THE REHABILITATION VILLAGE Helen Myezwa, Provincial Physiotherapist, Zimbabwe Paper presented at SASP Congress 1993 The rehabilitation village concept was started at Bindura Pro­ vincial hospital in 1985. This hospital has a bed capacity of 120 beds, but due to demand of its services, the hospital accommo­ dates, on average, 220 patients. After 1980, the rehabilitation department had identified a large case load including patients with cerebral palsy and mental retardation. Many of these cases were coming from far away, therefore parents were unable to come for assistance in management of the child on a daily basis, neither could they be admitted nor lodged in the hospital because of the already over burdened inpatient bed situation. Hence, the concept of the rehabilitation village was born. The concept took into account the existing economic resources of the country and future extension of such a service, manpower resources. In line with the PHC concept, the rehabilitation village is affordable, effective and appropriate. P H Y S IC A L S T R U C T U R E A N D U S E O F T H E V IL L A G E The village is a residential training facility for clients built in such a way that it simulates a rural setting. A full assessment and training recommendations are given in this environment where various skills are taught within the con­ text of the daily programme. The villages consist of three to five living huts which serves as sleeping huts. They are built with brick and cement with thatched roofs. An additional hut is built in such a way that the walls are only one metre high and the roof is supported by wooden pillars. This hut serves as a kitchen. It has a built-in bench and protected.fire place. The ablution facilities consist of two toilets and a bathing area. Most villages in Zimbabwe are built at a district or provincial hospital, at clinics or at other community centres. Training sessions are held for children who are divided into three major groups - those with cerebral palsy, mental retardation or communication problems. The carers can arrive a day before or on the morning the village is due to start. Each carer is required to bring their own bed clothes and candle. The programme runs for three days. During the first day, individual assessments take place and a review of the child is carried out with emphasis on progress, problems and difficulties. The second and third days have a programme set according to the group's needs. Individual sessions and activities of daily living are routine within the two days. A IM S A N D O B JE C T IV E S 1. To provide a forum for teaching and facilitation on how to manage the children in order to promote their development and optimum level of functioning. The village provides basic teaching in: * functional activities of daily living * handling and positioning of patients * promotion of functional communication * promotion of effective socialisation and behaviour. 2. To give knowledge and skills, and influence and promote a positive attitude in the mothers regarding the children's con­ dition. 3. To provide psychological support. 4. To prevent further disability through education. 5. To provide low cost appliances and other equipment where required and necessary, such as corner seats, proneboards, push-trolleys, educational toys, walking aids etc. Once logistical arrangements have been' looked into compre­ hensively, such as cooking and accommodation for facilitators and clients, the rehabilitation village will run very smoothly and the objectives are easily met. The majority of clients will find the money to come to the village three to four times per year. There are some who cannot manage this. Often if the mother institution where the village is held, ie the clinic or hospital, is willing, they will provide warrants for travel back home. A D V A N T A G E S O F T H E R E H A B IL IT A T IO N V IL L A G E • Mothers and carers support and teach each other in a group. • An average of twelve or more mothers can be seen at once with the cost of travel greatly reduced. Furthermore the time spent with a mother will allow for meaningful input and learning to take place because it gives time to do in-depth assessment and treatment planning with the child and carer during a functional day. • Follow-up visits in the community will be more meaningful and the mother is much more aware of how to balance activities for the child with those around the home. • The mother is much more in control and can teach other children and members of the family at home. The mother gets an in-depth education on the child's condition along with teaching on how to manage it. D IS A D V A N T A G E S O F T H E R E H A B IL IT A T IO N V IL L A G E • When the child reaches school-going age, placing is difficult as the schools will find it problematic to cope with children with learning difficulties and mental retardation. • The village itself, although resembling the home, is not the home. • For it to be successful, it is staff intensive especially as the numbers of mothers increases. • It is still very dependent on the professional. T H E V IL L A G E IN M A S H O N A L A N D C E N T R A L : IT S D E V E L O P M E N T A N D E X P A N SIO N The various provinces are at different levels with this venture. In some provinces, the village has started to decentralise from provincial centres to districts. This is fully recommended so as to run villages as close to the community as possible. The following is an example of one province. This is the province which had the first village, in Zimbabwe, running in 1986. In the past two years, Mashonaland Central has started to decentralise the rehabilitation villages. The Bindura rehabilitation village started in 1986. The programme was run and designed in Bindura and is continually adjusted and altered to suit the type of client attending._____________________________________________ TABLE 1: NUM BER O F VILLAG ES IN M A S H O N A L A N D CENTRAL 19 8 6 -19 9 2 YEAR NO OF VILLAGES NO OF CLIENTS PER SE SSID N LOCATION 1986 4 5 Bindura 1987 17 8 Bindura 1988 18 9 Bindura 1989 17 8 Bindura 1990 26 9 Bindura, Centenaiy, Howard 1991 26 10 Bindura, Centenary, Howard, M t Darwin 1992 32 12 Bindura, Centenary, Howard, M t Daiwin Table I shows a steady increase in the number of villages over the past six years. Up to 1989, the villages were run only in Bindura. There was an increasing demand for the service. The majority of the clients were identified and referred through out­ reach and other community visits; others through the static serv- Bladsy 58 Fisioterapte, Augustus 1994 Dee! 50 no 3 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) ices such as the outpatient department and through screening of low apgar babies on the maternity ward. Although the statistics showed an increasing demand and more referrals from the districts, the village had never been formally evaluated. The provincial therapist carried out a re­ search project on the specific purpose and function of the village and sought to determine the effectiveness of the service with specific regard to the cerebral palsied child and mentally re­ tarded child. The findings were very encouraging and showed that the village is being used as a means of gaining full and comprehen­ sive rehabilitation management. There were recommendations made from the evaluation and some of these have been imple­ mented. A further study was carried out by G Mugoto to deter­ mine the effectiveness of the village. The increasing demand and the positive results of the evalu­ ation led to the province deciding to decentralise the rehabilita­ tion villages from province to districts and, as the table illus­ trates, over two years, three districts have started their villages. In two of the districts, the villages attendance has been so high that they have already divided the clients and consequently are running two separate groups. Two of the district villages do not have the physical structure but utilise the concept effectively. As a result of further expansion of the village, there is now a need to standardise the approach so as to ensure quality input especially as not all staff involved have a wide experience in paediatrics. The department has now obtained a kit (the START home programme) which gives some guidelines on treatment techniques. This has been identified and will be used in combi­ nation with the materials produced by L Mariga (A Teachers Guide for Children Having Individual Learning Disabilities) (1985), on mental retardation and communication materials by J Morris and H House. Two more villages are targeted to open in another two dis­ tricts but because of the Economic Structural Adjustment Pro­ gramme (ESAP) and its effect on staffing levels, this develop­ ment may have to be shelved. The projected number of villages for 1992 was 32. Provincial-based staff are facilitating all district villages as they have only one or two members of staff in the districts. The province however has the highest number of out and in-patients and a staff establishment of six Rehabilitation Technicians and three therapists. CONCLUSION ^ Clients find the village effective for their immediate needs and the needs of the child. In both studies by Myezwa (1989) and Mugoto (1992), clients expressed support for the villages and found them effective for their individual needs. The village is certainly complementary to all community based activities. The mothers in the villages are already good teachers and we may look to having one day a bank of some of the mothers who can come as permanent facilitators for particular sessions. BIBLIO G R A PH Y 1. Mashonaland Central. Annual report rehabilitation department (1992). 2. Mashonaland Central. Annual report rehabilitation department (1991). 3. Ministry of Health, Zimbabwe and SID A, (1991). Evaluation of reha­ bilitation services in Zimbabwe. 4. Mugoto G. A study to determine the effectiveness of rehabilitation villages in Zimbabwe (1992). 5. Myezwa H. An evaluation of the rehabilitation village at Bindura provincial hospital (1989). 6. WHO (1982). WHO consultation of community based rehabilitation. iusctiŜ BUPROFEN B.P. 200mg P H Y S I O T H E R A P I S T S B B T Medical are the acknowledged leaders in the supply and provision of physiotherapists to the United Kingdom. . We operate a free service, specifically to help healthcare professionals find suitable jobs (Locum, long and short term), in hospitals and rehabilitation centres. Working with B B T you will earn the top rates available and also receive many other benefits inclining accommodation, training, overtime and bonuses. We provide a free support service to facilitate your career move to the UK. Due to the success of B B T to America we now require more physiotherapists looking to take up highly paid, rewarding posts in the United States. If you are interested in working in the United States or United Kingdom or simply require career advice, call Tony Campbell Tel: 09 44 71 976 7440 or 09 44 81 809 4006 evenings. Beresford Blake Thomas Ltd 8 Stratton Ground Westminster London SW 1P 2HP Fax: 0 9 4 4 71 9 7 6 7288 B * B * T BERESFORD BLAKE THOMAS LTD Physiotherapy, August 1994 Vol 50 No 3 Page 59 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )