Community Based Rehabilitation

COMMUNITY BASED REHABILITATION PROGRAMME OF
WOMEN’S DEVELOPMENT CENTRE

AUGUST-2007

WOMEN’S DEVELOPMENT CENTRE, No. 61 MULGAMPOLA ROAD, KANDY

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ACKNOWLEDGEMENT

A Documentation of such a comprehensive finish cannot be completed without the help of numerous sources and people throughout the long rugged path of success. I too realized this fact and so, I take this opportunity to thank them all.

Personally this documentation has helped me to gain knowledge and skills to understand people with disabilities and their struggle for survival. Therefore it indeed gave me a great opportunity to study the Community Based Rehabilitation programme (CBR) of Women's Develop Centre (WDC) understand the services they provide to the people with disabilities.

This documentation would not have been possible if not for the generosity of number of person who spent their time with me. In particular, I wish to acknowledge Ms. Pearl Stephen, Founder Director, Women's Development Centre (WDC) who prompted me to undertake this study and for giving me the guidance and support.

I also wish to acknowledge the support and informative guidance of Ms. Dammika Podiemanike, Coordinator, WDC CBR programme.

I extend my thank you to all the staffs of CBR programme for helping me throughout this study by providing and facilitating to obtain necessary information

Finally, I must mention here that all those who supported me in helping me to document have done so with an expectation of a successful documentation. Such an expectation has been my source of inspiration and encouragement. I express my sincere thanks to all of them albeit that I may not be able to present their names.

Having completed the documentation, it is my hope that it will serve as a source of information for those who are interested on the subject of community based rehabilitation especially who are interested on research on such a subject, for donors to get an understanding as to how their resources are serving the humanity and most of all as a reflective material for WDC management and staff for appreciating their own work as well as for further enhancement of their programme.

It is my wish that this documentation will bring more light to further enhance safeguarding the rights of the disabled persons.

Ranjan S.K. Nellimale
Documenter
August 2007
CONTENTS

01. INTRODUCTION 01

02. BACKGROUND DETAILS 01

• The aim of WDC is to • WDC Vision • Mission • WDC Target Group • Major areas of work • District Level Women’s Fora attached to WDC Women’s Network

03. OBJECTIVES OF THE DOCUMENTATION 11

04. METHODOLOGY OF DOCUMENTATION 11

05. THE METHODOLOGY USED FOR DOCUMENTATING 11

06. COMMUNITY BASED REHABILITATION 11

• What is CBR?

07. WOMENS DEVELOPMENT CENTER AND COMMUNITY BASED REHABILITATION 13

• Vision of CBR Unit of WDC • Objectives • Activities

A. Kandy Community Based Rehabilitation Centre 15

• Day care centre • Counselling • Speech and Language Therapy

a. Speech class b. Speech Therapy c. Language Therapy

• Physiotherapy unit • Special Education class • Behaviour Modification

B. Vocational Training Centre (VTC) Ampitiya 23

C. Manikhinna Community Based Rehabilitation centre 26

D. Matale Community Based Rehabilitation Centre 28

E. Teldeniya Community Based Rehabilitation Centre 29

F. Haragama Community Based Rehabilitation Centre 31

G. Madolkale Community Based Rehabilitation Centre 33

H. Ulapane Community Based Rehabilitation Centre 34

I. Pothgoda Community Based Rehabilitation Centre 36

J. Galpihilla Community Based Rehabilitation Centre 38

K. Community Blind Rehabilitation program 39

08. REMARKS 42

• Intervention • Rehabilitation • Prevention

09. CONCEPT OF COMMUNITY DEVELOPMENT 44

10. KEY LEARNING FROM THE DOCUMENTATION PROCESS 45

1. Impact on the disabled persons 2. Impact on Family living 3. Access to services and facilities 4. Impact on social relations 5. Capacity Building of Vocational Training 6. Access to loans for those with vocational Training 7. Community Awareness 8. Self Help Group formation 9. Parental Capacity Building 10. Advocacy

11. RECOMMENDATIONS 49

12. ANNEXURES 54

COMMUNITY BASED REHABILITATION PROGRAMME OF WOMEN’S DEVELOPMENT CENTRE

01. INTRODUCTION The concept of Community Based Rehabilitation programme is that disabled people should have the right to a good life and fulfil their needs. The help they need should be available to them at a low cost. It should offer to them and their family a way that suits their usual way of living, whether in a village, a town or a city. They should have education like everybody else and there should not be any disparity. They should be able to take up the normal activities like jobs and earning their own living without discrimination and exploitation. They should be able to take full part in all the activities of their village, or town or city or within their families. The idea of CBR is that, even if people learn very slowly, or have problems seeing or hearing or, find it hard to move about, they should still be respected as being men and women, girls and boys. Nobody should look down on them, nor be treated any less than a normal person just because they have a disability.

02. BACKGROUND Women's Development Centre (WDC) is an organization established in 1987 and registered as an NGO in 1989.

The aim of WDC is to: Help Women enhance their participation in Socio-Economic life and help them take up leadership roles in various capacities.

WDC Vision: To create a society where women and children are actively involved, having equal opportunity to, access to, and control over resources and working in the area of advocacy and policy to their own betterment and of their families.

Mission: Facilitate and create an environment to strengthen the position of women and children in society by addressing women’s and children’s issues and community awareness, thereby reducing victimization improving opportunities for engaging in income generation activities and awareness to improve their lives with increased knowledge and through group support and activities.

WDC Target Group: WDC’s work involves women from disadvantaged communities but also expands to include youth and children from all ethnic and religious groups’ predominantly in rural areas.

Major areas of work:

• Crisis Intervention • Community based Rehabilitation • Network with seven district fora and other organizations with similar aim and objectives. • Community development (health, community organizing, community awareness and working with schools) • Pre-schools and day care centres • Resource centre • Legal aid/counselling programme • Disaster intervention
District Level Women’s Fora attached to WDC Women’s Network

03. OBJECTIVES OF THE DOCUMENTATION • To explain the concept of the Community Based Rehabilitation (CBR) program as implemented by WDC. • How far has the CBR program brought positive impact to communities where it is implemented. • To identify where changes are required for a more effective CBR programme.

04. METHODOLOGY OF DOCUMENTATION The Community Based Rehabilitation program (CBR) has been documented by using Descriptive method. The documenter used mostly interviews and observations to gather information.

05. THE METHODOLOGY USED FOR DOCUMENTING The initial discussion with Mrs. Pearl Stephen as the author and initiator of the program as well as other key individuals helped in developing the interviews and observation guide. The information gathered were summarized and analyzed to provide major leanings and conclusions.

06. COMMUNITY BASED REHABILITATION Community Based Rehabilitation approach is said to be suitable for developing countries with limited resources to provide wider coverage of services. The importance of CBR approach is the transfer of minimum rehabilitation skills and responsibility to minimally trained family members and other volunteers in the community. The last decade saw the growth of community based rehabilitation in many developing countries, along with changes and adjustments in the concepts and practices related to this field especially in countries like Sri Lanka.

What is CBR?
Mrs. Pearl Stephen, Founder Director of WDC who initiated CBR, perceives that any intervention to disabled people is liberation for those who are the care takers of the most marginalised persons. In fact, it is the rationale for a women’s organisation such as WDC to be involved in the issues of the disabled.

According to her, it is a programme that safeguard the rights of the disabled persons changing their surroundings, including enabling the family and the community in this task. It is a sustainable process that utilises as much local resources and techniques as possible to intervene, rehabilitate and minimise occurrence of disabilities.

“A strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disabilities” (UN definition) “CBR is a strategy for enhancing the quality of life of disabled people by improving service delivery, by providing more equitable opportunities and by promoting and protecting their human rights” (E. Helander ).

07. WOMEN’S DEVELOPMENT CENTER AND COMMUNITY BASED REHABILITATION

The Women’s Development Centre (WDC) is a local Non-Governmental Organization (NGO) based in Kandy. The aim of the organization is to promote women’s status in society by building capacity, developing partnerships and supporting awareness on health, legal rights, gender leadership development crisis intervention and skills training, networking and action- research on women’s issues.

The WDC began by running a community health training program in collaboration with local medical officers of health. As the health volunteers gained the trust of many families and communities in which they were working, they learned of many disabled children who had received little, if, any, help. Many were hidden away in shame and fear, some even physically imprisoned in there homes. The parents were in desperate need of help and support in coping with the stresses and difficulties of caring for these children. Following requests from the parents, it was agreed that a rehabilitation programme be started in November 1990, with the children already attending the WDC centre in Kandy on two mornings in a week. Some of original health volunteers become the ‘rehabilitation workers’ and their training was extended by attendance at paediatric, psychiatric and ENT clinics as well as short courses at a special school for hearing – impaired children. The programme was well attended and rapidly developed, with new centres opening in local villages in response to community requests.

There are 10 community based rehabilitation (CBR) centres run by WDC in number of places such as, Ulapane, Manikhinna, Pothgoda, Madolkalele, theldeniya, Galphila, Matale, Ampitiya, Haragama and in Kandy. The village centres are in temples halls and other community premises. They function with the co-operation / support of the local community.

These different centres work with hospitals, schools, department of education, the divisional secretariats and the various service departments within these secretariats. The programme taps a lot of local resources from parents, divisional secretariats, department of social services etc. Most of these departments have a lot of respect for the quality of service rendered by WDC unit and the rapport they are able to develop with the departments and the clients alike.

Vision of CBR Unit of WDC: Create an environment where the person with special needs while enjoy equal rights and maximum benefits within the family and society.

Objective: • Minimize conditions that lead to disabilities • Rehabilitate persons with disabilities while being in community • Advocate on issues related to disabilities of persons

Activities: • Maintain community based rehabilitation centres • Maintain special education units • Maintain vocational training centres for person with special needs • Implement community education programs • Develop and support networks with and for people with disabilities • Mainstream of work and issues of person with disabilities

A. Kandy Community Based Rehabilitation Centre

The Kandy CBR group currently functions as a separate unit close to the WDC main office. A total of 48 staff are spread over ten CBR centres. There are 10 Staff members rendering their support to the Kandy centre.

In general, all of the centres whether in the urban areas like Kandy or other centres in rural areas, there are a basic set of services and activities rendered. Therefore, this document would not try to elaborate all these activities in all the centres but try to indicate some of the unique features of the different programmes.

The centre in Kandy, in the sense, can be seen as the hub and coordinating place. It is the training and orientation centre as well as assessment centre of many disabilities where a large number of clients from different parts of the island access their initials services and referrals.

The babies and children attending the CBR programmes have wide range of disabilities like hearing and visual impaired, language disorders, learning difficulties, and behaviour problems, physical and mental disorders. There is lack of space for special education schools and units so the children will move from the centres to get special education. However, some of the children are having multiple difficulties which make such placement more difficult.

There is a system to assist the very young and other children with difficulties. Those who come to seek the services of the WDC Kandy centre come from various parts of the island through different sources, such as through referrals from hospitals, doctors, hospital clinics, special education department, organizations and some times any one who has heard of this CBR program from a friend or relatives also bring their children or direct.

Some of the services rendered by CBR Kandy centre is counselling, speech and language therapy, day care centre, visual program, physio-therapy and special education class.

• Day Care Centre: The Day Care Centre of the WDC CBR unit entertains children requiring Day care facilities for both WDC staff and others. The uniqueness of this centre is the ability to integrate both normal and children with special needs. Presently there are 18 children (both girls and boys) in the pre school age in this day care centre. Two of the children are from crisis intervention centre of WDC at Haragama which serves women and young girls who have faced violence.

Shabana is a 6 years old child having a physical disability in her hand, early she got physiotherapy treatment from the centre and now she receives normal pre school education.

• Counselling: Counselling is an a interactive process conjoining the counselee who need assistance and the counsellor who is trained and educated to give this assistance, the counsellor can initiate and maintain the interactive process if he/she communicates feelings of spontaneity and warmth tolerance, respect and sincerity.

One of the main work done by CBR Kandy unit is providing counselling to the parents and the children with disabilities. When the parents approach the organization for help, the first thing that the CBR counsellors do is a detailed assessment regarding the problems of child and the related causes by using formats developed by them. In this process the CBR counsellors try to help the parents to clarify the problem and the way how to build the helping process. In the end of this process the counsellors will direct the parents towards next step and to the type of service required.

• Speech and Language Therapy: The main objective of this unit is to help children in improving Speech and Language skills.

a. Speech class: Speech class are conducted for children who are having speech difficulties such as stammering, autistic, Down syndrome etc. it is an individual effort with each child. These children are referred by schools and hospitals. The children go through initial assessment while being in the speech class. Those who require intense rehabilitation are identified and provided with further intervention.

After the initial assessments and corrective measurers, these children are referred to special education units and followed up on a monthly assessment basis. Some children are also followed up at homes during home visits

b. Speech Therapy: Those who are supported through speech therapy are those with more intense speaking disabilities such as those who have difficulties with voice and exeursing the tongue. Sometimes such intervention require around one year of treatment process.

c. Language Therapy: Language therapy is often for the children who have extreme difficulties in speaking such as deaf children. Such children are assessed and intervened to improve sounds, sign language etc.

The deaf children in particular are referred to the deaf school in Dodanwala to enable them to continue their school career. Even while the children enter the deaf school, they are still followed up until they reach a level of improvement.

• Physiotherapy unit: The Physiotherapy unit plays a vital role to improve the functional ability of children with physical disabilities. This unit performs a number of important services such as assessment of the level of functional ability of the children, perform rehabilitative exercise on children, education and trains parents on exercises, nutritional and health requirements of children to improve these condition. The other function of the unit is also to improve appropriate and affordable rehabilitative devices that could also be turned out in the rural homes.

• Special Education class: The children who come to the special education unit are referred by schools or these who are on the verge of dropping out of schools due to learning difficulties. These are children who require special attention or not able to cope in class room situations. Special education class provide the children with learning difficulties to over come their problem and to develop the knowledge. It provides the children to understand the weakness they have and to get the help of the staff of the centre. The staff have developed a good relationship with the children and it helps most students to improve.

• Behaviour Modification: This unit is one place where children who have extreme behaviour difficulties such as those who are hyperactive or are not able to concentrate. They are received to a special unit where they are provided with guidance and unique activities to help them sit in a place, improve concentration, improve working together, learn patience, etc. After these, children learn to control themselves, they are moved to other section for rehabilitative exercises.

B. Vocational Training Centre (VTC) Ampitiya

The aim of the vocational centre of CBR is to assist children with special abilities to develop their skills to enhance their dignity by helping them to explore and learn about their inherent skills and develop them further to enable productive and more independent living. The children have special talents. After their education, if they are not supported to enhance, they may be lost while they enter the lager society. This is especially true for the children with mental and physical disability. They normally do not get sufficient assistance from government.

To cope up with this situation and to reduce the problems they face, in 1999 WDC started the Vocational Training Centre (VTC) within the CBR. In the beginning VTC started with 24 students and given them training in carpet making, envelopes, paper bags and in carpentry.

The Ampitiya centre belongs to the (government) department of social serves and WDC was requested to run this centre. As WDC maintain very good rapport with government departments but lacks required resources, this request was considered timely and opportune. This centre has three units for residential care, vocational training and school for special education.

Mostly, the vocational trainings are for those children who pass out from various rehabilitation centres and have no other future prospects. At present, there are around 20 children both females and male children learning various skills, not only at the Ampitiya centre but also in other community level rehabilitation centres.

The type of vocational training are Carpentry, Eakle broom production, Candle production, Cement flower pots making, Handloom, Sewing/rug - making, Fabric/Pottery paint, Envelop making, Paper bag making, Home gardening, Greeting cards, Stocki-net flower making and Patch work.

It must be mentioned that it is not easy to train children with disabilities with certain physical mental disabilities. The teachers require patience and concentration all the time especially when they are training to use various tools. While some products can be promoted to competitive markets, this is not always possible. Some children take a very long time to learn the skills but some perhaps cannot go beyond making rugs. Some of the trainees who train the children themselves have been trained by the VTC

As part of network building the teachers of VTC also visit Digana rehabilitation hospital for spinal injuries to give vocational training for patients. This training while it goes as part of rehabilitative exercises, also provides a good training to start own employment in their houses. Further staff of Digana hospital says that those training also have tremendous psychosocial impact on the patients.

There are many programmes conducted in collaboration with the government organizations and most of the time the VTC receive invitations /requests to participate in their programmes. Specially sports events and other competitions. It really help student to appreciate their own capacities. In the year of 2007, 3 students were selected from Amptiya VTC to represent Sri Lanka for Para Olympics in china.

C. Manikhinna Community Based Rehabilitation Centre

Manikhinna centre was started in the year of 1992. During the 14 year period, it has provided a variety of services to the community. Currently the centre is located at the Ganadevi kovila, old temple and provides the services to the children with disability as well as to the community. The main aim of the centre is to use the available resource in the community and use them for the development of socially handicapped people.

Mainly this centre carries out the process to rehabilitate mentally and physically challenged children. Counselling, speech therapy, mentally retarded (MR) class, vocational training and Physiotherapy are the major activities carried out in this centre

The centre maintains good relationship with the temple and the local politicians and the benefit of good rapport improves their service to the community.

Manikhinna Community Based Rehabilitation centre has provided many services to the community. The program has enabled the community to build some houses and toilets among the needy families. Parents too get self employment training in order to make the family financially stable. The centre strongly believe to make a better environment for the child. Making the family self employed help the child considerably in the rehabilitation process. The training to parents on self employment further helps to integrate the children with disabilities within family and community.

So many changes have also occurred in the community sine the CBR program began in this community. Among them is the awareness of disabilities that has taken place among the community and community under stand this kind of children require special attention and care.

When the Manikhinna centre initially started, the staff visited many communities. In the process they also identified villages classed as ‘Low caste’, and those ‘working with devils’. these village were normally neglected by other villages, and government officers never visited them nor did the temple accept their alms. However, when the CBR staff started to visit them, inviting the priests and government officers to the CBR centre, the situation started gradually changing.

Sudeep is a 16 year old boy having learning difficulties. According to the doctors he is a mentally retarded child. He come from a poor family and his father left him and the family. CBR helped his mother to build a house because they do not have proper shelter. Currently this child is attending Speech and Language Therapy classes in the CBR centre. It is interesting to note that this child manages to read and write to some extent. When the documenter asked Sudeep whether he could visit his newly built house he was overjoyed. With outmost interest Sudeep help the documenter to visit his house and get information about his village. The development that has taken place in this child is important to the society as well as for the child’s own future.

D. Matale Community Based Rehabilitation Centre

Matale Community Based Rehabilitation Centre was started in the year 2000 and currently it is situated at Hunukate Alokaramya Temple. The service rendered by the staff of this centre are recognized by the people and they give their fullest support to the CBR program.

There are 75 children currently getting the services from this centre. It carries out the rehabilitation activities for mentally and physically challenged children. It provides Counselling, speech therapy, MR class, self employment training and Physiotherapy.

Due to ignorance and lack of awareness most of the community people face many problem. The CBR centre has taken steps to conduct awareness programs to the community, such as the orthopaedic camp conducted by the ‘Centre for Handicap’ organization. It is a good example of how the CBR unite coordinate with other organizations to improve the services for the people. Anther awareness program is on nutrition. It is an important program for the community as most of the parents and children do not have proper nutrition. Good nutrition has been identified as one of the most important aspects to minimize disability.

Documenter got the opportunity to speak with the midwife of the community and learned how the CBR program benefited the lives of people. According to her earlier there was no awareness among the people about the disabilities and they totally neglected those people with disabilities. But when the CBR staff started to work with the people they became aware about the problem and sought the help of the CBR centre. She also mentioned that the staff are able to build a good rapport with people and provide a lot of support to those who approach them.

Amila Kumara is a student doing his advance level (A/L) this year. His mother is working abroad and his father is dead. At the time he approached the CBR program, he was totally neglected by his family members due to his physical disability. He has difficulty to walk. Due to this difficulty he did not attend the A/L classes. But with the support of the CBR centre he has improved a lot and now he can walk by himself. He got so much of motivation from the CBR staff and support that encouraged him to do his A/L. He will sit for the examination this year. He is so happy about the CBR program and he says that because of this program his life has changed.

E. Teldeniya Community Based Rehabilitation centre

Teldeniya centre was started in the year of 2004. Currently the centre is lacated in the Teldeniya primary school. With the limited space this centre is functioning well and provids much services to the community. In this centre Counselling, speech therapy, MR class, self employment training and Physiotherapy programs are available for the community.

As the centre is located within the school premises, it has developed a strong relationship with the school programs and work closely with the school to provide better services. This centre also conducts awareness programmes and organized women's groups. This centre too provides training on self employment. Tailoring class seem popular. There is a teacher employed by Government handling this class for the parents of these children. In this centre staff have been able to create a good environment with government officials as well as other top level officials in order to provide better service to the community.

Documenter got an opportunity to speak with the school principal and learn how the CBR program fulfils the needs of the community. According to him, prior to the program there were no support to the children with mental and physical disabilities, they where totally neglected within the schools as well as in the community. The CBR programme provided these children with disabilities an opportunity to come out of their difficult situation. According to the principal earlier there was no one to help the children with leaning and behavioural difficulties in their education in the school. Teachers were disinterested in such children as they where more interested to help the able children. After the rehabilitation programme was started, we are now able to send these children to this centre and now I am happy to see the improvement of these children due to the help they got form this program. “Some of the children we sent to this centre have come back and are now studying with normal children, It is a joy nice to see how they have change”.

Deshika Kolabaga is a 6 year old child having much difficulty in her behaviour pattern. Since 3 years she is attending the CBR centre and gets speech therapy and special education support.

According to her mother Deshika underwent so much of difficulty with in the family due to her ways of behaviour. All her family members neglected and reject her. But since she started to attend the CBR program she has remarkably improved. She has been able to get over most of her behaviour problems, she is now able to do her work normally and manage to win every one hearts in the family. The family members now understand that she has to get special care and attention from the family.

Desheka’s mother is so happy about the staff of the organization and says that it is due to their care and support that her child has improved and she is thankful for them.

F. Haragama Community Based Rehabilitation centre

Haragama centre was started in the year of 2004, since then there have been so much of changes in the community because of the CBR program. It has given lot of services to the community for the upliftment of children with disabilities. Currently the centre is located close to the WDC Crisis centre.

Like other CBR centres this centre too caries out the duties of rehabilitating mentally and physically challenged children. It provides Counselling, speech therapy, MR classes, self employment training and Physiotherapy.

Most of the parents of children who come to the centre said that prior to bringing their children to the centre, they faced many difficulties due to lack of awareness on how to handle the children. But with the CBR programme, life has become much easier. It has also facilitated looking at the problems as a community.

The parents of these children are very poor and therefore the CBR programme also help the mothers through skills training on basket making etc. It is expected that after this training the mothers will engage themselves in self employment.

The documenter had the opportunity to speak with a group of basket-making women in the centre, they were so happy and willingly came forward to explain how and what kind of service they get from WDC as an organization. The mothers explained that prior to coming to the CBR program, they faced much hardships and their children experienced many difficulties in learning, behavioural problems, etc due to the disabilities. However the mothers are very happy about the improvement that they see in their children. They also feel relieved due to this improvement.

The mothers also appreciate the training they received to work with their children to participate in the rehabilitation process of their children.

G. Madolkale Community Based Rehabilitation centre

This centre was started in the year 2000. The program in particular supports the disabled children in the plantation sector. Currently the centre is located close to Paramsehwara Tamil College Madolkale, and looks after around 24children.

Because this centre is located in close proximity to plantation sector, most of the children come from families working in plantation sector. Serving the plantation itself is a unique experience for the WDC/CBR unit, as there are very few programs implemented to serve the estate sector.

Compared to all other projects of WDC/CBR unit, the parents of most children have a very low level of literacy. In general, though it is a community living close to each other, it is not a close community that supports one another. Since both parents go to work, the children with disabilities and practically the mothers who are burdened with many functions face a lot of difficulties. Initially the staff also found it difficult to located children. It was also difficult to make parents understand why it is important to pay special attention to children with disabilities. Gradually the programme has taken root in the community. The parents, teachers and children are now able to understand its importance. Because the school community and children appreciate the program, the organization enjoys good reputation. There are 24 children who attend speech class, speech therapy, MR class, and self employment training. Other than this, 2 families receive the help of WDC. One parent was helped to cement the floor of their house while another received tea plants to initiate an income generation activity. As the staff identified the problems of low nutrition being low, they also conducted training and education session on nutrition

The documenter had the opportunity to speak with some of children who were engaged in sewing handkerchiefs. These were children with learning difficulties as well as physical disabilities. According to them they are happy now because they get the opportunity to learn some useful things for their future and these children really feel more secure due to the CBR program. There are other skills training activities such as bag making, making envelopes and candles, etc.

H. Ulapane Community Based Rehabilitation centre

Ulapane centre was started in 1995. During the 17 year period it has given many services to the community to help through many development activities. Currently the centre is located in at the Ulapane Maha Vidyalaya and providing the services to the children through the special education unit.

In my view, compared to other centres, Ulapane is a difficult terrain to work due to hilly slopes. The area that the staff are required to cover is wide. Children are brought to this centre from very faraway places. The staff also require to travel far to make home visits. There are also many physically disabled children that the parents are unable to bring to the centre on a routine basis. Therefore, the staff are required to make much effort to visit all of them despite transportation difficulties in the area. Also the resources are very limited

Like other centres it mainly carries out the process of rehabilitation of mentally and physically challenge children. It gives Counselling, speech therapy, MR class, vocational training and Physiotherapy.

This centre has built a good reputation among the government officers and the social welfare organizations. “According to the school Principal, the CBR program has created so much of awareness about disabilities in the community that it has become easy to identify disabilities among the children. Initially people did not have an understanding what this center was doing for children with disabilities but, with time, they have gained understanding and started to help the school in ways they could. He said “It is a privilege, as a Principal, for me to take part in this program”.

Listening to the Principal it was clear to me that he is satisfied with the CBR program and appreciates the work they are doing. The change in awareness and the quality of life of children are remarkable.

The staff of the Ulapane unit also indicated that apart from the services they render to the children, the mothers of the children also have become members of a women's forum. Through this forum, the mothers get training and support to develop income-generation towards economic empowerment.

Ashma is a girl having learning difficulties. She has been dropped out from two schools and never given enough support and guidance for her education. She has been totally neglected from the school and it created some confusion and difficulties for her. When her father started to take her in to the CBR program she started showing improvement in her education and her father is vary happy about her development. According to her father she is getting proper care and support for her education due to which she is motivated and shows interest in studies. The Father said now he could understand why she was not able to study well in the schools, that it was due to the lack of capabilities of the schools teachers to understand slow learning. When such children started attending school and fall into the wrong and incapable hands of teachers, the school careers of children are ruined. Such children then become isolated and ashamed. They are branded as those who cannot study, rather than saying that they were in the hands of incapable teachers.

From the above case-study, it is clear that the kind of service provided to the community become more important and indeed it create lot of awareness about disabilities and what kind of services are available for them.

I. Pothgoda Community Based Rehabilitation Centre

This centre is located at Pothgoda Rajasinha Vidyalaya as a special unit. This unit started to work in the community since 2002. The importance of this unit is mainly to concentrate to bring behavioural changes and help slow learning children to get proper support through education.

The special emphasis of this unite is to provide special education to the children who are having learning difficulties due to M/R. It should be noted that not only children with MR face difficulties of being misunderstood, the parents too face difficulties and are saddened by the fact that they are not able to understand their children.

The parents of these children are engaged in cultivation as their main occupation and most of the parents are poorly literate. This has an impact on the development of the children. Children with disabilities normally get isolated from the families and get neglected. They may not receive proper care and support. Therefore, the services of the CBR unit become important to develop the sensitivity of the family towards children with disabilities, so that proper attention could be paid to children.

From the perspective of the children, when children are not understood and proper attention paid by the school, most children end up as drop outs from schools. Therefore, such units are playing an important role to lift the education level of children. They are able to make improvements and get back to the normal education after they gain improvement. The staff also shared that in families where there are children with disabilities, the families also have many conflicts that make the life of children extremely difficult. The staff understanding this situation, also provides counselling.

According to the principal, this unit has had major impact on the community and to lift the standard of education of the children with disabilities. Recently, the unit also conducted an awareness program to the school teachers on depression. Another awareness programme for the community was on nutrition. Such programmes have provided many benefits for the children and their families. He noted with satisfaction that some children have been able to get back their normal class after improvement.

J. Galpihilla Community Based Rehabilitation centre

Galpihilla Centre has been started 1998 and currently located at the Galpihilla primary school. The function of this unit is to provide special education to the children who have been identified to have learning disabilities.

Most of the children in the unit have multiple difficulties and shown improvement with CBR intervention. The children who come to this centre come from the nearby community. As has been explained, in relation to other centres, it needs to be reiterated the hapless situation of the children with disabilities where there is no understanding how to handle and care for such children.

According to the principal most families in the community are poor and this poverty situation directly affects children with disabilities. With the intervention of the CBR on the lives of children to develop their level of independence, it has helped to free the time of the parents which adds to their awareness and their co-operation in this regard.

Rumasha Abeyanaike was born in 1990 with physical disabilities. Her father is a labourer. His earnings are not enough to meet the needs of family. In 1992 she came to the special unit for treatment. Because of her physical disabilities she was not able to move freely. With the help and support of the centre she gained control over her limbs and posture. With the exercises, by the CBR staff and at home by her parents, within about 4 years she was able to sit. When she was able to control her limbs, she was trained to use thread frames to develop skills. She excelled in both education and in making lace work. Over the years she also learned to work with out help. All these achievements have made her family very happy.

K. Community visual Rehabilitation program

Community visual Rehabilitation program is one among the important activities carried out under CBR program. It mainly concentrates on the blind or the people who have difficulties in their vision. Currently this program functions as a separate unit under CBR program. This program was introduced in 2001.

Because of a good network system that WDC has developed they received an invitation from an organization based in the south of Sri Lanka to send three volunteers for a training program on blindness. After this training program was over, the 3 volunteers trained other staff in the WDC. A study that was subsequently conducted around Kandy, identified 128 persons with vision difficulties. Identification of such a large number of persons from all ages with vision difficulties is an eye opener to the divisional secretariat as the general perception was that blindness is not a problem in Kandy.

The aim of this program is to deviate from a purely clinical model of intervention. Therefore, the intervention contains a package of service of screening, awareness on prevention of blindness or to make those with vision difficulties independent and productive; counselling to those affected and their family members; reducing poverty through involvement in income generation activities etc.

While all 128 persons were referred for medical support, initially the programme identified 4 people for holistic care intervention. The expansion of the programme firstly concentrated in the Gangawata Korale divisional secretariat for 23 persons and later to Pathahewaheta and then to Harispathuwa divisions. In 2004, the number of clients in this programme increased to 43 persons.

The clients feel that since they participate in the rehabilitation programme, they received more respect from the family members, earn as well as, save money, and it has contributed to improve the quality of their lives

As part of the programme, the blind people underwent special training and counselling programme like how to do their day-to-day activities; how to use the white cane; and the ways of earn a living. Because of this program, some are engaged in small seale trade such as selling cloths, tea, etc, while some make paper bags, lamp wicks, joss sticks, etc.

Kusumawati is a middle-aged lady with vision problem. When the Community visual Rehabilitation program reached her, she was living with her sister and was dependent on her. Once she got sufficiently rehabilitated, she started working in a near by joss sticks factory. However she did not receive sufficient salary. The CBR staff helped her to manufacture joss sticks in her house. She was able to earn and save money from her business, and build her own house and started to live on her own. Now she cooks her own meals and does her day to day activities by herself. From the financial assistance she gets from the government and with the income generated from her small business, she is able to live happily.

Above case study a good example of how a Community Blind Rehabilitation program could help the lives of needy people. There are many social welfare organizations in and round Kandy district but the only organization giving support to blind people to improve mobility and to start self employment is Women's Development Centre (WDC).

Joss Sticks making

Goat rearing
08. REMARKS There is sufficient evidence that the CBR programme makes a big difference in the lives of the children with disabilities and their families. Most of the children in the CBR program come from the poorer sector which itself is a big a hindrance for development, as children tend to lack the basic needs that are vitally important. The programme has proven its viability to improve the quality of life.

• Intervention: It is evident from many responses, that the CBR staff are experienced and skilled than most others like teachers to make good assessments of client to identify the condition of the children with disabilities., whether they come from schools or community. They are able to be holistic in their assessments. They are also better able to build good rapport and win confidence of the children, their families and others such as school teachers, principals etc. Their level of professionalism and also the way they receive other support in the assessment enables them to develop more effective rehabilitation plan that is holistic.

• Rehabilitation: Rehabilitation is the most important process in CBR programme. It creates opportunity for the children with difficulties to receive right intervention and rehabilitation to overcome their problems with the help of the staff in the CBR program. There is a wide range of difficulties which are visible, with children like the physical disability, learning difficulties, behaviour problems, blind, profound deafness, hydrocephalous, down syndrome, multiple disabilities, speech problem, autistic and mental retardation. In the CBR programme they carry out activities to help the children to over come their problems and through this process they are rehabilitated. The activities such as Counselling, speech therapy, MR class, vocational training, special education class, awareness programs and Physiotherapy. It is remarkable to see how the staffs of the CBR program work closely with the children as well as with the parents to fulfil the task to improve the status of children and create an environment for the personal development and make rehabilitation process efficient. What is also interesting is that of available facility for those who get sufficiently rehabilitated, to follow vocational training to make their future independent and skilled, with life-long impact. The vocational training helps them to be employed or to start their own business with the support of their family members.

• Prevention: although it not possible to totally eradicate people becoming disabled, the CBR program carries out a number of programs to minimize people becoming disabled. While some of them are to raise awareness among the communities such as on intake of proper nutrition, discouraging marriages among blood relations, other are to eradicate poverty, poverty being the root cause for many evils including disablement. Further, the programme also helps marginalized community to learn various services such as health, come to receive rubella or other referrals or even making education more easily available to marginalized.

09. CONCEPT OF COMMUNITY DEVELOPMENT

The CBR approach is a holistic process spanning from individual development, continuing through to community. The process can be summarized in the following manner emanating fram the individual

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Speaking about a person with disabilities, he/she is a person with many problems/ difficulties from within and outside. So the CBR process renders services to solve the disabilities within and this makes the rehabilitation process more effective. When the mind of the person becomes stable and strong, it leads to the improvement of the body conditions. It then leads to develop the spirituality of a person. It is clear when a person develops ones spirituality it leads to the development of his/her social status. All these processes together with other support, then leads to economic improvement. When the rehabilitation of a person is achieved, the process does not end there. It then leads to have positive impact on the community. Rehabilitation process should develop like a scale and it will be a continuous process.

10. KEY LEARNING FROM THE DOCUMENTATION PROCESS

As a documenter, in this section, I wish to present my overall impressions regarding the CBR programme. In overall performance, there are many positive outcome and impacts as a result of the CBR programme.

1. Impact on the disabled persons: There is an observable change in the quality of life of the children and adults with disabilities as they get enrolled with the programme. They improve in mobility, coordinating limbs, enable continuation of education, improve in communication etc. most of all, it enhances their dignity transforming them from a dependent, helpless person to an a independent person with abilities. Therefore, the process promotes individuals to become more independent and productive. Engagement on vocational training is a good example of improvement towards economic independence. For creating this impact, the skills of the staff, their commitment, rehabilitation techniques and in particular the social counselling process, have found to be important.

2. Impact on Family living: Within the family, the disabled persons have gained more recognition and acceptance. There is also marked improvement in the sensitivity of family members towards them and therefore, the disabled persons have been able to get appropriate support from the family members. Instead of the dependant persons that were there before, with CBR intervention, the disabled persons are able to contribute to the house-hold chores or in some instances, contribute economically. By this contributions they make, some of the family members who were earlier trapped in to care giving roles, have been freed to become productive by themselves. It is notable in particular, how the mothers have been made free to a large extent. However, it must also be mentioned here that during the initial period of rehabilitation, the work of the mothers also increase tremendously. This extra commitment on their part has not been without rich reward.

3. Access to services and facilities: There is more recognition for the disabled person within the various services such as health, education, resource provision by the divisional secretariats etc. It also has improved the system of providing the referral the much needed attention from the service sector.

4. Impact on social relations: In general, there is increased awareness among communities regarding disability situations and therefore the need for community members to work together. While there is more recognition for the disabled persons within the family, especially parents have come together to discuss common issues regarding the disabled children. In the CBR centres, there is a marked contribution by parents together as a community to make the programme a success. Particularly in one community, the programme also helped to unify a socially isolated community.

5. Prevention of Disabilities: Promoting the use of Rubella vaccine, improved nutrition through awareness and training on use of low-cost and natural foods, awareness on compatible marriages etc are seen as specific contribution of the programme.

Apart from the above, the following are also identified as areas where there needs to be further improvement:

6. Capacity Building of Vocational Training: The present vocational training that are done especially in the rural centres, has a greater potential for improvement in terms of concept and technical inputs. Developing of capacity of teachers handling this work is important. Further, they also require knowledge and skills to make links to markets and the demands.

7. Access to loans for those with vocational Training: At present, WDC CBR programme provides a lump sum amount to those graduating from the VT. What is not clear is the after-support to family as a unit such as access to loans and follow-up in the development of the income generating activity to a viable enterprise.

8. Community Awareness: It is observed that the greater emphasis of the CBR is on the families directly involved in the programme. This the documenter sees as a limitation. Involvement of the community as a whole will create a bigger and sustainable impact.

9. Self Help Group formation: Strong Self-Help groups in the communities where the CBR programme is implemented is considered an asset as it is not only able to provide stability, but also provide economic support involving both the family members of CBR and other members in the community. One other ability of a self help group is also its ability to tap resources within and outside community.

10. Parental Capacity Building: It is noticed that for any emergency or a need, look up to the staff of CBR to provide leadership. Through community capacity building programme, while it can reduce the work load of staff, it could also provide sustainability to the programme. Therefore, it is desirable that within the programme, capacity building of staff be treated as a specific focus to achieve the set objectives of the programme.

11. Advocacy: There are many issues for which advocacy are required. It is unclear on WDC role on policy advocacy. Two specific areas that has paused a challenge are the effort to do away with the special education units and the other is the poor knowledge of parents and the clients on the rights for services and facilities for the disabled persons.

12. Linking community Development and Networking: The link between the efforts of the CBR with the community development and Networking which are key direction of WDC dose not surface clearly. Therefore, this coherence of the programme requires further enhancement as finally, goal achievement in communities are common.

11. RECOMMENDATIONS

The current CBR programme has a big impact on the lives of the disabled people and make the way for the social development. It is indeed a programme with lot of potential. However there are still areas with the CBR program, the staff can look, further father develop and improve the standard of the community based rehabilitation process.

01) Developing the capacity of the staff in Assessing local needs and resource identifications:

There is no one model of rehabilitation service that will suit all circumstances based on local situation. What is needed is a needs-based model for the different circumstances. Some early programmes of CBR were not successful because they did not undertake any research on the perception/needs of the target population, or even considered the availability of local resources. Although there has been improvement in this, the resource identification can be further harnessed. Additionally, there is much room for research based model development.

While WDC staffs do understand the cultural barriers and surrounding, the disabled persons, their families and even how such children are hidden due to many different reasons, it is certainly beneficial to conduct in depth study to explore information in order to develop local models of intervention in a more accurate way. In this servies, information within the family systems, factors that influence marginalization of disabled person from participating in social activities, career aspiration by the disabled person, etc.should receive critically sharp focus.

02) Disability related Policies, and Programs and Preventive Measures: It is apparent that the WDC staff contributes much in the intervention, prevention and rehabilitation process of the disabled and over the years there is both qualitative and quantitative improvement in their work. This does not mean that there is no room for further improvement.

The documenter observes that the knowledge of WDC staff in relation to the policies, programmes and preventive measurers that is available in the larger environment, including in the international arena would help in raising the awareness of communication and in motivating the communities more to wards advocacy.
03) Building up resource centre for CBR: It is important to maintain an information centre or resource centre to provide the latest information about community based rehabilitation programs in different parts of the world and its new findings for the development to build or improve the capacity of the staff. There is also a need to upgrade the knowledge of CBR staff in terms of latest development in the field of disability through personal enhancement as well as having access to IT information. • Family Help Line: It is observed that the families of the disabled children supported by WDC mostly live in remote areas with minimum access to infrastructure such as transportation etc. Such families can also be identified as multi-deficit families with poverty, voieance, marginalization etc. Due to remoteness of location of the families, for staff to visit with limited resources is seen as difficult. A family – help line is therefore suggested to be developed when such families could reach at time of needs especially for legal, counselling and referral support, as such a system to access will support as an initial measure. This may be a neighbourhood women's group, knowledge of professionals help with close proximity etc. This may work as a quick and effective linkage between community and the CBR program.

• Support Groups: It is observed that most of the families of the disabled children are accessing the CBR centres for every need related to their family needs, thes creating an a opportunity to make the families totally dependaed on CBR program. So in the long run this is not good to reach the CBR objectives. Therefore, formation of Support groups in their communities is strongly recommended. Support groups enable individuals with disabilities and their families to exchange ideas where both positive and negative views can be expressed. It also provides a capacity within the community in emergency situations which support groups can provide. ❖ Hope ❖ Information ❖ Friendship ❖ Sharing ❖ Problem-solving ❖ Personal growth ❖ Advocacy

04) Forming neighbour hood Groups: It can consist of 10 to 20 members in neighbouring villages near to CBR centres having homogeneity in social status, sex, income, occupation, disabilities. It is the basic organization of poor and the marginalized formed and working at the grassroots level. It is a group that can take responsibilities in the issues where CBR program is functioning. It will be a great chance to build up a strong community relationship to reach disabled people in all communities.

05) Awareness programs: Although CBR programme conducts many awareness programs to the community, it is important to conduct awareness programs to increase the knowledge and to build a strong support system. It provides a foundation where the CBR programs can be implemented more effectively with the help of the community. The awareness program can cover the flowing anticipated outcomes

• Local leaders have increase awareness and their capacity to make changes in their community and the values to organise local people to take positive steps to support the rehabilitation of disabled people. • Local people have to increased their sensitivity towards the disabilities and their vulnerabilities. • Local people have greater confidence in their own ability to make appropriate changes as they can to promote community based support to the people with disabilities. • Effective and ongoing community organization and action on safe-guards rights of the disabled. • Improved local services and facilities in education, health, sanitation which have a big impact on the disabled children. • To develop educated and confident people to take and speak of the issues related to self help measures.

06) Training of the CBR staffs:

Efficient training of the newly appointed staff in the CBR program in order to have a positive out come in whole program. It is suggested that the staff get training in every aspects of rehabilitation care in the main Kandy centre, by being able to spend certain amount of time in every unit till they are exposed and skilled. Further, the staff should get an orientation to the holistic nature of the CBR program.

UNITS

NEW STAFF

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COMMUNITY DEVELOPMENT

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HAGURANKETHA WOMENS FORUM

MIND

BODY

SPIRIT ECONOMICAL

SOCIAL

ECONOMIC

REHABILATATION

SIX-MONTS OF TRAINING THROUGH ALL UNITS

INDIVIDUAL

NAVODHYA DAKSHINA LANKA WOMENS FORUM

AKKRAPAUTTU WOMENS FORUM

HILL COUNTRY WOMENS FORUM

RAJARATA WOMENS FORUM

BATTICALOA WOMENS FORUM

VANNI WOMENS FORUM