Vocational Rehabilitation: Barefoot Realities in North West Pakistan

Barefoot Realities

Most of the world's disabled people live in rural Africa and Asia. Most plans for vocational rehabilitation originate in modern cities. Such schemes seldom reach rural disabled people. If they reach them, they tend to be irrelevant and inappropriate, based on assumptions distant from the real life situation of the rural disabled person. This paper starts at the other end, far from New York, Stockholm, Nairobi or Bangkok. It starts with the following probabilities:

1. Disabled people's relatives provide them with basic food and shelter for life, as far as they are able. They might not perform this duty with much pleasure, but they are well aware that it is their duty.

2. So most disabled people are not immediately forced to earn their living, or to do anything productive. They are disabled. That is their role in life.

3. Some disabled people accept this role and are suspicious of any attempt to change it -- especially the multi-handicapped person and those incapacitated in old age.

4. For some disabled people the role of passive recipient is intolerable. For many, their families have seasonal or permanent difficulty in providing even the bare necessities of life. Some have ambitions beyond mere survival, especially people disabled during their normal working life.

5. Families with the greatest interest in vocational rehabilitation will be those whose disabled member is passing from child to adult status: a period of several years, some time between ages ten and twenty.

6. Some disabled people find work by their own or their family's efforts. Yet for many, nothing productive comes along despite their wish to find useful occupation. Attitudes may then harden. Expectations adjust downwards. Hope withers.

Starting with these probabilities, what input will be accessible, appropriate and replicable for disabled people in rural Asia and Africa, independent of any elaborate delivery system? Initiation costs may be counted in single dollars, even tens of dollars, but not hundreds of dollars. Talk of cooperative organisations, marketing strategies, career structure, sheltered workplaces etc, is automatically disqualified.

The International Labour Conference, 1982, spoke of the "more imponderable and complex problems" facing vocational rehabilitation in the rural Third World [68th session, report VI(I)]. Are there any solutions that are neither complex nor imponderable?

One solution has been studied in north western Pakistan as part of a UNICEF-aided Community Rehabilitation Development Project based at the Mental Health Centre Peshawar. The brief ran:

"Identification of suitable handicrafts for various disabilities, which may be practised by older disabled children and young adults after a short training, probably at home or in small groups. The items envisaged are already in small-scale production and use in the Province and are locally marketable without difficulty. Details will be collected of 40 or more products, from supply of raw materials through every stage of processing to end-product and marketing, with economics involved. Possible items: clothes pegs, candles, raffia fans, rope, prayer mats, rubber buckets or pots, cardboard boxes, paper bags, chicken wire, brushes, simple toys, carved work, items made out of scrap e.g. from milk tins, oddments of cloth or wood."

Good at Making Things

The practical work was carried out by Mr. Fayyaz Bhatti, who is not a graduate, nor a qualified technical instructor, nor a trained craftsman. Fayyaz Bhatti passed his school leaving exam, and he is 'good at making things'. There are young men like that in every rural town and village. He was given a little money and a small room to work in. He went around the bazaars of Peshawar buying the sort of cheap, ordinary, local items listed above. He talked to the makers. He took the items apart to see how they were made. He found out what tools and materials were needed for each item, how much they cost, and of what quality.

During 6 months he covered 40 items, writing down the details, with some help. Field-testing was done initially by getting physically disabled or deaf young adults to follow the instructions and make some items. Later they were tried also with mentally retarded young men. There was an immediate demand for more of Fayyaz Bhatti's work.

The initial target was the disabled youth or young adult whose family had enough goodwill and initiative to look for some occupation for him or her, but who lacked the means or the information to create a work opportunity. The handicrafts under investigation would hardly enable a disabled person to achieve full economic independence. If one could make that much profit, too many able-bodied people would already be doing so, and a disabled person might make little headway. Start-up costs would also defeat most families in a competitive business.

On the Economic Margins

Economically marginal crafts suit the realities of many disabled people whose families expect to support them anyway. The family must make the small outlay of money and effort to buy tools and raw materials. The disabled people by their time and effort add value to the materials. When they have made a quantity, they or another member of the family can sit in the bazaar or at the roadside and sell the product at a small profit.

The effects are several. They become visible contributors to the family and to society. They become agents in their own lives, rather than passive recipients. They take on the role of a supplier of known items of everyday utility. Once this happens, attitudes can change: their attitude to themselves and the world; the families' and community's attitude towards them. They become people with some purpose, with some role and meaning.

They do not of course figure in the Gross National Product, nor in the figures of Employed Registered Disabled. They have not attained to 'independent living', nor to the status of paying income tax. They have not travelled to the moon and back, nor engaged in any other modern pursuits. Since nobody else in the village or small town lives independently of their family, or pays income tax, why should the disabled person do so?

Is the project ecologically sound? Does it take the bread from anyone else's mouth? Could it be wiped out by a flood of mass-produced plastic items, or a shortage of raw materials? How would a printed instruction manual be read by a non-literate village dweller? What length of training is required? Does it discriminate against women? These questions have variable answers according to local conditions. They are being weighed up for local answers in 80 or more countries since the study outline appeared with illustrations in Disabled Village Children, David Werner's rehabilitation compendium published by Hesperian Foundation (1987).

Families bring their older disabled child to the centre at Peshawar from all over Pakistan's North West Frontier, asking 'If there is no cure, what is he to do in adult life? Can you train him to earn his living?' Previously the answer was negative. The family went away with an economic burden. Now the possibility exists for families to see items that they could realistically imagine their disabled member making at home and selling locally. By taking up several items, the family guards against local problems or fluctuations in supply of raw materials, or the arrival of cheaper factory-produced competition.

Dissemination of the ideas, and brief training of disabled young people, has taken place through the local Associations mobilised by the Community Rehabilitation Development Project. Some local associations have already set up their own self-help day-centre in a rural town, and have a steady inflow of disabled young people seeking treatment and advice.

Not all of them will accept the cottage industry skills suggested. Of those who start, not all will be successful. But some succeed, and every success raises awareness in their neighbourhood and encourages other families with disabled children. Government social welfare officers, local voluntary agencies and development workers all helped to disseminate the ideas generated.

The selection of items to be made and the length of training varies according to the individual and the disability, and the social status and self-image of the family. The range of items offers possibilities to most young rural disabled persons. Many of the processes can be learned in a few hours. A few weeks of practice will improve quality. Some of the items might be perceived locally as 'girl's work', but most could be made by people of either sex.

Decorations

When I planned this study I excluded all decorative items, fancy work and ornaments, because I thought that in the villages people would not spend their money to buy such things. But Fayyaz Bhatti made them anyway. I told him to stop. He continued, but hid them from me. I did not manage to stop him.

Finally I realised that Bhatti's intuition was right, though he could not explain it to me. Poor people in villages do in fact sometimes buy cheap decorations, for weddings, feasts, national or religious celebrations. Economists state that the rural poor can hardly even buy food, so they have no spare money for decorations. Theoretically that is correct; but in practice there is more to life than bread and beans. The poor man may not think his life worth living at all if he does not sometimes 'waste' money on a tinsel decoration for his little girl, a coloured cardboard aeroplane for his small son.

Celebrations and decorations are of marginal economic utility, but of major usefulness in promoting the social life of a community. Likewise, a disabled person might be of marginal economic utility in a village, but can have a valued role in community life. When it is the disabled one who provides the decorations, makes and repairs the cheap toys, brings joy to the small children, he or she has a role with some honour.

In Conclusion

This micro study introduces nothing alien. It highlights existing possibilities and uses the information as a catalyst of self-help by disabled young people and their families. It responds to a known and ongoing demand and is based on the actual current assumptions of the people involved. It has a built-in development, in that success will become locally known through marketing of the products, and will contribute to positive attitude change. No limit can be set to what may be achieved by disabled people, individually or collectively, once they experience the encouragement of making their personal contribution to the family economy and the life of their local community.