Disabled Village Children: A Guide for Community Health Workers, Rehabilitation Workers, and Families, by David Werner. Hesperian Foundation, 1987, 654 pp. Paperback.

Disabled Village Children is a powerful, engaging, and readable reference for third world health and rehabilitation workers. It provides ideas and techniques relevant for the novice and the veteran, as well as for the interested observer. Unlike works whose main approach is clinical or academic, Disabled Village Children uses more than a thousand cartoon-style drawings and numerous photos to present information on child physical and mental development, manifestations of diseases and disabilities, and methods for treatment and rehabilitation appropriate in the third world. These drawings, and the colorful anecdotes of actual experiences sprinkled throughout the book, make for fun reading and easy comprehension.

The power of Disabled Village Children derives from its simplicity as well as from its recurring theme of a “bottom up” approach to health and rehabilitation in rural third world communities. Werner succeeds in combining the ideas of appropriate technology with the concept of appropriate organization. As against the traditional paternalistic “top down” methods for delivering services to the disabled, Werner advocates the active involvement of disabled children and their families in their own rehabilitation and in the control of the organizations which provide these services.

 

The playground brings non-disabled and disabled children together through play. For Werner, the “bottom up” organizational approach is inseparable from effective rehabilitation. It allows the rehabilitation worker to make the best use of the skills and knowledge of local people. It helps the disabled and their families maintain their dignity. It empowers the disadvantaged to assert their right to a more just society.

As a child, Werner himself was disabled from progressive muscular atrophy. In spite of his protestations, he was forced to wear inappropriate arch supports and braces which hurt him and restricted his movement. This experience allows Werner to identify with the disabled children he seeks to help and lends this book its compelling sensitivity.

As a child, David Werner himself was disabled from progressive muscular atrophy.

Disabled Village Children is divided into three parts, each of which appeals to a slightly different readership. “Working with the Child and Family” concerns the medical aspects of childhood disabilities and infant physical and mental development. “Rehabilitation Aids and Procedures” includes more than 100 pages describing methods of using appropriate technology and will fascinate those with a more technical bent. The procedures for correcting joint contractures and club feet are very creative.

An eight-page chart comparing six third world wheelchair designs is comprehensive and discusses in detail the comparative advantages of 12 wheelchair features.

“Working with the Community” is particularly interesting for those concerned with the social issues of disability. Here Werner explores the relationship between rehabilitation and the rights of the disabled. He sees rehabilitation in a rural third world setting as a fundamentally political task. Disabled persons share many of the same problems faced by their nondisabled neighbors, especially poverty. Often basic human needs must be taken care of before a family can turn its attention to the special needs of a disabled child. This means that disabled persons and their families can be leaders not only in the fight for their own special needs and rights but also in the tight for “a fairer, more fully human community.”

For Werner, the rehabilitation worker can (and must) be an agent for positive social change for everyone in the community. He dives ideas for starting village-based rehabilitation activities. He suggests not only the integration of disabled children into regular village life, but also the involvement of the community at large in rehabilitation activities.

One idea for integrating disabled and able-bodied children is creating an accessible playground. With the help of adults, local children can build most of the playground themselves. Since it will benefit all children, the entire community becomes involved. This section also contains chapters on education, sex, work. and play, including chapters on a children’s workshop for making toys, a popular children’s theater to raise disability consciousness among the community, and on games to help nondisabled village children understand the special problems of disabled children.

David Werner sees rehabilitation in a rural third world setting as a fundamentally political task.

For those interested in providing ongoing services in a third world setting, the chapter on organization, management, and financing of a village rehabilitation program is indispensable reading. This part also includes a chapter on examples of community-directed programs from Mexico, Bangladesh, Nicaragua. Pakistan, Thailand, and Kampuchea.

Every North American who has been involved in providing community assistance in a third world country should be keenly aware of the financial and organizational problems involved in maintaining a self-perpetuating program. Too often, once the initial seed money has dried up, little remains in the way of human and financial resources to carry on the work. Werner suggests solving the human resources problem by developing local leadership through the “bottom up” approach. The problem of finances, however, is more tricky. Werner argues that the goal of economic self-sufficiency, however noble, is a myth as long as these third world communities continue to suffer from poverty. He suggests a hybrid form of financing where up to half of the program’s needs are financed locally and half through outside funding sources. Ideas for local financing include contributions (in money or work) from families served and income-producing activities such as making items for sale and providing repair services.

Disabled Village Children rings true because it draws on years of actual work with disabled children in rural third world communities. It conveys not only a knowledge of techniques and devices for rehabilitation, but also a wisdom and sensitivity that can come only through time and experience. I enjoyed its fresh approach. HW