Story by Auttapon Srichitsanuwaranon
Photos by Kotcharak Kaewsurach

In Sisaket, a northeastern Thai province bordering Cambodia, disabled residents often struggle to access essential aids like prosthetics and orthotics due to geographic isolation and financial hardship. Many endure long, expensive trips to service centres, prompting calls for local repair facilities, travel subsidies, and personalised equipment to improve their lives.

With a population of 1.45 million people, the province is home to 63,973 disabled residents. According to data from the Department for Empowerment of Persons with Disabilities, this includes 35,175 people living with physical or motor impairments. Their access to essential aid, such as wheelchairs and anti-decubitus cushions, is severely limited. Solutions like decentralising services, reducing travel costs, and tailoring aids to individual needs have been proposed but action is still needed.

Samai’s First Wheelchair

Samai Sawasdeephor, president of Benchalak District’s Council for Independent Living.

Samai Sawasdeephor, 48-year-old, lives with a polio-induced disability.  She has been unable to walk since she was a year old.  For most of her life, she had no wheelchair either.  Instead, she crawled everywhere, making her daily life extremely difficult.

At 21, Samai received her first wheelchair through the efforts of the Subdistrict Administrative Organization (SAO), which filed a request with the Provincial Social Development and Human Security Office. It was not suitable for her, however. “It was a hospital-style wheelchair, heavy and impossible for me to move by myself,” she said. “I needed someone to push it, so I only used it occasionally. Most of the time, I still had to crawl.”

Today, Samai is the president of Benchalak District’s Council for Independent Living. Her current wheelchair, a donation from Japan, has transformed her life. It allows her to move independently without relying on others. “It makes me more confident about going out, ” she said. There are still issues with repairs, however. Problems with tires and bearings arise often, and while some repairs can be done at home, more serious issues require a trip to the repair centre—a 120-kilometer journey to the Sisaket provincial hub. “It is difficult,” she explains. “Sometimes, I have to wait for spare parts ordered online, which adds to the expense.”

Sisaket has only a few maintenance shops and repairs are not only costly but time-consuming. As spare parts are not always available, people living with disabilities often have to get by without their wheelchairs while waiting for repairs.

There is a real need for improved support services - financial assistance and policy measures that would empower people with disabilities to live more independently, improving their overall quality of life.

Struggling for Access

Natnaree Pongbanthao, a resident of Sisaket, who has been using a prosthetic limb.

For Natnaree Pongbanthao, a 53-year-old who was paralysed after being shot in 1997, the anti-decubitus mattress and cushion she received in 2024 from the People With Disability Club of Nong Ngu Lueam are more than just comfort items. "The anti-decubitus mattress and cushion are critical in preventing pressure ulcers," she said. "Without them, the ulcers would get much worse."

Natnaree, who lives in the Nong Ngu Lueam subdistrict of Benchalak district, relies heavily on these aids. The travel expense to obtain them was a burden, however. “I only receive 800 baht per month from Thailand’s Disability Allowance,” she explains. In Benchalak, hiring a car costs around 300 baht and a trip to Sisaket Hospital can set her back as much as 1,000 baht.

Natnaree’s challenges don’t end there. Her wheelchair, which she uses both inside and outside the house, even while bathing—rusts and breaks down frequently. “I have to replace it every year,” she said. But the wait time for a new one from the government is five years, and the requisition process is lengthy. "I often end up buying one myself or relying on donations, which usually results in a cheap, easily broken wheelchair."

She hopes the government will improve the system for requisitioning disability aids. “The process needs to be faster, and there should be service centres in communities to reduce the barriers to access,” she said, emphasising that such changes could significantly improve the quality of life for people with disabilities.

Accessing Prosthetics Remains a Challenge

Samruai Boonlord became disabled in 2009 after stepping on a landmine.

For people with disabilities in Sisaket, especially those in remote areas, obtaining essential aids like prosthetics is still a significant challenge. 117 kilometers from the city center, in the Khun Han and Kantharalak districts, residents struggle to receive the care they need.

One such is Samruai Boonlord, 58, from Nongbualane village in Khun Han District. She became disabled in 2009 after stepping on a landmine. “I waited about three months for my first prosthesis,” she recalls. “During that time, I had to adapt to everything. I used crutches and walking took a lot of effort.”

Over the past 15 years, Samruai has had to replace her artificial limb seven times. “Each time, it takes about two months to adjust and get used to the new prosthesis,” she explains. Traveling for fittings has been costly, with expenses reaching up to 1,000 baht per trip.  A branch of the Prostheses Foundation is located in Khun Han district, allowing her easier access by motorbike, but the larger issue of accessibility remains unresolved.

Distance and Cost: A Widespread Issue

Wichai Pokhaphan, a former paramilitary officer, was injured by a landmine while working in a cassava field on the Thai-Cambodian border in 1980.

Wichai Pokhaphan, 67, from Phum Sarol village in Kantharalak district, has a similar story. A former paramilitary officer, he was injured by a landmine while working in a cassava fields on the Thai-Cambodian border in 1980.  He wants to see a prosthesis repair centre in his community. “Traveling to Sisaket city for repairs is time-consuming and expensive. Having a local repair center would reduce costs and make services more accessible.”

Wichai, like many others, believes that decentralising disability services is crucial. Setting up repair centres in local communities or at sub-district health centres would make it much easier for people with disabilities to access the care they need.

Rittichai Sodsai, Chairman of the People With Disability Rehabilitation Association in Kantharalak

Rittichai Sodsai, Chairman of the People With Disability Rehabilitation Association in Kantharalak, agrees. Each year, his association helps 20 to 30 people access disability aids, including prosthetics. "Prioritising access to prosthetics would speed up the process," he said. "But the main obstacle remains the distance and travel costs."

Rittichai advocates decentralisation of both the requisition and repair processes, bringing services to sub-district and district hospitals. He also thinks that people with disabilities should have more agency in choosing their aids. “Each person uses prosthetics or disability aids differently. Letting them choose what suits their needs, instead of just accepting what the government provides, would lead to a better quality of life.”

Disability Rights: Insights from Sirindhorn Rehabilitation Institute

Dr. Witchinee Tongthong, the medical deputy director of the Sirindhorn National Medical Rehabilitation Institute (SNMRI).

The Sirindhorn National Medical Rehabilitation Institute (SNMRI) plays a critical role in providing disability aids and prosthetics in Thailand. According to Witchinee Tongthong, the medical deputy director of SNMRI, the institute's mission goes beyond just procuring equipment like prosthetic limbs and wheelchairs; it’s about enabling people with disabilities to lead more independent lives. “Prosthetics help those who have lost limbs, while disability aids such as wheelchairs let people go about their daily lives more normally," Witchinee explains.

Yet, even within the system, challenges remain—one being how some disability aids are classified. Anti-decubitus mattresses, which help prevent pressure sores, are often seen as a luxury items rather than essential aid. “They improve quality of life but do not directly help people stand up or go about their daily routine," Witchinee explains.

Funding Shortfalls and Rural Struggles

Wheelchairs parked at SNMRI.

Thailand’s disability support system serves a large population. In 2022, some 205,000 out of four million registered individuals needed disability aids. In that year, SNMRI received 17 million baht from various government sources, including the National Health Security Office (NHSO) and the Social Security Office. "On average, each person got 4,000 to 5,000 baht," Witchinee said, noting that the funds fall far short of what’s required. "Between 2022 and 2024, the system received 30 million baht but could still only meet 30% of that demand."

Hospitals in rural areas face the same challenges, particularly when it comes to funding. “Most hospitals exhaust their budgets on medicines, leaving little for disability aids,” Witchinee said. She points out that if aids aren’t specifically listed under hospital funds, staff are left to distribute whatever is in stock or buy items individually—making it impossible to draw NHSO’s funding.

Witchinee suggests that expanding service centres like SNMRI across more regions would significantly improve accessibility. “By doing so, we could reach more people in need,” she said, adding that streamlining the registration process for disability aid recipients is also crucial. "Right now, the process takes three months. If a doctor determines the patient's condition won’t improve, that timeline could be shortened."

The Strain on Medical Resources

A shortage of rehabilitation doctors is another issue that needs addressing, Witchinee notes.  She believes the problem could be addressed by improving working conditions and increasing salaries.

Despite the obstacles, she remains optimistic. “We have the capacity and will to improve things," she said. She thinks that with greater community involvement, those in need will have better access to services and support.

The Evolution of Disability Registration in Thailand and Ongoing Challenges

Donruedee Srisuppaphon, head of the quality improvement team at SNMRI.

The landscape of disability evaluation and registration in Thailand took a pivotal turn with the enactment of the Medical Rehabilitation Act in 1991, which focused primarily on physical impairments, like the loss of limbs. Another significant shift occurred in 2007 when the system was updated to align with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). The new guidelines emphasise the importance of helping people with disabilities to live independently and participate in society.

Donruedee Srisuppaphon, head of the quality improvement team at SNMRI, explains the shift: “Before, the evaluation was largely about counting how many limbs a person had. Now, we focus more on how well they can manage daily life, like walking or performing routine tasks.” Gaps remain in the evaluation process, however. Certain groups, such as individuals with mental illnesses, require more complex assessments.

Accessibility and the Quality of Disability Aids

One of the ongoing challenges lies in the suitability and quality of disability aids. According to Donruedee, the functionality of aids like leg prostheses can vary widely. Some models, for example, allow the wearer to sit cross-legged, while others restrict movement to a rigid 90-degree angle, significantly affecting a person’s daily comfort and mobility. "The right wheelchair, properly fitted to the user’s needs and size, is just as important,” Donruedee said. “Without appropriate options, people with disabilities may be forced to use aids that are uncomfortable or harmful to their health."

Another pressing issue is the accessibility of rehabilitation services. The shortage of rehabilitation doctors and the absence of dedicated Physical Medicine and Rehabilitation departments in many hospitals compound the difficulties, especially in rural areas. In some remote regions, there may only be one rehabilitation doctor—or none at all—leaving people with disabilities unable to access necessary services.

Addressing the Shortfall in Services

Insufficient medical staff and the lack of local repair services exacerbate the problem, particularly in under-resourced areas. Without proper maintenance services, those living in rural regions face even greater barriers to accessing care and keeping their aids in working order.

Donruedee advocates for expanding specialised services in communities and decentralising the registration process. “With more support from the government and state agencies, we can reduce obstacles and make it easier for people with disabilities to access the services and aids they need,” she said. Enhancing the scope of services and streamlining the system are essential steps in improving the quality of life for people with disabilities.