The International Centre for the Advancement of Community Based Rehabilitation (ICACBR)
Disabling Attitudes on Disability
In Bangladesh, one of the most densely-populated countries in the world, it is difficult enough to walk down the street without being pushed and shoved in all directions. But imagine trying to make that same journey in a wheelchair, on crutches, or with any physical disability. What about trying to work and go to school and live a “normal” existence where there is little to no accessibility in any public or private facilities?
However challenging these physical barriers may seem, they are often not the most difficult ones to overcome: attitudes to, and perceptions of, disability are often the biggest obstacles. In Bangladesh, where an estimated 1014% of the population is disabled, there is little awareness of disability, its causes or consequences. As a result, many “traditional” and superstitious ideas 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 will spread though physical contact. Access to education and employment for persons with disability is almost non-existent.
“Because of these negative attitudes, the physically disabled in a country like Bangladesh are very disadvantaged and extremely vulnerable,” says Dr. Malcolm Peat, Executive Director of the Queen’s International Centre for the Advancement of Community Based Rehabilitation (ICACBR). This is especially true for girls who, as Peat explains, are victims of "double disability," as the status of women in the country remains poor.
Since 2011, Peat and the core ICACBR team of Djenana Jalovcic (Director), Beth Richan (Project Manager), and Darko Krznaric (Project Manager, Interprofessional Project on Disability, Maternal and Child Health [IPODMCH]), have worked directly with health care professionals, persons with disabilities and communities in Bangladesh to educate them on the nature and causes of disability, raise awareness, and challenge prevailing attitudes through the establishment of what is known as “Community Based Rehabilitation” (CBR). CBR is a multi-sectoral strategy achieved through the transfer of skills, the building of local expertise, and the creation of an environment that empowers persons with disabilities to access and benefit from education, employment, health care and social services. Established in 1991 as a Centre of Excellence funded by the Canadian International Development Agency (CIDA), the ICACBR’s mandate is to advance the development of CBR worldwide.
The ICACBR has spearheaded international CBR initiatives with vulnerable populations in Canada and in over 15 countries in the Asia Pacific Region, Central and South America, Central and Eastern Europe and Africa, including those in conflict, post-conflict and democratic transition. To carry out their work, the ICACBR team works with networks of clinicians, disability advocates, researchers, educators, and students. Essential to the success of CBR initiatives are the partnerships with local governments, education/research institutions, and NGOs. The ICACBR works with these groups to develop curricula, to educate and train rehabilitation practitioners, and to design sustainable CBR services that will continue to thrive once the team returns to Kingston. In all of this work, mutual respect, cultural understanding and creativity are key.
Currently, the ICACBR is in Bangladesh leading the CIDA-funded IPODMCH initiative. In developing countries like Bangladesh, almost 500,000 women die and 1.5 million are disabled annually of childbearing-related causes. Eleven million children die annually, the majority of preventable causes; the mortality rate for children with disabilities is 80%. Bangladesh has among the highest infant and maternal mortality rates in the world.
Working with a local partner, the Centre for the Rehabilitation of the Paralysed (CRP), their goal is to educate and train over 1000 health professionals, students in health studies and 12,000 community members, including children, in five regions in Bangladesh. The training stresses the benefits of seeking skilled health care providers during pregnancy, labour and post-birth, to improve birth practices, nutrition, hygiene, and growth and development to reduce risk of death and disability. It also provides strategies to positively influence attitudes towards disability, support development and the inclusion of women and children with disabilities from birth.
The ICACBR hopes to again join forces with the CRP to break down the barriers, superstitions, and stigmas within communities, which prevent disabled children from enjoying equal rights and opportunities. Dr.Peat is quick to stress how important it is to involve children in these projects. “They are the future of Bangladesh and the ones that can make a real difference. Getting the children involved in these projects is a wonderful thing – they can change attitudes and do so much positive work with their energy and excitement.”
Profile by Melinda Knox
(e)Affect Issue 3, Spring 2013