Karate for Fun (and Therapy) of Children with Cerebral Palsy: An Astonishing Innovation in Madras (Chennai), India

In many countries today, children are fascinated by Karate and eager to learn this ancient, artful form of self-defense. Youngsters with cerebral palsy share this fascination with Karate-but rarely have a chance to learn it.

In SPASTN (The Spastics Society of Tamil Nadu), an innovative program in southeast India, children with mild to moderate CP are taught Karate. They take it very seriously. Likewise their trainers, who are volunteer professional Karate instructors, take the children and their learning seriously.

At its best, Karate is a physical art which teaches disciples self-mastery of body and mind, as well as a philosophy of harmony and non-aggressive self-defense. Its guided rhythmic movements conform with many of the therapeutic movements and positioning used for children with cerebral palsy.

 

Seeing these children proudly demonstrate their Karate skills is a mind-altering revelation, even to those of us who work routinely with disabled kids. It awakens us to the children’s hidden potentials. We learn that when the children are challenged with an activity they passionately want and chose to do, it is astonishing what they can accomplish. Observing their concentration and unexpected grace as they perform this ancient art stretches the boundaries of what therapists, caretakers, and the children themselves dream is possible. For doer and viewer alike, it is a liberating experience.

The Karate program at SPASTN was initiated by Karate master ShihanHussaini, who is also trained in social work and guidance counseling. The parents are delighted with the results, and the teachers are amazed. Observable benefits are many:

• better coordination, both gross and fine;

• improved behavior and attention span;

• a greater sense of personal adequacy, self image, feeling of fulfillment, and more self-confidence.

The introduction of Karate to children with cerebral palsy was observed by David Werner during a recent trip to India with the United Nations Economic and Social Commission for Asia and the Pacific (ESCAP). See [here](#addlink/pg 4)

Using What Works Best

In addition to Karate, the SPASTN Center assists children with cerebral palsy to discover and expand their capabilities. Rather than try to ’normalize’ them to do things the same way as non-disabled children, they help them to do things in whatever way is easiest and works best for them.

Children with mild to moderate spastic cerebral palsy practice Karate with concentration and pride. In the last picture, a boy (using his spasticity to good advantage) lies stretched rigidly between two chairs while a Karate master breaks a stone slab resting on the fearless boy’s body.

Disabled People as Leaders in Meeting Their Needs

 

The Independent Living Movement (IL)

In recent years disabled people-like many other disadvantaged and unfairly treated groups including racial and ethnic minorities, women, lesbians and gays-have begun to stand up for their rights. In the United States and Europe the Independent Living Movement, organized and run by disabled persons themselves, has fought for equal opportunity in terms of education, jobs, accessibility, transportation, and a leading voice in decisions that affect them. They have pushed for legislation in support of such equality and representation. While much still needs to be done, they have achieved a lot.

With regard to rehabilitation services, disabled people are also gradually taking a more leading role, although progress has been slower. Rehabilitation International, an organization which for years was traditionally run by non-disabled professionals, has gradually begun to give disabled persons stronger representation. But this shift toward acceptance of disabled people as partners rather than patients has been an uphill battle. Some 15 years ago, when the annual assembly of Rehabilitation International failed to give disabled participants a stronger role in decision making, the disabled persons in the assembly separated off and started Disabled Persons International. DPI has helped groups of disabled people in Third World countries organize and stand up for their rights. In many countries disabled persons have adopted the slogan NOTHING ABOUT US WITHOUT US.

• The strength of the Independent Living Movement is that it is led and organized by and for disabled persons themselves, who demand equal opportunity and full integration into all aspects of community life. There is little question that the legislation protecting the rights and opportunities of disabled people in the US and Europe has been achieved only because disabled persons and their families have organized and made their demands heard.

• The weakness of the Independent Living Movement is that it mostly involves and caters to middle-class disabled persons and too often overlooks the needs (and even existence) of poor, marginalized disabled persons. In Northern countries where the middle class is the majority, this may be more acceptable. But in the Third World where most disabled people live in extreme poverty, DPI and the Independent Living Movement have in many cases not done enough to include very poor disabled persons in their membership/leadership or to respond realistically to their needs. (For example, in many poor countries DPI avidly campaigns for wheelchair accessibility for those fortunate few who have wheelchairs, without showing adequate concern for the huge number of people who need wheelchairs but cannot afford them.) The poorest disabled persons tend to remain abandoned, unorganized, and unattended. Poverty and often hunger add to their disability.

 

Community Based Rehabilitation (CBR)

Community based rehabilitation is an initiative to deinstitutionalize rehabilitation services and to foster activities within neighborhoods and villages to promote basic rehabilitation and integration of disabled persons. The World Health Organization (WHO) has formulated a standardized approach to CBR, which it has launched in many countries. In most cases the WHO model might better be described as home based rehabilitation. It involves training a ’local supervisor’ whose primary role is to work with disabled persons and their families in their own home. The best of these programs place considerable emphasis on schooling, work, social activities, and other measures to foster the self-reliance and integration of disabled persons in the community.

CBR is an important alternative, insofar as institutionalized rehabilitation services in most Third World Countries are few and far between, urban based, very costly and reach only a small fraction of those who need them. The only realistic way that the vast number of disabled people in poor rural communities are likely to benefit is to demystify rehabilitation skills and place them in the hands of community volunteers, family members, anddisabled persons themselves.

• The primary strength of CBR is that it reaches into rural communities and tries to reach the poorest and most isolated of disabled person. It is an approach based on equitable coverage.

• The weakness of many CBR programs is that usually they lack leadership by disabled people themselves. The organizational structure of CBR tends to be hierarchical: the Program Supervisor supervises the Local Supervisor who supervises the Family Supervisor who supervises the disabled person, who is definitely on the bottom of the totem pole. Disabled people become the objects rather than the subjects of their rehabilitation.

Combining the best of Independent Living and Community Based Rehabilitation

In the last few years, disabled groups and rehabilitation workers alike have been awakening to the need to bring together the best of Independent Living and of Community Based Rehabilitation. They foresee great benefits in combining the self-determination and leadership of IL with the focus on the poorest and most isolated disabled people which is characteristic of CBR.

This combined approach of self-determination plus inclusion of the poor is something that Project PROJIMO has embraced since its conception in 1981. PROJIMO is run and staffed by disabled villagers. The program’s aim is to reach out to those who, for reasons of poverty or geographic isolation, have been unable to benefit from urban institutional rehabilitation services.

Because PROJIMO has been a pioneer in this empowering approach, it has provided ideas and inspiration both to disabled persons’ organizations interested in launching CBR initiatives, and to CBR initiatives looking for ways to involve disabled people in leadership roles. Disabled leaders and technicians from PROJIMO have been invited to visit community programs in several countries, as well as to share their methods and experiences in national and international workshops and fora.

As a long-time facilitator/advisor of PROJIMO and author of Disabled Village Children, a handbook that grew out of the PROJIMO experience, I (David Werner) have had the opportunity to participate in gatherings in many countries to explore and promote the merging of the best of IL and CBR. Some of the more important events include:

• Bangalore, India, April 23, 1993. Regional Meeting coordinated by Action on Disability and Development (ADD). The South India branch of ADD is directed by B. Venkatesh, a blind activist who co-founded the Centre for the Physically Disabled in Bangalore and who for decades has fought for the rights and empowerment of disabled people. In 1989 he visited PROJIMO. Now with ADD, he has helped launch and advise a number of rural CBR initiatives in which disabled persons play key roles. The keynote address of the Regional meeting-“Disabled People in the Struggle for Social Change” by David Werner-is available from HealthWrights.

• Solo, Indonesia, Nov. 22-26, 1994. Asian Regional Meeting on “The Role of Disabled Persons in Community Based Rehabilitation.” This meeting, attended by more than 60 disabled activists and leaders of organizations from several Asian countries was a major watershed in promoting the leadership of disabled persons in CBR. Many of the disabled participants who had been skeptical about CBR recognized its potential and the need for organizations of disabled persons to reach into poor neighborhoods and communities. A paper on “Strengthening the Role of Disabled Persons in Community Based Rehabilitation” is available from HealthWrights.

• Vienna, Austria, June 1995. “Consultative Expert Meeting on Integration of Disability Issues in Development Cooperation Activities” convened by the United Nations Division for Social Policy and Development. This meeting was called to put together a manual of guidelines for inclusion of disability issues and rehabilitation in international development assistance. A lot of attention was given to design and provision of appropriate technical aids. Participants supported a principle long emphasized by PROJIMO, namely that “It is important to adapt the assistive equipment to the disabled person, rather than the disabled person to the equipment.” In recognition that many of the most notable breakthroughs in assistive equipment-ranging from wheelchairs to artificial limbs and orthopedic appliances-have been designed and built by disabled persons themselves, this UN workshop determined to encourage the stronger inclusion of disabled persons as leaders and technicians in rehabilitation and in the design and individualized production of rehabilitation equipment. This emphasis from the United Nations will hopefully help to raise awareness of the rehabilitation establishment of the importance of including disabled persons as partners in defining, designing, and evaluating solutions to their needs.

One of the themes stressed in this workshop was that “A SOCIETY FOR ALL can only be achieved through an integrated approach.” A graphic illustrating this idea (an early version is included in the workshop report) is shown at the top of page 3 of this Newsletter.

• Madras, India, Sept. 5-14 1995. “Technical Workshop on Indigenous Production and Distribution of Assistive Devices,” coordinated by UN-ESCAP (United Nations Economic and Social Commission for Asia and the Pacific). This exciting workshop provided an opportunity for rehabilitation specialists and technicians from 22 countries in Asia and the Pacific to visit some of the most innovative rehabilitation programs in south-east India. Although most of the participants in the workshop were non-disabled, and although most of the programs visited were run by non-disabled persons, virtually all the programs visited were ‘disabled person centered.’ The staff of the programs visited repeatedly emphasized the importance of including the disabled client as a co-worker and equal in the problem-solving process. We saw many assistive devices which had been designed or improved by disabled persons themselves. These ranged from wheelchairs to special cushions to prevent pressure sores. (See the account of a village visit on the next page.)

 

A report on this ESCAP workshop will soon be available from: San Yuenwah, ESCAP, UN Building, Rajadaminern Ave., Bangkok, 10200, Thailand.

Linking Community-Based Rehabilitation (CBR) and ‘Independent Living’

• Rio de Janeiro, Brazil November 27-29, 1995. Although to date Brazil has little to show in terms of Community Based Rehabilitation, the potential for innovative CBR initiatives involving leadership by disabled persons seems high. In November, 1995, the National Coordination for Integration of Disabled Persons (CORDE), a division of Brazil’s Ministry of Justice, convened an international forum to explore “Alternatives in Community Based Rehabilitation,” with the goal of establishing guidelines and an “agenda for action” for promoting CBR in Brazil.

What made this policy-planning forum exceptional was that it was coordinated jointly by the Brazilian Government (CORDE) and the Independent Living Center of Rio de Janeiro (CVI-RJ). One third of the 30 participants were disabled, and disabled leaders and activists were given full opportunity to present their views and lead discussions. The CBR-planning forum was held following a huge 4-day symposium called DEF’RIO (Disability Rio), likewise sponsored jointly by CVI-RJ and CORDE. The symposium was also occasion for the public launching of the Portuguese translation of Disabled Village Children, the first edition of which was sponsored by CORDE with the help of UNICEF. CORDE will make the first printing (7000 copies) available free to disability groups and rehabilitation programs, especially those involved in or initiating community-oriented programs. The author of the book, David Werner, took part in the launching and presented the opening ‘position paper’ at the CBR planning forum.

The result of the forum represents a major breakthrough in policy-making in terms of a flexible, innovative, consumer-empowering approach to CBR. The problem-posing and planning process was participatory and democratic. A wide range of presentations and experiences was followed by ‘brainstorming’ sessions. Each participant drafted suggestions on cards, which were posed, discussed, and grouped according to theme. The result was a situational analysis, needs assessment, and finally conjointly drafted guidelines for action. Several outstanding recommendations of the final policy document are (paraphrased) as follows:

• Disabled persons, organizations, and family members should play a central role in the planning, design, function, and evaluation of CBR initiatives.

• Policy should be flexible, open-ended, and supportive of diverse approaches. Rather than formulating a single plan or ‘methodology’ for CBR, a range of activities should be encouraged that is rooted in, and adapted to the expressed needs/realities of local communities.

• The role of government at all levels should be to assist and advise rather than to control or normalize local programs, whether government supported or independent. It should help facilitate information sharing and interchange of ideas/experiences among grassroots initiatives, and should provide resources, advice, professional and institutional back-up, and promote intersectorial cooperation.

• Self-determination and full participation of disabled persons in society should be underlying goals of CBR. Existing organizations of disabled persons, independent living movements, and human-rights initiatives should be involved as facilitators/protagonists in an organized effort to achieve these goals.

• The underlying vision of CBR embraces equity and calls for wide-reaching social change. CBR is therefore part of a larger, humanitarian movement. This involves working toward a society which is inclusive and fair to all persons, which provides equal rights and opportunities to all who are weaker, different, marginalized, or exploited for whatever reason.

It will be interesting to see if this expanded and flexible vision of “CBR,” which involves strong leadership of disabled people and a variety of locally designed and managed approaches, will come closer to achieving full participation in society than do the top-down programs in many countries today.

Update on Child-to-Child for Disabled Children-PROJIMO, Mexico

In Newsletter #31 we saw how disabled rehabilitation workers at PROJIMO used Child-to-Child activities to encourage school children to be kind, not cruel, to a child who is different. We told the story of Jesus, a boy with spina bifida who also is partly blind and has only one leg. Jesus’ classmates had made school so miserable for him that he wanted to drop out. But after the Child-to-Child experience helped the pupils (and teacher) understand Jesus’s unusual needs and abilities, everyone became more understanding and friendly. Jesus enjoyed school so much that he chose to return to Ajoya (the village where PROJIMO is located) for school this year, too.

 

 

Jesus now helps to facilitate Child-to-Child activities in other villages. Not long ago a family from a village called Limon came to PROJIMO with two children with muscular dystrophy, age 9 and 11. The brothers, who walk awkwardly, were very shy. They did not go to school and their parents did not send them because they had been teased by other children. The PROJIMO team thought Child-to-Child might help. They invited Jesus to go with them to Limon.

During the Child-to-Child activities at the grade school in Limon, the two brothers watched from a safe distance. They were astounded when Jesus ran in a wheelchair race with the most athletic children in the class. Skilled in wheelchair use, the disabled youngster left his able-bodied competitors far behind in the dust. Having won respect of the other children, Jesus did ‘wheelies’ (balanced on the chair’s back wheels) and whirled in circles on two wheels, gracefully dancing. The able-bodied riders tried to imitate Jesus, with upsetting results. Everyone applauded Jesus, who thrived on the attention. Overcoming their fear, the two brothers with muscular dystrophy came closer to get a good look.

 

After the activities the PROJIMO team discussed with the enlightened class and teacher the importance of treating disabled children as equals, and of helping them to build on their strengths rather than pitying or teasing them for their weaknesses. The school children appeared eager to befriend and assist the two newcomers. And the brothers, after watching the children’s admiration for the blind boy in a wheelchair, lost some of their fear of school. Arrangements were made for the boys to attend school next term.

All benefitted from this experience, not least, Jesus. Not only did he win admiration from his peers, but discovered the joy of helping other children in need gain new self-confidence and hope.

During the Sept. 1995 ESCAP workshop on “Indigenous Assistive Devices for Disabled Persons” in India, one of our field trips was to an outstanding spinal cord injury rehabilitation center linked with the Christian Medical College (SMC) in Velore, about 100 miles west of Madras. Started in 1934 by a visionary woman doctor who had become paralyzed in an accident, this center is one of the best comprehensive programs for spinal cord injured persons that I have seen. The director and outstanding staff include their paraplegic and quadriplegic clients in the problem-solving process as friends, co-workers, and equals.

Spinal cord injury units in the United States and many other countries encourage most clients to use wheelchairs as their primary means of mobility. Walking is considered too problematic. However, in many parts of rural India wheelchair mobility is almost impossible (as one of the ESCAP team discovered on a village visit). Adapting to this reality, the SMC Center staff fits most paraplegic clients with leg braces and elbow crutches, and teaches them to walk. We were astounded how well some of the program’s graduates were doing.

We visited one paraplegic man at his home in a small village. On arrival we found Alok on his feet operating a rustic, motorized sugar cane mill. We had to look twice to see that he was disabled. On our arrival, he bounded over a pile of milled cane and greeted us warmly. We observed him in a wide variety of daily chores, ranging from clearing pathways to leading his cow across the narrow dikes of a rice field. He appeared in excellent health and was completely self-reliant, providing for his wife and children through his own hard physical labor.

Alok had built many adaptations to cope with his environment, including a pit latrine with a rounded wooden seat (unique for rural India) next to a water trough. To catheterize himself (for urinating) to save money he had stopped using a costly medical lubricant and used castor oil. But he found the commercial castor oil was unclean and caused urinary infections. So he started to grow his own castor trees and pressed the beans under clean conditions to extract his own oil. He said that with this clean home-made oil he’d had almost no problems with infection.

Observing the innovative problem-solving ability of village disabled persons like Alok made a deep impression on the visiting rehabilitation specialists and technicians. By the end of the 10 day program, many declared they would work more as ‘partners in problem solving’ with disabled clients, and encourage them to come up with, or improve upon, their own devices and solutions. These visiting professionals gained greater respect for the creativity and abilities not only of disabled people, but of poor, unschooled disabled people. And that is a major breaKthrough!

 

The influence of PROJIMO and Disabled Village Children reaches far and wide. Here the wall of the Gandhi Rural Rehabilitation Centre of Alumpundi, Tamil Nadu, India, displays a colorfully painted version of the drawing that has become a logo of PROJIMO and HealthWrights. The caption, translated into Tamil, reads “Look at my strengths, not my weaknesses.” The Centre provides rehabilitation and assistance, primarily to children paralyzed by polio.

The Social, Ecological, Cultural and Political Costs of Economic Globalization

In November of this year, leading activists, economists, researchers and philosophers from 19 countries around the world gathered in New York City to respond to the threats that economic globalization is posing to the environment, communities, human rights, equity and democracy. They presented a teach-in to over 1,000 citizens from around the country who are concerned that the globalization process is being driven by and for corporate interests without guidance or control of the people whose lives are directly affected by these changes in the global power structure.

Speakers at this event included Ralph Nader of Public Citizen, Vandana Shiva and Martin Khor of the Third World Network, David Korten of the People-Centered Development Forum and author of When Corporations Rule the World, Jeremy Rifkin of the Foundation on Economic Trends, and many other progressive thinkers and writers. David Korten’s address at the opening plenary session encapsulates the essence of the event and is printed here in its entirety.

The Failed Paradigms of Globalization: Address by David Korten

World Bank economist John Page told a meeting of Middle Eastern officials that the global economy is like the bullet train from Osaka to Tokyo. If you miss it, its gone and there is no way to catch up. He urged them to get on board quickly by restructuring their economies.

Harvard Business School professor Rosabeth Kanter, in her book World Class, tells us that the future belongs to those who are willing to give up their loyalties to community and nation to seek personal financial success in the global economy. She warns that those who remain loyal to people and places will be left behind.

Business Week tells us that East Asia—where the number of non-Japanese multimillionaires is expected to double from 400,000 in 1993 to 800,000 in 1996—is the leading example of what a global free market economy has made possible. “There are new markets for everything from Mercedes Benz cars to Motorola mobile phones to Fidelity mutual funds…To find the nearest precedent, you need to rewind U.S. history 100 years to the days before strong unions, securities watchdogs and antitrust laws.” Scant mention is made of the fact that free market economies have also left 675 million Asians living in absolute deprivation.

We have organized this teach-in because we strongly believe there is something fundamentally wrong with an economic model that calls on us to give up all loyalty to place and community—says we must give free reign to securities fraud and corporate monopolies and deny workers the right to organize—and tells us to run faster and faster after a train we have no chance of catching-so that a few hundred thousand people can become multi-millionaires by destroying nature and depriving others of a decent means of livelihood.

Millions of people around the world are no longer buying this monumental fraud against humanity—and their numbers are growing. We are here to celebrate their awakening—our awakening—from the myths and illusions of an industrial era that is now in its death throes.

These myths have become so embedded in Western industrial culture that most of us grew up accepting them as self-evident truths.

• The myth that growth in GNP is a valid measure of human well-being and progress.

• The myth that free unregulated markets efficiently allocate a society’s resources.

• The myth that growth in trade benefits ordinary people.

• The myth that economic globalization is inevitable.

• The myth that global corporations are benevolent institutions that if freed from governmental interference will provide a clean environment for all and good jobs for the poor.

• The myth that inflows of foreign money are a path to local prosperity.

Take the growth myth. To begin with our measures of growth are deeply flawed in that they are purely measures of activity in the monetized economy.

• If I were to divorce my dearly beloved wife of 33 years it would be good for the national economy. It would generate lawyers fees and I would have to buy and outfit an extra house.

• If a young parent stays home to care for his or her own child, it contributes nothing to the economy. If that same parent hires a baby sitter so he or she can take a job caring for other people’s children that counts as an economic contribution.

The growth myth has another serious flaw. Since 1950, the world’s economic output has increased 5 to 7 times. That growth has already increased the human burden on the planet’s regenerative systems—its soils, air, water, fisheries, and forestry systems-beyond what the planet can sustain. Continuing to press for economic growth beyond the planet’s limits does two things. It accelerates the rate of breakdown of the earth’s regenerative systems—as we see so dramatically demonstrated in the case of many ocean fisheries—and it intensifies the competition between rich and poor for the resource base that remains.

The disparities in this competition have become truly obscene. There are now 358 billionaires in the world. We could easily seat them all in a corner of this grand church. They have a combined worth of $760 billion—equal to the total assets of the world’s poorest 2.5 billion people—almost half the world’s population. And the proponents of globalization tell us they simply want to create a level competitive playing field.

In case after case we find that development projects—many funded with loans from the World Bank and other multilateral development banks—are displacing the poor so that the lands and waters on which they depend for their livelihoods can be converted to uses that generate higher economic returns-meaning converted to use by people who can pay more than those who are displaced. What growth in GNP really measures is the rate at which the economically powerful are expropriating the resources of the economically weak in order to convert them into the garbage of the rich.

Take the myth of free unregulated markets. It is almost inherent in the nature of markets that their efficient function depends on the presence of a strong government to set a framework of rules for their operation. We know that free markets create monopolies, which government must break up to maintain the conditions of competition on which market function depends.

We also know that markets only allocate efficiently when prices reflect the full and true costs of production. Yet in the absence of governmental regulation, market incentives persistently push firms to cut corners on safety, pay workers less than a living wage, and dump untreated toxic discharges into a convenient river.

Take the example of the Benguet Mining Company in the Philippines documented by Robin Broad and John Cavanagh in their book Plundering Paradise. In the quest for gold, Benguet Mining cut deep gashes into the mountains, stripped away trees and top soil, and dumped enormous piles of rock into local rivers. With their soils and water sources depleted, the indigenous people in the area can no longer grow rice and bananas and have to go to the other side of the mountain for drinking water and to bathe. The cyanide used by the Benguet corporation to separate the gold from the rock poisons the local streams, kills cattle that drink from the streams, and reduces rice yields of people in the lowlands who use the water for irrigation. When the tailings and cyanide empty into the oceans they kill the coral reefs and destroy the fishing on which thousands of coastal people depend.

The company reaps handsome profits. The local people bear the costs. Economists applaud the company’s contribution to the national output and export earnings. And the winners in the global economy are able to buy their gold trinkets at a more attractive price.

The one thing at which free, unregulated markets are truly efficient is in transferring wealth from the many to the few.

Take the myth of free trade. Many so called trade agreements, such as NAFTA and GATT, are not really trade agreements at all. They are economic integration agreements intended to guarantee the rights of global corporations to move both goods and investments where ever they wish-free from public interference and accountability. GATT is best described as a bill of rights for global corporations.

Take the myth that economic globalization is inevitable. Many of the people who claim globalization is a consequence of inevitable historical forces are on the payrolls of the global corporations that have invested millions of dollars in advancing the globalization policy agenda. Economic globalization is inevitable only so long as we allow the world’s largest corporations to buy our politicians and write our laws.

Take the myth that corporations are benevolent institutions. The corporation is an institutional invention specifically and intentionally created to concentrate control over economic resources while shielding those who hold the resulting power from liability for the consequences of its use. The more national economies become integrated into a seamless global economy, the further corporate power extends beyond the reach of any state and the less accountable it becomes to any human interest or institution other than a global financial system that is now best described as a gigantic legal gambling casino.

Take the myth that foreign investment creates local prosperity. Foreign investment is attracted by perceived opportunities to turn a quick profit-not to benefit some needy local community. Though they do have real world consequences, most of what we call “international capital flows” are little more than movements of electronic money from one computer to another in a high-stakes poker game.

From 1990 through 1994 Mexico became touted as an international economic miracle by attracting $70 billion in foreign money with high interest bonds ad a super heated stock market. As little as 10 percent of this foreign money went into real investment. Most of it financed consumer imports and debt service payments or ended up in the private foreign bank accounts of wealthy Mexicans—including the accounts of the 24 Mexican billionaires the inflows helped create. The bubble burst in December of 1994 and the hot money flowed out even faster than it flowed in. Mexico’s stock market and the value of the peso plummeted. Mexican austerity measures and a sharp drop in U.S. exports to Mexico resulted in massive job losses on both sides of the border. Most foreign investment seeks to extract local wealth—not create it.

Economic globalization expands the opportunities for corporations to go about their business of concentrating wealth-and from the corporate perspective, it has been a brilliant success. The Fortune 500 corporations shed 4.4 million jobs between 1980 and 1993—while increasing their sales by 1.4 times. Their assets by 2.3 times. And average CEO compensation by 6.1 times. The average CEO of a large corporation now receives a compensation package of more than $3.5 million. These same corporations now employ only 1/20th of 1 percent of the world’s population, but they control 25 percent of the world’s economic output and 70 percent of world trade.

And the consolidation continues. The value of corporate mergers and acquisitions world-wide completed in 1995 is expected to exceed the total for any previous year by 25 percent. Our development models—and their underlying myths-are the artifacts of the ideas, values, and institutions of the industrial era. Modern corporations have been the cornerstone of that era, concentrating massive economic resources in a small number of centrally controlled institutions. They brought the full power of capital intensive technologies to bear in exploiting the world’s natural and human resources so that a small minority of the world’s people could consume far more than their rightful share of the world’s real wealth. Now-as we push the exploitation of the earth’s social and environmental systems beyond their limits of tolerance, we face the reality that the industrial era is exhausting itself—because it is exhausting the human and natural resource base on which our very lives depend. We must hasten its passage, while assisting in the birth of a new civilization based on life affirming—rather than money affirming—values.

Countless citizen initiatives all over the world are creating the building blocks of the new civilization. Powerful formative ideas are emerging from these efforts, for example, the idea that economies should be local—rooting power in the people and communities who realize their well-being depends on the health and vitality of their local ecosystem. It is our consciousness-our ways of thinking and our sense of membership in a larger community—that should be global. Perhaps the most important discovery of all is that life is about living-not consuming. A life of material sufficiency can be filled with social, cultural, intellectual, and spiritual abundance that place no burden on the planet.

It is time to assume responsibility for creating a new human future of just and sustainable societies freed from the myth that greed, competition, and mindless consumption are paths to individual and collective fulfillment. We are here to embrace that responsibility and to build citizen agendas for change.

New Books Worth Reading

Disabled Children & Developing Countries

 

Too often the approach by rehabilitation professionals to the needs of disabled children in developing countries unimaginatively follows protocols designed in the North. Services and equipment are often culturally inappropriate, very costly, and delivered from urban ‘rehabilitation palaces’ far out of reach of the villages and communities where they are most needed. To reach the millions of disabled children who lack the assistance and opportunities they need to realize their potentials, basic skills and knowledge must be simplified and-at least in part-deinstitutionalized so as to make them available at the community and family level.

This new book, with 15 essays by professionals with insight and experience in Third World disability issues, provides a critical basis from which services for disabled children and their families can be planned more appropriately. Its pragmatic but caring approach often challenges the standard protocol. For example, it questions the value of starting a disability program with surveys, quoting WHO:

No country needs to undertake censuses, surveys or registration to find out the needs of its disabled citizens. They are so well known that CBR [community based rehabilitation] can go ahead without question marks. Every dollar spent on further investigation is a dollar misspent. (WHO 1984)

One of the editors of this important book, Pam Zinkin, is a pediatrician and health-rights activist with long experience in the Third World (especially Mozambique). For years she headed the CBR training-of-trainers program based in London, taking care to link the needs of disabled people to

the entrenched inequities facing poor and marginalized people, and stressing the need for fairer, more equitable social structures. A very insightful, warmhearted person with an unwavering commitment to social justice, Pam is the Regional Coordinator for Europe of the International People’s Health Council and is on the International Advisory Board of HealthWrights.

Innovations in Developing Countries for People with Disabilities

 

This important collection of essays explores initiatives in recent years to change how societies view disability. As the Forward stresses, “Most of these changes have been brought about by the continuous efforts of persons with disabilities. Their advocacy for the rights of disabled people has become a strong movement, aligned as it is with the human rights of other marginalized and minority groups.”

With examples from diverse countries and circumstances, the book shows how Community Based Rehabilitation (CBR) programs have pioneered new approaches to more fairly and equitably meet the needs of disabled persons, especially those unserved by institutionalized services. The book is organized in three sections:

1. Foundations,

2. Meeting Needs, and

3. Developing Services.

Many essays in each section focus on the growing role of disabled persons and family members in programs and decision-making affecting disabled persons. Section 1 starts with an discussion by David Werner on “Strengthening the Role of Disabled People in CBR Programmes.” Next is a chapter on “Fostering Parental Involvement” by Pramala Balasundaram of Samadan, describing a parent-run program for mentally handicapped children in a squatter settlement in Delhi, India. Section 2 includes chapters on mobilizing parents/communities in Guyana (Brian O’Toole), in Jamaica (Molly Thornburn), and in Norway (Pål Skogmo), among others. Section 3 starts with a chapter on “Mothers of Disabled Children as CBR Workers” by Barney McGlade and Rita Aquino in the Philippines. This is followed by accounts and planning and evaluation of contrasting CBR programs in Vietnam, Sri Lanka, India and Indonesia.

This book will provide CBR planners and workers with insight into the rich diversity of CBR initiatives, and the importance of leadership and activism by disabled persons themselves.

When Corporations Rule the World

 

In the words of Nobel Peace Laureate, Archbishop Desmond Tutu, this must-read book is “a searing indictment of an unjust international world order.” It provides a very readable, well-documented analysis of the way the dominant model of greed-centered development based on unbridled market forces has widened the gap between rich and poor, and has pursued maximum economic growth (for the rich) at the expense of humanity and the global environment. More important, Korten spells out a moderate but equitable, very rational alternative development strategy, which he calls “People Centered Development” (the title of his first major book).

According to Herman Daly (a senior economist who quit the World Bank in disgust):

Korten is an honest witness to the disastrous betrayal of common people and future generations that is carried out by corporations, governments, and multilateral banks. He cuts through the loud rhetoric of economic growth and global economic integration to the facts of increasing poverty, inequality, and dependence. I hope this book is widely read.

This book is in many ways complimentary to our forthcoming book, Questioning the Solution. David Korten is the founder of the People-Centered Development Forum, based in New York City.

Pictures, People and Power: People-Centered Visual Aids for Development

 

This clear, well-illustrated, do-it-yourself book is about “people-centered visual aids for development communication.” Part 1, titled “Reflection,” compares authoritarian with participatory methods, arguing that the latter are more likely to promote more equal distribution of power among people. Part 2, titled “Action,” provides the nuts and bolts to help community educators and activists design, make and use low-cost people-enabling visual aids. It includes many tips for how to make and use drawings to communicate more effectively.

In the words of the Brazilian educator, Paulo Freire, “People must learn to read their own reality and write their own history.” This book helps people learn to express and interpret their life situations through their own and other’s drawings and art. It includes practical guidelines for facilitators in this graphic, learner-centered process. For community health workers and health educators, Pictures, People and Power will be a welcome adjunct to Helping Health Workers Learn.

Milk, Money and Madness

This lucid, provocative book provides parents and health professionals with information they need to fully appreciate and advise about the importance of breastfeeding and the dangers of bottle feeding to both infant and mother. While it focuses mainly on events in the United States-which has the lowest breastfeeding rate in the industrialized world—the book has global implications. (The US was the only country which refused to sign the International Code advocated by WHO and UNICEF to curb the unscrupulous promotion of breast milk substitutes by multinational corporations.) The disturbing facts in this book are especially pertinent to the Third World, where in some countries the death rate from diarrhea is 20 times as high in bottle fed as in breast fed babies. The book reveals:

• how a product created to help sick children and foundlings was transformed into a powerful transnational industry with revenues of $22 million a day;

• how US taxpayers unwittingly underwrite bottle-feeding by spending over $500 million each year to provide 37% of the infants in the US with free infant formula;

• how the intimate, self-affirming experience of breastfeeding that is responsible for the survival of our species has been reduced to “just one feeding option.”

Naomi Baumslag is Professor of Pediatrics at the University Medical School in Washington, DC, and President of the Women’s International Public Health Network. (Naomi provided valuable advice for the “Killer Industries” chapter of our new book, Questioning the Solution.) Dia L. Michels is a science writer who also co-authored with Naomi A Women’s Guide to Yeast Infections, published in 1992.

Resource Guide to Innovative Health Solutions

This beautifully illustrated, clearly written booklet provides a brief summary of 20 innovative projects supported by Thrasher Research Fund over the last several years. The innovations cover a rich diversity of low-cost solutions to health-related needs. Most utilize local resources and build on indigenous knowledge and skills. The ingenious technologies cover everything from improved solar cookers to passive solar greenhouses; from fermentation of milk as an alternative to refrigeration, to policies and tools to reduce the use of tobacco by children; from hand dug wells and rope pumps to village industries run by micro-hydro power; from Vitamin A fortified rice to iodination of irrigation water.

For more information, with each technology an address is given of a key contact person or program. But perhaps the most important function of this booklet is to trigger the reader’s creative imagination. It presents a challenge not so much to replicate the examples shown, as to create new, more appropriate designs by working closely with the local people.

Among the projects summarized in the booklet is “Village-Based Rehabilitation” in PROJIMO, Mexico. In 1990 PROJIMO received a 3-year grant from Thrasher to develop innovative technologies through a process in which rehab workers and disabled clients work in creative partnership. In cooperation with PROJIMO, HealthWrights is now developing a sequel to Disabled Village Children to be titled Nothing About Us Without Us: developing innovative technologies for, by, and with disabled persons.

Hanyane—A Village Struggles for Eye Health

 

While this marvelous book has been in print for several years, we would like to draw it to readers’ attention. A review of this book by Tony Waterston in Postgraduate Doctor—Africa says:

This is the best book about primary health care since that marvelous inspirational book by David Werner, Helping Health Workers Learn. I started thinking it would be a laborious struggle through eye diseases, yet finished it at one sitting-the freshness of the writing and the originality of the approach impels one on. Though intended for health workers dealing with eye diseases, two thirds of the book is equally applicable to community workers from any discipline, in both developed and developing countries…
It is the first part of the book that is such a delight. It is an account in 30 short chapters of how a community nurse builds a community project for eye care with local mothers, using their expertise1⁄4 One understands after reading the book why so many community projects fail (particularly those organized vertically)—yet the rewards of success are so great.

This book relates the true story of how a young nurse, through trial and error, together with villagers evolves an approach to discovery-based learning in which everyone learns together and from one another as equals. It becomes apparent that eye health depends on many factors including good hygiene and nutrition, land rights, equality between men and women, social justice, and ultimately grassroots organizing and creative problem solving. The wide scope, sensitive approach, and gentle but liberating motif of this delightful book is reflected in its expressive line drawings, a few of which are shown on the next page.

War Surgery, Field Manual

…this manual adopts the standpoint of poor and vulnerable communities and staff, caught in wars they did not ask for.

War is still a common event. And tragically, today’s wars kill, injure, and disable many more civilians than soldiers. Land-mines designed to maim rather than kill cause millions of injuries to hapless men, women and children, even long after the fighting has stopped. Recent efforts by the United Nations to ban production and marketing of land-mines have been blocked by powerful nations (China, Russia, USA, etc.) where arms manufacturing for foreign markets is a giant, lucrative business. The voice of peace-makers is muted in an age when corporations rule the world.

“War Surgery, field manual” is a practical, detailed handbook written for surgeons and other medical staff who attend injured people in situations of war. But it contains a wealth of information useful in the management of all sorts of serious injuries, accidental or intentional. It is an indispensable tool, especially for doctors, paramedics, and health workers who work in remote areas far from surgical centers. Hundreds of excellent line drawings by the author make the procedures easier to follow. All medical terms used are explained in a glossary. As far as we know, no other manual covers this information with such depth and clarity. Sadly, the book is over-priced at $100.00, plus postage.

Available from Third World Network, 228 Macalister Road, 10400 Penang, Malaysia.

Announcing: Three New Translations - Adaptations of ‘Disabled Village Children’

 

Disabled Village Children, a guide for community health workers, rehabilitation workers, and families has been revised and adapted by the Volunteer Health Association of India (VHAI) for use in India, a country that has roughly 1 in 5 of the world’s disabled children. The Indian edition is available through VHAI, 40 Industrial Area, Tong Swasthya Bhavan (behind Qutab Hotel) New Delhi 110 020, India.

 

 

Disabled Village Children has been translated and produced in Russian by the All Russian Society of the Disabled (ARSD) with collaboration from the World Institute on Disability (WID). For information on obtaining copies contact World Institute on Disability, 510 Sixteenth Street, Suite 100, Oakland, CA 94612, USA.

 

The Portuguese edition of Disabled Village Children appeared in November 1995 and was launched at DEF’RIO, an international disability conference held in Rio de Janeiro. Hardy thanks go to Eugene Williams, a disabled activist who put an enormous amount of work into raising funds for the translation (from UNICEF and others) and into shepherding the many stages of translation, editing, layout, and production. Limited numbers of the Portuguese edition will be available from HealthWrights. For larger orders contact CORDE in Brazil: Tel:(55 61) 266-7980, Fax: (55 61) 226-7980.

Intensive Spanish Course at PROJIMO!

 

PROJIMO has reinitiated its Spanish course with great enthusiasm. PROJIMO offers a unique opportunity to learn Spanish by participating in an innovative rural rehabilitation program where young disabled persons help each other learn a variety of skills. During the day, work one-on-one with the Spanish teachers who will tailor the course to your needs and level of knowledge. Live with a village family where you can practice and improve your Spanish. The course is being offered for $100.00 per week, including room, board and tuition. If you would like to participate in this intensive Spanish Language Training Program, please contact Mari Picos or Conchita Lara at Proyecto PROJIMO, Apartado Postal 9, Ajoya, San Ignacio, Sinaloa, MEXICO. You may also get more information by contacting us here at HealthWrights.

A Call to Protest the Conservative Congress Majority’s Contract on America and its Children

In his ground breaking book When Corporations rule the World, David Korten portrays the pernicious inequalities in the USA (see p. 105). He quotes from a CBS TV interview with a sharecropper’s child in Selma, Alabama:

“Do you eat breakfast before school?”
“Sometimes, sir. Sometimes I have peas.”
“And when you get to school, do you eat?”
“No, sir.”
“Isn’t there any food there?”
“Yes, sir.”
“Why don’t you have it?”
“I don’t have the 35 cents.”
“What do you do while the other children eat lunch?”
“I just sits there on the side” (his voice breaking).
“How do you feel when you see the other children eating?”
“I feel ashamed” (crying).

The gap between rich and poor in the United States—as in most of the world—has been rapidly widening in the last decade. As the income disparity grows between the ruling and working classes, and as the real earnings of lower and middle class workers steadily decline, new laws give more and more tax breaks to the rich while burdening the poor with mounting taxes.

 

Today one in five children in the US lives in poverty and the proportion keeps growing. Since the early 1980’s, conservative legislation began to methodically roll back the safety net built over the last 60 years, which guaranteed every child in America—including the poorest—a bare minimum of food, shelter, education and health care. But now the attack against children in America is accelerating.

This year the conservative majority in the USCongress, led by Newt Gingrich and Bob Dole, are promoting legislation which will mean that:

• 2.2 million children will be dropped from the school lunch and breakfast program-the only nourishing meals many children get all day; *

• 5.6 million children will lose basic income assistance through Aid to Families with Dependent Children-often the only income of poor families; *

• 6.6 million children will lose health care coverage. *

These permanent changes in the law—together with cutbacks in successful programs like Head Start—will push millions of children deeper into poverty and leave them at a greater disadvantage, even as the total wealth (GNP) of the nation increases.

The House of Representatives has already voted to cut Head Start by $137 million, a cut that in 1996 will deny 48,000 additional children its comprehensive education, health, nutrition, and social services. Such cuts are dime-wise and dollar-foolish, for they undermine the future of the country: its children. Because of the developmental stunting and undernutrition that often accompany poverty:

• Children who spend the first 5 years of life in poverty score 9 points lower in intelligence tests than children whose families were never poor.

• Poor children are 1.3 times more likely than non-poor children to have learning difficulties.

• Low-income children are twice as likely as middle income children and 11 times as likely as wealthy children to drop out of secondary school after age 16.

The cuts in these programs to benefit needy children are being made supposedly to reduce the huge debt of the federal government. But rather than depriving defenseless children it would make far more sense to slash the inflated military budget, or to reduce the current inflated subsidies to big business—especially subsidies and tax write-offs to health-destroying business such as the tobacco industry.

It is unconscionable that in the wealthiest of the world’s nations—where obesity and overconsumption are growing problems—health care, adequate food, and education are not among children’s fundamental rights. What is amazing is that more Americans—especially among the poor and middle classes—have not mounted a stronger protest against this elitist, grossly undemocratic rollback of the socially progressive legislation designed to guarantee that all people’s basic needs are met. It appears that social activist Noam Chomsky is right when he accuses the mass media of ‘Manufacturing Consent.’ (See Chomsky’s book by that title.)

Unfortunately the current draconian rollback of socially progressive laws and long established humanitarian imperatives is not limited to the United States. The US government-military-industrial complex, with the help of the international financial institutions (World Bank and IMF), has imposed a globalized market model of development which places profits for the rich before the needs of the poor. As a result, humanity and the global environment are in peril.

It is time for ordinary people to wake up, to recognize the current barbaric nightmare of institutionalized greed for what it is, and to demand government and legislation that protect the basic needs and rights of all people-not least of all our children. But for this to happen, a new people-to-people network of communication is required, one that by-passes the lies and distortions of the mass media and helps ordinary people make an honest analysis of factors and forces that govern and determine their lives.

For this, all of us need to become better informed. We need to join groups that are actively critical of current regressive socio-political trends, and which propose more human, egalitarian and sustainable alternatives. And we need to help awaken more people to the crucial issues at stake.

Sources of information:

• For those concerned about the rights and well-being of children in the USA, we suggest you write for more information and possibilities for action to the Children’s Defense Fund, 25 E Street NW, Washington DC 20001.

• For a socio-economic perspective on our current global crises and for possible alternative paradigms for development, a good place to start would be David Korten’s new book, When Corporations Rule the World, or perhaps some of the writings of Noam Chomsky. Or subscribe to Third World Resurgence, New Internationalist, or Z Magazine.

• For insights into forces and factors affecting health policies and the health of populations, especially children, we hope that our forthcom ing book Questioning the Solution will be a useful resource.

Book: The Politics of Suffering: The Imact of the U.S. Embargo on the Health of the Cuban People

There are many ways in which rich and powerful nations use heavy-handed sanctions to force weaker nations to comply with their demands. One of the most devastating sanctions is the embargo, which can reduce a country’s income from exports and block import of critically needed medicines, food, and other goods. The result is spiraling economic hardship, a breakdown of health care and other public services, and growing poverty, hunger, disease, and social unrest. As ever it is the poor and most vulnerable who suffer most. Two countries where embargoes have eroded the well-being of the populace, especially children, are Iraq and Cuba.

Iraq. The death toll of Iraqi soldiers and civilians during Desert Storm was unconscionably high and involved heinous violations of human rights (such as when American tanks buried alive Iraqi soldiers who had surrendered). But the toll and atrocities of the war itself pale in comparison with

the aftermath. According to recent research by the UN Food and Agriculture Organization, “As many as 576,000 Iraqi children may have died since the end of the Persian Gulf war because of economic sanctions imposed by the Security Council.” (NY Times Int. Dec. 1 ‘95, p. A6). Rising malnutrition among children means damage will extend for many years. The study found that

this August in Baghdad, 28% of children under age 10 are stunted, up from 12% in 1991. The percentage of ‘wasted’ or emaciated children requiring urgent attention has risen to 12% in 1995 from 3% in 1991, and child deaths from diarrhea have tripled. Water and sanitation systems have deteriorated, hospitals are running at 40% capacity, food prices are high, and many people live on starvation diets of only 1000 calories a day.

“These findings illustrate a strong association between economic sanctions and increase in child mortality and malnutrition rates,” the study says. “The United Nations humanitarian arm offers palliatives for the alleviation of suffering while the UN Security Council is intent on continuing the sanctions [until the Iraqi government yields to its demands for arms control].” However, little attempt is made to limit the massive, lucrative sales of arms from rich countries to poor. Meanwhile, millions of children pay the price with their health and their lives.

Cuba. The US embargo against Cuba has likewise caused huge economic dislocations. These are described in a revealing new booklet called The Politics of Suffering: The Impact of the US

Embargo on the Health of the Cuban People, by Diane Kuntz and published by the American Public Health Association. The devastating impact on Cuba’s economy was intensified by the demise of the Soviet Union (formerly Cuba’s main trade partner). And it was further aggravated by the so-called “Cuban Democracy Act of 1992” with which the US government further tightened and tried to globalize the embargo. As a result, food supply has diminished and the Cuban diet is less adequate both in quantity and quality. Medicine and medical supplies are scarce. Power shortages are frequent, factory production is often disrupted, and under- and un-employment have increased significantly.

Only because of Cuba’s excellent health system and political commitment to Health for All, has the small island nation so far been able to sustain its remarkably high health indicators. Cuba, with a GNP (national income) per capita only 1/20 that of the USA has managed to achieve—and, in spite of the embargo, sustain!—child mortality and life expectancy rates equivalent to those of developed countries. Its immunization and prenatal care rates are far superior to those in the US, and Cuba has fewer hungry children.

Yet despite Cuba’s enormous efforts to safeguard the health of its citizens, the embargo is taking its toll. Hospital admissions have increased, as have crime, prostitution, the black market, and social unrest. Some infectious diseases such as sexually transmitted diseases, diarrhea, and hepatitis A are on the rise. Anemia in pregnant women and children has increased due to reduced availability of iron rich foods (meats, eggs, etc.), and there are more low birth-weight babies. An epidemic of nutrition-related neuropathy also emerged, but has been largely corrected through vitamin/folate supplements. The nation has been able to sustain the population’s overall high level of health only through closely controlled rationing, which contributes to a groundswell of unrest (which is, of course, one of the goals of embargoes and other means of ’low intensity conflict.’)

The study concludes that “While the overall health of the Cuban population has not yet seriously eroded as a result of the economic decline, severe problems threaten to emerge in the future.”

Today, so-called ‘health care reforms’ are cutting back and privatizing public services and transferring more of the costs of health care to those who can least afford them while the gap between rich and poor widens. Despite these overwhelming obstacles, Cuba still provides the world with a model of good health at low cost, through equity. It is this viable alternative to the greed-centered health and development model of the global marketeers that most threatens the USA and spurs the tightening of the embargo.

End Matter

Board of Directors

Allison Akana

Trude Bock

Roberto Fajardo

Barry Goldensohn

Bruce Hobson

Myra Polinger

David Werner

Jason Weston

International Advisory Board

Dwight Clark — Volunteers in Asia

Maya Escudero — USA/Philippines

David Sanders — South Africa

Mira Shiva — India

Michael Tan — Philippines

Pam Zinkin — England

Maria Zuniga — Nicaragua

This Issue Was Created By:

Trude Bock — Editing and Production

David Werner — Writing and Illustrating

Jason Weston — Layout, Writing, and Online Edition