.2. Accessing Healthcare

To explore the healthcare situation for the disabled Ghanaian, participants were asked if people with disabilities are able to get their health needs met. Participants highlighted issues of access, cost of medication, and health insurance coverage. They mostly talked about their experiences when they visited the hospital and most of them said disabled people are given preferential treatment at the hospital. According to the participants, they are not required to get in a line before seeing the doctor as Jonathan explained:

When we the disabled go to the hospital for treatment, we are attended to first, before the others even if there are people there before you go. I go to the hospital often and I am attended to before the others. But I don’t know if the experience is different for other disabled people.

Most participants expressed that they were highly appreciative of the reception that they receive when they visit the hospital. However, some participants complained about how they were treated by nurses. Their responses described nurses as uncaring, rude, unkind, and unsympathetic. According to them, nurses did not either pay attention to them or did not attend to them in a timely manner. Kofi, a physically disabled man shared one such hospital experience:

And I tell you, I blasted a nurse in front of my doctor, I blasted her. Because anytime I go to the hospital, I check my pressure and the rest, take my folder and go and sit in front of my doctor to be attended to. The nurse took patients cards and comes to call them, and I told her I am a special patient to the doctor so please call me in, so I see him.

Then she would say I should take time and I waited for 3 hours. Then I took out my

phone and called the doctor and told him the nurse kept me waiting for a long time and he said I should come in. The nurse did that simply because I am disabled.

Kofi’s quote reveals neglect and discrimination by the nurse, as other patients were called but he was told to wait.

Participants also described their perceived prejudice and felt that nurses wanted to avoid contact with them. They discussed how nurses have ignored them and attribute this action to their disability status. Interactions with nurses can thus be incredibly frustrating. Mavis said, for example:

Sometimes you meet the nurse and you tell them you are deaf so will you help me? She is like okay, then she gets busy and forgets about you so unless you keep reminding them over and over again else, they are not going to help you.

As Mavis’s story reveals, she recognizes that she has to be persistent with nurses, in order to get their attention and care. These findings are similar to a study by Kodom et al., (2019), which found that many clients did not like how they were treated by most nurses, irrespective of the hospital they attended. A research by Agyemang-Yeboah, et al., (2017), revealed that the overwhelming workload of a nurse, due to the low nurse- patient ratio in Ghana, makes it difficult to even meet the basic needs of the patient.

Nurses in that study also stated that they are also unable to provide quality care to patients due to tiredness.

While many participants seemed pleased with the treatment that they received in hospitals by their doctors, this was not the case for my deaf participants. According to them, accessibility in a hospital is a unique challenge. There are no sign language interpreters at hospitals to help them communicate with the nurses and doctors. This

communication barrier restricts deaf people from accessing medical care at the hospital.

With regard to this communication struggle, Ato said:

So, you feel depressed because they keep ignoring you and you go meet the doctor and you don’t have an interpreter. So, some deaf people cannot write so how are you going to explain yourself to the doctor.

As Ato noted, health care experiences can be psychologically difficult and disappointing. Similar to what he mentioned, other participants also said that most deaf people are not literate. Therefore, it is difficult for them to communicate with their doctor. As a result, deaf patients may not always receive proper medical diagnosis or be prescribed the right medicine. Ken, a deaf participant explained how this communication barrier directly affects his medical care. He shared:

Some of the doctors try, they are not trying to discriminate against deaf people, but they don’t understand sign language so how can they truly help us with the sickness if they don’t know sign language? So, they are just guessing something. Maybe they are pointing at something and the deaf patient will be like ‘okay yes’ and then they give you the medicine but what is the medicine for? As the deaf person, you don’t even know. You don’t know when to take it. If you are given a medicine and say you are to take once a day in the morning with food, but you cannot even read, how do you know how to take the medicine? Sometimes they write it on the label but not all deaf people can read.

This is not only a healthcare challenge, but a serious potential threat to the health and life of the deaf patient.

The major problem for deaf people is undoubtedly the lack of sign language interpreters. Deaf people do not need sign language interpreters only at the hospital but

almost anywhere they find themselves in the society. Deaf participants mentioned that there is lack of interpreters but also explained that they have no money to afford a sign language interpreter. Ato stated:

Yes, you have to pay, it is a big problem. So, a deaf person who don’t have a good paying job cannot afford an interpreter because how are you going to pay them? When you are going to look for a job and they realize you are deaf they will not employ you so how can you pay an interpreter?

With regard to accessing an interpreter, deaf participants provided a variety of ways to obtain one. For example, an agency or non-governmental organization group may help deaf individuals find interpreters but that does not necessarily mean they will cover the cost.

Some participants believed that the government should be responsible for providing interpreters to deaf people. For example, Ken said:

We feel like we cannot do more in life because we have no access to communication, so the government must pay for interpreters, it is their responsibility for paying for interpreters. Everything is connected to the government so they should be the one paying for interpreters. That will help us to get access to a whole information.

Ken’s quote recognizes how the lack of access to communication prevents deaf people from self-actualization. He also notes how the communication issue is a structural, rather than individual, problem. Therefore, he calls for the government to be held accountable to the country’s deaf citizens and provide them with interpreters.

Health insurance coverage is another major issue. Participants expressed that they want the government’s National Health Insurance Scheme (NHIS) to cover most of their

drug prescriptions. Beyond the lack of coverage of prescriptions, NHIS does not cover most of the health conditions associated with disability. As a result, many participants discussed how they are not able to afford their treatments. Araba shared:

When I go to hospital, they write prescriptions and when you go to buy these drugs, you are told the health insurance does not cover those drugs so if I don’t have money what should I do?

Generally, participants said the cost of healthcare is expensive and they lack money to pay for prescriptions.

Some participants also revealed that people with cerebral palsy need routine physiotherapy and that too is expensive. Amos explained:

When we also take the cerebral palsy, in fact a lot is going on in terms of their health needs. The health insurance does not even cover, they need physiotherapists. And in Ghana here, when you attend one (physiotherapy), it is 10 cedis so multiply 10 or 20 cedis by the number of times they go to hospital.

In Amos’ response, he mentioned the need for physiotherapists for people with cerebral palsy. This finding is consistent with Crowley et al.,’s (2013) study that revealed the lack of health professionals in Ghana. For example, there were only 10 trained Speech

Language Pathologists in Ghana in the year 2013. Participants in the present study recognized this problem as they called for establishment of special hospitals for disabled people. Some of them also added that there is the need for special doctors. Most participants cited people with cerebral palsy when they spoke of the need for these special hospitals and doctors. This could imply that among the disabled, people with

cerebral palsy receive less medical attention and lack of medical experts to treat them.

James discussed his concern for the need of specialists.

Their health need is not met to expectation because here, we don’t have specialized facilities for such people and you know, trying to interrogate them takes a lot of time and a lot of observation and the normal clinical or health facilities don’t have that patience and that time to assist them or to listen to them.

James’ observation that mainstream health facilities do not have patience to attend to disabled patients is in line with how other participants described treatment by nurses.

4.3.3. Educational Barriers

According to the participants, many disabled people have low level of education due to a variety of factors including parental negligence, inaccessible school environments and lack of financial support. Some participants explained that parents refuse to enroll children with disability in a school. Mensah said, for example:

For majority of us, the education level is not that good. Sometimes it is the parents of the children with disability. Because they see the disability in that child they just forget about that child. Like they don’t take that child to school.

Mensah’s quote is telling of how parents view the capabilities and potential of their children with disabilities. Specifically, they do not see their children as able to learn and become a contributing member of society. According to Gina, her father stopped her from attending school when she became disabled as a young girl. She shared:

It is difficult. When I became disabled, my own father who gave birth to me said I stop should stop the school and stay home because I cannot do anything. He said I should stay at home.

Most participants could not tell why parents may decide not to enroll their disabled child in school. It could be that they believe disability would affect academic performance of child or it could be negligence on the part of the parent.

However, the narrative of deaf participants was different. According to them, they were enrolled in mainstream ‘hearing’ schools instead of deaf schools. They explained that their parents took them to mainstream schools because they were not aware that there are deaf schools in the country. From their perspective, this lack of awareness of deaf schools was one major barrier to their education. Abigail and Prisca recounted how their parents did not know of the existence of deaf schools in the country.

The reason why my parents did not send me to school is because they said there was no deaf school. They said they had no idea that Ghana has a deaf school. For example, my mother did not know that there is a deaf school in Ghana, so she sent me to a hearing school and I stayed in the hearing school for 3 or 4 years before I went to deaf school. And my parents were surprised there is a deaf school. (Abigail).

My parents had no idea there was a deaf school, so they took me to a hearing school, and I was there for 5 years. My parents were searching for a deaf school then finally someone told them there is a deaf school and they took me to the deaf school.

(Prisca).

Mavis also narrated her experience of how she found a deaf school.

I kept seeing about 15 pupils in a blue uniform with deaf symbols, and I asked myself where is the school, where is the school and finally I found out.

Her experience probably implies that there is less publicity of deaf schools in

Ghana. Participants suggested that public awareness be created about deaf schools to

ensure that more deaf children are taken to school. One participant, Ken, who is also an instructor at a deaf school, said:

Ghana has deaf schools, but people don’t know. Every region in Ghana has a deaf school. Eastern region has 4 deaf schools, central region has one government deaf school and one private deaf school, the rest of the regions has one deaf school each. The government has to announce to the people so that the people will know just like how our parents know.

Ken said that the curriculum used for teaching in deaf schools does not help students. He observed that deaf schools are provided with the same curriculum used in mainstream schools and there is the need to develop one specifically for deaf schools. He further explained:

The Ghanaian government is not trying to understand how deaf people learn. So, we feel like the government does not care because they are not really trying to understand us. The curriculum that they bring to the school does not help deaf students at all because it is for hearing people but hearing people and deaf people don’t learn the same thing.

Ken’s quote explains his dissatisfaction with the lack of effort by the government to address the educational challenges encountered by the deaf.

For those who have been enrolled in school, many of them were unable to complete their schooling. One major challenge that hinders school completion, according to the participants, is that the school environment is not accessible. Disabled students are faced with challenges such as climbing stairs to lecture and residence halls, as well as offices on campus. These accessibility challenges do not make the school conducive for the disabled student to study and excel. According to Jonathan who recently completed

his degree, the disabled student must be “strong minded” to be able to complete his/her education at any level, in order to overcome this structural issue of building inaccessibility. He said:

For education, look at our institutions, most of them are not accommodative for disabled people to feel comfortable to study. For instance, somebody whose lecture hall is at the top, somebody who is using a stick, and that person needs to attend a lecture at the top, that person will not feel comfortable climbing the stairs. There is no way that is convenient for such person to go up there, it becomes a challenge and if the person is not strong minded, the person might fall back.

Araba, a wheelchair user also said that it is a problem going to school as a wheelchair user due to inaccessible buildings at school.

Another major challenge that impedes education for disabled people is the lack of financial support, specifically not having money to pay school fees. Disabled students lack financial support from family, and educational institutions do not provide them with scholarships. Adam, a physically disabled man shared his experience of struggling to further his education;

I am disabled, I have been struggling, even currently I am struggling to do masters and where to even get fees or where to get support is not there. There is nothing, apart from me being able to use my brain to school and that one too, if I get the opportunity, I will even want to become a professor in the next 5 or 10 years to come. Because if I get the opportunity to do the masters, I will continue with the PhD but the environment is not supportive.

Another participant, Jonathan, also recounted his experience as a student, adding that educational institutions do not encourage students with disabilities to succeed in school. He believes that lecturers must develop the practice of supporting students with disabilities and explained:

Our institutions do not motivate students with disability, it is just some few tutors and lecturers that would see you with the disability and encourage you that keep it up.

Though I would want us to be treated equally in terms of marks, but there should be some flexibility with someone with disability to be able to have access to equally write as the one who is fit.

The present study found out that there is lack of inclusive education. This is the situation where persons with disabilities are not enrolled into mainstream schools. Even though deaf participants said that they wanted to attend a deaf school, most participants reiterated the need for inclusive education. For example, Mensah said:

People do not enjoy inclusive education in Ghana which makes education system not accessible. For example, cerebral palsy, blind and deaf people do not attend the normal school as the abled counterpart.

Mary also explained that:

When they attend school, these ones (persons with cerebral palsy) are the special ones, we call them special ones, so when they go to the mainstream schools instead of the special schools, they are educated by the other students themselves, as they involve with them. That is when they will be able to pick up rather than separating them.

According to these participants, inclusive education enhances accessibility and may help improve the learning abilities of the disabled student.

4.4. Mobility Issues Restrict Independence

This theme explores barriers that exist in the built environment and transportation, which negatively affects the social lives of persons with mobility disabilities.

Specifically, this issue was perceived to prevent disabled Ghanaians from exhibiting self- determination and making contributions to society in more meaningful ways. The theme has sub-themes such as inaccessible buildings and roads, lack of disability equipment, inaccessible vehicles and discrimination in transport vehicles.

4.4.1. Inaccessible Buildings

Most buildings, including government offices are not disability friendly and which restricts mobility. This is a major challenge especially to the physically disabled, who expressed their worry over the situation. Inaccessible buildings may prevent disabled people from accessing services or accomplishing an errand as Joe explained:

It is a very big challenge because we cannot access the buildings. It is really a worry to us because if you need to go do something in the building, you cannot. Now when they want to construct a building, they should pave a way that will be accessible for us especially the tall buildings. Sometimes our complain on this issue is aired on television yet nothing is done about it.

Joe expressed frustration with public demands made for accessible building going unheard. Kofi, a physically disabled man shared his experience of how he had to climb stairs to the 3rd floor of a high court building. According to him, the fact that government buildings are not disability friendly is the reason why private individuals put up buildings that are not accessible either.

Look, the high court building in Accra has no elevator, I have to climb to the 3rd floor. I had to go with someone because I cannot go alone. So, if even that government building has no elevator, how much more a private person’s building?

Inaccessible buildings do not only restrict mobility of disabled people, it may also cause physical pain or injury to disabled people who work or require a service in a building that is not disability friendly. In this case, they are forced to for example, climb stairs to a top floor of the building that has no elevator. This act causes or aggravates the disability-related pain. Adam, a physically disabled man narrated his experience of climbing about 30 stairs to the office where he works. He described this as painful, considering that he works 5 days in a week.

As for accessibility, I don’t consider myself alone, once I climb a staircase, maybe

30 stairs to an office to work and feel pain out of that and have to fulfil the working days, all the 5 days coming to work, it is a hindrance to my colleague who is on the wheelchair.

I always assume myself that if I were to be on a wheelchair, how will I be able to access that.

Stairs were also a problem for Selina, who is also physically disabled. She said that her doctor advised her not to climb stairs, but there was no way of avoiding them in her workplace. According to Selina, she was in severe pain the following day after her doctor’s visit. She described:

Two weeks ago, I was advised by doctor not to climb stairs but because the complains from work were too much, I decided okay, let me just risk it, I climbed stairs.

The following morning, they had to carry me like a baby. Now I am supposed to go to

urban roads to see the director, but I won’t go, I won’t climb the stairs. No, I won’t. I suffer the pains a lot.

From Selina’s response, it can be deduced that part of her duties is to work in other offices where she would have to access only by climbing stairs. She also mentioned that there were complaints from her workplace because she refused to use the stairs due to her disability. This perhaps suggests that disabled workers are not given the necessary disability accommodations in the workplace. What became evident was how the lack of accessible buildings affected the independence of the participants. Nii discussed an experience that reflects this issue. He said:

Public buildings in Ghana are not disability friendly. They have not constructed a way for disabled to use, rather they want disabled persons to use the same way with the

‘abled’. I was invited for an interview at social welfare and if not that somebody helped me into their office, I would have slipped. The walkway is a slope and not disability friendly.

These findings are in tandem with research by Naami, (2019), which identified that many public buildings were inaccessible. The study also found that there is lack or no functioning elevators in multi-story buildings, which causes participants to struggle to enter them.

Participants believe that the government is not enforcing a law that would ensure that all buildings are disability friendly. Indeed, there is a legal structure in place to ensure building accessibility. However, there is a lack of political will to comply with it.

With regard to governmental policy, Amos explained:

The disability law was promulgated in 2006 where a grace period of 10years was given after which all building should be accessible to the disabled in Ghana. After the expiration of the grace period, buildings are shooting up without being accessible to the disabled people.

Amos observed that new buildings are constructed with no accessibility for the disabled, even though the law directed that existing buildings are made accessible within the 10 years period.

This quote reveals the government’s failure to ensure that buildings are disability friendly.

Roads are also not accessible for disabled pedestrians. According to participants the nature of roads makes it difficult for crossing as Jonathan explained:

The way the roads are constructed, it is difficult for me to cross because some are too wide, and I cannot cross within a short time unless I get someone to help me cross.

Sometimes the cars stop for me to cross but the motorbikes don’t. Sometimes car will stop for me to cross then before I realize, a motorbike will be approaching with speed.

Generally, there is the lack of sidewalks and the few existing sidewalks are not expansive enough. This problem results in disabled people having to endanger their lives by using the major roads (Naami, 2019). From Jonathan’s quote, it is particularly important to point out how he has to get someone to help him cross the road. This describes the lack of independence and how disabled people may have to depend on others for road safety.

4.4.2. Lack of Disability Equipment

Most disabled people do not have disability equipment such as white canes, wheelchairs, and hearing aids. According to participants, this issue restricts their movements and daily activities. For example, Freda noted:

The mobility issue is the problem because I am not able to move freely because I don’t have a wheelchair, I am also unable to do some work and unable to enjoy life as the others.

In this quote, Freda compares her life as a person who would benefit from a wheelchair to that of a person who does not need this equipment. In particular, she notes the difference in ability to work and enjoy life. Thus, she is restricted from pursuing professional and leisurely activities.

This mobility-related problem also is a safety hazard and can result in harm.

Amos, for instance, spoke about a friend who injured himself, due to not having the proper mobility equipment. He said:

Very recently a colleague of mine said he wanted to do something in his room but because he doesn’t have the white cane, he hit the head against the wall and lost his tooth.

So, these lack of equipment problems are affecting not me alone but all disabled people.

This could be due to lack of money to afford or replace the disability equipment that could address their impairment needs.

4.4.3. Transport Minibuses

The primary means of road transport in Ghana is the passenger-carrying minibuses, locally called ‘trotro’. These commercial vehicles are privately owned by individuals who are under the Ghana Private Road Transport Union (GPRTU). The

GPRTU serves as the umbrella group that unites private commercial vehicle owners and their drivers. Even though these minibuses serve as efficient way of road transport, they are not disability friendly, as disabled passengers have to struggle with small space while on board. The government also runs a bus transport system which according to participants is also not disability friendly. Kofi described:

For transport issues, when you go to the lorry stations, accessing the vehicles is very difficult by some of us especially those with the wheelchairs and then for the blind too unless you get someone to assist you.

Here again, a participant raised the link between the lack of accessibility and the need for assistance, which inhibits the freedom of disabled people. According to research by Naami, (2019), “the entrances of the buses and trotros were largely inaccessible, compelling some persons with mobility disabilities to either crawl or be carried into such vehicles. Either way of entering the buses is associated with risk: crawling could expose the passengers with disabilities to infectious diseases while falls and hurts could result from being carried” (p. 11). The issue of accessibility also has a finance dimension.

According to participants, boarding a taxi would be a more convenient and comfortable means of transport but they cannot afford to pay transport fares.

4.4.4. Discrimination in Transport Vehicles

Participants reported cases of discrimination against them when boarding and/or on board a commercial minibus. These acts of discrimination include the driver refusing to pick up disabled passengers, especially wheelchair users as Amos described:

The perception of disabilities has led to the extreme forms of stigmatization which results in transport or vehicle owners refusing to accept disabled from boarding their buses individually or as a group.

According to Dan, a physically disabled man, drivers feel a disabled passenger would be a burden when on board. This could imply that drivers are impatient with the longer time it would take a disabled passenger to board the minibus as compared with a non-disabled passenger. Dan explained:

Sometimes when they realize you are a disabled person; the driver will just bypass you without stopping. Someone with crutches, the driver will just move without stopping because he realizes when he picks you, you will become a burden to him so he will just move.

This type of discrimination is mostly directed at wheelchair users and could, perhaps, be due to the perception that it would take extra time for the disabled passenger to get on board. It could also mean that drivers may not have sufficient space to put the wheelchair. Amos described:

The commercial drivers will not pick someone in the wheelchair. Even if you are in the car and there is a place for you to sit which is occupied by an ‘abled’ person, the

‘abled’ person will never get up for you to sit, so this is the transport system we have in

Ghana, it is very challenging.

Amos’ quote reveals the act of non-disabled passengers occupying seats for disabled passengers and refusing to give up the seat.

John, a physically disabled man shared his personal experience of not being picked by drivers because he is in a wheelchair.

When I first moved here, I attended a school. I was using wheelchair and sometimes when I am going to school, some drivers refuse to pick me because I am using a wheelchair. So, I would have to wait till a driver decides to stop and pick me.

Participants also revealed that often, non-disabled passengers are impatient with them when boarding or on board a commercial minibus. Below is a short-inset story told by Freda, a physically disabled woman who shared her experience:

Eeii… hmm… ‘y3 p3 nt3m, y3 nt3mt3m’ (we are in a hurry, hurry up) eei they will be shouting on you. If you are not fast, you can fall. Even one day I fell because of that because of shouting, I fell from the car. I was getting down from the car, one of my legs was in the car and one was on the ground. I fell straightforward and when I was on the floor, the driver and his conductor came to say sorry and that was all and they left.

In Freda’s example, the transportation experience appeared difficult and painful, due to the harassment she experienced. The impatience led to her falling, and she could have been injured. Freda seemed to feel that the driver could have been more apologetic, even though he said that he was sorry. Mary discussed a similar experience of harassment and even physical assault on public transportation. She explained:

When I am going to board a car, they will not help me, they get angry at me and some people push me to get out of their way.

While disabled passengers are on board, non-disabled passengers avoid having body contacts with them. This is another case of discrimination reported, which seemed to be prevalent. This act could be due to cultural perception of disability being a curse or capable of transmitting bad luck. Some people also think disability is contagious, which may be why they try to avoid body contacts. Araba said:

What I see when going out is that you sit inside a car and people will be shifting away.

In a similar way, Mensah explained his struggle with public transportation:

And even when you sit in the car, people will not want to draw closer to you, so it means that you have to find a private means of transport when you need to move around. So, transport means is also a bit problematic with movement.

As Mensah identified, the cultural response to him as a person with a disability on public transportation makes him feel like he has to find a different means of getting around, which implies additional costs.

Interviews with deaf people revealed that they face unique transportation barriers.

There are bus stops where passengers are supposed to board minibuses but generally, passengers stand by the sides of a road to board a commercial minibus. This is because many bus stops are located in inconvenient places, and not accessible to disabled people, mostly persons with mobility disabilities (Naami, 2019). Standing by the roadside, passengers identify the minibus going to their destination by paying attention to the conductors who frequently sticks out their neck from minibus and shout the destination(s) of the minibus to passengers. Conductors also use hand symbols that indicates where the minibus is going, and most passengers understand these symbols. Deaf participants revealed that have difficulty in identifying where a commercial minibus is going to since they cannot hear what the conductor says as described by Ato:

Even you want to board a car, and they are saying Accra, Accra, Accra and you don’t know what to take because you don’t hear what they are saying. With something like that, the hearing people don’t realize that they are oppressing the deaf people, but it

is just the natural way of the hearing world, they don’t understand deafness. Naturally, how we feel (both deaf and hearing) are exactly the same but just that we cannot hear, on the inside your life is a deaf person but it is all the same.

Deaf passengers largely rely on hand signals by the minibus conductors to determine the destination of the minibus. However, Abigail explained that this technique may not always work as some symbols may represent more than one destination.

Not really, for example, Kwame Nkrumah circle is not the only circle, there are other circles. Also, in Tema they have a roundabout and others elsewhere so if the mates are signaling for roundabout, there are many of them so which one? But it does help.

According to Prisca, another way which helps to board the right minibus to a destination is when you recognize a mate from a previous trip.

Sometimes if they use their face and signs, you could remember that. Sometimes you know the mate from before, so you know where they are going so that helps too.

According to deaf participants, communication barrier occurs because the conductors cannot read as described by Mavis:

The mates don’t go to school, so it is not helpful writing to them. So, you show them your destination written on paper, but they ignore, and they just tell you to enter because they want their money, it is their money they want so then they take you to the wrong destination.

Because mates may not know how to read, writing the destination on a piece of paper may not always be a successful strategy. As Mavis’s example illustrates, mates may take advantage of deaf people by collecting the transportation fee without ensuring accurate drop off.

4.5. Lack of Family and Community Exclusion

This theme examines the exclusion faced by disabled Ghanaians at the family and community levels respectively. The common family and community experiences that the participants shared are indicative of how exclusion is not an individual matter but, rather, a larger social problem. The theme has two sub-themes including lack of family support and connection and community isolation.

4.5.1. Lack of Family Support and Connection

Support for disabled people, especially by family and friends is part of the traditional Ghanaian cultural norms. Respondents of research conducted by Naami,

(2015), reported to have received various forms of support from family, friends, non- governmental organizations, churches, mosques and the government, including food, housing, clothing and emotional support. However, participants in the present study reported that they do not receive any support from family. Begging is thus a strategy for survival as noted by James:

Disabled people do not receive support from family. Because some of them have been abandoned by family and end up begging on streets.

This finding is in line with a research by Sayibu, (2016) which found that there is a decline in support from family. This issue has driven most disabled people to the streets with no other option than to beg. Participants described feeling rejected from their families, including by their siblings. One participant explained how this denial resulted in him turning to the church for help with living arrangements, which was provided. Kofi shared:

There is no family support at all, even I was living with my own sister and she ejected me from her house, so it is my church that has rented a place for me to be living.

So, I don’t get any support from them, to be honest with you, my grandson, sent me 100 cedis only yesterday and I was surprised.

Like Kofi, Nii also felt that family life is a challenge. He said:

Also, at home it is difficult living with my children and relatives. When I need something, it is difficult to get. Because you do not give them anything, they do not benefit of anything from you, so to get anything from them is very difficult.

What is remarkable about Nii’s story is that he interpreted the reason for his family’s lack of support as being his family’s belief that he does not contribute to the household. While Nii’s experience of family hardships was the norm, a few participants mentioned that they do, in fact, receive support from some family members. Mary said:

As for family support, I may say my brother, as for that my brother I will not forget it, he helps me a lot but for my sisters, I may say somehow. Because when I ask them to do something for me by sending them, they don’t like to go, they will be complaining but for my brother he is good. As for my mother too, she helps me a lot.

In Mary’s case, she recognizes the reluctance of her sisters to assist her, but, at the same time, notes how other family members like her brother and mother are very helpful.

The lack of family assistance makes obtaining life goals, such as completing a degree, particularly difficult. Without this social support, many disabled people have to be self-reliant. Joe, for example, explained this challenge:

To be frank, it is not good. I struggled and completed school in the year 2007 and since then I have solely been taking care of myself. I have struggled by myself all this while to be where I am today.

Not only is there often a lack of family support, but, in some cases, even neglect.

One participant, in particular, described how a disabled child’s parents mistreats him.

James explained:

With the barriers, basically we have barriers with respect to most people not trying to spend on their disabled people. Families would not like to take them to school, some families would not like them to even belong to a certain social groupings and the severe ones is an example I had with a woman. Her son does not do anything, when you talk he does not hear, when somebody beats the child, he does not react, he roams about and when you say anything he does not understand so ‘wa gyae nu saa’ (The mother has abandoned her child). The child of about less than 10 years can go to town and be away from home for 1 month, 2 months and the parents do not care, woman said the child’s father neglected or rejected the child.

As James described, parents of disabled children may show little concern for their wellbeing and whereabouts. A deaf participant also revealed that, as a young child, her parents did not give her the needed attention. Rather, they mostly focused on her hearing siblings. This could mean that deaf children receive less care from their parents in comparison to their hearing siblings.

According to several participants, most disabled people depend on other people outside of their families for various forms of support due to neglect by family. It was

found that disabled people may rely on friends and neighbors for basic needs like food.

Amos said:

Even one of our members, because he is not working, it is hard for him to get food to eat and it is a very big problem. Sometimes he just sits in front of the house and when a friend is passing, he tells him he is in need before they give him something.

Sometimes when they go out to buy food, they get lucky and someone pays for it.

Like Amos, Nii also described how he may “get luck” with a friend, who pays for food. He recounted:

So, as at now I depend on friends. Sometimes when I go out to buy food, I get lucky and a friend pays for me. That is how I live now.

For disabled people in the Ghanaian context, friendships, when able to be cultivated, thus take on new meaning. In particular, this relationship is important for facilitating financial and nonfinancial support that otherwise familial ties would provide to disabled people.

Dependence on others outside the family extends beyond paying for food and also includes accompaniment when traveling. For example, Gina, a participant with a disability, described the challenge her nephew, a wheelchair user, experiences when going to school. She explained:

Me per se, I do not have much difficulty with that but other disabled people especially wheelchair users. My nephew who is a wheelchair user and a student at

Kumasi finds it very difficult traveling from here to school. So, we had to manage and get him crutches. When he is traveling back to school, we have to get someone to be with him and take him to school and it costs us a lot because we pay for the person’s transport

fare. We need someone to help him with his luggage because the only thing he can carry is his backpack, and he has to be lifted by someone into the car.

Gina’s quote also points to the challenge of inaccessible vehicles faced by mostly persons with mobility disabilities in boarding a car.

4.5.2. Community Isolation

According to participants, disabled people are generally excluded from participation in communal activities. This is contrary to the principles of the United

Nations Convention on the Rights of Persons with Disabilities (CRPD) which the

Parliament of Ghana ratified on 12th, March, 2012. This exclusion could be due to the discrimination faced by disabled people because of the cultural perception of disability as a curse or evil. No matter the reason, this marginalization is widely experienced and affects relationship building. John, for example, shared his experience of rejection by his peers:

When you are disabled, you are shunned by friends who were your classmates, you cannot attend any social gathering, even the moment you are there, they will start to look at you, so in general, it is like you are not part of the society anymore. And then maybe it takes someone who is God fearing to assist you. The moment you are disabled you are cut off from society, that is the perception.

John’s use of the phrase “it takes someone who is God fearing to assist you” corresponds with other participants response about the lack of support received as a disabled person. In a similar way, Mensah expressed:

We are hardly involved in social activities. It is only a few ‘abled’ people who involve disabled people in social activities.

Kofi described how this social marginalization results in disabled people coming together to build bonds among themselves. He explained:

We are not involved in social activities in the community, unless it is an activity by disabled people then that one, we socialize amongst ourselves. But if ‘abled’ people are doing something, they do not invite us .to join them.

Aside from being excluded from participation in social activities, disabled people are not included in societal decision-making. They are not invited to public forums to share their ideas or make suggestions on social issues. Even in the event where a disabled person is allowed to contribute, their ideas are not considered. John said:

Disabled people in Ghana are sidelined. We are excluded in decision making and even when you contribute, they don’t put it into consideration.

Amos observed that disabled people are not invited to national occasions such as the Independence Day celebration of Ghana. This implies that the challenge of exclusion at the societal level is widespread. Amos explained:

Are disabled people included in social activities? Talking about the social activities, I want to bring everything to Ashaiman, we have chief executive officer who represents the president in the municipality. We have farmers’ day, we have

Independence Day, that is the 6th march, do they invite the disabled for even those activities? NO. So, if a whole president in Ashaiman, the CEO of Ashaiman municipality does not invite the disabled to that programme, then what about Ghana? It means that we are forgotten completely.

This quote perhaps implies that government so far has failed to achieve the principles of the United Nations Convention on the Rights of Persons with Disabilities

(CRPD). Most importantly, it failed to ensure the guiding principles that state that persons living with disability are shown respect for inherent dignity and not discriminated against, as well as entitled to the full and effective participation and inclusion.

4.5.3. Conclusion

This chapter analyzed findings from qualitative interviews with participants, to explore the social experiences and conditions of persons with disabilities in Ghana. The chapter discussed sub-themes such as disability seen as a curse, lack of disability equipment, discrimination in transport buses, inaccessible buildings, and lack of family and community exclusion. The next chapter, which is the concluding chapter, summarizes the study’s main findings, presents participants’ recommendations and finally outlines limitations of the study and avenues for future research.

Chapter Five

Summary, Conclusions and Recommendations

Introduction

This concluding chapter summarizes the study’s main findings. Additionally, participants’ recommendations for improving the social conditions in Ghana for people with disabilities are presented. Lastly, limitations of the study and avenues for future research are outlined. This study was important for assessing how the Social Model theory (Oliver, 1996) applies to Ghana as a Global South country. The findings add to the literature on disability by advancing an understanding of the social experiences of people with disabilities in Ghana from the perspective of Ghanaian disability leaders. The findings also identify themes of Global North Disability Studies that are relevant to the experiences of Ghanaian people with disabilities. In terms of practical significance, this research provides the government and NGOs working with disabled people with policies and recommendations to improve the welfare and social experiences of disabled

Ghanaians.

5.1 Perceptions About the Causes of Disability

Results from this study reveal that in Ghana disability is believed to be caused by supernatural forces or beings, such as evil spirits, in line with previous research

(Agbenyega, 2003; Geurts & Komabu-Pomeyie, 2016; Kpobi & Swartz, 2019; Naami,

2014). Several participants said that disabled people are seen as cursed and/or bad luck.

There is also the belief that being disabled is a punishment for the sins committed by ancestors, parents or the disabled person themselves. Based on these explanatory models of disability, some participants said they were taken to pastors for divine healing with the

intention to exorcize the evil spirit. Also, in some communities, a child born with cerebral palsy is generally believed to be a ‘river child,’ which means they came from a river. As a result, they may be murdered. In general, these common beliefs about disability lead to social stigma; and disabled people face marginalization in their daily lives, whether they are among strangers on a bus or even with members of their own family. Participants disagreed with the belief that disability is caused by evil spirits, so it is worth noting that explanatory models of disabled people often conflicted with popular beliefs. Several participants said they were not born disabled, adding that circumstances later in life made them disabled. For example, a participant revealed that she became physically disabled after she was injected with a wrong medicine during a measles outbreak at the age of eight. Another participant also said she became physically disabled through the same situation. In other words, they emphasized natural, rather than supernatural causes of impairment. Participants believed that anyone can become disabled at any stage in life.

5.2. Building Romantic Relationships

Participants said it is difficult to find a romantic partner, due to disability.

Generally, it is believed by the participants that people are not interested in marrying a disabled person. Participants attributed this issue to the belief that disability is linked with evil spirits. This makes it difficult for people to accept the disabled individual and be willing to live as partners. The study also found that families of non-disabled people, who decide to marry a disabled person, may disagree and not be supportive. For instance, a participant said he was described as an abomination by the family of a non-disabled woman when he revealed his intention to marry her. Disabled people, therefore, have doubts as to whether they would be accepted by the family of a non-disabled person, who

shows interest in marrying them. Participants also said that they believe that most disabled men are shy to propose love to women because of the fear of being rejected, due to their disability. There is the belief that a disabled man, who is able to build a romantic relationship with a non-disabled woman, may have used ‘juju’ (magical powers). For example, a physically disabled participant said people believe he uses ‘juju’ to get non- disabled women to love him. It was also revealed that disabled men, mostly who are in the working class, are able to build romantic relationships better than disabled women.

According to the participants, most disabled women are single parents, and it is common that disabled women have children with more than one partner. They explained that this occurrence is because the men did not love and understand them and/or they refuse to perform responsibilities as a husband and, more importantly, a father.

5.3. Societal Exclusion

Participants reported that they are excluded from participating in social activities.

Disabled people are also sidelined when it comes to making decisions in society. They explained that even when they are given the opportunity to contribute, their ideas are not taken into consideration. The experience of exclusion has resulted in disabled people coming together to build bonds among themselves. A participant expressed his discontent on how disabled people are left out during national gatherings such as the Independence

Day celebration. He explained that this implies that exclusion of disabled people in social activities is widespread.

5.4. Family Support and Welfare

Several participants said that they do not receive any support from family.

Participants recounted that they felt rejected from their families, including by their

siblings. For example, one participant narrated how he was evicted by his sister from her home, which resulted in him turning to his church for help with living arrangements.

Another participant said he believed he receives no support from family, because he does not contribute to the household. Due to the lack of family support, it is difficult for most disabled people to accomplish their goals. They tend to depend on others who are not family members for various forms of support, including financial and nonfinancial. Some participants revealed that they receive support from some family members, and other family members are hesitant in supporting them. For example, a participant said she receives support from her brother and mother, but her sisters are reluctant to assist her.

Parents may also show little concern about the wellbeing of their disabled children.

5.5. District Assembly Common Fund

The study found that the participants were dissatisfied with the amount disbursed from the common fund. The participants said the money they receive from the common fund could not be used to establish a business to financially support themselves. A participant explained that he received less than the amount he requested. Another issue the participants raised was delay in the disbursement of funds. Even though the common fund is to be disbursed quarterly, several participants said that they received the funds at least on a yearly basis. A participant for instance said the last time he received funds was five years ago.

Beneficiaries of the common fund account for how funds were used during a monitoring process. Several participants showed disapproval over the requirement of providing receipts of purchases with money received from the common fund. They explained they do not always receive receipts for purchases. Also, most participants were

not in favor of a proposed policy by the district assembly to provide them with what they would need (i.e. in-kind goods) instead of providing cash. The participants disapproved this policy, explaining that the district assembly may provide something they would not need. Some participants also alleged that corruption occurs during the disbursement of funds and these corrupt practices are perpetuated by some government officials at the district assembly.

For example, a participant alleged that some officials invest funds to be disbursed to the disabled people that have to be used in the officials’ own businesses. They also said there is discrimination in the disbursement of funds, explaining that officials would want only their preferred candidates to benefit from the funds, rather than consider everyone who is eligible. It is imperative to state that despite their dissatisfaction about the management of the common fund, participants rely on it for financial safety.

5.6. Barriers in Society

The present study found that most participants were unemployed. Participants explained that employers are not willing to employ a disabled person because of the perception that a disabled worker would be unproductive. For instance, a participant said an employer denied him employment on the basis that he is not physically fit. Another participant also said that disabled people are denied unemployment even when they are indeed qualified for the job. He explained that most employers deny qualified disabled applicants just on the basis that they are disabled. Some participants also believed that unemployment is a national challenge and most disabled people are unemployed because they are in competition with the non-disabled for the same jobs. Several working

participants revealed that they are discriminated and looked down upon by co-workers at their workplace.

The study also found that most disabled people who are working are self- employed. But again, there is the lack of financial support to be self-employed.

Participants blamed the government for not making efforts to ensure that disabled people are employed. They expressed dissatisfaction at government’s failure to enforce the acts and policies it developed to ensure that disabled people are employed. For example, a participant said that the government failed to ensure that fifty per cent of people, who work at road toll booths, should be disabled, as mandated.

On accessing healthcare, participants shared their experiences at hospitals.

Several participants said they were given preferential treatment such as not having to join line to see the doctor. Other participants, however, complained about the attitude of nurses towards them. They explained that they were mostly not attended to in a timely manner by the nurses, describing their attitude as uncaring, rude, unkind, and unsympathetic. It was also found that deaf patients struggle while accessing the hospital due to the lack of sign language interpreters. Deaf participants said the lack of sign language interpreters at the hospital creates a communication barrier between deaf patients and the doctor. They explained that this communication barrier affects correct diagnoses and prescription by doctors. A participant revealed that deaf people do not go to the hospital because of the communication barrier. The participants reported that the

National Health Insurance Scheme, which they are enrolled in, does not cover most of the health conditions associated with disability. Participants explained that the cost of healthcare is expensive, and they do not have the money to pay out of pocket.

Regarding education, several participants said most disabled people have low level of education. They explained that, mostly, children with disabilities are not taken to school because parents believe they lack the capabilities of learning. A participant recounted that her father stopped her from attending school when she became physically disabled. Also, deaf participants revealed that their parents were not aware that deaf schools exist in Ghana and provided this issue as their justification for not being enrolled in school at an early age. One participant, in particular, expressed displeasure about the curriculum for deaf schools. He observed that the same curriculum prepared for mainstream schools is what deaf schools are provided with and argued that it does not help deaf students.

School environments and buildings are not accessible for disabled students and some participants recounted having to climb stairs to lecture and residence halls pose a challenge to their education. A participant disclosed that lecturers do not encourage disabled students to perform well in their academics. Participants complained that there is lack of financial support for their education. A physically disabled participant, for example, revealed that due to the lack of financial support, he is struggling to pay his school fees. Results from the study showed that participants perceive that there is a lack of inclusive education.

5.7. Mobility

The participants said they are unable to access most public buildings, including government offices because the buildings are not disability friendly. A physically disabled man shared his experience of climbing stairs to the 3rd floor of a high court building in Accra, because there was no elevator. It was found that accessing buildings

that are not disability friendly caused physical pain or injury to participants. Another physically disabled woman said she experienced severe physical pain after climbing stairs to an office at her workplace. Participants further stated that there is lack of political will by the government to ensure that all public buildings are disability friendly.

Another challenge was inaccessible roads. It was revealed that the nature of roads makes it difficult for the disabled to cross and most disabled people lack disability equipment such as wheelchairs to enhance their mobility. In terms of transportation, commercial minibuses are also not accessible for disabled passengers. Participants observed that they are discriminated against by commercial minibus drivers because they are reluctant to pick them due to their disability. They also added that drivers are mostly impatient with them when they are boarding or alighting from the minibus. Several participants reported that non-disabled passengers avoid having body contacts with them when they board a minibus.

5.8. The Social Model of Disability and Ghana

As mentioned earlier, the social model, was developed in the Global North by

Mike Oliver, (1996), and it highlights the social barriers that disabled people experience.

The model demands that the physical or built environment must be changed, in order to ensure that disabled people have access. It advocates for equal rights of disabled people and calls for change in prejudicial attitudes. This model emphasizes that society and not the disabled individual is the locus of the problem. In other words, it locates disability within the environment and not the person. Given that a major objective of the present study is to assess how the Social Model theory applies to Ghana as a Global South

country, the following section is dedicated to discussing the findings in light of the theory.

5.8.1. Applicability of the Social Model of Disability to the Ghanaian Context

Findings from the present study revealed that in Ghana, disabled people are blamed for their disability. In other words, disabled people are seen as the cause of their impairments. This notion is embedded in the cultural belief system in Ghana and hence influence the cultural attitude of many Ghanaians. There is the popular belief that a person is disabled because they have been cursed (Amenyedzi, 2016; Anwar, 2017;

Naami, 2014; Opoku et al., 2007).

Another way that disability is located within the person, is that disability is linked to witchcraft, ‘juju’, and magic (Agbenyega, 2003). Some disabled people are believed to be witches or wizards due to their disability. It is also a common belief that disability is a result of a punishment for sins committed either by parents of the disabled person or by the disabled person themselves.

These negative cultural attitudes directed at disabled people, prevents their social integration and affects their social lives. For example, because they are seen as cursed and bad luck, non-disabled people avoid having contact with them. These cultural beliefs also make it difficult for disabled people to find and build romantic relationships. The perception of disability being a curse and caused by evil spirit has resulted in unwillingness of non-disabled people to build romantic relationships with, or marry, a disabled person. According to participants’ observations, individuals are unwilling to associate with disabled people, let alone to choose them as partners.

As mentioned earlier, the Social Model demands that disability is located in the environment and not the individual (Oliver, 1996). It is imperative to note that the only situation where the disabled person is not blamed for their disability, is when it is believed that the disability is caused by sins committed by the parents. In this case, the disabled person is seen as the victim, rather than the cause of their disability, thus enduring punishment for the sins committed by the parents. Even though in this case, disability is not seen as caused by the individual’s impairment, it does not also locate disability in the environment either. In other words, it does not see disability as caused by the way society is organized.

Disabled people also face economic barriers, as a result of insufficient funds received from the government, under the DACF. Disabled people are given this funding to establish a small business to financially support themselves. However, since the amount they receive is insufficient, they are unable to use the money for such purpose.

Moreover, there is delay in disbursements of funds, and this issue adversely affects the economic situation of the disabled people. Also, the bureaucratic procedures, coupled with alleged corruption in the disbursement of the funds, reveals a structural barrier, that restricts disabled people from accessing the funds that would better their economic situations.

There are institutional barriers and impediments in the built environment that restrict disabled people from employment, as well accessing healthcare and education.

Disabled people are unemployed mostly because employers are not willing to employ them, due to their disability. In other words, most employers believe that a disabled worker is not physically fit and would not be productive. Office buildings are not

accessible to disabled workers as they may have to climb stairs, due to lack of elevators.

With barriers in accessing healthcare, deaf people for instance, are reluctant to seek treatment at the hospitals, because of the lack of sign language interpreters. They are not able to communicate with the doctor, and this results in wrong diagnosis and prescription of medications. In terms of access to education, there is the lack of governmental funding for disabled students, and this problem makes it difficult for disabled students to further their education to the tertiary level. School buildings are also not disability friendly, as disabled students, for example, may have to climb stairs to attend classes.

These physical barriers adversely affect the social lives of persons with mobility disabilities and to a large extent, may prevent disabled Ghanaians from exhibiting self- determination and making contributions to society in more meaningful ways, as mentioned early on. Given the inaccessible nature of most public buildings, including government offices, disabled people, especially, those with mobility impairments are restricted from accessing services or accomplishing an errand. These inaccessible buildings also inflict physical pain or injury to disabled people, whenever they try to access these buildings.

Environmental issues include transportation barriers. For example, the passenger- carrying minibuses, locally called ‘trotro’, which is the main means of transport, are not disability friendly. Disabled people have to struggle with small spaces when in these buses. Many drivers are unwilling to pick disabled passengers, and they face discrimination while on board. The transport buses operated by the government are also not disability friendly. These conditions deny disabled people of the freedom to move freely.

Family support for disabled people is not always present, as also reported by

Sayibu, (2016). Disabled people go through the experience of rejection from their families and including their siblings. There is exclusion of disabled people from social activities and decision-making meetings in society. This impedes their rights to be shown respect and not discriminated against, as well as prevents their full and effective participation and inclusion in Ghana.

The social model of disability applies in the Ghanaian context. As results from the present study show, disabled people are faced with many barriers in society, and these barriers hinder their full participation in society. For example, participants reported that most buildings are not accessible to them. Participants also reported that there are cultural beliefs that impede their social integration. Cultural beliefs such as disability seen as a curse or bad luck, for example, make it difficult for disabled people to obtain jobs and find romantic partners, as well as access education and health.

5.8.2. Perspectives on Disability

The present study reveals that the medical model of disability (Ansell, 2016;

Areheart, 2008; Brisenden, 1986) is employed to understand disability in Ghana. The medical model classifies disability as an illness or a defect (Oliver, 1996). In the

Ghanaian context, disability is seen as an illness or defect that is caused by evil spirit or a curse, that needs a cure, or healing. Accordingly, disabled people are sent to various religious leaders for healing (Anwar, 2017). For instance, deaf participants reported to have been taken to pastors, for their deafness to be cured. Some deaf participants described the pastors they were taken to for healing as ‘fake’. They explained that these pastors are unable to cure deafness. Indeed, some religious leaders confirmed that they

were unable to cure intellectual disability (Kpobi, & Swartz, 2019). Even though parents believed that disability can be cured by these religious leaders, the disabled participants disagreed. The participants believed it is a condition that they have to live with. They advocate for barrier removal in society instead, rather than attempting to find a cure. This indicates that both the medical and social models of disability apply in Ghana.

This study also offers insight into the moral model of disability that was revealed through the interviews. The moral model of disability associate disability with sin and explains that disability is caused by evil spirits (Devlieger, 2005; Kaplan, 1999).

According to Creamer, (2012), “within the moral model, attention is paid to how disability is interpreted as either good or bad, and how people with disabilities are imbued with moral weight” (p. 340). Results from the present study show that the moral model of disability applies in Ghana. For example, several participants reported that disability is seen as caused by evil spirits. Also, disability is associated with sin, as findings reveal that there is the perception that an individual is disabled due to a sin they or their parents committed.

5.9. Advancing Global South Disability Studies

There is relatively little information on how the social model applies in Ghana, and limited studies that explain the general situation of disability in the Ghanaian context.

Findings from this research will contribute to past literature on the Global South

Disability by adding the perspective of disability leaders on the experiences of disabled

Ghanaians. Chataika, (2012) argues that the story of the Global South must be primarily told by researchers from the Global South. This study meets Chataika’s, (2012) criteria because I am from Ghana.

According to Chataika, (2012), the knowledge of the people from the Global

South is imperative, because it challenges oppression, voicelessness, and stereotyping.

Findings from this study are important because they offer an understanding of the specific cultural dynamics and disability issues that might not be present in the Global

North.

For example, the belief that the disabled people are cursed, and even accused of witchcraft, adversely affects their social life and ability to integrate into society. As a result, people avoid associating with them. These experiences are related to oppression and stereotyping, and participants suggested that there should be awareness on disability, in order to stop these negative cultural attitudes. This research thus builds on a study by

Agbenyega, (2003), that found that due to specific cultural beliefs and superstitions about disability, disabled people face stigmatization and labelling.

There is little information about the DACF. Therefore, the present study builds on literature by providing insight into the DACF. Participants extensively expressed their concerns and suggestions about the disbursements of the funds. The issues were insufficient amounts disbursed from the DACF, delay in the disbursements, bureaucratic process of accessing the funds, and alleged corruption in the disbursement of funds.

According to Naami, (2012), “few social welfare benefits propel persons with disabilities into poverty” (p.6).

5.10. Participant Recommendations

Participants’ recommendations focused mainly on socio-economic issues. For instance, several of them suggested the need for employment opportunities. In terms of disbursements of funds from the District Assembly Common Fund, they proposed an

increase in the amount they receive as well as ensuring that funds are disbursed in a timely manner. Several participants advocated for resource provision and changes in physical structures. They suggested the provision of disability equipment such as wheelchairs, white canes, and hearing aids by government or Non-Governmental

Organizations. Participants recommended that authorities should ensure that public buildings and government offices are disability friendly, level bumps and slopes, and remove potential mobility impediments. Participants proposed that it is imperative to widen the NHIS coverage on cost of medicines to cover disability-related illnesses as well as provision of special hospitals or medical practitioners for persons with cerebral palsy. Participants also advised that hospitals provide sign language interpreters to help deaf patients to effectively communicate with their doctors. It was also recommended that the awareness of deaf schools be improved. Regarding transportation, it was suggested that government provides disability friendly bus stops and buses for their transport needs.

5.11. Policy Suggestions

From my fieldwork experience and study’s findings, I observed that the government’s initiative of allocating three per cent of district assembly funds to persons with disabilities is laudable. However, there is the need for a database of information of all disabled Ghanaians to help better manage their funds and to avert any corrupt act during the disbursement processes. I also recommend that the government provide funding to disabled students to support them in furthering their education as well as establish vocational and technical institutions to train disabled people in skilled professions. I observed that discrimination against persons with disabilities is high due to

the cultural belief that disability is caused by evil spirit. The government should encourage disability awareness by lobbying prominent persons in the Ghanaian society, such as chiefs, politicians, religious leaders, and entertainers to promote inclusive attitude toward disabled people, since they wield much influence on the populace.

NGOs should focus more on providing vocational and technical training to persons with disabilities, since there is a desire for self-employment. NGOs should also promote cooperation with local leaders, such as chiefs, queen mothers and opinion leaders to develop more understanding of disability as well as the rights of persons with disabilities. NGOs should also collaborate with the government on disability awareness programs.

5.12. Limitations and Avenues for Future Research

First, I used the convenience sampling method to recruit participants given my access to disability leaders through my primary contact. Therefore, the present study focused on people in leadership positions in the disability organizations. A limitation is thus that people in leadership positions may not fully reflect the experiences and perspectives of the average disabled Ghanaian. Therefore, further studies should be conducted that involve people who have not risen to leadership positions.

Disability organization leaders felt that the concerns of disabled Ghanaians have been ignored for far too long. The general feeling of participants was that they had the opportunity by way of their participation to voice their concerns and hoped that they would be delivered to the leaders in government. Attempts to put pressure on me to carry their concerns to the government officials were prevalent. I had to reiterate often that the study was mainly for academic purposes, so as to minimize their expectations. Some

participants were leery of more research that results in no tangible results. Therefore, I recommend a more explicit participatory action research (PAR) approach (McTaggart,

1997), that would integrate disabled people in projects that result in social change, especially since people that I interviewed shared that they would like to see research be used to help improve their lives .

Interviews of the present study were conducted in an office setting. It would have been insightful to observe the participants in their residential or community settings, in order to see how my observations overlap with what participants discussed in the interviews. I would have observed some of their social experiences at home and in their community to see firsthand the challenges that they face in their everyday lives. Also, the

‘informal’ setting would have encouraged participants to actively participate.

Also, there was the limitation of translating some interviews from the local language, Ga, into English. Given that some participants interviewed in the local language used local jargons, not all responses could be translated word for word.

However, aside from being fluent in Ga, I also studied the language in school. This knowledge of the local language coupled with my proficiency in the English language, therefore helped with the translation and transcription.

Due to time limitation and practical considerations, participants for my study were recruited only within the Greater Accra region of Ghana. Hence, further research should be conducted that involves recruiting participants from the various regions in Ghana to obtain broader findings and compare rural and urban experiences of disability. Also, it was not possible to validate the findings by administering the translated and transcribed data to a section of the respondents, in order to confirm or

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provide alternative translation and interpretation. In other words, member checking was not possible, due to the researcher’s inability to travel back to Ghana or communicate with participants via e-mail, given time and resource constraints. This action would have added more credibility to the findings. Notwithstanding, the findings do represent, to a large extent, the social experiences of persons living with disabilities in Ghana.

101

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Appendix A

Email Recruitment Script

The University of Toledo College of Arts and Letters Department of Sociology and Anthropology Mail Stop 956 2801 W. Bancroft St. Toledo, OH 43606-3390

Tuesday, April 23, 2019

Dear Sir or Madam,

I am inviting you to participate in the study, “Disability in Ghana,” which is being conducted as part of a Masters in Sociology by Solomon Amoatey and is being supervised by Dr. Karie Peralta, Professor of Sociology. This research aims to identify the disabling barriers that people who are disabled in Ghana experience. As a disability leader, you will be asked about your organization’s priorities and your campaigns. You will be asked to explain what barriers you are trying to remove through your disability advocacy. The interview will be conducted at the offices of the Ghana Federation of Disabled People at Barnes Rd, Accra. You are responsible for arranging and funding your own travel to/from the interview. The interview will take approximately one hour. If you have any questions about the research, please contact the Primary Researcher, Dr. Karie Peralta on (1) 419 530 4659 or email [email protected] If you have concerns about the ethics of this research, please contact the Institutional Review Board on (1) 419 530 6167 or email [email protected]

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Thank you for your consideration.

Sincerely,

Dr. Karie Peralta

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Appendix B

Informed Consent Form

Department of Sociology & Anthropology 2801 W Bancroft St Toledo, Ohio 43614 Phone 419 530 4076 Fax 419 530 8406

ADULT RESEARCH SUBJECT - INFORMED CONSENT FORM

(Disability in Ghana)

Key Information:

• You are being invited to participate in a research study about disability in Ghana • The purpose of the study is to identify key issues concerning disability rights in Ghana • This research will take place at the Ghana Federation of Disability Organisations offices in Barnes Rd, Accra and will consist of a semi-structured interview that will take approximately one hour. • There are potential risks, including loss of confidentiality. • You may benefit from your participation in this research by gaining a better understanding of research procedures and clarifying your own thoughts on disability rights in Ghana. • Your participation in this research is voluntary

Principal Investigator Dr. Karie Peralta, Professor of Sociology, phone 419 530 4659

Other Investigators Mr. Solomon Amoatey, student, phone 419 530 4076

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Purpose: You are invited to participate in the research project entitled Disability in Ghana which is being conducted at the University of Toledo under the direction of Dr. Karie Peralta. The purpose of this study is to identify disabling barriers in Ghana (such as inaccessible buildings or negative attitudes about disability).

Description of Procedures: This research study will take place in the offices of the Ghana Federation of Disability Organisations, Barnes Rd, Accra. It will take approximately one hour. You will be asked to answer semi-structured questions about disability rights in Ghana.

Your interview will be tape-recoded.

“Permission to record: Will you permit the researcher to audio record during this research procedure?

YES NO

Initial Here Initial Here

Potential Risks: There are minimal risks associated with this research, including the loss of privacy. However, in order to protect your identity, you will be asked to choose a pseudonym for this research.

Potential Benefits: The only direct benefit to you if you participate in this research may be that you will learn about how sociological surveys are run and you may learn more about disability in Ghana. The field of sociology may benefit from this research by learning more about disability rights. Others may benefit by learning about the results of this research.

Confidentiality: Signed consent documents will be kept in a locked file cabinet. Only the primary researcher and the student will have access to that filing cabinet. Interview transcripts and audio files will be kept for seven years before they are destroyed, and the signed consent forms will be kept for three years after the project finishes.

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You may be directly quoted in publications stemming from this research, but your personal name will not be used. You will be asked to choose a pseudonym to further protect your privacy.

With your permission, the information that is collected from your participation in this research may be used in future research studies without your consent, but only after your identifying information has been removed from the information. If you do not grant permission for your data to be de-identified and used for future research purposes, you can still participate in the research described in this document. Your agreement to this is voluntary and there are no consequences should you decline to allow your data to be used for future research purposes. Do you permit the researcher(s) to use and/or share your deidentified data for future research purposes?

YES NO Initial Here Initial Here

Voluntary Participation: Your refusal to participate in this study will involve no penalty or loss of benefits to which you are otherwise entitled and will not affect your relationship with The University of Toledo. You may skip any questions that you may be uncomfortable answering. In addition, you may discontinue participation at any time without any penalty or loss of benefits.

Contact Information: If you have any questions at any time before, during or after your participation (or experience any physical or psychological distress as a result of this research, you should contact a member of the research team (Dr. Karie Peralta or Mr. Solomon Amoatey, Phone 419 530 4659).

If you have questions beyond those answered by the research team or your rights as a research subject or research-related injuries, the Chairperson of the SBE Institutional Review Board may be contacted through the Human Research Protection Program on the main campus at (419) 530-6167.

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SIGNATURE SECTION – Please read carefully

You are making a decision whether or not to participate in this research study. Your signature indicates that you have read the information provided above, you have had all your questions answered, and you have decided to take part in this research. You may take as much time as necessary to think it over.

By participating in this research, you confirm that you are at least 18 years old.

Name of Subject (please print) Signature Date

Name of Person Obtaining Consent Signature Date

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Appendix C

Semi-structured Interview Guide

I would like to start with some general questions about disability in Ghana. Please tell me your thoughts in as much detail as you can.

• How would you describe the overall situation for people with disabilities in Ghana?

• How would you describe Ghana’s cultural beliefs about disability?

• What are the barriers people face?

• Is there a lot of discrimination?

• What is education like for people with disabilities?

• What is the employment situation for people with disabilities?

• Are people with disabilities able to get their health needs met?

• Do people with disabilities have difficulty with transport?

• How would you describe accessibility in Ghana?

• Are people with disabilities included in social activities in Ghana?

• Do people with disabilities have difficulty with finding love or relationships? If so,

why?

• What is family life like for people with disabilities in Ghana?

• Is disability different for boys and girls, or men and women, in Ghana?

I would now like to ask some questions about the disability organization you are involved in.

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• Can you describe your organization please?

• What are some of the successes and challenges your organization has had?

Finally, I would like to ask you some questions about your own life as a person with a disability.

• What has life has been like for you as a disabled person?

• What are the main barriers you have faced?

• What are some of the things you are proudest about?

• If you could change one thing about disability in Ghana, what would it be?

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