Teamwork - Rehabilitation Services within the Community

The workshop was planned to emphasize the possibilities for rehabilitation within the community wherever possible, and to demonstrate that such options are feasible when the professionals themselves are open to such an approach and willing to look for innovative solutions.

During visits to closed institutions for mentally disabled, for example, the focus was on out-patient sheltered workshops. Here, patients are no longer kept in hospital, but instead live in sheltered housing in the community and work in various workshops according to their abilities. These observation visits helped the course participants to understand the complex issues involved in designing viable, cost-effective programs for people with disabilities, which would enable them to function, even with a severe handicap, in the community.

This course was unique in that it attracted a wide variety of people from many different professional backgrounds, including psychiatrists, heads of health institutions and social workers at many different levels and from 23 different countries. Such people would normally expect to attend professional seminars with others in their own particular profession. Here they were part of a wide cross-section of professions, and had the opportunity to communicate and coordinate with educators, health-care and social workers, researchers, other concerned professionals, and heads of voluntary organizations for the disabled.

Throughout the three-week workshop, participants visited different institutions dealing with both physical and psychological problems. One characteristic which particularly impressed everyone, no matter what their professional background and work experience, was the prevalence and effectiveness of the teamwork they witnessed in every place they visited.

Beit Levinstein Government Rehabilitation Hospital is the largest of its kind in Israel and cares for people in need of physical and psychological rehabilitation as a result of illness or accidents. The Deputy Director of the hospital, Prof. Haim Ring, has himself traveled to many countries to conduct training courses for MASHAV and is therefore quite familiar with conditions in the field. His thorough understanding of the needs of the workshop participants resulted in an impressive lecture and guided tour of the facility.

Visits were made to different open and closed settings catering to the needs of a wide age range and severe to moderate levels of mental and physical handicap. Participants had the opportunity to visit a school for autistic children, in the same suburb as MCTC one day, and on another day to visit a drug rehabilitation program on top of Mount Tabor, a remote mountain. Kfar Tikva, a nearby kibbutz-like village, serving a moderately mentally handicapped population, provided an example of new thinking about disability for the participants (see next article).

Of equal interest was the work of the NGO, Yad Sarah, Israels largest volunteer organization. Yad Sarah provides rehabilitation services for the infirm and the handicapped in their own natural family environment and has built a nationwide network for lending medical and rehabilitative equipment, either for free or at a nominal cost.

During the course of the workshop some of the participants were interviewed about their own work and their impressions of the workshop they were experiencing:

Assistant Professor Mustafa Sercan from Turkey always knew that he wanted to be a psychiatrist. He works in the biggest mental hospital in Istanbul with its 1000 long-term chronic patients and 1000 beds for acute cases. Istanbul itself is a city of 10 million inhabitants and there is no other mental hospital there, only the availability of psychiatric services in private and university hospitals.

Although Sercan is a member of his hospitals coordination committee for rehabilitation services and programs, he had had no previous experience in this area. One of his aims is to establish halfway houses and day centers for people needing care and he was happy to admit that: The workshop enlarged my horizons on this issue. I had read a lot, but in this workshop I had possibilities to see real examples. There are a lot of examples in this country and a lot of enthusiasm.

Jawdat Melhems impressive command of spoken English attested to the large number of teachers from abroad who had taught him occupational therapy in the College Hospital, Amman, Jordan. Occupational Therapy is a new profession in Jordan. The College Hospital opened in 1989 and Melhem graduated after a three-year course, in 1996. There are only 30-40 occupational therapists in the whole country and much of the work is still done by volunteers from the U.K. and the U.S.A.

Melhem works in a program for Community Based Rehabilitation for the physically handicapped and travels to villages and outlying areas to reach people who cant get around. There are 12 centers for occupational therapy in the north and south of the country; he sometimes travels two hours to reach a center.

Magdalena Skiba, from Poland, is the President of the Board of Directors of the Polish Association for Persons with Mental Handicap in Gdansk. She became involved with the Association because of her own personal experiences with her six-year-old son.

Skiba works full-time as a volunteer and has been on the Board of the Association for five years. The Association offers professional services and parental support and is also responsible for policy making. The headquarters are in Warsaw, yet in Gdansk alone (a city of half a million people), there are 50 employees, including administrators, therapists and maintenance staff.

The Gdansk branch tends to 450 children from birth to seven years, who are under regular care for diagnosis and counselling. For those aged three years and up there is a public pre-school program and for children aged seven years and up, there is either a regular or special school program.

The MCTC workshop enabled Skiba to add to her knowledge about the field and she now feels able to update some of the methods at home. She found it a very wide-ranging course and, through what she heard from policy makers, acquired lots of new information and techniques that will help her in her management tasks. Skiba was especially interested in the infrastructure of volunteers that she observed. In common with many of the course participants, she found teamwork and volunteerism admirable aspects of the care in Israel.

Guyana is a small country with big problems, according to Barbara Lawrence. Director of Rehabilitation Services at the Ministry of Health there. The government spends money on other pressing health issues, such as malaria, and the high emigration to the U.S. from Guyana means that the physiotherapy services rely heavily on volunteers from India, Cuba and the U.K.

Lawrence herself graduated as a physiotherapist in 1980 after studying for three years at physiotherapy school in Jamaica with people from all over the Caribbean. In 1990 she braved the colder climes of Winnipeg in Canada to receive her B.Physio. and in 1992 she was appointed Principal Physiotherapist in Guyanas capital Georgetown, doing far more administration than hands-on therapy. She has been Director of Rehabilitation Services since 1998.

After what shes seen in Israel, she is optimistic, in the sense that theres lots to be done but admits to being full of trepidation about where to start.

By contrast she felt that People here are lucky. Social workers have a key role to play. We physiotherapists are the ones who deal with the problems of the patients. We never have all the right professionals together.

Sun Zhonghua, Commissioner International Affairs at the China Disabled Persons Federation, Beijing, was up early every morning during his stay at MCTC to conduct Tai Chi classes for all interested participants at the Center.

Zhonghuas career has changed direction drastically over the years. From training and working for 14 years as a polymer materials engineer, he moved to a teaching position at Beijing University, in the Faculty of Aeronautics and Astronautics. Then, with the establishment of the China Fund for the Handicapped in 1984, he moved away from academia and started working for the Fund. In 1988 the China Disabled Persons Federation, an umbrella organization covering all disabilities of all 60 million disabled people in China was set up and ratified by law. It is a huge organization, with about 40,000 full-time employees in local federations and prefectures.

Sun Zhonghua is one of 170 workers in the headquarters in Beijing. For seven years he was the National Secretary for China and he is currently Commissioner of the Department of International Affairs.

He feels that psychological rehabilitation in China has been neglected and this course has given him the impetus to research it further and bring it to the attention of policy-makers. Teamwork is needed to train the professionals and needs representation high up in State policy.

MCTC intends to repeat this course in the year 2000 and to offer a similar workshop in the Spanish language to answer the demand from Latin American professionals in these fields.