The Need

The need for an appropriate technology of rural rehabilitation is enormous. Severe physical disability affects the lives of millions of children and their families mostly living in rural areas of developing countries. Polio, cerebral palsy, and deformities caused by accidents, burns and infections are among the most common causes. But the majority of disabled children never receive the therapy, family guidance and orthopedic aid they need to develop their potential capabilities. The infrequent rehabilitation services that exist are mostly provided by expensive professionals in the cities—and even there they are available only to a fortune few. There is a great need to simplify and extend the science of rehabilitation, physical therapy, and orthopedic aids so that basic skills are widely available to community health workers and through them to the familities of disabled children.

What is PROJIMO?

Project PROJIMO in western Mexico is a modest yet innovative response to this enormous need. It is a rural rehabilitation program run by local villagers, most of them disabled. The main purpose of the program is to give families the understanding and skills they need to help their disabled children develop their full potential. The project is structured to develop self-reliance in all who participate: workers, parents, and children. It is a community-based program in so far as it is directed by local persons from poor farmworking families, and has the participation, in various ways, of much of the community.

What Does PROJIMO Mean?

PROJIMO is a Spanish word for “neighbor” in the most kindly sense as in “love your neighbor”. But P.R.O.J.I.M.O. is also an acronym standing for “Programa de RehabilitatiO/n Organizado por Jovenes Incapacitados de ME/xico Occidental” or “Rehabilitation Program Organized by Disabled Youth of Western Mexico”.

How Did PROJIMO Get Started?

Even from its early years, Piaxtla had a unique involvement with disabled children. Children with polio and other disabilities needing orthopedic surgery were occasionally brought into the Ajoya Center. Surgery proved too expensive in Mexico. So in 1970, arrangements were made for selected children to receive free surgery and braces at Shriners Hospital in San Francisco, California.

When children who had been dragging themselves around on their hands and knees returned home walking with crutches, the word spread rapidly. Soon disabled children from far and wide were arriving at Ajoya, and the health team did its best to make arrangements at Shriners for those in greatest need of surgery.

A problem arose with the repair of braces (calipers). Village children are very active. Frequently their braces break. Or they outgrow them. The health workers could not depend on outsiders for repairs.

In 1975 Piaxtla sent a village health worker, Roberto Fajardo, to study brace repair at Shriners. Roberto was the first of the village health workers to receive special training in Rehabilitation.

As the years went by children with different disabilities continued to arrive at the health center. Some were taken to Shriners Hospital. But many had problems that did not require hospitalization or surgery. Some needed wheelchairs and others needed artificial limbs, still others needed simple therapeutic exercises. The children’s familites needed advice on how to help their children become as independent as possible, despite their handicaps. But the village team lacked the knowledge and skills to do very much.

Finally the village health workers came together to discuss what they could do better to meet the needs of the many disabled children who came to them. They decided to start a community rehabilitation program—if the villagers were willing. They called a village meeting and presented the idea. The community responded enthusiastically. Several women offered to provide room and board to visiting children and their families. Local craftsmen offered to help in converting an unused mud brick building into the rehabilitation center. And the school children offered to help build a rehabilitation playground.

What Does PROJIMO Do?

The main job of Projimo is to HELP FAMILIES OF DISABLED CHILDREN TO BECOME AS ABLE AND INDEPENDENT AS POSSIBLE IN HELPING THEIR CHILDREN IN WAYS THAT ARE INEXPENSIVE AND ENJOYABLE.

This means it does it’s best to:

 

• TEACH FAMILIES to carry out simple therapy and exercises, build aids and equipment, and encourage self-reliance in their children;

 

• CREATE COMMUNITY SUPPORT by bringing together families of disabled children, providing examples of disabled persons as happy and productive members of society, encouraging disabled and non-disabled people to study, work, and play together, coordinating the work of village volunteers, and educating the community through role plays and Child-To-Child activities;

 

• PROVIDE REHABILITATION EQUIPMENT, (braces, prostheses, walkers, wheelchairs, etc.) ORTHOPEDIC PROCEDURES, (such as correcting club feet by casting) and PHYSICAL THERAPY;

 

• ARRANGE FOR FREE SURGICAL CARE at hospitals in the USA for severely disabled young people who cannot be helped locally.

Who Makes Up the PROJIMO Team?

PROJIMO was started by disabled health workers from Project Piaxtla, with Roberto as coordinator. They invited disabled local villagers to join the team. In addition, they recruited 2 able-bodied craftsmen (one a blacksmith and leather worker, the other a welder and mechanic) to teach their skills to disabled workers. David Werner, North American pioneer in village health care (also disabled) became program adviser. The PROJIMO work team has gradually grown to 15 (10 disabled).

 

Javier Valverde, who had surgery for foot deformities at Shriners Hospital, also studied brace-making at a San Francisco brace shop, and is now one of the leaders of PROJIMO. The team elected him ‘oustanding worker of the year.’

 

Marcelo Acevedo was disabled by polio. Project Piaxtla helped Marcelo get surgery, schooling, and trained him as a village health promoter. Later, Marcelo joined the PROJIMO team. He studied brace-making as an apprentice in orthopedic shops in Mexico City and in the U.S.

 

Don Ramon, left, a local sandalmaker, disabled by an old bullet wound and arthritis, is the oldest member of the team.

 

Teenaged Ruben (on left), disabled by polio, first came for treatment and alter joined the staff. Here he helps with the record keeping. Ruben had never worked before. When he received his first play, it was the happiest day in his life.

 

Conchita, with cerebral palsy, first came for help learning to walk. Later she joined the team, especially to become the friend and helper to Teresa, a girl with juvenile rheumatoid arthritis.

Other disabled North Americans have visited PROJIMO to share skills and ideas. Ralf Hotchkiss, master wheelchair designer, and Bruce Curtis, organizer andcounselor, have advised the team. Rehabilitation professionals from Mexico and the U.S.A. have also come to learn and to teach.

Many villagers have helped (for example, by building sidewalks and wheelchair ramps and opening their homes to disabled children and their familities). They too are part of the PROJIMO team.

The Rehabilitation Playground

Setting up a playground was one of the first and most visible activities of the new program. The team decided to model it after a bamboo rehabilitation playground in the Khao-i-dang refugee camp in Thailand. (David Werner had taken photos on a recent visit and shown them to the villagers.)

However, there was to be one big difference. Local able-bodied children halped to make the playground, with the understanding that they, too, be allowed to use it. The team felt it was important that disabled and able-bodied children play together.

The children worked enthusiastically on the playground, which is no referred to affectionately by the villagers as ‘el Parquecito’—or The Little Park.

 

 

 

 

 

One of the main ideas of the playground is to give parents of disabled children ideas for exercise aids and playthings they can make at home using local resources at almost no cost. Parents can try out different types of equipment with their child—those that the child likes they can make themselves.

For example, the playground has a variety of swings suitable for almost any child.

 

 

Technology

Several workers have become remarkably skillful—even creative—at making braces, special seating, walkers, and therapeutic aids. They have also learned to straighten contractures and correct club feet. They have consistently had good results.

Wheelchairs

Many disabled persons need wheelchairs and cannot afford them. Those that do have them often have chairs that are inadequate for their needs or are so broken down they barely move. For villagers—or poor people from the cities who live on unpaved streets—no appropriate wheelchairs are available commercially.

For this reason, PROJIMO began to create rugged ‘rough terrain’ wheelchairs.

Braces (Calipers)

PROJIMO has been experimenting with ways to make low-cost, lightweight braces.

One experiment has been to use old plastic buckets. The plastic is headed in an oven over a plaster mold of the child’s leg.

Artificial Limbs (Prostheses)

The challenge in producing artificial limbs is to make them at a cost poor people can afford. Within a month after PROJIMO began to make prosthetic legs, a request came from an orthopedic surgeon in the state capital asking if he could refer amputees to the village rehabilitation center. Although high-quality modern prosthetics are available in the city, most of the amputees cannot afford them.

Salvador, one of the village health workers, learned how to make artificial legs at the Khao-i-dang refugee camp in Thailand.

Relearning to Smile—The Story of Teresa’s Rehabilitation

To close this statement on Project PROJIMO, it seems fitting to tell Teresa’s story. It is not really a success story—not yet. For Teresa’s rehabilitation has been a slow struggle; she still has a very long way to go. We tell her story because Teresa is the child who has spent the most time with PROJIMO (7 out of the first 12 months). She is the child who has most tested, frustrated, and enlarged the team’s capacity for personalized aids, creative adaptations, therapy and love.

Theresa has suffered from juvenile rheumatoid arthritis since age 7. When her mother first brought her from a distant village at age 14 her body had long since stiffened into the shape of a chair. The only thing that she moved as her eyes. Her joint pain was so great that she pent every night crying. Years before, a doctor had prescribed aspirin, but in time she developed such stomach distress that she had stopped taking it.

Theresa had lost hoped. Once she had been a cheerful, ordinary child. She had completed 3 years of school. Now she spent her life sitting silently in front of a television. She spoke very little, answering questions with single words. It was seeks before the PROJIMO team saw her smile.

The PROJIMO team as once put her back onto aspirin, but with care that she take it with meals, lots of water, and an antacid. Then they began a long, slow process of rehabilitation, which is documented in these photos.

Teresa was improving steadily. Unfortunately, when she returned home for Christmas she fell ill with dengue (break bone fever) and nearly died. Her family stopped both exercises and medication. When she returned 6 weeks later she was as stiff and bent as when she had first come. She was so depressed she spoke to no one, not even her parents. The team began her rehabilitation all over again.

Teresa still has a long way to go before she is fully functional and independent, but she has come a long way. Now she spends an increasin amount of time back in her village with her family. Together with her family, she is taking more responsibility for her own therapy and continued improvements. The village team of PROJIMO have helped her gain new understanding and use of her body, new friends, and a new, more hopeful view of herself.

With the help of the PROJIMO team, Teresa has a new happier outlook on life—and a brighter future.