A Regional Training Course in Community Based Rehabilitation

Quito, Ecuador, September 18-24, 2000

This course was organized by Christoffel-Blindenmission (CBM) for participants in programs assisted by CBM in 14 Latin American countries. The course was skillfully coordinated by Karen Heinicke-Motsch of CBM Ecuador. Facilitators included Dr. Molly Thornburn who for 3 decades has done outstanding work in community health and child development in Jamaica. David Werner was also a guest facilitator.

The course focused strongly on management, organization, and evaluation. It also included hands on, learning-by-doing activities, in the areas of Appropriate Technology and Child-to-Child.

Although each program had been asked that at least half the participants sent to the course be disabled, in fact only 2 of 50 participants had notable disabilities. Therefore one of the main objectives of the course was to help participants learn how important it is to include disabled persons and their families in CBR initiatives.

To emphasize the importance of listening to and including disabled persons in every aspect of CBR, a number of activities were planned, including allowing local disabled persons to express their concerns and recommendations.

Here we will focus on the activities involving the Appropriate Technology workshop (coordinated by David Werner). First the course participants visited disabled children in their homes, observed the limitations, possibilities, and resources in the home environment, and discussed with the children and their families their needs and wishes. They explored what the child and family felt might be helpful in terms of assistive equipment or devices. Together they made a provisional design (or cardboard model) of the equipment and later presented their ideas and designs in a plenary session for more input.

The next day the course participants made assistive devices together with the children and their relatives. They did this in a local wheelchair-making workshop run by The Paraplegics Association of Pichincha. This was a valuable experience for the course participants, since the disabled workers had far more technical skills (such as welding) and experience than the participants. Results were impressive.

Here we present briefly the process of working with families to create the assistive devices.

Alex is a seven year old who lives with his single mother and siblings in a borrowed house on a steep hillside near Quito. His family is quite poor. Alex has arthrogryposis (stiff joints) affecting both legs. His knees don’t bend (except to the side) and his feet double inward (varus contractures).   The boy loves to run about on all fours. On the steep slopes he is agile as a mountain goat. He also has crutches for going to school. They keep his hands cleaner and protected, but he doesn’t like them because with crutches his knees hurt more and he feels less secure on the steep paths. The course participants saw that Alex’s crutches were too small. They made him bend over while walking, which contributed to his mild hip-flexion contractures. Also the hand grips were much too high, making it harder to bear his weight on his hands, so he was bearing too much weight in his armpits. A debate arose about what would be best for Alex. A therapist thought Alex should only use crutches, because it is “more normal” to walk upright and because properly adjusted crutches (standing straighter) might help correct his hip contractures. Others, listening to the child, agreed that it was safer on all fours. So they made for him some simple “hand boots” to protect his hands and keep them cleaner in muddy weather. They also made Alex new crutches. Although he still preferred walking on all fours and loved his “hand boots,” he also found walking easier and less painful on his new crutches, which let him stand straighter and bear more weight on his hands (less on his feet). Alex and his mother were happy with the devices, and with taking part in creating them.

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