As much as we can, we try to explain basic principles and give reasons for doing things.
After village rehabilitation workers and parents understand the basic principles behind different
rehabilitation activities, exercises, or aids, they can begin to make adaptations. They can make
better use of local resources and of the unique opportunities that exist in their own rural area.
In this way many rehabilitation aids, exercises, and activities can be made or done in ways that
integrate rather than separate the child from the day-to-day life in the community.
This is not the first handbook of ‘simplified rehabilitation’. We have drawn on ideas from
many other sources. We would like to give special credit to the World Health Organization’s
manual, Training the Disabled in the Community, and to UNICEF and Rehabilitation
International’s Childhood Disability: Prevention and Rehabilitation at the Community Level, a
shortened and improved version of the WHO manual. The WHO manual has recently been
rewritten in a friendlier style that invites users to take more of a problem-solving approach
instead of simply following instructions.
This handbook is not intended to replace these earlier manuals. It provides additional
information. It is for families, village health workers, and community rehabilitation workers who
want to do a more complete job of meeting the needs of physically disabled children.
HOW WE DECIDED WHICH DISABILITIES TO INCLUDE
Because this book is written for village use in many countries, it was not easy to decide what
to include. People in different parts of the world give importance to different disabilities. This is
partly because some disabilities are much more common in one area than another. For example,
• polio has been eradicated in most countries through effective vaccination programs.
However it remains a common disease for thousands of children.
• deafness and mental slowness are much more common in certain mountain regions
because of lack of iodine in the diet (or in salt).
• blindness due to lack of vitamin A is common in some poor, crowded communities, and
areas where a single crop has replaced diverse food production.
• rickets is still common in regions where children are wrapped up or kept in dark places so
much that they do not get enough sunlight.
• burn deformities are frequent where people cook and sleep on the ground near open
fires and in war zones.
• amputations are a big problem in war zones, refugee camps, and ‘shanty towns’ along
railway tracks.
• disability from tuberculosis, Hansen’s disease (leprosy), measles, malnutrition, and
poor sanitation are especially common where lack of social justice lets some people live
in great wealth while most live in extreme poverty.
As more communities around the world are affected by HIV, more children are being born
to HIV infected mothers. As treatment becomes more accessible, many more children are
surviving and living with HIV disease. This book does not separately address illness and disability
related to HIV/AIDS, but many of the sections will be useful for children with HIV (care for
pressure sores, assistive walking devices, etc.). For more information, see a general health
book like Where There Is No Doctor or a book specific to HIV such as HIV, Health and Your
Community (to order, see page 642).
Local beliefs also affect how people see different disabilities. In an area where people
believe that seizures are the work of the devil, a child with seizures may be feared, teased, or
kept hidden. But in places where everyone accepts seizures as ‘just something that happens to
certain persons’, a child who sometimes has seizures may participate fully in the day-to-day life
of the community, without being seen as ‘handicapped’. Both of these children need medicine.
But probably only the mistreated one needs ‘rehabilitation’.
ABOUT THIS BOOK
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