Hesperian Health Guides
The Importance of Community-Run Rehabilitation Centers
In an attempt to get the focus of rehabilitation out of big institutions and into the home, some community-based rehabilitation programs have tried to manage without any kind of local rehabilitation centers. ‘Local supervisors’ make home visits and work directly with the families of the disabled. However, when additional assistance or aids are needed, the local supervisor often has nowhere to turn. She has to send the disabled person to professionals in the city. For reasons of distance, cost, fear, or failure of the support system, these referrals too often do not work out. As a result, rehabilitation is often incomplete, and people get discouraged.
Of course, referral to large city hospitals or centers will still be important for selected individuals. However, there are several strong arguments in favor of setting up a small village or community-based rehabilitation center run by local concerned persons:
- It is a visible, practical, low-cost base for coordinating rehabilitation activities in the home, and for providing back-up services outside the home.
- It can produce a wide range of rehabilitation equipment and aids quickly and cheaply, using local resources, with participation of families, schoolchildren, and local craftspersons, when possible.
- It can include a ‘playground for all children’ and organize activities to encourage understanding and interaction with the disabled.
- It can provide meaningful work and training experience for local, otherwise often untrained and unemployed disabled persons. It gives the families of disabled children and other villagers the chance to see what a useful, helpful, and rewarding role disabled persons can have in a community.
- Although the best place for day-to-day rehabilitation is often the home, there are families for whom this may be very difficult. These include families in which one or both parents have left or are dead, or have drinking problems, or where stepparents or other family members are cruel to the child, neglect her, or abuse her sexually (a fairly common problem). In many homes, the family does the best it can. But the extra work of trying to care for a severely disabled child may simply be too much for the family that has to work long hours just to survive. Under any of these circumstances, special care at a community center may be of enormous benefit to both the child and the family.
- If many small community centers join to form a ‘network’, they can exchange ideas and learn from each other. Or different centers can ‘specialize’ in producing different supplies or equipment. For example, one village center might make wheelchairs, another toys, and another low-cost plaster bandage for casting. Then different centers or programs can supply each other at low cost.
Home-based rehabilitation often works much better with the help of a local, community-run center.