Health for the Millions, Vol. 6, No. 6, Dec. 1980.pdf

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HEALTH FOR THE MILLIONS

Vol. VI

No 6

/Vf

WHAT ,s THEIYDP

December 1980

ALL about

?

CONTENTS

1.

Disabling Myths

2.

Who is Afraid of the
Disabled?

The year 1981 was proclaimed as the International Year of
Disabled Persons (IYDP) by the UN General Assembly in 1976.

Enabling Cancer Patients
through Imagery
6. Disability to Ability

3.

9.

Community to COMMUNITY

11.
13.

A Cause for Hope'
News from the States

15.

What's Enabling

16.

Enabling at Low Cost

•

The keynote theme is : “Full participation and equality." This
means integration should replace the present trend towards separa­
ting the disabled from the able at school, at work, at home and in
society in general.
The above official IYDP logo represents two people holding
hands in solidarity and support of each other in a position of
equality.
Objectives

The aim of the Year is to encourage the rehabilitation of the
estimated 450 million people on earth who suffer from some form
of physical or mental impairment.
Five principal objectives for the Year have been set:

(a) Helping disabled persons in their physical and psycholo­
gical adjustment to society ;
(b) Promoting all national and international efforts to provide
disabled persons with proper assistance, training, care
and guidance, to make available opportunities for suitable
work and to ensure their full integration in society ;

Editor: S. Srinivasan

Executive Editor: Augustine
Veliath
News & Events: Nalini Bhanot
Production: P. P. Khanna

Assistance: Ponnamma George
Circulation: L. K. Murthy

(c) Encouraging study and research projects designed to
facilitate the practical participation of disabled persons
in daily life, for example, by improving their access to
public buildings and transportation systems ;

(d) Educating and informing the public of the rights of dis­
abled persons to participate in and contribute to various
aspects of economic, social and political life ;

(e) Promoting effective measures for the prevention of dis­
ability and for the rehabilitation of disabled persons.
Another principal objective of IYDP is to further the implemen­
tation of the 1971 Declaration on the Rights of Mentally Retarded
Persons and the 1975 Declaration on the Rights of Disabled
Persons, both of which were adopted by the U N General Assembly.

Owned and published by the
Voluntary Health Association of
India, C-14, Community Centre,
Safdarjung

Development

Area,

New Delhi - 110016, and printed
at Sabina
Printing
387,24, Faridabad.

Press,

Specific objectives for India set by the government of India
include evolving a national policy on the disabled, developing a
strong national disability prevention programme and giving a
positive rural bias to services for the handicapped. The govern­
ment also proposes to encourage the forming of cooperatives by
handicapped people, by providing special concessions in terms or
finance to such cooperatives. A sample survey on the handicapped
in India and legislations for the handicapped are among some of
the other laudable objectives of the government of India

COMMUMTY HEALTH
CELL
326, V Main, | Block
f'Oramangala
eangalor»-560034
India

EDITORIAL

DISABLING MYTHS
Talking about the IYDP and measure, Enter the harried pa­ by making them objects of not so
the disabled gives one a benum­ sserby
who chews a lot of ’ helpful pity.
bing feeling of having gone tobacco, and who probably is an
through all this before. What was alcoholic with chronic ulcer. He Disability Awareness
it the other day ? Oh yes, the i sees the limping boy, tut-tuts
The best one can do for
Year of the Child I And what away with well-intentioned con­ the disabled under the cir­
happened to children, especially cern, and makes a mental note cumstances is to educate our­
of the poor, anyway?
that the next time the blind-relief selves. Then, we could systemaI
Such cynicism however has boys come for money, he will | tically plan and do something
no place in the river of healing. • definitely give away half his day’s concrete to prevent disability in
the long run. Prevention is better
'They only fester the wounds. We I wages.
have to quietly accept the fact
No, says an article in this than firefighting. How much of
that a great many people who issue. Disability comes in many firefighting can we do any way
do not mean what they say will forms. The boy with the missing I even if we pit all our resources
make speeches and wash their limb is only one of the many. against the enormous need?
Rehabilitation of the disabled
sentiments in public. A few The harried passerby would do
disabled children of the poor well to direct the well-intentioned is more effective if the disabled
will be garlanded on social occa­ concern towards himself. Alcoho­ 1 person is enabled to live as normal
sions and even taken to the lism, chronic ulcer and compul­ a life as possible in society. This
national capital to shake hands sive smoking in themselves carry i means the disabled person is
with the powers that be. A great the seeds of permanent disability. provided opportunities to earn his
living and participate in society
many more disabled children of If not checked in time, that is.
:
without
special discrimination.
the rich will go abroad and
Disabling Poverty
:
This
also
means artificial gadgets
attend special camps in Paris,
1
are
kept
to a minimum and a
Argentina or Alma-Ata. Let
The single, major cause of
j
solution
is
found to the question
them.
■ disability throughout the world
; of his rehabilitation at a cost
The IYDP is a time of focuss­ • is still poverty. Poverty leads to
■ which he could afford. Full partiing the energies of those who : ignorance, disability and more I cipation and equality require that
One such resulting
are interested and involved. It is poverty.
the disabled of any kind are not
an opportunity for some mean­ disability due to poverty is malnu­ victims of pity, scorn or social
ingful long-term planning for the trition. More children die due to rejection. The disabled have to
disabled at the local and national malnutrition in India than due to help themselves as much as
levels. It is a time for initiating any other reason. Any long-term possible and society helps them
a rethinking on existing activities, attempts at prevention and reha­ as little as needed.
achievements and priorities and bilitation of the disabled in India
Solutions and plans for the
have to be viewed therefore in the
initiating new action too.
prevention
and rehabilitation of
light of the poverty of the Indian
the
disabled
therefore cannot be
Disabling Stereotypes
peoples. Thus it is meaningless
imposed from the top. They could
to
talk
about
fitting
the
disabled
Closely related to these
be only effective if there is com­
attempts is our understanding of in our villages with artificial limbs, munity participation just like any
who is the disabled person. The however low-cost they be. For
other health effort.
popular picture of a disabled who can afford even a so-called
Disability lies in the minds of
low-cost
artificial
aid?
Many
a
time
person is the little boy who
1
men.
It is only in the minds of
it
is
neither
low-cost
nor
an
aid.
limps along with an artificial leg
I men that the practices of healthy
They
even
increase
the
depend
­
or an artificial limb, with some
braces thrown in for good ency of the disabled on society I enabling can start.
health for the millions/december

1980

1

WHO IS AFRAID
OF THE DISABLED ?
Disability is of many kinds.
There is the disability due to
genetic disorders. 3% of all those
born in the world have some
kind of genetic disturbance. Of
this the largest single group of
disabled — the mentally retarded
—is usually estimated at 1-4% of
all new born children in theworld.
35% of the new borns in India
and Sri Lanka have a birth weight
of less than 2.5 kg, compared to
6-8% in Europe.
Disability can be also due to
non-genetic disorders. These in­
clude malnutrition, disability due
to diseases during pregnancy,
complications due to lack of mid­
wifery, impairment of fetal deve­
lopment, nutritional disorders and
disability due to diseases like T.B.
leprosy, malaria and poliomyelitis.
Many of them imply social reject­
ion (T.B. leprosy). Some of them
diminish the ability to work (mala­
ria, T.B.). Some of them like polio
are short-term infections with
life-long implications.
Malaria is back. And malaria
is a major disabler in countries
like India.
There are other equally severe
forms of disability due to other
communicable diseases like men­
ingitis, encephalitis, trypanosomi­
asis, hepatitis, herpes, osteomye­
litis, septic arthritis, chronic eye
infection, trachoma,
onchoce­
rciasis, otitis, V.D., and what
have you.
Then we have disabilities due
to what one may call somatic noncommunicable diseases like arthri­
tis, paralysis, diseases of the
heart, lung and brain, cancer and
epilepsy.
2

To all this you only need to
add the havoc caused by alcoho­
lism, drug abuse, traumas, inju­
ries, accidents, artificial and natu­
ral disasters like earthquakes,
floods and pollution. And you
have a pretty picture of man and
nature, and how nicely they get
along with each other.
If you are interested in things
like counting, do not try it. World­
wide estimates are not worth
writing home about. The total
number of disabled in the world
is something about 516 million or
13% of the world population. If

you allow for double counting you
will succeed in cutting it down to
400 million which is 10% of the
world population. At conserv­
ative estimates that is.
As if this horror story were
not enough, disability of some
kind or the other is multiplying
every second due'fcfman against
man — hatred, lack of love and
lack of mutual tolerance. They
cause wars among nations. And
quarrels at home and at work. And
they stop little children from blo­
ssoming. And old men from
dying peacefully.

HEALTH FOR THE M1LLIONS/DECEMBER 1980

Carol Huss, Mira Shiva, Renu Khanna and Celine P.

Enabling Cancer Patients
Through Imagery
Numerous authentic research studies have shown the link between stress and disease. The
relationship between stress and peptic ulcers, hypertension and coronary problems is already
considered an established fact. Recent work done on the effect of stress on the immunological
system of the body is mind-boggling. What emerges is the concept of a carcinogenic or cancer
prone personality and the recognition that people with such personalities require something more
besides drugs, surgery or radiation in the management of cancer. The focus would have to be not
merely on the physical aspects of the disease but also on the underlying psychological factors in the

patient.
Dr O Carl Simonton, a radiation oncologist in Fort Worth, Texas, and his wife Stephanie
Mathews Simonton, programme director at the Cancer Counselling and Research Centre, Fort Worth,
first started using positive imagery techniques for stress reduction in the treatment of cancer
patients in 1969. The therapy, individual or group is geared to allow the patient to see how he can
actively participate in his return to health.
A team consisting of Carol Huss, Mira Shiva and Renu Khanna of VHAl, and Celine, initiated a
six-week course on stress reduction using techniques of positive imagery. These techniques
included art therapy, music therapy, yoga, dream analysis, meditation and biogenics.

The scene was the Cobalt
Conference Room, Ruby Hall
Nursing Home, Poona.

We sat with eleven very appre­
hensive, intensely worried people
suffering from cancer of different
parts of the body. Some had a
relative with them, some had
nobody. The patients formed a
mixed group ranging from Bhandare, a 68 year old man with
cancer of the throat, whose wife
was in the last stage of the same
disease to the 27 year old Sushila
who had cancer of the cervix. She
was a mother of three small
children and her husband had
deserted her. The majority of
them belonged to an economi­
cally weaker strata of society.
Very few understood or spoke
English and some knew only
Marathi.
These patients had
come because they hoped that
what we had to offer might help
them counter their disease.

six weeks we would help them to
bring about a change in their
attitude towards their disease; a
change in their attitude toward
living with the dreaded carcinoma
and help in the building of supp­
orting and helpful relationships in
the group, in a supportive atmo­
sphere they would be able to talk
about their worries and troubles
and find ways of coping with
stress. We emphasised that this
programme would not necessa­
rily result in the disappearance of
their disease.

sharing left the people feeling
much less apprehensive. Our
friends bade us goodbye with
somewhat tentative smiles.

We began with an introduct­
ion to ourselves and the progra­
mme. We explained that in these

Before ending the first session we had discussed their com­
mitment
to the programme.
Would they be able to come
every Tuesday and Friday for two
hours ? Would a relative or friend
accompany them so that the
support and continuity would be
ensured at home during the week
and even after the six weeks? All
the same, our group was reduced
i to six patients at the next meet­
First Fears
ing. Having read about the high
We then asked them to talk dropout rate in the Simontons’
about themselves. They came out work, we were not very dis­
hesitatingly. Most of them spoke couraged.
in low, faltering tones. Their an­
xiety and worry was evident. Some War with WBCs
of them broke into tears when
The doctor in our team exthey faced the question of “atti­
; plained, in simple Hindi, how can­
tude towards their disease.’’
cer is caused. Using a number of
“What can I hope for ? I know I attractively sketched visuals, she
what cancer does", sobbed I told them about white blood corSushila. We listened silently and i puscles, WBCs, and the body's
feelingly. Though painful, this I immunological system. She fur-

HEALTH FOR THE MILLIONS/DECEMBER

1980

3

of just twice a week. With each
instance of their initiative and
interest, our team felt greatly en­
couraged and was spurred on to
greater spurts of creativity.

Eye-opening Art
The next time we met, we sup­
plied crayons and papers and
asked the group to draw their
perceptions of their own WBCs
and cancer cells. The Ruby Hall
staff were a little doubtful about
these illiterate people being able
to effectively participate in these
ther went on to explain howstress home and asked the person ' mental imagery exercises.
negatively affects this protective accompanying them to lead the
We forged ahead nevertheless.
mechanism of the body. The patients in the imagery.
In our subsequent meetings The drawing activity started.
group was keenly interested and
thoroughly taken up by the drawing. we introduced some simple yoga Creativity and optimism flowed
exercises and the group enjoyed? and produced eye opening results.
After this, we went on to do doing these too.
Philomena, an illiterate woman,
a relaxation exercise. Each one
who had probably never held a
took up the shavasana pose and Patient Initiative
pencil in her hand, drew a purple
relaxed deeply. With soft strains
At the third meeting a patient vulture which signified her WBCs
of Ravi Shanker music in the back­ said he wanted to start the and small turquoise chickens as
ground, in this state of relaxation, session with a prayer. Everyone her cancer cells. When asked why
we led the group into an exper­ in the group (we had a Muslim, only one vulture, she said “Wait!”
ience of guided imagery. We told two Hindus and three Christians) and proceeded to surround the
them to picture their WBCs as the welcomed this. Henceforth, a chickens with a number of other
guardians of their body and to bhajan was an integral part of vultures.
imagine the cancer cells as weak, each meeting.
..
Axxu.
x.
Urmila got really excited by
ineffective creatures. We then
At this meeting,the group also | this task. She drew one h..™
asked them to imagine that the
WBCs were at war with the
cancer cells and were winning !
The weak cancer cells were slowly
dying and decreasing in number.
Slowly the realization dawned
on the group that it is their mind
that gives orders and instructions
to their army of WBCs, the guar­
dians of their body. The meaning
of the exercise was now under­
stood and they saw the relevance
of positive imagery. They also
understood the need to steadfastly
avoid negative thoughts and feel­
ings of resentment, frustration,
anger and sadness. They had just
got in touch with their own power
to heal. We asked them to do this
exercise three times a day at
4

HEALTH FOR THE MILLIONS/DECEMBER 19S0

eating up a number of small eggs
(cancer ceils). She added flowers,
green grass, birds in the sky and
a strong tall tree to complete her
picture. Sushila drew a numberof
strong powerful men with bulg­
ing biceps attacking a fish with
vicious looking daggers.
All the patients said that they
had drawn the identities of their
WBCs and cancer cells the way
they had visualised them while
doing the guided imagery exerci­
ses. These people were beginning
to think positively about their
health. From being people who
passively observed their body
being sedated or drugged, they
were growing to be people who
had owned their power to heal.
They now had hope.

Coming Together
The individuals who had come
together on the first meeting were
now a family of persons. They
mutually helped and supported
each other. Urmilla, who had
missed two meetings because of
severe diarrhoea (a side effect of
cobalt therapy), was seen in the
company of Manorama
and
Sushila one day. The two were
sitting on either side of her and
offering words of reassurance and
sympathy. Manorama was heard
inviting Sushila to her home any
time she felt worried or depress­
ed. Sushila herself was a chang­
ed person—by the sixth meeting,
she showed herself to be a
woman of courage and hope. She
offered to be a resource person
in any future work with similar
groups of cancer patients.

We hope that this kind of
support and fellowship will conti­
nue even after the 12 scheduled
meetings. The follow-up plan of
the programme consists of threeday meetings for intensive group
counselling after three months.
*
*

run—Tli 11|—IM

WMMWMMlimMMIIJI

The Figures and
The Non-Figiires
If you are interested in the
arithmetic of the disabled you
soon learn that there are no
reliable figures of the disabled and
their disabilities in India. Indeed,
that appears to be the case with
much of the developing world.
This is hardly helpful for large
scale planning. Some estimates
however have been made.

The Disabled Child
Two out of five persons in
India are children (0-14 years).
Half of this population is in the
age group 0-6 years. 81% of the
total child population of 230
million are in the rural area
(figures are of the 1971 census).
40% of all deaths occuring in
India are in the age group 0-5
years. The rural infant mortality
rate is 131 per thousand. 30% of
these deaths occur in the first
week of life itself and another
20% die in the first week to one
month period. There are more
deaths in the perinatal period
(28 weeks of gestation to the first
week of life) than in the next 30
years of life. Perinatal deaths are
caused by low birth weight, peri­
natal hypoxia, birth trauma and
neonatal infections including teta­
nus and unsafe obstetric practices.

If the child survives the first
week, it has to pitch its strength
against diarrhoea, pneumonia,
measles and other infant diseases.
40% of the deaths in the 0-14
years age group are due to diarrh­
oea.
Malnutrition,
respiratory
infections and
communicable
diseases contribute a substantial
number of deaths too.

the other. 56% of the children’s
diseases treated at health centres
are due to intestinal infections,
respiratory complaints and nutri­
tional disorders.

Malnutrition
There are 60 million malnouri­
shed children in India, says one
estimate. 80-90% of Indian child­
ren do not receive enough of the
key vitamins and minerals. 75%
do not get enough calories and
50% do not receive enough
proteins.
Every month approximately
one lakh children die and every
15,000 go blind as a result of
malnutrition.

Handicapped
There are no separate figures
as to the number of handicapped
children. The total number of
physically handicapped personsis
estimated at 15 million—9 million
blind, 0.75 million deaf, and 5-6
million orthopaedically handicap­
ped. This does not include, how­
ever, those with impaired hearing
or the visually handicapped. The
number of mentally disabled is
estimated to be 15 million.
Spastics (cerebral palsy) alone are
over a million today in India.
8000 spastics are born every year.
Of the estimated 2 million
deaf-mutes in India, 5% of them
are children or school-going age.

To all this if we add handi­
capped persons due to the many
other not so obvious causes, we
could well have more than the
general world estimate of 10%
disability (that is we have now in
30% of all school-going child­ India atleast 60 million disabled
ren suffer from some ailment or • people).

HEALTH FOR THE MILLIONS/DECEMBER 1980

DISABILITY TO ABILITY
Bethany village is a rare | kilometers from Delhi. In a short Sixteen Years Later
story in self-help rehabilitation. , time there was a nucleus of
Much has happened in sixteen
Its workers get a living wage. thirteen families, willing to give
years.
The huts have been repla­
up
begging
to
become
part
of
a
Its two major industries show
a profit which helps in the new community that offered them ced by pucca houses — 23 family
other expenses of the village. a home, a new life style, and the units and six single units. There
The story as told by the opportunity to help themselves to is an office, a storeroom, a dyeing
achieve normal, productive lives. shed, two weaving halls with
‘Handloom Lady.’
A well was sunk, a handpump fifteen looms, three poultry hou­
Sometime during the fifties and installed, and huts were built. ses which produce 1,200 broilers
early sixties various people from Bethany Village was born and the per month, two tubewells, a dis­
the South, mostly from Tamil- dream of Dr Dorothy Chacko pensary and electricity. The land
nadu, drifted toward Delhi. They' came into being. For her contri­ has been expanded to almost
had one thing in common... all of bution and leadership, Dr Chacko twelve acres of which 7| acres
them had leprosy... all of them was awarded a Padma Shri is being farmed by the residents.
were social outcastes. Some of in 1972.
All the residents of the Village
them left by choice, rather than
have the stigma of leprosy hang
over their families and perhaps
ruin a daughter’s chance for a
good marriage. Begging was the
only means of livelihood at that
time. They were united by their
common rejection and common
afflictions. They lived in groups
around Delhi and Panipat. Some
of these people who came
from the South were weavers by
birth and brought with them the
skills that were later to be an
important input into the life of
the Village that was to be Bethany.
It was at this time, by what
might be regarded as an act of
providence, a group of people in
Delhi became interested in reha­
bilitation of leprosy patients and
their dependents. The objective
was more broadbased rehabili­
The Poultry Industry
tation than the limited goal of
institutional care. Gradually, the
Mrs M Wingard is referred to as the “Chicken Lady”. From
Leprosy Rehabilitation Society,
experience she learned that layers were uneconomic...she switched
Bethany Village, was formed.
to broilers...she found that the difference in profit on a bird sold live
on the local markets, and that of a bird sold dressed in New Delhi
The Birth of Bethany
can be as much as five to seven rupees. On 1000 to 1200 birds per
month, this can make quite a difference. The demand for Bethany
So Bethany village began in
broilers has increased to a point where, under our present method of
1964 on 3 J acres of barren land,
set aside by the Panchayat of
one to one selling, we can no longer meet the supply and without
Teha, Haryana State, some 65 ; a better sales outlet we cannot handle any further production.
HEALTH FOR THE MILLIONS/DECEMBER 1980

are employed in these three :
industries,
handloom, poultry |
and agriculture. The weaving I
teen weavers and one tailor. Ten j
women do part-time work, fring­
ing and knotting. The broiler i
industry supports five poultrymen •
and provides part-time employ- !
mentfor slaughtering and dress- I
ing. One man works full time in 1
agriculture, while each family has :
land for cultivation. The Village i
supports one rickshaw puller plus other part-time workers on various 1
jobs. Five people are completely ;
handicapped and are fully suppor- ;
ted by the society.

Disabled ?

The Handloom Industry
Experience over the past few years showed that the first thing
we had to do was to produce a quality product. The second, and
more difficult thing was to sail it. We made tablecloths and napkins,
and had many good customers, but our stock on hand kept increa­
sing. We discovered that we were producing a luxury item, geared
to the affli ent, consumer society—which can absorb only so much,
and which does not always select handloom when a choice is avai­
lable. More recently we have switched to more practical, serviceable
items. A Delhi export company has been our oldest, regular
customer, and they purchase everything from our four big looms.
CMC Ludhiana was a big help to us when they gave us a very large
order for bedsheets. Holy Family Hospital, Delhi, has become a
regular and valuable customer...we count on supplying them with
their bedsheets every year. Finally, two relief agencies have decided
that wherever possible, they will buy from projects like ours for
relief purposes... bedsheets for hospitals and institutions, blankets
for disaster relief. In all of these cases, our buyers have understood
that if we are to make a rehabilitation project self-supporting, our
product will not necessarily be competitive pricewise, with the
cloth made on powerlooms. However, our customers also verify
that in quality and durability, our bedsheets and blankets are
superior. We had good help in marketing some of our products
overseas, but we have found the export market difficult and demanding and not really geared to a small project like ours.

Often we, the not so disabled, ;
keep forgetting that our leprosy :
patients are disabled at all.
Their integration into normal life •
seems so complete. The children ,
of the leprosy patients are not ■
similarly handicapped. 25 child- i
ren presently go to school like |
any other normal children of nor­
mal parents. Many of these
children are in boarding schools.
All these children come home to
spend their vacations with their
families at Bethany. Acceptance
of the residents by their own
children is perhaps the most
satisfying index of their almost
complete integration. One of our
young women has finished class
XI and taken secretarial training
and is employed at Batala. One
of the daughters of the leprosy
patients of our village is a gradu­
Dr P N Behl of the Skin Insti­ also incharge of the handloom
ate nurse and three more are
in nurses’ training. One of them tute, who is also the chairman of production. Both of them have
married a partner of her own the society, sends his team to been leprosy patients, and are
choice. Another had the tradi­ check on the health of the villa­ capable men doing excellent jobs.
tional marriage arranged by her gers regularly. None of the resi­
family. The spouses come from dents of Bethany Village have
Measured in terms of success
families without leprosy history. active leprosy now. The socie'y and failure, much has been acco­
The parents of the spouses too employs a full time resident mplished at Bethany Village,
are known to call on the parents supervisor (who is a trained aud­ thanks to many well wishers at
of their daughters-in-law.
itor) and a physio-therapist who is home and abroad.
HEALTH FOR THE MILLIONS/DECEMBER 1980

The Future
in our progress toward “com­
munity” and “responsibility”, we
have not moved forward as much <
as we expected. Our tradition of
management through communi­
ties would need a serious dekko.
There are 598 institutions
We tend to retain too much frivolworking for the physically and
vement not only in policy making
mentally handicapped (188 for the
but also in day-to-day decision
blind, 148 for the deaf, 146 for the
making. This is an area for future
orthopaedicaliy handicapped, and
improvement. We are now trying
to place more decision making 116 for the mentally retarded)
into the hands of the local pan- besides some 200 Associations
chayat. The reluctance on both ! working for this group. Besides,
there are the following facilities
sides needs to be overcome.
in the country:
What else does the future
hold for Bethany Village? Frankly,
Rehabilitation Centres
: J
I hesitate to anticipate and pres­
Rehabilitation Units
; 13
cribe. Bethany has been a part
P. T. Schools
: 10
of 'my life for the past 10 years.
0. T. Schools
: 6
But without prejudice to any
Speech Therapy Schools
: 3
future plans, I could say that
Prosthetic and Orthotic
(a) the need for the Village to be
Engineering Schools
: 2
self-supporting; (b) a retirement
' Artificial Limb Centres
: 32
fund for aged Bethany residents;
Three universities and two
and (c) accommodation for new
patient residents, would be our academic bodies provide post
priorities. Our immediate plans graduate-education in Rehabilita­
are to work in cooperation with tion Medicine. Also we now have
nearby
leprosy
rehabilitation under the Ministry of Social
projects in and around Delhi. We Welfare the following institutions:
need to do this more than any­
thing else if we are to sell what - National Centre for the Blind, Dehradun
we produce and keep our­ - Training Centre for the Adult-Deaf, Hydera­
bad
selves going without outside
monetary aid. And if we are to
- School for Partially Deaf Children, Hyderabad
sell what we produce, we must - Model School for the Mentally Retarded
produce what the market dem­
Children, New Delhi
ands. What we have in mind is - Institute of the Physically Handicapped,
something like a central marketing
New Delhi
agency which could do the nece­ - National Institute for the Deaf, Bombay
ssary advertising and handle, the
- National Institute for the Orthopaedicaliy
sales orders for our broilers,
Handicapped, Bon-Hugly, Calcutta
handloom cloth and other goods.

THE ACTUAL

AND n E YET TO BE

We need a lot of ideas and
support from everybody who is
Interested in the rehabilitation of
the disabled. And we are willing
to share our experience for we
feel we have something special
going in Bethany Village.
♦
♦
♦

8

There is a government of India
corporation—the Artificial Limb
Manufacturing Corporation (ALIMCO), Kanpur — manufacturing
prefabricated parts at subsidised
costs. However they still seem
to be costlier than artificial limbs
manufactured by other agencies.

Other Facilities
Besides there are numerous
concessions and facilities availa­
ble to the physically handicapped
in university education, in Indus­
trial Training Institutes for scho­
larships, for employment and
vocational rehabilitation. There
are six vocational rehabilitation
centres of the government in the
country and 17 special exchanges
for the physically handicapped.
There are special apprenticeship
training schemes in 103 trades for
the deaf, dumb, blind and orthopaedically handicapped. Special
interest loans, grants-in-aid and
travel concessions by rail, air,
road and sea and even for supply
of petrol are available for the
handicapped.
There is no postal charge on
transmission of blind literature—
both inland and foreign. Institu­
tions for the blind and deaf are
permitted to import, free of duty,
required equipment for education
and training, if received as bonafide gifts. There are even incometax concessions for the perman­
ently disabled. There are lots of
legal provisions in the constitu­
tion which are there more in
theory than in practice.

Not Enough
All these many services are not
enough. The services for the
education, training and rehabilita­
tion of the disabled are so inade­
quate that they cater to the needs
of only four percent of the blind
and two percent of the deaf.
Also, the entire area of
prevention of disability of all kinds
needs a lot more resources and
management of high calibre and
committment and vision.
1 FOR THE MJLLIONS/DECEMBER 1980

T. VIJAYENDRA

community to COMMUNITY
The Story of a Community Vision Project
Since independence a host of
new communities are springing
up in the backward areas of our ,
country. These are the public '
sector enterprises and their town- |
ships. While the location of these
industries were chosen explicitly ;
for the development of these .
regions, the communities that
have sprung up have been blind
to the miseries of the people
around. Nay, sometimes, they ,
even contributed to the intensifi- !
cation of their poverty and misery. ■

Like most public sector town­
ships, HOCL too has a modern 50
bed hospital fully equipped with
modern facilities. But unlike other
such hospitals, its services are
available to surrounding villagers.
This was so becausethe manage­
ment was aware that they had the
only well-equipped hospital in the
region and the people needed its
services.

At the hospital they have a
deeply committed doctor.
He
organised specialists from Bom­
bay for operations. A majority of
the cases were either for cataract
operations orcorrection of vision.
Within 8 months they covered 18
villages and treated more than a
thousand patients, out of which
34 needed surgical treatment and
393 needed spectacles. Nominal
fees of Rs 10/- for the operations
and 5/- for the spectacles were
charged. As a preventive mea­
sure, Arovit tablets were distri­
buted to more than 2000 school
. children.

|

However in the last few years !
a slow change is coming. More
and more industries are getting
into rural development. The proc- '
ess quickened since 1977 when
tax relief for rural development ■
was announced. Many innovative
contributions have been made.
The Community Vision Project
of Hindustan Organic Chemi- '
cals Limited (HOCL), Kulaba, ,
Maharashtra, is one such project. <

The Project
The company is.Jocated in a
backward tribal region although
it is only 75 kilometers from
Bombay. From its very inception
in 1960, the management tried to
avoid the ill effects that a modern
industry can cause in a backward
region viz, land alienation, defor­
estation and increasing the mise­
ries of the people. So rural deve­
lopment played an important role
in its activities.

There were 12 women and 8 chil­
dren in the group. They carried
a quick survey of all the indi­
viduals in the villages. Where
adults would have hesitated in
entering other people’s houses,
the children merrily went in and
asked questions. Conjunctivitis
patients were treated immediately.
More serious cases were recorded
and referred to the hospital.

ELPIHELPIH
ELP!HEtP!tffLP!

In 1978, there was an outbreak
of conjunctivitis in the region.
Some of the employees got toge­
ther and collected money. They
got two jeeps from the manage­
ment and they went to the villages.

health for the millions/decembbr 1980

With the initial success of this
project it was decided to extend
it to meet the demands of the
neighbourhood on a permanent
basis.
The project has been
registered as a trust and they
are trying to raise a fund of Rs 5
lakhs. The company is also
likely to give a matching fund.
The immediate target is to ensure
total eye care for the 20 villages
near the company and later to
cover the two taluks of Panvel
and Khalapur.
9

Community
Participation
The project also gives another
dimension to the concept of
community participation. Commu­
nity participation usually means
that the beneficiaries should parti­
cipate by way of funds, labour
and organization. Here also the

community did contribute by way
of paying, partially for the opera­
tions and the spectacles.

However what is important here
is the participation of the HOCL
employee community. Funds for
the project were collected from
a large number of employees.
Women and children of the emp­
loyees went to the villages as
volunteers and mixed with the

families in the villages. Many
activists told us that it was a
very moving and educational
experience for them. Thus lear­
ning from the villagers is as imp­
ortant, if not more, as teaching
to the villagers. We have, here
a model of a community to COM­
MUNITY project like the CHILD
to child project.
«
♦
*

Travel Concessions
For The Blind
By Air : 50%concession on dom­
estic flights of Indian
Airlines Corporation.

Courtesy UNICEF

The First Indian
Braille Writer
A big advance in the education
of the blind has been made by
the invention of the Braille mach­
ine. Now for the first time, an
Indian company has announced its
manufacture of the NFB UTTHAN
Braille Writer.

For further details contact:

Utthan Products
'Anurag’, Near Kamal
Colony
Navrangpura
Ahmedabad, Gujarat.

By Sea : Scindia Steam Naviga­
tion Co, Ltd and Bom­
bay Steam Navigation
Co, Ltd charge 25% of
the basic net fare or
single fare if the blind
is accompanied by an
escort.
By Rail: 50% fare for the blind
person and escort. 25%
if the blind person travels
without an escort.
By Road: Most State Road Trans­
port Companies give

50% or more conces­
sions. Karnataka State
RTC allows free travel
and Gujarat RTC gives
75% concession.

To obtain such concessions,
the blind person must carry a
certificate of blindness.
For
further details contact:

National Association for the Blind
51, Mahatma Gandhi Road
Bombay 400 023

Crime Prevention Guide
For the Deaf and Blind
The New York City Police
Department has designed a guide
to help disabled persons.
The guide presents infor­
mation about crime prevention
in the form of booklets in both
Braille and large print (English
and Spanish), as well as cassette
tapes. It will be available for
the handicapped at public and
special libraries as part of the
programme.

For further information please
contact the Crime Preventior
Section, 120-55 Queens Boule
vard-Kew Gardens,. N.Y. 11424
USA.

10

HEALTH FOR THE MILLIONS/DECEMBER 1980

Book Preview

A Cause for Hope

—

a v folio

HEALTH FOR ALL:
AN ALTERNATIVE STRATEGY
Published by the Indian Insti­
tute of Education, Pune, 1981,
pp. 250
approx. Paperback,
Rs. 18.00. Hard cover Rs.65.00.
Copies available from VHAI.

cal’ factors i.e. political,
economic, social and cultur­
al dimensions;
(c) Also, till now policies have
been made at the top and there
has been no attempt at get­
ting the people to participate
in programmes at any level.
In order to change this state of
affairs the report recommends
that the following steps be taken:

—

that health be integrated
into overall development.
This is to be brought about
by rapid economic growth
with the objective of doubling
the national per capita in­
come by
2000 AD and
giving full scale employment
to all at reasonable wages
through food-for-work pro­
grammes. The report also
talks about improving the
status of women, adult edu­
cation programmes, welfare
programmes for scheduled
caste and tribes, developing
an intensive integrated FP
programme, rural
electri­
fication and better housing,
and finally creating a demo­
cratic, decentralised parti­
cipatory form of government

—

improving supportive pro­
grammes like nutrition, envir­
onmental
sanitation and
health education.
by training a new cadre of
health workers, the commu­
nity health volunteers, with
emphasis on decentralisation
of services at the gram
panchayat level.
by giving more importance
to the preventive and pro­
motive aspects of health as

HEALTH FOR ALL : AN ALTER­
NATIVE STRATEG Y is a report of a
study group set up by ICSSR and
ICMR and aims to make health
a reality to all by 2000 AD by
suggesting a radical change in
the present health system.
Today it is obvious that more
than 30 years of planning has not
brought about any significant
change in the health statistics.
The morbidity and mortality rates
still continue to be high. There
has hardly been any change in
the massive problems of malnu­
trition and environmental sanita­
tion. Communicable diseases still
take a heavy toll of human lives.
The report states that the root
cause of all this has been

(a) the imitation of the western
model of an over centralised
heavily curative, urban elite
oriented, costly and depen­
dency creating health delivery
system;
(b)

treating health in isolation
with little or no attention
being paid to the *non-medi-

—

HEALTH FOR THE MILLIONS/DECEMBER 1980

compared
services.

—

to

the

curative

by having a clear-cut drug
policy that would make the
basic essential drugs avail­
able at low cost.

Although the report starts on
a radical note by stating that
health has more to do with the poli­
tical system than with the organi­
sation of health services, it ends
by taking a definite conservative
stand. For instance, the report
states
that given favourable
social
and political factors,
even a
comparatively limited
economic
growth can lead
to an outstanding improvement in
health status. However the first
recommendation made is that of
doubling the per capita income.
It has been proved time. and
again that doubling of per capita
income does not necessarily
mean an improvement in the eco­
nomic status of the whole popu­
lation. Further, even while talking
about improving the economic
condition of the people the report
sidetracks from the main issue.
On the one hand it talks about
the radical transformation of the
society while on the other hand
food-for-work programmes have
been recommended. Nowhere in
the report is the non-implementation of the land ceiling act or
the need to redistribute resources
even mentioned.

The report cites the examples
of China and Cuba as two coun­
tries that were able to bring about
an appreciable change in the
health status of the people with­
out an equally appreciable change
11

in their-economic growth. How­ > clearly state how this money is to going to solve the health problems
ever, the report does not highlight ' be utilised, even though they do of the country.
the ideology of these governments recommend
allocation
of
money
On the whole, in the context
and the historical process through for promotive and preventive acti­ of the Indian political system
which they were able to accom­ vities. From the structure that today, this report like many other
plish these spectacular achieve­ has been laid out by the authors it ‘radical’ reports has its inherent
ments. The concept of ‘bare foot ’ seems that a major proportion of contradictions
and limitations.
doctors’ succeeded in China I this money is going to be budge- However, the fact still remains
because there was an active , ted for salaries (i.e. 2 VHWs/1000 that such a high powered body
participation of the people who I population, Rs. 100 each, 2 MPWs has tried to view health in all its
were politicised enough to know i for 5000 population, etc). Once dimensions. Herein lies hope.
their rights and responsibilities. | again that will be assuming that
Thus by trying to duplicate only creating more health professionals is
— C Sathyamala.
one part of the total process i.e. I_____________
training of CHWs is not necessarily going to mean a change in BOOK NEWS
the health delivery system because 1
the essential political climate is
Impaired, Disabled or Handicapped ?
not present. This argument can
be applied to most of the recom­
INTERNATIONAL CLASSIFI­ with organ or system function,
mendations given. Just by decen­
tralising services one is not really i CATION OF IMPAIRMENTS, resulting from any cause. In prin­
ciple,
impairments
represent
bringing about a radical trans- ■ DISABILITIES AND
HANDI­
disturbances
at
the
organ
level.
formation of the society.
CAPS. A manual of classifica­
I tion relating to the conseque­
Disabilities(D code), reflecting
The report states rightly that |
nces of disease. Geneva, 1980, the consequences of impairment
the main reason for failure of the I
207 pages. Available with WHO, in terms of functional performance
present health system is the lack 1
and activity by the individual.
New Delhi. Price Sw.fr. 15.
of people’s involvement. The I
This manual of classification Disabilities thus represent distur­
report recommends that people (
aims
to improve information on bances at the level of the person.
should be made the active decis- |
ion makers. But the study is ; the consequences of disease.
Handicaps (H code), concern­
recommendation
making the same mistakes by I Following a
ed
with
the disadvantages experi­
laying down, of what in their opin- ■ made at the International Confer­
enced bythe individual as a result
ence
for
the
Ninth
Revision
of
the
ion are, the steps towards develo­
Classification of of impairments and disabilities.
pment. Even the budget, with the International
Handicaps thus reflect interact­
amount of money to be contribut­ Diseases, in 1975, the Twenty­
ion with and adaptation to the
ed by the community towards the ninth World Health Assembly
individual's surroundings.
meeting
in
May
1976,
approved
new health system, has been
“
the
publication,for
trial
purposes,
worked out. The decisions have
The three main purposes of
already been made. Where are the of supplementary classifications the manual are analogous to those
people going to participate now ? of Impairments and Handicaps for which the International Classi­
If perhaps the communities had and of Procedures in Medicine, fication of Diseases (lCD)is most
been involved in the planning, the as supplements to, but not as widely used, i.e.,
suggestions might have been quite integral parts of, the International
■ Classification of Diseases".
different.
— the production of statistics
In addition to its opening on the consequences of disease.
A word about the financial
implications of this new scheme. chapter on the consequences of
— the collection of statistics
It has been recommended that the , disease, the manual contains
relevant to the utilization of
.
three
independent
classifications:
government should spend about
services.
8-9% of the budget on health as
Impairments (I code), concercompared to the2% it is now spe­ , ned with abnormalities of body
— indexing and case-record
nding. The report however does not I structure and appearance and retrieval.
12

HEALTH FOR THE MILLIONS/DECEMBER 1980

npillAfc

I bership with voting rights in the
organization, but the governing
board shall coopt individuals
committed to VHAI/KVHS philo­
sophy and programmes. They
should not be elected to any
official position in the organisat­
Resource persons of the ion. The present system of voting
September
1980
programme based on bed strength will be
included Dr Joyce Biswas of discontinued. Irrespective of bed
Calcutta Urban Service and the strength every member institution
is eligible for one vote only.
staff ofCINI.
It was also decided that VHAI/
KVHS should provide technical
Southern Region
assistance and guidance to mem­
bers to plan and implement pro­
In Review
grammes and projects. VHAI
The Southern Region VHAs should not undertake funding of
had their biannual steering com­ hospitals and programmes for the
mittee meeting on October 25-26 time being, it was felt.
at Bangalore. It was decided that
the regional coordinator would Of Laws and Wages
be an invitee to State VH A gover­
Another issue which has been
ning board meetings. He shall
attend atleast one meeting of abuzzing in KVHS is how to
each board and that of the gene­ implement the gazette notificat­
ral body every year. Another ion on Minimum Wages for the
hospital
employees.
highlight of the meeting was that private
Members
raised
several
problems
a six monthly performance review
of the organising secretary with at the special general body meet­
the elected secretary and the reg­ ing on September 24. A lively
discussion ensued. It was decided
ional coordinator will be carriedto
send a delegation to meet the
out in future.
labour minister to clarify various
A SWOT analysis of all the
clauses in the gazette notification.
state VHAs in ten regions was
The meeting with the labour
done to help plan for the future.
The emphasis for the next one minister took place on October
year in the southern region would 17, 1980. A memorandum was
News of further
be on low cost health care, and submitted.
workshops on physical assess­ action is awaited. Copies of the
ment, school health and holistic minimum wages notification giving
payscales for various work cate­
health.
gories in the hospital can be
Kerala
had from K M George, Organising
Secretary, KVHS, M-10/36 Changampuzha Nagar, Cochin 686022.
No to Project Funding
There was a special general
body meeting of KVHS at ErnaMadhya Pradesh
kulam on September 24, 1980.
Among the decisions taken during
Rising prices, hospital and
the meeting were that KVHS medical expenses and demand for
should not have individual mem- higher salaries have led MPVHA
COMMUNITY HEALTH
•LL
>80
326, V Main, I Block
13

IvyVVVv sbotes i

Eastern Region
Fantasy and Planning
The first Eastern Region stee­
ring committee meeting was held
on October 1-2, 1980 at Dhyanashram near Calcutta. There was
sharing and discussion on issues
and problems pertaining to the
VHAs in the region. As an
outcome of a fantasy session led
by Renu Khanna of VHAI, the
members were able to identify
ten priorities and action plans for
the same for the next three years.
Low cost care, professional and
personal growth, the idea of reor­
ganisation and regional team were
among the ten priorities.
West Bengal

In Bengali and in Nepali
WBVHA initiated a training
programme in Bengali on commu­
nity health and development
from September
8-28, near
Calcutta. The participants found
the programme very useful and
an evaluation meeting of the
training programme has been
fixed for December 10-12, 1981.
Meanwhile DP Podar, the orga­
nizing secretary, plans intensive
follow up on all the participants.
He feels future
programmes
should ! ideally be for a month
atleast.
Following the warm
response to the training progra­
mme in Bengali, a similar one
is planned in Nepali. It will be
held in Darjeeling District for the
hill areas, tentatively in October
1981.
HEALTH FOR THE MILLIONS/DECEMBER

Koramcngala
Bangalore-560034 '
India

also to choose the theme of their
1981 Annual Meeting as: “The
Cost of Health Care: Can Volun­
tary Institutions Afford?" The
dates are February 6-7 at Raigarh.

Bihar
Directing

Epileptic patients are not inc­
luded in any category of thehandicapped. It is estimated that there
could be 54, 00,000 epileptics in
the country who do not enjoy
either adequate treatment or
rehabilitation services.

BVHA

The BVHA directory has rea­
ched the stage of final proof-read­
ing and
printing and it is
coming out well. It is expected to
be completed by December, 1980.
The theme of the next AGM
of BVHA is going to be “Lowcost Patient Care". The dates
are Feb 21-22, 1981 at Patna.
This AGM will also be prob­
ably the last for Anney Kurien as
the organising secretary of BVHA.
Plans are afoot for a new orga­
nizing secretary.

Gujarat

A High Calorie Response
The response to the 5th annual
convention and general body
meeting of GVHA, on September
27-28, exceeded the wildest dreams
of Fr Urrutia and his friends. The
highlights of the convention
included “Vitamin Raja”, a pre­
sentation by the Johapura health
workers on simple communica­
tion, and the health exhibition.
The 80 participants went back
with joy and mutual support.

Delhi
The annual meeting of the
state organising secretaries took
place at Cochin, September
16-19, 1980. There was sharing
of reports of activities and pro­
blems over the year. Some
important issues which camp up
14

for discussion include funding
of State VHAs,
examining
the need and possibility of new
structures and new ways of work­
ing in the VHAs and in VHAI.
The meeting was also attended
in part by Dr Samuel Joseph
as a representative of the VHAI
board.
*
*
*

Killer Malaria
The greatly increased incid­
ence of malaria is causing enough
concern, though of graver concern
is the rise in cases of Plasmo­
dium Falciparum, a killer malaria.
NMEP records show that last
year this disease took 147 lives
which is the highest since the
parasite entered India from the
Far East in 1975.

in Uttar Pradesh. In Patna, cases
of Plasmodium Falciparum acco­
unts for over 50% of the positive
cases of malaria.

This malarial parasite can
attack the brain and does not
respond to Chloroquine though it
does respond favourably to qui­
nine. According to Dr Patraib,
Director of the Eradication Pro­
Official statistics further show gramme, the problem is not the
that the parasite has spread from treatment of this kind of malaria
the North Eastern States of Naga­ but reaching the drugs to remote
land, Assam, Meghalaya, Aruna- areas, orienting the doctors
chal Pradesh and Mizoram to towards giving proper treatment
Bihar, West Bengal, Orissa, to the disease and getting to the
Andhra Pradesh, Madhya Pradesh, patients before the malaria has
Maharashtra and now to Mirzapur reached an advanced stage.

Fr Muller's
Completes a Century
1980 is the centenary year
of one of the oldest health
centres
of South India: the
Fr Muller’s Charitable Institutions,
Mangalore.

While
debate
rages
in
Fr Muller’s today as to what
ought to be a fitting centenary
memorial, one cannot let the 100
years of service pass without due
reverence and celebration. Their
homeopathic poor dispensary is
still regarded as a remarkable

achievement
of
integrating
allopathy with other systems of
medicine. The South Kanara
district health survey undertaken
by Fr Muller's in 1977-78 was surely
the first of its kind in India,
and probably in the world. A
Fr Muller’s centenary charitable
society has been formed as an
offshoot to implement some of the
survey findings.

Like the Kannada poet, we
too will say Dhanyosmi to
Fr Muller’s.

HEALTH FOR THE MILLIONS/DECEMBER 1980

Enabling News

What’s Enabling ?
techniques for disability prevention and
rehabilitation

A No-cost Aid

* investigate and assist the development

In Philippines a community­
of locally produced, low-cost technical
based project has been started |
aids
to assist disabled children in I * develop and distribute training mate­
two villages in Neuva Ecija. It
rials
focuses on the prevention, early * provide enquiry and liaison services
detection and intervention mea­
and produce a newsletter to help with
this
sures for impairments in young
children under the age of six. * examine the possibilities of incor­
Preliminary results show very
porating rehabilitation projects into
primary health care programmes.
clearly that many impairments
are temporary and can be modified
AHRTAG is ideally suited to
or eliminated if detected in time.
provide
these services. It already
One mongoloid baby was trans­
has
a
wide
selection of training
formed from a listless child to a
materials and other data and the
lively, responsive girl in just a
few months because of the capacity of disseminating this in­
application of no-cost simple formation both at community level
intervention measures, such as and nationally within primary
health care programmes.
physical intervention/stimulation,
Further information can be
singing and talking and playing
with the child. But the most obtained from Ann Darnbrough
important factor was the change or Arna Blum at AHRTAG, 85
of attitude on the part of the Marylebone High Street, London
mother and neighbours: from WIM 3DE, UK.
negative to positive, from shame
and pity to supportive and encou­
raging. To help children with Government Efforts
impairments, programmes must
In East Africa, Kenya has the
involve the whole community.
, most facilities for the rehabilita-

l tion of the handicapped, includ­
ing a public hospital unit in
The AHRTAG Connection
Nairobi for amputees and the
As a contribution to the 1981 j orthopaedically handicapped and
IYDP, the Appropriate Health I a prosthetics and orthotics trainResources and Technologies Act­ I ing center. Services are under
ion Group (AHRTAG) has set up the direction of a Senior Rehabi­
a unit which will help to spread litation Officer within the Ministry
information on disability prevent­ of Social Services. This unit is
ion and rehabilitation among inte­ responsible for case finding and
service delivery throughout the
rested organizations.
country. It also works closely with
The main aims of the unit will be
private organisations serving
to:
select groups of handicapped
* gather information on appropriate
persons. To relieve the shortage
HEALTH FOR THE MILLIONS/DECEMBER 1980

of physical therapists, parents
are being trained to help their
crippled or retarded children at
home.
Tanzania has now made edu­
cation of handicapped children
compulsory.
This
education,
which includes the blind and
deaf is to a large extent carried
out with the regular public school
system. However, severely handi­
capped youths may attend special
schools operated by the private
organizations with supplemental
grants
from the Ministry of
Education and Social Welfare.
In addition, there are manual
training programmes for the
handicapped in various parts of
the country. After 18-24 months
of training, the client is employed
in private industry or placed in a
cooperative production workshop;
and a few handicapped trainees
are given tools and equipment
for the operation of their own
business.
CHILD-to-child
PROGRAMME
and the
INTERNATIONAL YEAR OF
DISABLED PERSONS
WANTED URGENTLY !
.... Information
on
disabled
children.
A FREE copy of CHILD- to-child,
published by the Macmillan Press,
and a set of CHILD-to-child acti­
vity sheets will be sent to anyone
sending a real life description of
how a child helps his or her dis­
abled brother or sister or the dis­
abled child of a neighbour. These
stories are urgently needed for
the CHILD-to-child Programme in
the International Year of Disabled
Persons (1981).
Please send an account, long
or short, to:DUNCAN GUTHRIE, CHILD-tochild Programme, c/o Institute of
Child Health, 30 Guilford Street,
London WCIN IEH, ENGLAND.
15

ENABLING
Malaysia: Rattan and Bamboo
The cost of imported materials for the
manufacture of aids for physically disabled
children led a physiotherapist, Ms J K
Hutt, working at the Spastic Children’s
Association in Johore, West Malaysia to
design equipment from locally available
bamboo and rattan. Imported equipment
was unsuited to the build of local inhabit­
ants, and their way of life. The custom in
Malaysia is to sit on the floor, or on much
lower seats than in the West, and to use
squat toilets. Walking aids, therefore, need
to be designed so that the user could reach
a standing position easily from sitting on
the floor.
Stabilized cane

From: Rattan and Bamboo (Ref. 2179) a report prepared by the Dis­
abilities Study Unit. Wildhanger, Amberley. Arundel. W. Sussex,
U.K. Cost?12.00
16

Child’s walker
and trolley
>A" dia. rattan frame

rattan binder
wooL^n roc!

mild steel bar
5" dia. wooden wheel

'A" thick boarding

India: Lowcost Wheel Chair
In India, Shailendra Yagnik of the
National Institute of Design at Ahmedabad has developed an inexpensive wheel­
chair specially designed for Indian conditi­
ons. It has three wheels, two of which are
standard bicycle wheels, with the third
supporting wheel in the rear being a stand­
ard caster wheel. The seat and backrest
form a single detachable unit which can be
tightened and adjusted to different-sized
users, whether children or adults. The min­
imum level of the seat is kept at 14 inches
to match the height of the Indian toilet seat
so that transfer is easier. It also folds for
convenient storage and transport.
This wheelchair could be produced by
smallscale industry. Standard components
and indigenous materials are used to red­
uce the cost. When mass produced the
cost is expected to be 30% less than’that
of existing wheelchairs, which tend to be
heavy, uncomfortable, and difficult to
manoeuver.
health FOr the millions/december

]980

AT LOW COST
- •—---

1—^—■

---

Mexico: Community
Health Care
David Werner has evolved a
series of techniques for rehabilitat­
ing disabled children, together with
community health aides and parents.
A local woven shawl, held at each
end and slung under a child's sto­
mach, can be used to help him learn
to crawl. A table-top can be reshap­
ed so that a child can stand within
it, supported by his elbows and help
with household chores. A simple
frame of branches can support a
child learning to walk, or squatting
to go to the toilet.

From: Donde No Hay Doctor (Where There Is No Doctor) by David Werner

Uganda: an orthopaedic workshop

I

In many developing countries, thousands of
J paralysed people still crawl through lack of
supports, and polio as a cause of paralysis is
on the increase. In Uganda in 1960 the first
orthopaedic workshop to make simple calipers
Was started at negligible cost. Experience had
shown that copies of the type of support used
in industrialized countries with welded tops and
adjustable side arms were inappropriate. They
were impractical, unnecessarilycomplicated and
expensive; they broke too easily because of
inadequate craftsmanship, and they were prod­
uced in tens when they were needed in hundreds.
These are examples of simpler supports, made
without welding or drilling
Calipers arc used mainly to support the weakened lower limbs of a
Mio victim. Those made in the industrialized countries arc inappropriatefop
people living in rural Africa. Their complicated design and breakability
does not withstand the rigourous lif style, and their expense puls them
heyond the reach of all but a few. The. calipers illustrated here are made
ky virtually unskilled craftsmen without screws, healing or welding, and

Cost Onf'-Jift ieth of the price of an imported caliper.
I'rom: A Simple Guide to Poliomyelitis by /?• L. 1! 'hrtep, I'xfcss n
°f Orthopaedic Surgety, Makereie I.w.iiersity College, T-yi.da IMtt.

A child with cerebral palsy was
developing “scissor legs” because of
contractures in spastic tendons. A
large pot was used as a toy box to
separate his legs and keep them
extended.

Calipers

Declaration on the
Rights of Disabled Persons
\
3. Disabled persons have the recreational activities. No dis­
inherent right to I'espect for their abled person shall be subjected,
human dignity. Disabled persons, as far as his or her residence is
whatever the origin, nature and > concerned, to differential treat­
seriousness of their handicaps and | ment other than that required by
disabilities, have the, same funda- ' his or her condition or by the
mental rights as their fellow-citi- ■ improvement which he or she
zens of the same age, which may derive therefrom. If the stay
implies first and foremost the right of a disabled person in a specia­
to enjoy a decent life, as normal lized establishment is indispens­
able, the environment and living
and full as possible.
i conditions therein shall be as
4. Disabled persons have the close as possible to those of the
same civil and political rights as normal life of a person of his or
other human beings; paragraph her age.
7 of the Declaration on the Rights
of Mentally Retarded Persons i 10. Disabled persons shall be
applies to any possible limitation ’ protected against all exploitation,
or suppression of those rights for i all regulations and all treatment
of a discriminatory, abusive or
mentally disabled persons.
degrading nature.
8. Disabled persons are entitled
Disabled
persons, their
to have their special needs taken ; 13.
into consideration at all stages I families and communities shall be
of economic and social planning, ' fully informed, by all appropriate
means, of the rights contained in
9. Disabled persons have the ' th i&» Declaration
right to live with their families or :
plenary meeting
with foster parents and to partiy 9 December 1975
cipate in all social, creative or '
N General Assembly

For Private Circulation only

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