The Centre for the Rehabilitation of the Paralysed has been making a difference in the lives of one of the most neglected sections of society since it was founded in 1979 by Valerie Taylor.
Md. Shameem Ahmed Sohel takes a look inside CRP and the work they are doing to bring the disabled into the mainstream of society.

Take these broken wings
and learn to fly again

According to the World Health Organization (WHO) ten percent of our total population are disabled, and most of those are physically disabled. With such a large number of disabled people, achieving national development is difficult. But it's the real phenomenon of our society that disabled people are very often deprived of social opportunities and their rights.

Superstition surrounding disability and paralysis means that sufferers are often faced with the prospect of becoming ostracised from their communities. Local beliefs often view a paralysed person as bad luck or a bad omen. Many also believe that disability is contagious and can be passed from one person to another like a disease. Consequently, when the need for help and support from the community is most needed, disabled people are often left isolated. In Bangladesh, physical limitations are often not the most difficult obstacles a disabled person needs to overcome. Attitudes to and perceptions of disability are often even more challenging.

As with many Southern countries, there is little awareness in Bangladesh of disability, its causes and consequences. Many 'traditional' views on the subject still prevail, especially in rural settings. Disability is often seen as a curse from God, inflicted as retribution for the sins of the disabled person's parents. Many believe that disability is infectious and that having a disabled person in the house will bring on an 'evil wind' after which others will be infected with this condition. Treatment for spinal injuries and other disabling conditions is often based on superstitious methods and performed by untrained village doctors in settings which are neither hygienic nor appropriate. This maltreatment often causes further injury or aggravates the condition of the patient. Avoidable complications are a common consequence of treatment by unqualified practitioners.

The Centre for the Rehabilitation of the Paralysed, popularly known as CRP, is a non-profit making NGO, which for the last 25 years has been providing treatment, training, education, and rehabilitation for the disabled people in Bangladesh. CRP began as the Rehabilitation Centre for Paralysed Patients (RCPP) and was founded on December 11, 1979 by a dedicated British women by the name of Valerie A Taylor.

It started functioning with four patients in two disused warehouses of the Shaheed Suhrawardy Hospital in Dhaka. In 1981, RCPP moved to another location at Shangker, Dhanmondi. The following year, the title of RCPP was changed to Centre for the Rehabilitation of the Paralysed (CRP).

In 1987, CRP again moved to a 50 bed facility in the Farmgate area of Dhaka. In 1990, CRP moved to a suitable location of 13 acres of land in Savar, 25 km north of Dhaka. Now, CRP-Savar has a 100 bed specialised hospital, which provides treatment for spinal cord injury patients. CRP's multi-disciplinary team cares from the day of admission up until the patient's reintegration into the local community. Members of CRP's multi-disciplinary team include doctors, physiotherapists, occupational therapists, nurses, social workers, and counsellors. Other services provided at CRP-Savar include: physiotherapy outpatients, occupational therapy outpatients, halfway hostel, social welfare unit, paediatric unit, CRP's inclusive school, William and Marie Taylor School, Bangladesh Health Professions Institute (BHPI), metal workshop, wood workshop, special seating, orthotics and prosthetics workshop, and the Madhab Memorial Vocational Training Institute.

For the last 25 years, CRP has provided treatment and rehabilitation services from its indoor-patient facilities for about 4,661 people with spinal cord lesion.75 per cent of ex-patients now live as active members of their families and contribute to the household economy. More than 250,000 people who have neurological and other spinal injury related problems received treatment from our out-door patients service.

CRP has expanded its horizon by establishing some sub-centres in different locations in the country. These sub-centres are CRP-Mirpur, CRP-Gonokbari, CRP-Gobindapur, CRP-Manikganj, and CRP-Nababgang.

Among the centres, CRP-Gonokbari has distinguishing characteristics. It is a residential vocational training and independent living centre for disabled women and girls which helps them to cope with the obstacles relating to their disability, along with the everyday obstacles in a patriarchal society like Bangladesh. It is often the case that if a woman becomes paralysed, her husband will take another wife, leaving the woman to look after herself and her family with no support. If a woman can earn a living through the skills learnt at CRP-Gonokbari her chances of successful re-integration into the community and acceptance by her family increase dramatically.

The main hostel at CRP-Gonokbari accommodates up to twenty-eight women and girls, giving them the chance to learn the necessary skills to be able to cope with life and their disability when they return to their community. Vocational training courses include embroidery, weaving, tailoring, shop keeping, shoe making, gardening, art, fishing, and medicinal plant cultivation.

Further education is also provided along with training in basic living skills. Together, this training gives the residents of CRP-Gonokbari the opportunity to live as independently as possible after leaving the centre and returning to their community.

CRP-Mirpur is a 13-storey centre in Dhaka city. The centre was designed with accessibility in mind. A wheelchair access ramp provides access from the ground floor to the fifth floor. The treatment facilities at CRP-Mirpur includes outpatient physiotherapy service, which is mainly focused on patients with various orthopaedic conditions, neurological conditions, and paediatric conditions. The most common treatments are for back pain, neck pain, osteoarthritis, sports injury, stroke, and cerebral palsy. The physiotherapy department at CRP-Mirpur is well-equipped and staffed by qualified therapists. Out-patient occupational therapy service at CRP-Mirpur includes treatment for stroke, head injury, hand injury, cerebral palsy, and children with developmental disorders.

At Gobindapur, in the north-east of Bangladesh, CRP runs a small centre which provides out-patient and community based services. Physiotherapy and occupational therapy are provided in a specially built clinic within the 13-acre property. Conditions treated include stroke, cerebral palsy, back pain, neck pain and arthritis. In addition to this,staff from CRP also undertake clinics at the local Upazilla Health Complex and conduct home visits.

In addition to the therapy services offered at CRP-Gobindapur, three bungalows can be rented by guests who want to enjoy the peaceful surroundings. The bungalows are situated in a secluded hilly area, surrounded by tea gardens and rubber plantations.

CRP has undertaken efforts to extend its service to far-flung areas in the country through a network of community-based rehabilitation programs. CRP has operated a CBR program since 1994, working in collaboration with the government Social Services Department. At that time, work was carried out in 61 upazillas of 8 districts (Tangail, Moulvibazar, Gazipur, Narayangonj, Moulvibazar, Gazipur, and Mymensingh).

This year another 55 upazillas under five divisional districts (Khulna, Barisal, Chittagong, Rajshahi, and Sylhet) were added.

The CBR program includes: formation of self-help groups, awareness raising and disability preventation, arranging mobile clinics. The purpose of the self-help groups is to encourage disabled people to combine their skills and resources and influence their own development. The aim of the awareness and prevention campaign is to raise awareness within the community about disability issues and help the community to identify and best utilise the contribution disabled people can make. The awareness and prevention campaign location are schools, colleges, bazars, clubs, Union Parishads, local organizations, bus, train, and launch terminals. The aim and objective of the mobile clinics are to provide access to medical and therapy service, to advise on mobility aids, etc.

As is the case in most developing countries, road traffic accidents in Bangladesh result in many people suffering spinal injury and paralysis. CRP's road safety program is a vital component of its awareness raising activities. In response to the high numbers of accidents CRP started its Savar Accident Prevention Zone campaign in 2000, using the main west-bound highway leading out of Dhaka, close to CRP's headquarters in Savar, as its focus.

Despite, or perhaps because of, its good state of repair, this is one of the most dangerous stretches of roads in Bangladesh. Accidents involving overloaded trucks and buses, passenger cars, smaller modes of transport, and pedestrians occur on a regular basis. The campaign involves awareness raising activities at schools, colleges, bus stands and with transport companies and associations, lobbying of relevant bodies and the erection of 32 road safety signboards along the 20km stretch of highway through Savar sub-district.

CRP has taken the initiative to extend its road safety signboards to cover longer stretches of the highway leading to Aricha ferry ghat, Kaliakor, and the Ashulia Road leading out of the northern suburbs of Dhaka.

Disabled people in Bangladesh face immense difficulties in accessing services, facilities, and opportunities. There are a number of reasons behind the poor accessibility in Bangladesh, however, probably the root of the problem is lack of awareness of disability and the needs of disabled people. This results in disabled people being marginalised and excluded from mainstream society. They are rarely consulted or considered when infrastructure or services are being planned . Without understanding disability and the needs of disabled people, the situation cannot radically improve to solve a problem that first needs to be understood.

Accessibility is often seen only in terms of physical infrastructure. It is obvious that many disabled people are not able to enter buildings, cross busy roads, get on or off buses or trains, or use public facilities. Thus, it can be said that disabled people are denied access to transport and freedom of movement. To create better awareness and understanding CRP organised a number of national level seminars on accessibility. Government high officials, policy maker, planers, NGO representatives, intellectuals, etc. were present the seminars.

CRP's social welfare department tries to improve people's understanding of disability and also to raise awareness about its causes and consequences. Social welfare officers from CRP often go on home visits to check up on ex-patients and monitor how they are coping since returning to the community. It is important to identify any difficulties the ex-patient may be facing in the reintegration process. The information gathered is useful when planning awareness raising campaigns and vocational training for patients. Advice and assistance are given, taking into account the kind of conditions the patient will be returning to.

On a broader level, community awareness of the issues faced by disabled people is crucial for rehabilitation. Physical and emotional rehabilitation count for nothing if a disabled person is not accepted back into the community due to superstition, stigmas or lack of understanding. CRP holds regular awareness raising rallies, lobbies relevant government and non-governmental agencies, and produces a number of publications aimed at increasing awareness about disability. Information is also disseminated through CRP's website and the national mass media.

With the slogan: "Service to Sufferers is Service to God" CRP started providing services for the disabled people in Bangladesh. Now, the World Health Organisation (WHO) has given approval to CRP as a collaboration centre for training and development of disability issues.

The vision of CRP is to ensure the inclusion of disabled people into mainstream society and the mission is to promote an environment where all disabled people can have equal access to health, rehabilitation, education, information, and employment.
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Md. Shameem Ahmed is Publication Officer, CRP.