A post by Shruti More, our permanent OT in Kullu
Community Based Rehabilitation is a strategy within general community development for the rehabilitation, equalization of opportunities and social inclusion of all people with disabilities. The primary objective of CBR is the improvement of the quality of life of people with disability / marginalized persons. Key principles relating to CBR are equality, social justice, solidarity, integration and dignity.
CBR is not an approach that only focuses on the physical or medical needs of a person or delivering care to disabled people as passive recipients. It is not outreach from a centre. It is not determined by the needs of an institution or groups of professionals, neither is it segregated and separate from services for other people.
Conversely CBR involves partnerships with disabled people, both, adults and children, their families and communities. It involves capacity building of disabled people and their families, in the context of their community and culture. It is a holistic approach encompassing physical, social, employment, educational, economic and other needs. It promotes the social inclusion of disabled people in existing mainstream services. It is a system based in the community, using district and national level services.
Institutional rehabilitation provides excellent services to address the problems of individual disabled person and is often available only for a small number at a very high cost. Moreover, the endeavor in an institution, is often out of context to the felt needs of the disabled person, and thus falls short of their expectations. In an institutional rehabilitation program, the community is not linked with the process. Hence, when the disabled person returns home, it may become difficult for them to integrate into their community. Disability often requires life-long management, therefore, activities aimed at enabling people with disability should be community based as much as possible. The most basic rehabilitation activities can be carried out in the person’s own community.
In every society, disabled children have the same social needs as other children. They need to be loved and respected, need to play and explore their world with other children and adults and opportunities to develop and use their bodies and minds to their fullest ability, whatever it might be. The way people treat disabled persons differs from family to family, community to community and country to country.
Since the foundation of Handimachal in 2009, providing training to local community in the field of disability and rehabilitation has been one of our main objectives. We had already taken some steps in this direction by conducting awareness camps in villages and schools, and organising workshops for teachers and parents.
Our motive with conducting the Community Based Rehabilitation Training Program is to look at ways to actively involve members of the community (disabled persons, their families, concerned adults, and others) in meeting the needs of disabled children and in helping them to find a meaningful place in the community. We are looking for ways to help the community respond more favorably to disabled children and their needs. Usually of course a village or a neighbour does not decide, on its own account, to offer assistance, acceptance, and opportunity to disabled persons and their families. Rather, disabled persons and their families must begin to work together, to look for resources, and to re-educate both themselves and their community. Finally when they gain enough popular understanding and support they can insist on their rights.
We shortlisted five motivated women and one mother of a special-need child, and these six women are undergoing a month-long intensive training to become trained community rehabilitation workers. Out of the six women, we will select three women to work with us for a period of one year in our outreach programs.
CBR workers are key in the implementation of CBR. They are usually the main persons in contact with families. Their main role will be:
- to act as local advocates on behalf of people with disabilities and their families with the health services personnel,
- to provide liaison and continuity of care in the community on behalf of professionals eg. they will continue the supervision of our home-based programs,
- to act as directors of community initiatives to remove social and physical barriers that prevent inclusion,
- to provide a positive role model for service users if they themselves have a disability.
The course structure has been based on the framework of a manual called “Getting to know Cerebral Palsy (see below), which was introduced to us by Tina Gericke, a senior OT volunteering with us at present. The course syllabus is based on the book “Disabled Village Children’’ which is available in Hindi and a “CBR Training Manual” edited by CBR network Asia. Hindi being a widely spoken and understood language here, we had to translate most of the syllabus in Hindi.
Designing an appropriate syllabus which covers our area of focus and keeping it simple but informative and educative enough for the community workers to comprehend was a challenge. Though Cerebral Palsy is our major case load, we have covered a range of other childhood disabilities too. The course structure is made practical and functional, with a lot of case studies, practical demonstrations, discussions and activities.
We are glad to have an interactive and enthusiastic bunch of women trainees. We just had our first home visit with them last week, and we could see the positive results of the three weeks of hard work put in by us. We are positive that these trained community workers will provide Handimachal with some extra helping hands to make a difference in the lives of our special need children. The CBR training ideals have been beautifully depicted in an old Chinese verse:
Go in search of your People;
Learn from them;
Plan with them; Serve them;
Begin with what they have;
Build on what they know;
But of the best leaders when their task is accomplished,
Their work is done, the people all remark:
"We have done it ourselves"
Thank you to everyone for making this happen in Kullu !
Discover the model developed by the London School of Hygiene and Tropical Medicine: