Hesperian Health Guides
Kinds and Levels of Village-Based Activities
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There is no formula or blueprint for starting a village rehabilitation program. How things get started will depend on various factors: the size of the village, the number and nature of disabled children, the interests and talents of parents and other persons, the resources available, the distance and difficulties for getting specific rehabilitation services elsewhere. Also consider the possibilities for getting assistance (voluntary, if possible) from physical therapists and other rehabilitation professionals, craftspersons, health workers, schoolteachers, and others with skills that could be helpful.
If rehabilitation is ever to reach most of the children who need it, most rehabilitation activities must take place in the home with the family members as the primary rehabilitation workers. And even where plenty of money and professional services are available, the home and community are still the most appropriate place for most of the rehabilitation of most disabled children.
For home-based rehabilitation to be effective, however, parents need carefully prepared and selected information, friendly encouragement, and assistance. And at times they will need back-up services of rehabilitation and medical workers with different kinds and amounts of skills.
A good arrangement, perhaps, is a referral chain, starting with rehabilitation in the home with guidance from a small community center run by local, modestly trained workers. If possible, the center has close links with the nearest low-cost or free orthopedic hospital and professionally-run rehabilitation center, to which the relatively few children with disabilities requiring surgery or complex therapy can be referred. Outside professionals (orthotists, therapists, and others) can help by making periodic teaching visits to village rehabilitation centers. They can also invite village workers to visit and apprentice with them in their city shops and clinics. (Apprentice means to learn by helping someone more skilled.)
Some villages will be too small or lack the resources to start their own community rehabilitation center. However, it has been found in several countries that once a modest center in one village opens, the word spreads. Disabled children with family members soon begin arriving from surrounding villages. In time the rehabilitation team may be able to help disabled persons and their families in neighboring villages to organize their own sub-centers. Disabled workers from these sub-centers can learn by ‘apprenticing’ at the original center.
The above ‘ideal’ is more or less the way Project PROJIMO in Mexico works, although with certain difficulties and obstacles.