Lessons from Zambia
Two weeks ago I was in Lusaka, Zambia. I spent one day seeing families through our Community Based Rehabilitation program (CBR). This is a program where community workers go into the communities, find people (most of them children) with disabilities, refer them for medical assistance, design a rehabilitation plan, and work with the families and communities to provide on-going support.
CBR is a good program with a great strategy.
In the one afternoon in Lusaka we saw five straight cases of children with cerebral palsy (CP). There was much similar in all these cases. Each was a child and a mother. Each child needed extensive exercises and massage to release the tightening muscles. Each plan needed daily work from the mother and there was an art to know how far to push each child – past the point of pain and not as far as damage to the muscles.
Two things struck me in those visits.
The first was the link between poverty and disability. At the beginning of each visit the community worker would brief us on the individual case – reading from the case file. In all of these CP cases the mother reported long, hard labour with no medical help. One of the causes of CP is complications during birth. In each case it appeared that earlier medical intervention in the birth process would have prevented the child from having CP. The reason the mothers did not seek medical attention, again in all cases, was cost and access to medical care. If these mothers were not living in poverty they would have had medical attention. Poverty prevented the birth from being easier. Almost assuredly each of these children would not now have a disability if these mothers were not so poor.
The phrase “link between poverty and disability” rolls off our tongue so easily sometimes. It is a stark reminder how real that link is – it is not a phrase.
The second thing that struck me was how important the CBR program was to these mothers. These were young mothers – one was 18 years old. In most cases the father had left – not able to handle the stress of poverty and a family with a child with a disability. The mothers desperately needed the community worker to come in once a week and offer them support. These mothers needed the human contact with someone who cared and understood. The CBR program in Lusaka also brings these mothers together once a week in a support group – where they can learn from each other, support each other, and just talk with others who are experiencing what they are experiencing.
CBR is not a program that works only with the individual with a disability – but works with the family and the community.
Like I said – CBR is a good program with a great strategy.