Project Projimo: A Program For and By Disabled People
by David Werner
My main interest is in innovative community program where disabled persons themselves or members of their families take the lead in management, provision of services and decision making. My interest in program that are run by and help empower disabled persons comes from my own personal bias, for I, myself, have a physical disability.
PROJIMO is a Spanish word for ‘neighbour’. But it also stands for Program of Rehabilitation Organized by Disabled Youth of Western Mexico. PROJIMO is a rural program run by disabled villagers to serve disabled children and their families. It was started in 1982 by disabled village health workers from an older community-based health program, Project Piaxtla, now in its 23rd year. In the early years of Piaxtla some of the health workers selected by their villagers happened to be disabled. As the years passed, some of these disabled persons proved to be among the best health workers. Perhaps this was because participation in the health work had brought them from a marginal to a central position in their community. For whatever reasons, they tended to work with greater compassion and commitment than most of the able-bodied workers. In time, some of the disabled health workers became leaders in the primary care program.
The disabled health workers became increasingly concerned that they knew very little about meeting the needs of disabled people, especially children. Adding to their problem, the prices in the cities for braces or calipers, wheelchairs, therapy and other necessities for disabled persons, were often too high for the villagers to afford. The cost to get a child with polio walking could economically ruin the child’s extended family. The orthopedic devices made by specialists in the cities also tended to be elaborate and heavy. They were usually fitted onto big boots that made the child feel out of place in her village. Surely, thought the health workers, there must be more simple, low-cost alternatives. Five years ago the health workers met with the other villagers of Ajoya to ask for community support to start a rural program for disabled children. The villagers responded enthusiastically and PROJIMO began.
Over the next few years, adventurous rehabilitation specialists with a sense of innovation and community commitment—including physical and occupational therapists, brace makers, limb makers, wheelchair makers and special educators—made short volunteer visits to the program to help teach their skills to the village health workers. As appropriate methods and skills were tried, they were drafted into a series of simple and clear guidelines, experimental instruction sheets, and handouts for families. These were tested and corrected over and over again, until finally they were put together to form the reference manual, Disabled Village Children. Today, among a wide range of rehabilitation services including physical therapy and correcting club feet and contractures, the disabled team makes low-cost lightweight braces, wheelchairs and artificial limbs at about one-tenth the cost of less appropriate models made in the cities. Word of the village program has spread and disabled children have been brought to the program from 10 states in Mexico. More than half come from the slums of the cities. In a village of 850 people, PROJIMO has helped meet needs of over 1,500 disabled persons, mostly children and their families.
PROJIMO differs from many rehabilitation programs in a number of ways:
Community control. Unlike many “community-based” programs, which are designed and run by outsiders, PROJIMO is run and controlled by local disabled villagers.
De-professionalization. The village team, although they have mastered many “professions” skills, is made up of disabled persons with an average education of only three years of primary school. Their training has been mostly of the non-formal, learn-by-doing type. There are no titled professionals on the PROJIMO staff. Rehabilitation professionals are invited for short visits to teach rather than to practice their skills.
Equality between service providers and receivers. When asked how many “workers” they have, the PROJIMO team has no easy answer. This is because there is no clear line between those who provide services and those who receive them. Visiting disabled young persons and their families are invited to help in whatever way then can. Most of the PROJIMO workers first came for rehabilitation themselves. They began to help in different ways, decided to stay and gradually became team members and leaders.
Self-government through group process. The PROJIMO team has been trying to develop an approach to planning, organization, and decision-making in which all participants take part. They are trying to free themselves from the typical “boss-servant” work relationship and form more of a “work partnership”. The group elects its co-ordinators on a one-month rotating basis so that everyone has a turn. This leads to a lot of inefficiency and confusion, but to a much more democratic group process.
Modest earnings. The PROJIMO team believes that they should work for the same low pay as that of the farming and laboring families they serve. They can see that the high pay demanded by professionals and technicians is one reason that the children of the poor often cannot get the therapy and aids they need.
Grassroots multiplying effect. The PROJIMO approach has been spreading in various ways. Locally, families of disabled children in a number of towns and villages have begun to organize, build playgrounds, and form their own special education programs in other parts of Mexico and Latin America to visit and take ideas back to them. Some programs have sent disabled representatives to work and learn at PROJIMO for several months so they can start similar programs in their own area.
Unity with all who are marginalized. The PROJIMO team sees society’s unfair attitudes towards disabled people as only one aspect of an unjust social structure. They feel that disabled persons should join in solidarity with all who are rejected, misjudged, exploited or not treated as equals. This feeling has led the team to become more self-critical and to seek greater equality for women within their own group.
Project Projimo: A Program For and By Disabled People is reprinted from Community Based Rehabilitation News, April 1990.
This article appeared in “Disabled People in International Development,” Coalition of Provincial Organizations of the Handicapped (COPOH), Winnipeg Canada, produced with the assistance of the Public Participation Program, Canadian International Development Agency (CIDA).