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A project looking at Vellore town: its rehabilitation needs and how they can be met. |
Around 5% of the population of India are thought to have disabilities that may benefit from rehabilitation services to improve their quality of life. The World Health Organisation and United Nations Development Programme have found that a Community Based Rehabilitation (CBR) Programme is the best way to to this for a large population. How that service should be modified in a community with no organised Primary health care, or in an area with a well-developed health care system has not been addressed.
This web page describes the CBR services provided by the PMR department in Vellore that have tried to answer those questions. A similar page was written as an academic report and so uses more technical language CBR: a technical report. Please read which ever you like.
The common problems faced by people with disabilities are:
The challenge is to find a way to deliver rehab services that works for people with disabilities (PWD) in Vellore and then prove that it works. Community based rehabilitation (CBR) services are one way to do this.
Working together:
10 boys make a
pyramid and all are
visually impaired/blind
Dr Sara runs LCECU clinics
in the centre of town to
make them easier to get to.
A different way of doing things in CBR has been suggested that educates people so they know how to sort out their problem: an "educational model".
The educational model is different from traditional medical services. Medical services are often seen as being the expert:non-expert model. The healthcare professional such as the doctor is the "expert" about the disease which the patient has. The "non-expert" is the patient who is told what to do by the "expert" doctor. Understandably many people disagree with this model for many reasons!
The educational model says that the healthcare professionals have information about the disease and how it can be treated. The patient has information and knows how the disease stops them doing things. Lets put the two together as that way we should come up with a good answer. So the healthcare professionals will pass on what they know, so educating the patients. Together they can find the best way to sort our the patients problems.
People with disabilities face many challenges. They often cannot do things due to their disability eg cannot walk. CBR can help people find new ways to do things. The disability has many other effects on their lives. As they cannot walk it is difficult for them to get out of the house. So they cannot get into the community to meet people, shop, go to school or work or be part of any family or community activities. CBR can help people do all these things with their families and communities. People with disabilities are also often "discriminated" against. Many people think they cannot do things that they can do. Many people also looks down on them and will not allow them to do things. CBR looks to find ways to remove this discrimination.Thus
CBR is a way within community development
for the
rehabilitation, equalisation of opportunities and social
integration
of all people with disabilities.
In Vellore we feel that:
Overall we felt that a community based rehabilitation project was the best way to do this for people with disabilities in India. Starting such a project should look at the culture of the people, involve the community and should fit in with other services that already in Vellore for PWD.
The department of Physical Medicine and Rehabilitation (PMR) and the Low Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore, South India have been jointly running a CBR programme in the urban slums of Vellore since 2002. The slum population of Vellore town is 67,174. This project has been covering a population of approximately 23,000.
This project was set up to show that Community Based Rehabilitation can help people with disabilities in Vellore town through the right assessment, treatment and training. The approach used in the CBR project is an education model which has been found to work in other developing countries. The project uses the WHO training manuals and stresses that people with disabilities need to be able to do things and know about things. People without disabilities must have good attitudes to pwd.
The Local Supervisors (volunteers who live in the community) go to classes. They are given the skills they need, including problem solving and how to make use of things they can find near by, plus knowledge on how various disabilities can be treated. They then find people with disabilities in their local area and help them to identify their "felt needs". "Felt needs" are what the PWD wants help with. These needs are then looked at by the Local Supervisors (LS) and PWD working in partnership together to find an answer. The LS act as local rehabilitation resource persons through this education model. The CBR find out what can be bought nearby and what services, colleges and schools there are and set up ways to refer people on to otheres if needed. This should improve the quality of life of PWD.
A more detailed break down of the project is given below.
To show that people with disabilities (PWD's) can be helped by suitable assessment, treatment and training in a Community Based Rehabilitation Programme.
Surveying Vellore
town slums
To assess
what people with disabilities can do as they are found by the Local rehabilitation workers
what people with disabilities and their Community think they need from Rehabilitation services
To demonstrate that this kind of CBR
Can help people to dress, get around, bath more easily etc.
Can improve the physical health and quality of life of disabled persons and their families.
Can keep complications as small as possible.
To enable people with disabilities to learn how to become problem solvers and so to overcome their problems.
To show that disabled children can be educated in their community.
To help disabled adults to see what jobs they could do.
To train them in technical skills and work, as near to their homes as possible.
To train and encourage them in business skills like looking after their money.
To help people with disabilities settle in their jobs.
To enable PWD's to become "resource earners rather than being merely resource burners".
Training for the rehab
workers using
fun and games!
To teach the local supervisors how to solve problems.
To train the local supervisors to use what is available. These resources will include people such as their fellow local supervisors and teachers, plus books like those used on the course.
To study what happens as we set up this pilot CBR project and then use this information to modify the larger project that will follow.
To follow up people with disabilities at home, in schools and at work - to study the good and the bad, and to learn from them.
To look at the effect of CBR on the health, social well being and the quality of life of PWD's.
To look at the good and bad bits, easy and hard, cheap and expensive areas of our rehabilitation services. The services include CBR, general rehab and highly specialist rehab services.
The World Health Organisation funded this Community based rehabilitation project for two years. The work started in 2002 and has continued with various sources of funding. A document on Vellore CBR has been published in the WHO India website.
http://whoindia.org/EN/Section20/Section23/Section308.htm
Samuel Nagar children
singing a song
on road safety
Children from one of the slum communities (Samuel Nagar) visited a local school (Ida Scudder School) on their Founder?s day. Encouraged by the LS and the team they sung songs, danced and did drama about
"prevention of disability through accident prevention".
The school enjoyed their visit and were very impressed.
The CBR team took part in an Exhibition at LCECU on 9th and 10th December 2004. The pictures and posters looked at problems with General health eg heart problems, life style eg how smoking is bad for you, and what PWD can do.
LCECU Exhibition
Local school children
take part
at the LCECU
Experiencing disability
by NCC students
Interaction with
community volunteers
Role play on role
of volunteers
Presenting a plan of action
following a group discussion
Health status monitoring
by the hospital staff
Camp participants
enjoying a game
Exhibiting talents
Role play by LS
at Filterbed Medu
network meeting
-Look at our strength-
Anna Nagar &
Samuel Nagar group
Spinal cord injury causes people to be paralysed in the legs and/or arms, they also cannot feel anything. This can last a life time.
A workshop on "Prevention and management of Spinal Injury" was organised at Voorhees College for members of the National Cadet Corps (NCC) students from local colleges on 11.2.2005. A team planned and organised this programme. The team was from the Rehabilitation Institute and Low Cost Effective Care Unit (LCECU) of CMC including a person with spinal cord injury Mr. Manoharan .
An awareness session on "Blood donation" was given at Samuel Nagar for the community volunteers by the CMC Blood bank staff. Following this meeting a group of youth have come forward to give blood as and when required.
A session on the "Role of Teachers" in having disabled children in the normal school was conducted by Mr. Guru Nagarajan for 60 secondary school teachers at Kaniyambadi.
A presentation was done at Ida Scudder School. It was on the "role of volunteers" - what can be done as volunteers for PWD in the community. The aim was to encourage volunteering among school teachers and students.
A meeting held for volunteers from the community who were in a networking programme to plan to start a forum/meeting called "friends of PWD"
The CBR team of CMC was asked by the Hesperian Foundation to look at the draft of the "health manual for women with disabilities" before it was published. This was done with Mrs. Usha Jesudassan, a freelance journalist, the local supervisors from the CBR project, women with disabilities from the community and the CBR team members over two days.
Dr. Sara Bhattacharji & Mr. Guru Nagarajan helped a Focus group to discuss the problems of the elderly in 2005. The group were students from Indra Gandhi National Open University.
Mr. Guru Nagarajan helped on two training sessions on "Initiation of CBR in Tibetan Community" at Bylakuppe and Mundgod (Tibetan settlements in Karnataka) by the department of Health, Central Tibetan administration. Ms. Heather Payne from the Christian Medical Association of India (CMAI) and Ms. Kirpa Verghese, CMC graduate also helped.
At the request of the community members through one of the Local Supervisors (LS) (cbr worker), a general health screening camp was held in Kagithapattarai. 168 peoples attended the camp. The LS's help in getting everything organised was much appreciated.
A camp just for the elderly people living in Anna Nagar, Samuel Nagar was held. 43 old people took part in games, focus group discussions and medical screening.
A one-day festival for networking PWD in Vellore Town was held at a local school by the LS. 111 persons including 74 PWD actively participated despite heavy rain. Several programmes including indoor games, awareness sessions, a talent show and group sessions were conducted. It is encouraging to note that a number of community volunteers helped to organise the programme. This festival was the first step to shift from individual focussed intervention to group work.
Blind leading the blind:
Mr. Murugan donated
a walking stick to
Mr. Pattabi.
Following CBR thiruvizha 3 LS have started group meetings of the PWD in their area. The PWD have begun to identify the needs and problems among themselves and are starting to solve these problems using the time, expertise and financial resources found within the group. They have also made use of government and other public or private resources available. The team felt that a series of training sessions on "capacity building" will be useful for improving the organisation of these groups.
The team hope to learn the dynamics of rehabilitation needs in the urban community through this project. This project was also designed to be a pilot project for the larger rural project. The full urban project will provide a CBR programme to other areas where there are needs. The department and charitable donations fund the continuation of the project. The experience gained from starting this project has helped to offer training on CBR for WHO fellows and guidance and training for Tibetan settlements at Karnataka State. Training on CBR may be organised if asked for
The Department of Physical Medicine & Rehabilitation offers a training programme in CBR which is
Training will be in English.
The course is open to professionals in the health / rehabilitation field. This training is open to doctors, nurses, allied health professionals, social scientists, those in GO/NGO sector with an interest in CBR. A minimum of 4 trainees should be available for training.
At the end of this training programme the participants would be able to
Contact for further details regarding CBR training:
S. Guru Nagarajan
Social Worker,
Rehabilitation Institute,
Christian Medical College,
Vellore. 632 002, Tamil Nadu
Phone: 0416-2284554
Email: guru@cmcvellore.ac.in
Physical Medicine & Rehabilitation: Summary
Christian Medical College, Vellore
checkinsert
Patient care enquiries for PMR: please contact Dr. Debbie Skeil:
Email: pmrcmcv@gmail.com
Appointments
Email: appointments@cmcvellore.ac.in
Phone: 0416 - 228 3429 / 0416 228 3430
Patients coming back to CMC and who have a CMC hospital number can book appointments online.
http://clin.cmcvellore.ac.in/index.asp#new
Enquiries about working as a doctor, therapist or nurse and internship enquires: please contact the principal's Office:
Email: princi@cmcvellore.ac.in
More detailed contact information can be found at Contact Us
We hope this information is accurate; if you have any additional information
that may be useful or spot any mistakes, please let us know.
Last Edited Nov08
