The implementing methodology to incorporate the
philosophy of UNCROSS into the real practice is “community based rehabilitation”. The availability of the child
centered rehabilitation services is less in Nepal. There are only few
rehabilitation centers that provide services in a sustainable fashion.
Government of Nepal has not completely owned this sector though it has started funding
(small amount) on few of the rehabilitation center located in some other
districts. Surkhet, where ADC is located is not being funded by the government
till date. The small rehabilitation center which was running by the hospital
was recently closed due to the crises of funding. Now only one rehabilitation center that is “International Nepal fellowship” is at the function in Surkhet that
provides services to the person with spinal cord injury and leprosy. As per the
recent census the population of the children having the age range 0-14year in Surkhet is 122,431. Out of them,
1.94% is with disability which is 2375. Out of 2375 children with disability,
36% are with physical disability which is 855.
The figure gives huge number of children who need rehabilitation services in
Surkhet only. Therefore ADC was established in 2011 with an objective of
improving the quality of life of these children through the appropriate
rehabilitation and referral services.
Association
for Disabled and helpless Children (ADC) is located in Surkhet district. Surkhet is one
of the regional hub of Nepal among five others. It’s a valley braced by the
hills around and is adjacent to 5 other districts. ADC is
located in the heart of Surkhet which is called Birendranagar. ADC mainly focuses
on children with disability who are helpless and marginalized. As the
prevalence of C P among the children is maximum, the rehabilitation services of
ADC are more focused on them but however ADC also provides the services to
children with other type of physical disability.
Service Delivery
1.Physiotherapy
 |
| Yamuna for Physio Therapy |
 |
| Pragyan is treating By P T A Om Basel |
The services being delivered at present is physiotherapy through qualified and experience
physiotherapist and experienced physiotherapy assistant. For the children who
stay throughout the day and children who are admitted in hostel,two
physiotherapy sessions are provided. For the new child, at first assessments
done and therapy is planned accordingly. Similarly, for the regular child, reassessment is done
in every 2 months.
Physiotherapist
also sets a SMART and participatory goal to all children. The therapy is
delivered in the form of play which is the standard management principle for the
rehabilitation of the children with disability. Once in a quarter, a group
therapy session
that
comprises of 10-15 children with
family members is also conducted. Different joint play activities are designed
for the children and family members. The group therapy session is a therapy methodology
of the children in one way and in other way it also promotes the exchange of
thoughts among the family members of the children with disability. The exchange
of the information and the games always boost their morale, makes them happy and
more participative at the rehabilitation process.
2.2
Counseling and special education
 |
| Special Education Teachrt Bind Teaching The Students |
At
present, ADC does not have qualified counselor and special education teacher
who have received an educational degree from recognized institution. But there
is the dire need for this service as family members at the initial visits are
observed with huge stigma and over expectation. An international model of disability creation process highlights
the personal and environmental factors that affect the activity of the person
with disability. It’s not only an impairment that contributes to the activity
of the person with disability, in fact there other factors like self-esteem of
person with disability, attitude/support of family members , attitude of
community ,availability of the services(rights and benefits) and other social
factors equally contributes to the activity of the daily living of the person
with disability. Therefore ADC decided to include the counseling and special
education as the service in adjunct to physiotherapy and referral services. ADC
has a special education teacher based at the ADC rehabilitation center.She is a
mother of the child with CP and has been contributing to the disability sector
at Surkhet for the long time. She has a very good understanding of national
polices related to disability as well as rights and benefits of the person with
disability in Nepal.
Herc ore job responsibilities are,
·
Educating the family members about the
importance and their roles at the course of rehabilitation
·
Supporting the family members on receiving
the rights and benefits for the children with disability that has been allocated by the government of
Nepal.
·
Providing the basic education to the
children with disability who attend the rehabilitation session
·
Supporting the Physiotherapist on
conducting the group therapy session
·
Assisting director if assistance is
required for priority office work.
2.3
Accommodation facility linked with therapy goals
 |
| Inpatient having lunch in ADC kitchen |
Rehabilitation is a long term, joint and participatory process. Therefore the routine followup
and the active participation of the family member is must to achieve the set rehabilitation
goals. Similarly in presence of the family members and based on the mutual
understanding the therapy goals for the children is set and a joint strategy is
made towards the achievement of the goal. The system of the joint goal setting
has made parents more responsible toward the rehabilitation of their children
thus supporting the timely achievement of the goal. On the other hand,
participatory goal setting also satisfies the philosophy of the right based
approach of the service delivery.
The appointment for the
routine therapy follow up is given. Family members are encouraged to attend the
therapy session daily and if not at least twice a week so that they could learn
the home exercises and other precautionary measures.
2.3.2
For the children from distant villages and nearby districts
Most
of the children with disability belong to very poor socioeconomic category and
they could not afford to stay for the full rehabilitation with their child at
Surkhet. Therefore, ADC attempted to ensure the equitable and accessible
services to those children by starting the free hostel facility in it’s’
rehabilitation center that has capacity for the 3 children and their 1 family
member. The name of ADC is being popular in nearby districts day by day. This
could be the reason behind receiving the frequent request from the family
members of a new child from other district. At present, based on the severity
of the condition, ADC prioritizes the hostel need of the children. A call or
the information is passed to the waiting family in queue upon the availability
of rooms.
1. Some other pertinent activity and
evolutions of the projects
3.1
Meeting with Dr. Jack
 |
| Dr. Jacques Vigne & Gyanendra Gautam |
Dr.
Jack is the French psychotherapist, social worker and the writer of different
book in religious subject Psychotherapy. At present he contributes in social
work staying at Uttarakhanda, India. He has been the backbone and path shower
to ADC from the beginning to now. His eternal support and expertise has always
served a milestone for ADC.
In
October 2013, Manager of ADC, Mr. Gyanendra Gautam conducted the meeting with
Dr. Jack and did the overall reporting of ADC. Dr. Jack advised ADC to
capitalize the three year of the work experience in disability sector and use
that knowledge for the further strengthening of service in a sustainable
fashion.
3.2 Monitoring visit by
Mr. Michale
 |
| Chantle playing with Children |
 |
| Michael & Chantle |
ADC
would like to deeply thank Mr. Michale and his wife Chantal, who have been the
pillars to brace the ADC since from it’s establishment to now at every stances.
Like previous year, this year also Michale and his wife conducted the
monitoring visit to ADC in October 2013. The overall service delivery part and
the way ADC utilizes the resources for the children with disability was
monitored. His feedback on further improving the service delivery and
documentation parts has been deeply realized and being converted into the actions.
3.3 Visit by Butwal
Rotary
 |
| Butawal Rotary Team , handover the equipments provided by a French Rotary |
On 18th September 2013, the team from Butwal rotary did the supervision visit to ADC. The
executive board of ADC did a warm welcome to the visitors and also made
visitors well known about the working modalities and the dimensions of ADC on
the service delivery for the children with disabilities.
 |
| Butwal Rotary Providing Cheque to ADC Manager |
2.
Sincere gratitude to the donors
Since
after the establishment, ADC has been attempting to strength it’s services to
till date through
the supporter who live inside and outside Nepal. ADC and on behalf of children
and parents of children with disability would like to whole heatedly thank to
all for the kind support
who really thought about these children to make their life meaningful. ADC and
these children would like to extended sincere gratitude and thanks to you all.
You will be always respected and remembered your support on the inner core of
the heart.
Challenges faced
·
Increasing enquiringly the hostel
increases the waiting list of the children belonging to nearby districts.
·
District level environment not favorable
to directly fund ADC on the service delivery
·
Provision of the developmental like
standing frame, CP chair and corner seat is very much required during the
rehabilitation and also for the home use. These devices are available at the
rehabilitation center at other district which is almost 100 km far.
On the hand cost for each of these devices is not lesser than NPR
2500 which
is not affordable by the family members.
·
Continuous festival holidays, elections
and unexpected strikes hampered the productive hours of ADC in the month of
October and November.
Lesson learn t:
·
Counseling is seen as very much
productive methodology to convince and ensure the participation of the family
member at the process of participatory rehabilitation of the children with
disability
·
Involving the family members at the
process of goal setting of their children increases their contribution towards
the achievement of the goal in time. This has resulted the good support being
received by the children with disability from their family members.
Key priorities for coming quarter
·
Conduct the meeting with local level authority
for the funding provision of required developmental aids
·
Request district level disable people
organizations and women children office to conduct the social audit of ADC
through their visit and consultations with family members of children with disability.
·
Establish the referral system with
Mid-western regional hospital (government of Nepal). This will also help to
identify if any other medical intervention is required. The government of Nepal
has a provision to provide free medical service(doctor assessment, medicine and
some surgeries) to people with disability upon producing the disability card
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