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Miracles For The Many

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THE DISABLING WORLD [image, unknown]

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Miracles for the many
Teresa Tunay reports from two villages in the Philippines where the last six months have seen dramatic improvements in the lives of disabled children through an important new experiment in low-cost community-based care.

THE disabled children of the developing world number some 140 million boys and girls. Ninety-nine per cent of them are receiving no trained help whatsoever. In capital cities, imported technology and expensive rehabilitation centres perform miracles for the few. But the need now is for new ideas to work a miracle for the many.

The beginning of that miracle might just be happening right now in two villages of the Philippines. In 1979, a survey in the villages of Camp Tinio and Mananac showed that there were 568 children under the age of six and that 119 of them were disabled in some way - over 20 per cent. Under the name of `Reaching the Unreached' a programme waslaunched to help those children without taking them out of the community and without using expensive technology.

Today, only a few months later, 46 per cent of those children have shown very significant improvements.

The original survey also found Josefina, a 10 month old baby girl who was a victim of Down's Syndrome. In other words, she was a mongoloid child. When her home was visited by one of the survey team, Josefina was virtually a wilting head of lettuce in her mother's arms. He body appeared boneless. She could not even hold her head up. Her eyes were lifeless and she responded to neither the sound of a voice nor to a smiling face.

Today only 16 weeks later, Josefina has put on weight, runs around the house in a baby walker, plays enthusiastically with a string of coloured beads, and is just as responsive as any normal child of her age. Says a next door neighbour, `If I hadn't seen it with my own eyes I wouldn't have believed it.

Josefina's `therapy' did not require institutionalisation or gadgetry. Her mother was shown how and where to `tickle' her baby to exercise the muscles. The treatment progressed through gentle kneading of the child's limbs to a daily ritual of therapeutic exercise. Soon, the child began to make steady and continued progress.

The guilt and shame of Josefina's mother, and the lack of anyone to tell her that her baby needn't be hidden from the public eye, that there was nothing to be ashamed of, and that the baby's muscles need not waste away, was a greater handicap than the impairment itself.

The key to low-cost but dramatic improvements in the lives of the majority of the disabled lies in releasing the care and support which is latent in the family and the community. And it was from that point that the `Reaching the Unreached' programme began. Two young researchers, one trained in occupational therapy and the other in pre-school education, went to live in the village, renting a small but at a nominal rate, from the village or 'barangay' captain.

In discussion with the community, they agreed to concentrate their efforts on children under the age of six, not only because the young child is the most vulnerable, but also because the earlier the help the more potential there is for improvement and the less damage is done to the normal processes of child development.

Village volunteers were trained. Non-technical indicators were listed for the detection of impairments. And the community as a whole was involved in finding impairments in their children, in discussing their attitudes towards it, and in planning and carrying out the rehabilitation programmes themselves.

Community care
As work progressed, the link between malnutrition and disability was quickly exposed. Eighty per cent of the children with multiple impairments were also found to be malnourished. Across the board, the prevalence of malnutrition mirrored the extent and severity of disability. To tackle the problem, parents, teachers, and midwives, day-care workers and volunteers were trained to make the best possible diets from locally available food. The advantages of breastfeeding were fully explained and discussed and ways of making good weaning foods were studied.

Next came training in pre-natal care, immunisation, sanitation and hygiene, and the distribution of Vitamin A to combat blindness. At the same time, the importance to child development of stimulation and play, often denied to disabled children, was discussed with their families. And ideas began to emerge, fuelling enthusiasm, for toys made from locally and cheaply available materials like sea shells, corn husks, and bamboo.

The swift and significant improvement of almost half of the village's disabled children has gathered its own momentum within the community. Much has been learnt by both the people of Camp Tinio and Mananac and by the researchers and field workers. And much still needs to be done. But the idea of basing prevention of disability and rehabilitation of the disabled on community care and involvement, and on primary health care strategies, has shown how much can be done with how little. And this small beginning of a 'miracle for the many' holds out more hope for the 140 million disabled children in the developing world than all the technology under the sun.

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