Does one become a person with disabilities after spinal cord injury? In reality, paralysis does not necessarily disable a person. Limbs may not function as they used to be but there is more than one way to skin a cat. Humans are adaptable creatures. For centuries, we have created ways and devices to simplify work. Likewise, in the present age, we have the innovation to invent assistive devices to substitute for the loss of limb functions.

Even the simplest everyday implements such as spoons and toothbrushes have been adapted for the use of people with limited hand function. On the other end, electronic technology has enabled a person who is completely paralysed to use the personal computer for work and leisure. Head-mounted pointing devices and voice recognition software has allowed people with severe physical impairments to perform all the tasks that a non-disabled person can do with a computer.

The built-environment is another area where people with physical impairments are disabled not by their own impairments but by facilities that are not accessible. To understand why this is so, there is a need to define the difference between impairment and disability. They may seem like two words with the same meaning. When we look closely there is a vast difference between the two.

Impairment describes the imperfect condition of the body such as paralysis of the limbs, blindness and deafness. Impairment does not and should not lead to disability. A person with impairment experiences disability when faced with environmental and attitudinal barriers.

A wheelchair user who is a person with impairment experiences disability when the only access into a building is via a flight of steps. A suitable ramp eliminates the disability and allows the wheelchair user to get into the building. He now no longer experiences disability. The ramp also provides an easy means of access into the building for people with temporary mobility impairments and the elderly.

Environmental barriers such as this are the result of attitudinal barriers. The lack of understanding of the needs of people with impairments, ignorance and discrimination leads to the construction of infrastructure that is disabling to certain groups of people. Just because things have been done the same way for thousands of years do not mean that it must continue to be done the same way now.

So, does one become a person with disabilities after spinal cord injury? It is evident that paraplegia and tetraplegia is not the sole cause of people being disabled. There are many other factors that restrict persons with physical impairments from achieving their full potential. There is a need to understand this and work on solutions to resolve it. Creating an environment that includes the needs of everyone is not difficult. All that are needed are a change of mindset and some creativity.

The term person with disabilities is universally accepted to mean person with impairments, be it physical, visual, auditory or intellectual. This term puts the burden of disability on the person when in reality environmental and attitudinal barriers are major disabling factors. Removing those barriers will result in removing the disability imposed upon persons with impairments. A better term, for the lack of a more suitable one, would be disabled person. It describes a person who is disabled by the environment and attitudes.

In the initial years after spinal cord injury, I was often stricken with urinary tract infections (UTI). This could be due to the indwelling catheter that was not properly maintained, insufficient intake of water, improper diet and low-resistance to infections. Urinary tract infection can lead to serious complications such as infection of the kidneys (acute pyelonephritis), inflammation of the bladder (cystitis) and inflammation of the urethra (urethritis) if not properly treated.

Early symptoms of urinary tract infection includes the urge to urinate often but only passing out small amounts of urine (cystitis), a burning sensation while urinating (urethritis), blood in urine (hematuria) and urine that is cloudy and strong-smelling. Advanced symptoms includes tremors, chills, high fever and symptoms related to high fever such as nausea, hallucination, poor appetite and vomiting.

Antibiotics were prescribed each time I had urinary tract infection. Little did I realise that over the years, I had to take stronger and stronger antibiotics because the infection-causing bacteria became progressively resistant to the more common antibiotics. It came to a stage where the urologist advised me to try to clear the infection by drinking more water because the urine culture and sensitivity (C & S) showed that nothing but the strongest antibiotics will work for me and some of the bacteria are already multi-drug resistant. In addition to that, I have to avoid antibiotics that are nephrotoxic to prevent further damage to my kidneys.

We all know that prevention is better than cure. Therefore it is important to take steps to reduce or even prevent the occurrences of urinary tract infections. Good practices include drinking sufficient water, replacing an indwelling catheter according to schedule, ensure cleanliness during intermittent catheterisation and bowel programmes, and emptying the bladder at predetermined intervals to prevent bacteria from multiplying.

If there is a need to take antibiotics for urinary tract infections, the full course must be completed. Stopping the course halfway when the symptoms have disappeared may not have fully eliminated all the bacteria and could even restart another infection. Taking partial courses can make the bacteria resistant to the same antibiotic later on. One should never self-medicate with antibiotics bought over the counter without proper medical diagnosis and advice. It is important not to abuse the use of antibiotics to prevent the occurrences of antibiotic resistant and multi-drug resistant bacteria as it will leave doctors with very few treatment choices and may result in the use of more expensive drugs.