These articles 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).
by David Werner
NOTE: Dr. David Werner visited Angola in September of 1989. The following is a summary of his article "Visit to Angola".
A visitor to the capital of Luanda is immediately struck by the many disabled men, women, and children hobbling along with the help of wooden poles or crutches. Most of the disabilities are due to amputation or polio, both the result--directly or indirectly--of the "Low Intensity Conflict" (LIC) to which the Angolan people have been subjected since independence. The incidence of polio is due to the breakdown of health services in a land where access to rural areas has been cut off by random but persistent terrorist attacks along roads.
This war against the Angolan people is largely due to the intervention of foreign governments. The US government, for example, has poured millions of dollars of assistance--much of it in the form of military hardware and training in the tactics of LIC--to UNITA (National Union for the Total Independence of Angola) the "Rebel", partly mercenary guerrilla troops sustained by South Africa.
The large number of disabled people is part of the strategy of LIC. Leaving people seriously disabled puts a greater economic burden on families and on the nation than does killing people. It also takes a bigger toll psychologically: disabled people remain far more visible than the dead.
I was invited to Angola to serve as a resource person at a training workshop on vocational rehabilitation of disabled persons. After a discussion of possibilities, we decided to actually try to make a variety of aids and appliances. For if disabled persons could master these skills, they would not only help to answer the mobility needs of the vast (and growing) numbers of disabled people, but would also have important work to do.
We scrounged bits of wire, old broken plastic buckets, blown-out car tires and inner tubes, bits of metal, old packing crates, and branches from ornamental trees. From these items, the groups managed to create a wide range of devices, including: a log scooter-board with wooden wheels; a folding sitting frame for a disabled child; a special seat and toys for a cerebral palsied child; a tray suspended by cord for one-handed transport; parallel bars for learning to walk; an enclosed swing made from a tire turned inside out; underarm and Canadian crutches made from tree branches; hand "shoes" soled with pieces of car tire, for crawlers; an arm rocker permitting a person with paralyzed arms to feed self; ramps for wheelchair access and for exercise; an orthopedic lift for a sandal, made from old rubber sandal; a pair of leg braces, made from a plastic bucket, designed for a little girl with a severe, progressive bowing of the knees; a large wood wheel with flat wooden spokes, lined with car tire (the design was later adapted for the wheelchair); an all wooden wheelchair, made from old packing crates.
Perhaps the most worthwhile part of the workshop was the growth of understanding and mutual respect that took place among the participants. We learned from each other, and a new sense of appreciation, camaraderie and self-confidence developed.
The disabled persons also talked about forming a network or association--which would be a first for disabled people in Angola.
Our most sobering thought, however, was the realization that for every artificial limb or wheelchair or pair of crutches the members of our workshop produce once they return to their provinces, dozens of additional people will become disabled by the continuing war. We agreed that our rehabilitation efforts for and by disabled people--although important--do little to resolve the root problem. The root problem lies in a global power structure based on greed and unlimited acquisition for the few at the expense of the many, a power structure that strategically misinforms the public, while using illegal and immoral terrorist tactics to pursue its ends.
I returned from Angola convinced that the biggest changes regarding the disabled community in Angola need to be made in South Africa and in the USA. The US government must stop supporting terrorists who strategically disable individuals, communities and nations. The people of the United States must learn what their government is doing. They must know that it is violating international law and every code of human decency. They must know that such violence is causing untold death, disability, disease, displacement, and suffering.
They must see--and help their government to see--that in the long run there will be no winners.
NOTE: Since this article was written, Namibia has become an independent state. Angola thus no longer borders on South Africa, and is therefore no longer a "security threat" to South Africa. We can only hope that this will result in the situation in Angola becoming more stable and less violent.
This article first appeared in Vox Nostra No. 1 (1990).
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.
This article is reprinted from Community Based Rehabilitation News, April 1990.