Activities

Core Programme Clusters

Disability, Injury Prevention & Rehabilitation

Community Based Rehabilitation, an Urban Experience Activities Defining the Community or Area The community and the target group for CBR should be clearly defined at the outset of any programme. This could be decided based on proximity to available resources, requests from the community, availability of infrastructure and possibility of inter linking with existing services either GO or NGO. In our project we chose the poorer area of the Vellore town (a population 20,000) focusing on people with disability. This is already part of the area served by LCECU, within easy physical reach. The existing links of the LCECU with the local community facilitated the process of CBR. Entering the Community		Foreword Community Based Rehabilitation Why CBR? How we did CBR? Activities Methodology Lessons from the field Evaluation Sustainability Acknowledgement Contact
	To initiate the CBR process, the community must become aware not only of what the needs and problems of the disabled are, but also be confident thatthere are solutions possible within the community. This awareness may arise within the community through one or a group of its members. More often it occurs because of the efforts of the third person or a group who acts as “facilitator”. (which was the role of our team). In this case, getting to know the community and gaining their trust is the crucial first step for initiating CBR. This can be done in many ways.
When we started the initial visits to the community we spent time talking to people. We had tea in the local teashops and chatted with people around there. The patients and their relatives from the LCECU, who lived in these communities, played a facilitative role for establishing initial contacts in the community. In this way, we were able to identify and meet some of the local leaders. We also made contacts with leaders of youth groups, schoolteachers and women’s groups. The purpose of the project was explained and discussed with them.
Once rapport and links were established, public meetings were held. These meetings were held wherever there was a place available like street corners, temple premises, playground, under the trees, etc. They were informal and interactive. Issues, priorities, and fears of all were openly voiced and discussed. In many communities we visited, we found that people’s priorities were different from ours. Many communities felt that the health and development needs of the non-disabled were not being met and should have priority over the needs of PWD, who were anyway less productive. However with discussions some communities understood that addressing the needs of PWD would eventually lead to overall development within the community. eg. an elderly person with stroke, if rehabilitated, would liberate the care givers to carry out other productive functions. There was scope for the PWD to have a productive role in their home or community. In our project, these meetings generated a lot of discussion inspiring some people to volunteer their time, effort and service for their neighbours in the community. The educational and training approach rather than direct service delivery approach seemed a novel idea that aroused their curiosity and interest. Among the communities who were willing to participate in this educative model, further discussions were held to select volunteers for the project. Selection of volunteers
Although all the people who volunteer are deeply committed and want to help, there could be practical difficulties for some of them. Further discussions were conducted highlighting their aptitude, ability and availability for this task. However it needs to be mentioned that there were communities who were not keen on projects focused on the development of the disabled people. No volunteers came forward for the programme from these communities. We held several discussions with volunteers and their families as well as with local leaders before the selection. It was decided to have one volunteer for every 2,000 people whom we call a Local Supervisor (LS). After discussions on the nature of the volunteer’s work, some volunteers found that they could not spare time or that they could not cope due to poor literacy skills or aptitude.
We do have two volunteers who cannot read or write, but were chosen for their abundant enthusiasm. Those who were not selected were encouraged to continue to be a part of the wider support network and have been helpful in mobilizing resources, joining in activities like health awareness camps in their areas. Eligibility Criteria for Local Supervisors In our project, we felt that LS should: - be from the local community - be able to read and write in local language - have family support - have time to spare for community activities (2-3 hours a day) - have positive attitude towards PWD and community development - have experience in dealing with disability or could be disabled persons themselves Training (The WHO manual for CBR formed the basis for the training programme.)
	The aim of training was to create awareness, enhance knowledge and provide skills needed so that the volunteers and PWD could be effective agents of change in the community. Through the training the volunteers and the people with disability were empowered and enabled to facilitate the process of Community Based Rehabilitation. The learning process took place within the community as well as in the institutions outside the community. The trainees and trainers were both a part of the learning process. We found the WHO manual translated into the local language to be user friendly, practical and effective.
Trainers The project staff, people with appropriate technical skills from the secondary and tertiary care centres, NGOs, Government agencies, PWD, medical specialists and educators were involved as trainers.