PROJIMO: Program for Rehabilitation by Disabled Youth of Western Mexico
by Heather Toporowski, B.Sc.P.T.
February 9, 2005

It has been a desire of mine for some time to use my physical therapy training and experience to volunteer in another country. I have also been interested in learning Spanish, in order to be able to volunteer and travel in Central and South America. I have not had any previous overseas volunteer experience and so I was looking for an opportunity that would enable me to learn more about the concept and provision of Community-Based Rehabilitation. I was also looking for an opportunity that would allow me to volunteer for a shorter period of time, as many programs require commitments of one to two years.

Through research on the Internet, and also through reading a book on CBR (Disabled Village Children by David Werner), I became aware of Project PROJIMO, in Sinaloa, Mexico. PROJIMO offers a unique opportunity for health professionals to combine volunteer experience with Spanish immersion (via classwork and living with a PROJIMO family).

The program began in Ajoya, a small hill town in Sinaloa, in 1981, with the advocacy of David Werner, who continues as an advisor. The program relocated in 1999 because of increasing problems with crime and violence related to the drug trade. The program moved to Coyotitan, a small town just over an hour from Mazatlan, which is safer and more accessible. A second program, the Children's Wheelchair Project, makes wheelchairs and is located in Duranguito nearby. Several books have grown out of the experiences, including Disabled Village Children and Nothing About Us Without Us.

The development of PROJIMO was spurred by the fact that Mexico has no welfare system and does not have widespread free access to health care or statutory provision of disability aids such as wheelchairs or artificial limbs. Consequently, it is difficult to find adequate rehabilitation, counselling and services. Orthopaedic aids and Physical Therapy are very expensive. The few free services reach only a small fraction of the children that need them.

The PROJIMO program is a community- based rehabilitation and education program run by and for disabled people. Many members first came for rehabilitation or aids and then decided to stay, and learn and work. Different persons take charge of different aspects: consultations, record-keeping, accounting, and different shop activities, such as making aids and wheelchairs. It has cooperative, informal organization and management.

The two main objectives of the program are:
§ To work with disabled persons and their families to increase abilities and opportunities.
§ To raise the consciousness of non-disabled persons and school children to include disabled persons in the life of the community and "to look at strengths, not weaknesses".

Disabled workers provide therapy, counsel families about how to assist (but not overprotect) their disabled family member, and teach activities of daily living, including self-help skills necessary for living independently. Families are encouraged to participate as they are able, providing assistance with exercises, making aids, carrying out daily maintenance and other work at PROJIMO. They also make a wide variety of adaptive equipment including prostheses, orthopaedic aids, custom seating, and wheelchairs.

Other activities include teaching in schools to encourage integration of children with disabilities, and programs for prevention of injuries in school children.

The intensive Spanish immersion program costs $150 U.S., which covers the cost of a home stay with a PROJIMO family, and four hours daily of classes with two teachers who formerly came to PROJIMO for rehabilitation, and who now are "maestros." Volunteering is very flexible, and volunteers develop their own schedule for work and classes with the input of the PROJIMO staff. The centre operates Monday through Saturday.

When I arrived I was greeted at the Mazatlan airport by Miguel, who is the PROJIMO driver, amongst his other duties. Coyotitan is a small town of about 1000 people, inland and at the base of the foothills of the Sierra Madre mountains. The PROJIMO complex is on the outskirts of town and includes a therapy room, offices, workshops, and rooms for live-in patients. Surrounding the rehabilitation complex are the homes of the PROJIMO staff.

Conchita Lara and Mari Picos are coordinators of the program, and I was privileged to stay with Conchita and her family, husband Miguel, and teenage daughters Camellia and Emily. The home stay included the provision of meals, and I tried many simple but delicious Mexican dishes in their home.

Initially, I took four hours of Spanish classes each day, and tried to fit in volunteer time in the therapy room in both the mornings and afternoon. As my stay went on, after discussion with my teachers and with Mari, I cut back my time in classes in order to spend more time in therapy. They were very supportive and understanding of my choices. Ultimately, I ended up with 2-3 hours of Spanish classes daily, as well as spending 5-6 hours per day on therapy activities. Evenings were spent doing Spanish homework, writing up programs for patients, and sometimes playing volleyball or football with the village kids. I was also able to attend some of the school visits and the wheelchair shop at Duranguito. Other outings included attendance at a Rotary Club Health Care Fair in Culiacan, a large city about 2 hours away.

I worked with quite a variety of people with different conditions during my time there: children with cerebral palsy of varying types and severity, adults with paraplegia, quadriplegia, and hemiplegia, orthopaedic conditions such as fracture and total joint replacement. Some people came for appointments as outpatients, and there were also some people who lived-in for intensive rehabilitation.

Generally Mari would begin the intake when a new patient arrived, and I would be asked to join in as appropriate. We would conduct an assessment and develop a plan in collaboration with the patient and family. At that time also, other PROJIMO workers would participate, if it became apparent that specialized seating or other aids would be required.

I worked closely with Maggi and Ines, two therapy workers. They had much experience and knowledge and were used to working with therapists in a very collaborative way. The goal was for me to work closely side by side with the workers so that we could teach each other, in order that when I left, they would carry on providing therapy with the new skills and knowledge attained. This is preferable to a therapist treating patients independently and then leaving, without having built capacity in the program to carry on without the "professionals." I also assisted by developing several handouts for exercises for various conditions, as well as helping with artwork for school posters.

Participating in the PROJIMO experience was interesting, rewarding and also tiring! I learned a lot about the philosophy and experience of Community Based Rehabilitation, which will prepare me for other volunteer placements I hope to have in the future. I also found myself stretched as a physical therapist, as I worked with wheelchair training, making recommendations about seating and orthopaedic appliances, and assisting in developing ADL skills. One of my proudest moments was when I successfully built a splint to enable a patient with quadriplegia to feed herself for the first time. My ability to communicate in Spanish also improved as a result of my experience there- from working in therapy, from my classes, and also from living with a family.

I would recommend the PROJIMO program to anyone interested in getting started in Community-based Rehabilitation. It is important to have some familiarity with Spanish before arriving, as only one or two PROJIMO staff have very limited English. The other staff, patients, and people in the community of Coyotitan speak Spanish. I think it would be difficult to volunteer in a meaningful way without some basic language skills. I would also recommend reading some of the publications of HealthWrights before attending, as I found this assisted very much in my preparation. I would be happy to share more of my experiences or answer questions. I can be contacted at:

htoporowski@yahoo.ca
or
h.toporow@telusplanet.net