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Community Based Rehabilitation, an Urban
Experience
How We Did CBR?
Planning:
The
Department of Physical Medicine and Rehabilitaton
has many years of experience with rehabilitation of individuals with
disability. The staff of PMR have been working with severely disabled
patients and have developed an expertise for the comprehensive rehabilitation
of these patients.
The
Low Cost Effective Care Unit has been working with the urban poor of Vellore Town for over 20 years, providing secondary care
services as well as referrals to the tertiary care centers
as needed. Primary care has not been developed until more recently.
Issues
faced:
The
team at LCECU/PMR has always been aware of the high costs of treatment of
individuals, the preventable nature of several of the injuries that lead to
disability, the inappropriateness of some of the training within the
institution and the problem of accessibility for the majority of disabled
people in the community. We are also aware that in a tertiary care centre,
disabilities due to hearing, seeing, difficulty in learning and development
are taken care of by different departments and wholistic
care is hard to provide.
Some
of these issues were discussed with people with disabilities from the local
communities who sought treatment at LCECU.
This led to the idea of setting up
a CBR project
Aims
objectives:
The
aim of our CBR project is to empower people with disability to achieve their
potential through the active participation of their family and wider
community, thus transforming the community to be a better place for PWD.
Principles:
Volunteers
or Local Supervisors: In order to base the rehabilitation in the community, it was
imperative to select volunteers from among the community. Volunteers (Local
Supervisors-LS) were selected in consultation with the community.
Educative model:Rather than a purely medical or social model,
we attempted a judicious mixture of both, through an ‘educational model’.
This envisages the creation of trained resource people (LS) in the community
who can then utilise the skills and knowledge acquired to help PWD.
Awareness creation:Community awareness was focused on prevention
of disabilities, eliminating social stigma and how to cope with the PWD in
the community.
Utilizing local resources:The primary emphasis was to harp on locally
available resources wherever possible, eg;
innovative devices, mobility aids as well as support from local people.
Need Based Approach:If the community and people with disability
are to be empowered, it is crucial to ascertain the needs as perceived or
felt by them. Any attempt that fails to take
this into consideration is bound to become a futile exercise.
Solutions
that appear good to project personnel may fail because it has not addressed
the felt need of PWD.
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A
young disabled person sought help from the rehabilitation team. The
deformities, contractures and other medical problems were quickly
identified by the team. Surgical correction of deformities and corrective
appliances were provided. The team felt with all these expensive
interventions the disabled person could lead a productive life. Much
to the dismay of the team he continued to be dissatisfied with the outcome.
His expectations from the rehabilitation team was to get some support
services to start a shop i.e. Vocational Rehabilitation. This felt need was
not recognised initially as attention was focused entirely on the
deformities. Subsequently, he was able to start a shop as a vocation, and
he put away the appliances, and was quite satisfied on achieving his felt
needs.
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