Hesperian Health Guides
The Role of a Villager-Run Rehabilitation Center
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Some of the most important rehabilitation activities take place with the family in the home. Others take place in the school, the marketplace, the village square, and, when necessary, in the nearest orthopedic hospital. The key to helping all this happen can be the village rehabilitation center.
A village rehabilitation center run by modestly trained disabled workers, together with the families of disabled children, can provide a wide range of services. These may include training and support of families, community activities, nonsurgical orthopedic procedures, and making orthopedic and rehabilitation aids. The program need not try to do everything at first, but can start with what seems most important and gradually add new skills and activities as needs and opportunities arise.
Eventually, a community team can gain considerable skill in many areas. For example, the village team of PROJIMO is able to adequately attend the needs of about 90% of the disabled children it sees (except for blind or deaf children for whom its services are still not adequate). Only about 10% need referral to orthopedic hospitals or larger rehabilitation centers. Visiting experts have found that at times the therapy or aids provided by PROJIMO are more helpful than those previously provided to the same children by professionals in the cities.
The chart on the following page gives an idea of possible activities and functions of a village rehabilitation center. It also lists activities of possible ‘subcenters’ in neighboring villages, as well as referral and support services needed from urban orthopedic and rehabilitation centers, and outside specialists.
POSSIBLE ACTIVITIES AND FUNCTIONS OF REHABILITATION CENTERS AT DIFFERENT LEVELS
- parent meetings, mutual assistance and shared child care between families of disabled
- playground for all children (disabled and non-disabled)
- group action to get disabled children into school
- special group activities for children who cannot attend normal school
community awareness raising activities:
– involving schoolchildren and villagers in building playground, improving accessibility, making toys and equipment
- organized (group) visits to the village rehabilitation center in the neighboring village
- educational and preventive activities
- perhaps one or more ‘village rehabilitation assistants’ to help with basic therapy and rehabilitation, under guidance from rehabilitation workers from the village rehabilitation center
- all of the activities listed for the sub-centers. And also:
- family and small group training in basic care, therapy, and development of disabled children (guidelines and advice)
- workshop for making and repairing (and teaching families how to make and repair) orthopedic and rehabilitation aids including:
– special footwear
– special seating
– artificial limbs
– therapy aids
- non-surgical orthopedic procedures (straightening joints with series of casts, etc.)
- arrangements within village to provide room and board for visiting disabled children and family members from neighboring villages.
This may include:
|– village families who are willing to take in visiting families at low cost|
|– a ‘model home’ where visiting families can stay, equipped with low-cost adaptations and equipment for better function and selfcare by the disabled|
|– coordination, informal training, visits and advice to parent groups or subprograms in neighboring villages|
- workshops and/or agricultural projects where disabled youth can learn income producing skills to bring in some income to the program or family
- prevention campaigns, for example:
|– vaccination against polio and childhood diseases, with special focus on underserved families and communities|
|– education campaign against overuse and misuse of injections|
- activities to involve and include as much of the community as possible (adults and children) in the program; possibly,
|– help with therapy|
|– help with play and entertainment|
|– accompany disabled children on outings, help them get to school, etc.|
|– village support committee|
|– a toy-making workshop where village children make toys for disabled children and also for their little brothers and sisters|
- ‘outreach’ to help start neighboring sub-centers, with provision of training, backup referral services, and regular visits
- referral services for: orthopedic evaluation, advice and surgery as needed (at low or no cost)
- orthopedic and rehabilitation equipment too complicated to be made at village level
- periodic visits by orthopedic surgeons to village rehabilitation center to evaluate possible surgical needs of selected children
- short teaching visits (3 days to 1 month) by visiting specialists (physical therapists, occupational therapists, special teachers, brace makers, limb makers, rehabilitation engineers, etc.) to teach and advise the village team. (It is important that such visitors play a secondary, background role and not be present all the time, nor take charge or work independently with children.)
- apprenticeship opportunities: learning for village workers in the centers of the different specialists