ONE IN TEN
Volume 20 - 1999
A PUBLICATION OF REHABILITATION INTERNATIONAL/UNICEF COLLABORATION ON CHILDHOOD DISABILITIES
- English Version -
Early Intervention for Children with Disabilities
Editor's Note
This issue of One in Ten documents the value of Early Intervention for Infants
and Young Children with Disabilities. It reports on current approaches to
ensure that children with all types of disabilities, even in the poorest countries,
are provided stimulation, affection, interaction and interventions appropriate
to their needs.
We have covered a diversity of disabilities-autism, spina bifida, deafness,
mobility impairments, learning/cognitive impairments and blindness; included
articles from varied cultures and countries-Chile and Colombia, Poland and
the Czech Republic, East Africa, Afghanistan, Laos and New Zealand, Bangladesh
and the Philippines. We have also featured the viewpoints of parents of disabled
children, childhood disability specialists, disability advocates, international
organizations, development agencies and networks working to deliver early
intervention services under challenging conditions.
Considering the diversity of viewpoints, cultures and disabilities, it is
interesting that many common denominators were revealed among projects, reinforcing
key principles and findings:
1) the importance of forging equal partnerships between service providers
and parents and parents' groups;
2) recognition that child development tenets, such as the crucial role of
on-going stimulation and interaction from earliest infancy, are even more
critical to the development and progress of a child with a disability; and
3) the importance of adults with disabilities as role models for children
with disabilities and to reassure parents that their children too can develop
skills and talents and grow up as valued members of their communities.
If we have not included your project, please contact the editor as we will
be covering this important topic again in a future issue.
Table of Contents
2- Overview: Infants and Young Children with Disabilities
4- Early Intervention: From the Perspective of a Parent
6- Integrating Disability into Bangladesh Development Programmes
8- Early Intervention in New Zealand
9- Early Detection of Spina Bifida and Hydrocephalus in Developing Countries
10- Bilingual Program for Deaf Children in Colombia
13- Chile: Early Stimulation to Improve Communication Skills of Autistic Children
14- Early Intervention with Young, Multi-Disabled, Blind Children in Poland
15- Philippine Organization of Disabled Adults Provides Services to Children
with Disabilities
16- Family Support for Children with Visual Impairments in the Czech Republic
17- Early Intervention against Pressure Sores for Children and Adolescents
who Use Wheelchairs
18- Reaching Deaf Afghan Children
19- Success Story: Integrated Kindergartens in Laos
20- Book Series for Families of Young Disabled Children in Developing Countries
20- Lessons With a Child Who Is Blind
21- Action Opportunities in Childhood Disability 2000
22- Resources
Overview: Infants and Young Children with Disabilities
By Barbara Kolucki, ECCD and Children's Media Consultant to the UNICEF-Maldives Office.
Global Trends
Around the world, almost every day in the media one can find something new about the critical importance of first five years of a child's life. Parents are being told about the variety of things they can do to stimulate their baby's growth and development. There are new magazines being published, new websites, consultative groups to the United Nations Agencies, new international NGOs and Foundations devoting time and money to Early Childhood Care and Development (ECCD). Even advertising for diapers/nappies and toys now often contain important messages about ECCD in them!
Much of the new research is basically confirming what parents and practitioners in the field of early child development have known and been practising for many years. What we have now is new scientific data to support this knowledge and practice.
A brief summary of this research:
" The years 0-3 are critical in the formation of intelligence, personality,
and social behaviour, and the effects of neglect are cumulative. (The UNICEF
ECCD strategy --in internal draft stage-- concentrates on the age group 0-8
years)
" Brain development before the age of one year is more rapid and extensive
than previously realised - the brain nearly triples in size within the first
year of life.
" Brain development is much more vulnerable to environmental influences
than suspected. This includes not only nutrition but also the quality of interaction,
care and stimulation.
" There is evidence of the negative impact of stress during the early
years on brain function. Children who experience extreme stress during the
early years are at greater risk of developing a variety of cognitive, behavioural
and emotional difficulties.
" There are proven "windows of opportunity" for learning during
the first years of a child's life. If these windows are not opened at the
critical time period, it will be difficult if not impossible for a particular
type of learning to occur at a later date.
" Children who have fathers that are involved in nurturing and care giving
often learn better and have fewer social and behavioural problems later in
life.
UNICEF's New Priority Area
For UNICEF, and its work with collaborators throughout the next decade (2000
- 2010), one of the key priorities will be Early Childhood Care and Development.
Executive Director Carol Bellamy calls it a logical extension "of everything
we have done before; it takes us beyond survival. It affirms that a healthy
and nurturing environment in the early years brings with it physical, psychological
and cognitive benefits which will sustain the child for life. It recognises
that mere physical well-being is not enough; there must be the kind of loving
emotional support which brings meaning to childhood". (Carol Bellamy,
CF/EXD/IC/1999-02).
To this end, UNICEF has established an inter-sectoral working group on young
child development that met in September of 1998, followed by a December 1999
meeting on Early Childhood Care in New York City. The Workshop focused on
programming that has been initiated by several UNICEF Country Offices, particularly
those highlighting 1) the central role of families; 2) the supportive role
of communities; 3) enabling national environment and; 4) communication and
advocacy. Programme Guidelines on ECC as well as Tools for Assessment were
also discussed.
In 1995, "Growing and Changing: a guide to Early Childhood Development
for parents", a series of four 10-minute animated videos and guidebooks
were produced by UNICEF. The series covers basic information on normal child
development and simple ways a caregiver can nurture skills in language, social,
emotional, physical and motor development. They are available in English,
French, Arabic and Spanish through UNICEF, attn: Bill Hetzer, 3 U.N. Plaza,
New York, N.Y. 10017 USA. Some countries, including Lebanon and Turkey have
already re-packaged the videos together with live-action segments from their
country.
Infants and children with disabilities
Babies are born with physical, social and psychological capacities allowing
them to communicate, learn and develop. This is true for all infants, including
those who are disabled. What might be different is the limited or lack of
use of a particular sensory organ or a physical impairment of one type or
another like cerebral palsy or club foot. Or, the child might be cognitively
impaired. But even the most severely disabled child can learn. If the child's
capacities are not recognised and supported, these capacities will wither
rather than grow and improve.
How does some of the new research relate to infants and young children with
disabilities? What is unique to babies who are disabled and what are the implications
for early intervention? Here is a summary of some disability specific information
that must be shared with laypersons and caregivers around the world:
" The greater the degree of sensory deprivation for an infant (visual,
hearing, movement) and the longer it lasts - the more permanent the impairment
or disability.
" Even in the case of sensory deprivation, it is not only the particular
sense that might be impaired, but also cognitive, social and emotional development.
" For many impairments, the timing for intervention is critical. Simple
surgery, treatment or exercises is usually much more successful if it is done
in the first years of a child's life. For example, a cataract should be removed
from an infant before the age of six months. Other types of surgery, for example,
alignment surgery for strabismus, are usually recommended between the ages
of 6 - 18 months. (Ref: "Rethinking the Brain: Early Child Brain Development"
-- presentation kit from the Families and Work Institute, NY & "What's
Going On In There", book published by Bantam Books.)
" It is not uncommon for some disabilities to go unnoticed unless parents
are aware of what to look for. For example, many children are not identified
as being deaf or hearing impaired until the age of two or more. Most babies
who are deaf often coo and babble and so unless the baby's hearing is checked
regularly, or a parent notices that the baby does not react to loud sounds
- it is not noticed until the time a "typical" baby begins to speak.
Since hearing is connected to every other aspect of development, however,
it is important to make an early identification. Children who are introduced
to sign language early usually do better (academically, socially as well as
in the complexity of use of sign language communication) than those who do
not learn it until they enter primary school. In addition, many children can
benefit from hearing aids.
" The sequence of skill acquisition is sometimes affected when a baby
is disabled. For example, a child who is blind might be delayed in walking
but not in sitting. Because of lack of visual stimulation, as well as a self-protective
fear, many babies who are blind will be less motivated to move and explore.
" Baby's brains are vulnerable to stress. Children who are in situations
of war, violence, and abuse, especially in the first three years of life,
can develop brains that are visibly smaller as well as suffer from emotional
problems.
" Because we know that experience affects the size and structure of the
brain, it is imperative that children who are diagnosed with a disability
receive as rich and stimulating an environment as possible.
Disability specialists lead the way
In many western countries, programmes of Early Intervention for infants and
young children with disabilities have been the norm for around the past 25
years. Identification of a disability at birth or within the first months
of life has allowed for youngest infants to be placed in a programme where
they are nurtured and stimulated together with addressing their medical needs
and the emotional needs of their family. Remarkable programmes exist to train
parents on what they can do at home, specific techniques with regard to caregiver-child
interactions based on disability-specific rehabilitation, and play situations
where young children who are disabled can learn developmental and social skills.
The overall opinion is that these programmes have been and are effective.
What is important to point out is this: these programmes have been doing for
many years exactly what is being presented today through the media as new
information for non-disabled infants. In fact, the disability specialists
have a lot to teach all of us working in the field of ECCD.
What happens, however, to the majority of infants and young children with
disability in the world - the nearly 80% that live in developing countries?
For sure, many are cared for and loved by their families as much as any child
in the world. There are numerous families that instinctively know what to
do, how to adapt, and the importance of integrating their child into family,
school and community life. There have been pioneers, too, that have brought
early intervention projects to countries like Jamaica, Guyana, Malaysia, the
Philippines, India and others. These projects are exceptional and some have
spawned "satellites" to more rural, isolated areas. And more community-based
rehabilitation (CBR) programmes that were originally designed for adults with
disabilities now include a component for children.
Working uphill against ingrained attitudes
Having worked in over a dozen countries, mostly in the developing world, I
find that a major challenge to reaching infants with disabilities in their
earliest days is the deeply instilled social attitudes that lead to these
children being hidden and isolated. Even with advances in many parts of the
world, there are still millions of people who have never seen a positive portrayal
of a child or adult with a disability in a book, television programme or film.
They might not have ever met an independent person who is disabled. If a parent
believes that his child cannot learn, will not be able to study, will never
marry or hold a job - then it might seem reasonable to simply love that baby
and care for the child's basic needs. The low expectations of disabled infants
and children leads to their being spoken to less, played with less, taken
outside the home less, stimulated less, educated less.
Basic information
We must remember that it needn't be an expensive, "proper" Early
Intervention Programme to make a difference in the life of a young child who
is disabled. All parents of infants and young children who are disabled can
make good use of the following tips:
" Every infant, disabled or not, can benefit from nurturing and stimulation
of their senses. The more a child is spoken to, sung to, read to, danced with,
exercised, played with, encouraged to explore in a safe environment - the
more the brain and body will develop.
" The earlier a disability is detected, the more the child can benefit
from both rehabilitation as well as simple interventions that help maximise
abilities and potential.
" There are simple things a parent can do to detect a disability in their
young child. These include: holding a brightly coloured cloth or toy on one
side of a baby's face and watch to see if the infant follows it to the other
side with her/his eyes; standing quietly behind a baby and then clapping one's
hands or slamming a door to see if the infant makes a startling motion; noticing
if a baby after around three months can lift her/his head when placed on her/his
stomach; smiling at a baby and watching to see if the baby responds by smiling,
cooing, looking back, etc. Most parents and grandparents know what other children
have done around a particular age - they already have a skill in early detection!
" There are simple things that can be done in any home to enrich the
baby's environment. These include: safe, tactile toys; brightly coloured or
black and white mobiles; labelling objects and actions; infant massage that
includes talking with the baby, naming body parts and responding to the baby's
cues; encouraging the baby to communicate in whatever possible way; guiding
touch and movement; etc.
" All children, disabled and not, need and will benefit greatly from
continuous contact with caring adults and children their own age. The more
children and adults with disabilities become visible in the community - the
more they will be joined by others with disabilities who now see they are
welcome in the community.
Conclusion
The Convention on the Rights of the Child (CRC) includes the right of children who are disabled to equal opportunity as well as to have their disability detected and treated as early as possible. The UNICEF Mission Statement includes a commitment to ensure special protection for children who are most disadvantaged, including those with disability. The new focus and priority attention to ECCD must also include infants and young children who are disabled. The families of these children must be included as well. This cannot be seen as a specialised or add-on component of ECCD but one that is integral to ECCD. It is not only absolutely critical but it is possible for every programme, every product and every country to include infants and young children with disabilities. This is a moral and ethical imperative that will, as the research tells us, positively or negatively affect the lives of millions of children in the world.
Author's Note: The author wishes to acknowledge some of the professionals
who have been pioneers in support of UNICEF and other global ECCD efforts:
Cassie Landers, Cyril Dalais, Dan O'Dell, Nigel Fisher, Bob Myers and Judith
Evans.
Early Intervention: From the Perspective of a Parent
By Zuhy Sayeed, Chairperson of the International Committee, Canadian Association for Community Living
(Condensed from an article published in "Exceptionality Education Canada", 1997, Vol. 7, Nos. I & 2, pp. 9 20, available from Faculty of Education, University of Prince Edward Island, 530 University Avenue, Charlottetown, Prince Edward Island C1A 4P3. Fax: 902- 566- 0416)
Rashaad's Story
There are very few pictures of Rashaad's early months. We too, went through
the agonizing period that many parents face, pretending that if the niggling
feelings are ignored, they will go away. We, as 'supposed enlightened' people,
were not immune to this to the feelings of hopelessness and the feelings at
times of hopeful optimism. Rashaad was eight months old and we fought the
thoughts that we needed to confess our fears but, we were still running away.
During a visit to India, a paediatrician confronted us with, within 15 minutes,
all that we had been fighting. We slowly and painfully came to the threshold
of the process of learning. It was hard, and the two cultures between India
and Canada threw us into a vortex of confusion and uncertainty. The searching
stage began - a frenzy of hopping appointments and a thousand questions.
This is but one story, yet a familiar one. As a preschool teacher, as a physician,
as two people involved in the "movement" for some twenty years and
who have travelled the country meeting scores of parents, families, adults
and children who have been labelled - we know that this story has been told
over and over again in many places and many time spans. For us, the nightmare
led to AWARENESS. The stages led to our growth.
My husband's involvement with people with differing abilities began even before
we were married. We thought then, when our second child was 8 months old,
that we had it cased. We knew the options - we were flippant enough to think
that dangerous narrow way "there will be places for him in the future..."
we said to ourselves. A deadly trap and a direction that would have set his
goal for life at age one. A nightmarish thought. Even as we dared vocalize
that thought, we knew that we couldn't accept only one option. The only acceptance
needed was to accept the challenge.
And so it began. Our journey took us to the offices of a doctor, who, in answer
to my questions showed me information of how children thrive with love, support
and intervention. I believe he used the word "stimulation". His
advice to us was clear, take him home, love him and stimulate him all the
time.
My life with the Early Intervention Programme began in the physiotherapist's
office one early summer day in 1983. She spent two hours with me, giving me
strength and support, even before she met Rashaad. It led to the Early Intervention
Programme and our early interventionist who came into our lives when we were
spinning in May 1983, without whom all the successes may have gone unnoticed
in the pursuit of bigger gains -who pushed us further and further to plan
ahead, to do, to be assertive, to be creative, and to dream.
And who - block by block, step by step proved to us that our efforts at treating
Rashaad as "normal" as possible, and constantly stimulating and
interacting, everyday there were minuscule, yet positive differences. The
awareness was born and the realization that a very important thing was happening.
So from denial and confusion, how do we all jump to the seeking of knowledge
and not just accepting?
For us, it was the early intervention program that gave us valuable tools
and taught us the lessons. Those were lessons of empowerment -of realizing
that empowerment means seeking knowledge, of acquiring the ability to think
critically- and the ability to dream. Realising that, the empowerment of our
family leads to the growth of all our children and that the search for knowledge
leads to good decision-making. Taking our children out into the community
from the protective, secure, constant environment of the home gave us all
kinds of experiences, options- and knowledge- to cross all bridges with confidence.
That a path with no obstacles leads nowhere and our only limits were those
of vision. The thing to do when all else fails is to try again.
Today, Rashaad is a confident, motivated young man, celebrating his 16th birthday.
He has given us the vision, the strength and our roles as change agents.
Reflections
I have been involved with the field of early intervention from 1983 to the
present. Once you experience early intervention, it becomes part of your life.
For me, the contact with the Early Intervention Programme cemented the realization
of needing to look beyond the preschool age, to school, extra curricular activities,
beyond school, work, and so on we always needed to be a few steps beyond ourselves.
The necessity of "thinking ahead" led us to realise that we have
to prepare our son to live in the community, but we must also prepare the
community for our son.
My contact and involvement with Early Intervention has led me to firmly believe
and embrace the fact that we are in this together. What we all need is a world
of interdependence, not just dependence or independence. The dangerous message
of segregation, either voluntary or imposed, will result in our sons, daughters
and friends being labelled for life and opportunities being withheld from
them.
The role of an Early Intervention Programme is much broader than just service
delivery. The expertise in child development is important, but what happens
when the programme ends? If the parent is not empowered to seek the knowledge
they require, ask the questions they need to ask and demand what they know
to be fair and just, what legacy has the programme left? We have learned about
interdependence and that we have a collective responsibility for the betterment
of all.
What do parents need from Early Intervention Programme professionals? We need
encouragement, hope, support, and we need to know that they value us and our
families and that they do not judge us. We need them to make believers of
us, walk their talk, believe in their hearts that inclusion is right, just
and fair and they must be able to live that philosophy, as they are advocates
for our children as well.
The United Nations defines handicap as "the relationship between a person
and the environment". The environment is rapidly changing. We are today,
in the name of progress, sending out strong signals to our sons, daughters
and friends, that somehow they are not of value.
How then can we make a difference? Families and community members have been
the driving force of change in the history of our movement for the acceptance
of persons with disabilities into community. As parents and professionals
the challenge is there. No longer do we have time to gaze at each other from
separate sides of the fences.
Conclusion
Early Intervention is the first step in an evolutionary process the foundation
that benefits families, communities and society as a whole. It is the inherent
right of all people that belong to our communities to go to school, to play,
to work, to live in our communities. The history of deinstitutionalisation
has shown us the pain that segregation poses for individuals, families and
communities--and the debates that then are perpetuated about the sanctity
of life. Early Intervention Programmes begin the experience of inclusion.
We yearn for our children, all of them, to live as anyone else and be welcomed
in warm, nurturing communities and grow alongside their peers. For it is our
children who will be the future caregivers, teachers, employers, leaders and
pillars in our communities. Maybe then the cycle of discrimination will be
broken. Maybe then our children will grow up with a sense of self-confidence,
self worth and compassion. Maybe then we will have great human beings who
will live in harmony and peace.
Integrating Disability into Bangladesh Development Programmes
By Shah Alam Liton
The Oxfam-GB Bangladesh office has supported disability work since the 1980's.
But that support was only to NGOs working directly with disabled persons.
The issue of "Integrating disability in on-going programmes without additional
funds" was raised and discussed in the Oxfam Partners meeting in 1994.
All the partners agreed that disability is not a welfare issue, it should
be considered on the development agenda. Disabled people have rights to participate
in the development process and to have an equal share of development benefits.
The partners decided that disabled people should be integrated in their on-going
programmes. But the problem was that Oxfam had only a few partners with experience
and skills in the disability field. So we identified a need of training for
all levels of workers on disability issues.
In 1995, Oxfam organised three workshops for the partner agencies that were
not then directly working with disabled people.
In 1996, Oxfam decided to support development of a "Training of Trainers
Manual on Integrating Disabilities into Development" based on the findings
of the above workshops. In 1997 the manual was published in Bangla.
Results
In 1998,Oxfam organised two training courses using the manual for the trainers
working with the partners. As a result of the training courses 25 NGOs have
made the following changes:
1. Partners started to conduct surveys and soon identified 19,012 persons
with disabilities in their working areas. Still the survey is going on. It
will help us as well as our partners to fully integrate disabled persons after
completion of survey.
2. Most of our partners are running Non-Formal Primary Education schools for
the children in rural areas. The partners have already integrated 423 disabled
children in the schools. This initiative is helping to increase acceptance
of disabled children in the community.
3. A few of the Oxfam partners are running Functional Education Centres for
adults and already 246 persons with disabilities have joined in education
classes in the same schools with other women. This is a good opportunity for
disabled women to become literate and it also increases their community acceptance.
4. In Bangladesh, NGOs are working with disabled persons by helping them to
form groups. The partners have already included 2657 disabled people in the
existing groups. Of these, 2311 persons are saving to create their own capital
for Income Generating activities. The groups meet once a week, and therefore
disabled people's mobility has also been increased. The Development Workers
regularly meet with the groups and discuss various issues such as primary
health and hygiene, causes of poverty, problems of the poor, how to solve
these problems and how to determine responsibilities of the community.
5. Partners have given credit support to 626 disabled people for Income Generating
Activities based on their experiences, knowledge, skills and interest. The
family members are also happy to see their involvement in producing income.
It is also a process of reducing dependency on the family.
6. Bangladesh faced a huge flood in 1998 and some 3403 affected disabled people
were provided food, shelter and other relief and support.
7. Most of Oxfam's partners have Primary Health Education programmes. Due
to lack of mobility most disabled people cannot enjoy the clinical support.
After identifying persons with disabilities, partners' mobile clinics began
to travel closer to where disabled people live. This has created opportunity
for 1283 persons with disabilities to have access to primary health care facilities.
8. It has been observed that disabled people can be exploited by family and
by community members. Oxfam partners have provision to provide legal support
to the victims, specially the women. The partners have also provided legal
support to 122 persons with disabilities in their working areas. This support
is helping to establish the rights of disabled persons in the family and community.
9. Partners are also trying to develop the capacity of the people with disabilities.
Disabled people are invited to attend various trainings such as leadership
development, primary health care, group management, gender awareness, etc.
In addition, disabled persons are also encouraged to be members of various
forums such as disaster committee, village development committee, health committee,
salish (local dispute mitigation) committee, etc. It should be noted that
566 persons with disabilities have been trained on various human and skills
development issues. And 65 disabled people are now included in these various
committees.
10. The Oxfam-GB Bangladesh office recruited a disabled staff member in 1995.
One disabled young woman is working with Bangladesh office as volunteer. The
partners have also recruited 23 persons with disabilities that are working
as secretary, computer operator, accountant, schoolteacher, community development
worker, etc.
Conclusion
The Oxfam-GB Bangladesh office is still learning through this integration process. A lot of problems and new needs such as lack of mobility aids, lack of accessibility, lack of awareness among family & community, lack of skilled workers, absence of physiotherapy facilities, need of disability-friendly policies, etc have been identified. Now, the time has come for Oxfam to consider how to strengthen the integration process.
Early Intervention in New Zealand
By Lesley Adams, Manager New Zealand CCS, North Taranaki and Pat Hanley, National Policy Manager, New Zealand CCS, Wellington
There have been significant changes in New Zealand over the past decade in
the development and delivery of Early Intervention Programmes. This year has
seen the formation of The Early Intervention Association of Aotearoa New Zealand*
and the first National Early Intervention Conference.
The approach for Early Intervention in New Zealand is family focused, meaning
that the services will focus on the child within the context of the Parent/Whanau/Caregiver*
in the wider context of the community. It is based on partnership between
the service providers and the Parent/Whanau/Caregiver. The intent is to adopt
the least intrusive model of intervention from all service providers.
Early Intervention programmes are based around the child's Individual Development
Plan (IDP). This plan is developed following an assessment often using Assessment
Tools such as the Carolina Assessment, Evaluation and Programming Systems
(AEPS) and the Hawaii Early Learning Programme (HEL). The assessment information
is gathered from all who are involved with the child including family members.
On completion of the assessment, an IDP meeting is convened. This is the family's
meeting and they decide who should attend. From this meeting a plan is developed
with responsibilities and timeframes identified.
Developments in New Zealand in early intervention and education have seen
progress towards focusing on the holistic needs of the child. There is acknowledgement
of the rights of children with disabilities to access mainstream education
alongside their non-disabled peers, and a team approach bringing together,
not only teachers, therapists and para-professionals, but also parents and
caregivers. The system is perhaps unduly bureaucratic and complex but that
reflects the early stages of these developments. There are also real problems
in matching resources with needs and meeting the need for workforce training.
A further challenge is to deliver quality services to rural and remote low
population communities and within different ethnic groups.
For more information, please contact:
New Zealand CCS, National Office
P.O. Box 6349
Wellington, New Zealand
Tel.: 64 4 384 5677
Email: phanley@no.ccs.org.nz
Notes:
*Aotearoa is the original Maori name for New Zealand
*Whanau is the term used for the traditional kinship-based personal and family
support network, which continues to play a significant role in child rearing
and in society.
Early Detection of Spina Bifida and Hydrocephalus in Developing Countries
By Pierre Mertens, President International Federation for Hydrocephalus and Spina Bifida (if)
Of each 1000 children, 1-2 have Spina Bifida (SB: open back) and 4 out of
5 of them develop Hydrocephalus (HC: a large head due to fluid in the cavities
of the brain). This means that 10 million people worldwide are born with or
acquire these conditions, which cause severe disabilities such as blindness,
cerebral palsy, intellectual disabilities, and epilepsy. Many of these disabilities
can be avoided, if appropriate information and medical and rehabilitative
care is made available soon after diagnosis.
There is good reason to believe that the prevalence of Hydrocephalus &
Spina Bifida in developing countries is higher than in other countries. Spina
Bifida can in many cases be prevented by taking Folic acid (0.4mg a day) before
conception and during the first weeks of pregnancy. For women at risk (who
already had a baby with Spina Bifida) a higher dose (4mg) of Folic acid is
needed.
In many industrialised countries, these children are increasingly able to
lead 'near normal' lives. In developing countries however, many disabled people
survive but in conditions which vary from appalling to inhuman. In industrialised
countries a significant step towards better services has been to assemble
the parents and patients in national organisations.
North/South Collaboration
While national organisations focus on service delivery in their own countries,
the International Federation looks across borders to facilitate the creation
of national organisations where services are still weak. "If" links
parent groups in the northern part of the world with developing countries
in the South. Where certain technical criteria are being met (availability
of good hospital, surgeon, paediatrician, follow-up program), then "if"
will provide them with support and evaluation.
"If" believes that the success of future affordable activities will
depend on collaboration between hospitals, surgeons, and grassroots organisations
working with disabled people in the community. Such activities will only be
affordable and viable if they make as much use as possible of locally available
resources and infrastructure. "If" signs Memoranda of Understanding
with each hospital and local community- based rehabilitation programme, specifying
roles and responsibilities. Staff trained by these community based rehabilitation
programmes ensure follow-up. "If" provides training and logistic
back-up.
"If" started in Dar es Salaam (pilot and training program) and Moshi
in Tanzania, Kijabe (pilot and training program) in Kenya, and Kampala in
Uganda and facilitated hundreds of operations already. The "if"-project
builds on what has already been achieved by parents and existing service delivery
systems.
A recent workshop with all partners involved has underlined the need of training
at all levels. The main conclusions were:
-"If" strongly believes that the 'third ventriculostomy' (TV) type
of surgery in developing countries may also be a technically better solution
for HC surgery in some cases. It will certainly facilitate the above strategy
of service delivery to these patients;
-A paediatrician or trained physician should be involved; and should be available
for follow-up services;
- Criteria should be developed as to which cases may require shunting;
- Advice to improve the treatment of Hydrocephalus & Spina Bifida must
also be provided;
- Exchanges of information and training between the participating centres
are essential;
- A Register of newborn children with Spina Bifida must be set up to give
information on the prevalence;
- Prevention campaigns aimed at women at risk must be part of each project;
- Formation of parent groups is essential to guarantee long term appropriate
care and permanent involvement of the target group.
Details:
International Federation for Hydrocephalus and Spina Bifida (if)
Cellebroersstraat 16
1000 BRUSSELS, Belgium
P.Mertens@village.uunet.be
Bilingual Program for Deaf Children in Colombia
By Paulina Ramírez, Speech Therapist. Masters in Hearing Impaired Communication and Language, Instituto Nacional para Sordos (INSOR), Colombia
Dominating most of the history of education of hearing impaired students in
Colombia has been the clinical model and the opinion that the deaf person
is lacking. Schools for the hearing impaired have focused on methods for the
rehabilitation of the sense of hearing, and the formal teaching of the spoken
language used in the surrounding community. In our case, this language is
Spanish. The participation of deaf teachers has been rejected, and Colombian
Sign Language (LSC) has not been taken into account in either the advancement
or the education of hearing impaired pupils.
The idea that deaf people must speak the language used by most both invaded
the education field and defined the goals to be achieved in teaching children
younger than five years old. The outcome of this clinical approach towards
children who were born deaf or towards those who became deaf while in pre-school
is that upon reaching Grade One in their academic education, deaf children
had no language at all, either signed or spoken. This lack of language minimizes
their possibilities of academic success and promotes low expectations among
parents and teachers (Johnson , Liddel & Erting, 1989).
As the governmental office for educational policies dealing with the country's
hearing impaired population, INSOR, in 1996, developed an innovative proposal
concerning deaf children less than five years old. This proposal was based
on the conviction that children who are born deaf or who become deaf in early
childhood can timely and naturally develop the intrinsically human skill of
language. This early acquisition of a language can easily be achieved by teaching
a language such as the Colombian Sign Language (LSC). LSC is a natural language
that has visual-gesture characteristics that deaf children can grasp.
Research findings
Prior examples of related research were provided by the Mérida Preschool
Childcare in Venezuela (Anzola, 1989); the Bonaventura Parent Organization
in Denmark (Mahshie, 1995); the Centre for Bilingual Early Childhood, CEBES
(Domínguez, 1994) and from Sweden (Ahlgrem, 1994). All these international
experiences emphasized the importance of facilitating contact between the
children and adult users of sign language to ensure absorption of linguistic
sign during the so called "critical period" of the development of
the child's brain.
The Bilingual Program for an Integral Approach to Deaf Children Less than
Five Years Old (Programa Bilingue de Atención Integral para Niños
Sordos Menores de Cinco Años) was built as an alternative method, based
on social and cultural concepts of hearing impairment practiced within the
confines of the full time child-care centre managed mostly by deaf community
members. This has made it easy to recreate a genuinely natural communicative
atmosphere where communicative interaction, i.e. the people involved in the
dialogue and the contexts of communication are as real as possible. Moreover,
in this setting we have been able to prove that deaf children acquire their
first language - the LSC- naturally and in the same stages as adults do.
The programme is based on the following assumptions:
Early Intervention with deaf children must be language related
Deaf children must have access to linguistic structure in the same way non-hearing
impaired children do, i.e. "language immersion." To achieve this,
the Colombian Sign Language must be the permanent environment to ensure the
full participation of competent users of LSC, i.e. deaf persons.
Deaf children are to be perceived only as what they are: children
Deaf children are children that cannot hear. In terms of cognition and psychology,
they are normal children. Therefore, they must be in places where they can
play and have the same opportunities their hearing peers have so they are
able to learn, participate and carry out activities, and to grow into adulthood
with a positive image of themselves.
In this country, deaf children's first language is Colombian Sign Language
(LSC).
Sign language allows deaf children to efficiently communicate and be successful
in society.
The best linguistic role models for deaf children are deaf adults.
Those who have been identified as the best role models to teach language,
social identity and the strengthening of self-esteem to deaf children are
deaf and fully competent LSC speaking adults.
Parents of deaf children must be understood as parents and, as such, must
receive the support they need
The impact of a deaf child falls on the family as a whole. The whole family
must go through an adjustment period to the new situation, and they must receive
timely help, pertinent information and answers to their questions.
The programme goals are:
- To offer the young deaf child a linguistic environment that favours the
early acquisition of the Colombian Sign Language, to offer them basic care,
and to promote the development of diverse human dimensions: cognitive, communicative,
aesthetic, physical, emotional, and social.
- To offer support to the primary family group, and to establish social and
communication links between both parents and their deaf children, and the
hearing impaired community.
- To develop educational strategies towards all those involved: either deaf
or non-hearing impaired to facilitate the efficient performance of their responsibilities,
and to help them revise the concept of what to be a deaf child means.
The programme evolves round three main points: integral care, linguistic and
communicative development, and the training of deaf parents and adults.
Integral Approach
An integral approach entails all daily actions, processes and contacts that allow for the complete development of a deaf child within a non-restrictive environment that favours the visual processing of information. It is known that playful activities generate the best environments to learn about the world and to acquire a First Language. Those responsible are mainly hearing-impaired adults and a preschool teacher. Family and other local hearing impaired community members' participation is encouraged.
Linguistic and communicative development
The most effective learning of LSC by deaf children derives from genuine interaction with adults and peers who use the language. Our preference is to create interaction by promoting conversation and meaningful dialogues, story telling and reading of fiction and descriptions. Throughout all these activities, adults cooperate with hearing impaired community members in advancing the children's communicative and linguistic development in the same way parents and siblings do in daily situations. The learning of the language does not come through academic activities.
Training of deaf parents and adults
The programme must have a special focus on the training of parents so they
achieve a closer contact to the hearing impaired community, learn Colombian
Sign Language, answer questions that arise on subjects concerning their child's
development, and receive guidance when they request it.
Since a programme goal is that both parents and deaf children because progressively
interested in learning LSC and get in contact with the hearing impaired community,
the programme must promote recreation, cultural and learning activities both
within and without the institution with the participation of hearing impaired
persons. The contact between deaf children's parents with hearing impaired
adults; other deaf children's parents and deaf children help parents to accept
their children's deafness and encourage their active participation in the
programme.
Vital presence of deaf adults
The presence of deaf adults is of vital importance. These adults become role
models of their culture, promote qualitative progress in the children's development
and contribute to a sound identity and a sense of place that is necessary
to any human being. We have also found that the learning of a First Language
creates a base that is fundamental to learn a Second Language, such as the
oral language of the majority culture.
We believe what has been proposed is an innovative and non-prejudiced understanding
of the hearing impaired child. These children, by using the Colombian Sign
Language (LSC) become proficient and efficient speakers of a natural language
and build up a concordant linguistic history that helps structure identity
and personality, and strengthens the necessary basis that hearing impaired
children need to start their academic education in bilingual and bicultural
settings.
For more information, please contact:
Instituto Nacional para Sordos
INSOR
Carrera 47 #65A-28
Santa Fe de Bogotá
Colombia
Tel: 57 1 25 08 400, 57 1 54 21 222
Tel/fax: 57 1 250 91 27
E-mail: insor@andinet.com
Bibliography
· AHLGREN, I. (1994). Sign Language as First Language (Lengua de Señas
como primera lengua). En: Ahlgren, I. y Hyltenstam (eds.). Bilinguismo en
la Educación de los Sordos. Chapter 11. Signum: Hamburg.
· ANZOLA, M. (1989) Early Intervention: An Experience in Bilingualism
(Intervención Temprana : Una experiencia de Bilinguismo). Paper presented
at Deaf Way. Washington D.C.
· DOMÍNGUEZ, A. (1994). Prior Experiences to Bilingual Education
of the Hearing Impaired (Antecedentes de la Educación Bilingue de los
Sordos). INSOR: Bogotá, Colombia.
· JOHNSON, Robert; Carol Erting y Scott Liddell. 1989. Unveiling the
Programs: Principles for better reaching goals in the Education of the Hearing-Impaired.
(Develando los programas: principios para un mayor logro en la educación
del sordo). In: PIETROSEMOLI, Lourdes (ed.) El aula del sordo. Márida,
Consejo de Publicaciones, Universidad de Los Andes, pp. 9-59.
· MAHSHIE, S. (1995). Educating deaf children bilingually. Washington
: Gallaudet University.
Chile: Early Stimulation to Improve Communication Skills of Autistic Children
by Maria del Carmen Aguilera Perez, Autism Specialist and Director, Centro Leo Kanner, Santiago, Chile.
An objective of communication is to exchange messages with another person,
and children with autism are impaired in this activity. Autistic children
also differ from other children in how they acquire a language, because they
show little initiative towards communication and do not spontaneously communicate
either verbally or non-verbally with others.
Communication is a process built on basic formats of interpersonal relationships,
an understanding of contingencies, anticipation, the prediction of instrumental
behaviours, gradually approaching communicative competence. This is the point
where behaviour and psycho-linguistic methods converge, and spontaneous and
functional use of language is achieved, resulting in purposeful communication.
Based on the above, communication creates language.
This paper focuses on the stimulation and development of pre-linguistic skills.
It is a result of an eight year cooperation with families of two to three
year old children at the Centro de Tratamiento de Trastornos de la Comunicación
Leo Kanner (Leo Kanner Center for the Treatment of Communications Impairments),
Santiago, Chile.
A child learning to communicate must first pay attention to objects and people,
learn to sit down and to focus for short periods of time, to play with toys
adequately, to mimic, and to use gestures and sounds.
The following activities will help stimulate pre-linguistic skills.
Materials: Balls, string, paints, puppets, bubbles, musical instruments such
as drums, and water sticks, plus manipulatives of daily use.
1. Paying Attention and Sitting down
The objective is to stimulate the child to listen to sounds, voices and objects.
2. Imitation of Movement
Mimicry is an effective and natural learning method, but there are some children
that need to be taught how to imitate. It is easier to mimic actions before
sounds, because the child's mother or health technician can physically help
him or her.
3. Imitation of Sound
The child's stimulation may begin through imitating his or her own sounds.
That is to say, by repeating the sounds the child already knows.
4. Object Permanence
Object permanence entails stimulating the child to understand the object still
exists even when he/she cannot see it at any given moment. This stimulation
can be achieved by using objects he/she cherishes or are important to him
or her. (milk bottle, favourite food, etc.)
5. Practical Games
Before the child understands an object's name, he/she must have the chance
to explore and learn that different things are tools for different purposes.
For example, a musical instrument is played and not tossed away, and a ball
is to be played with, but can also be tossed. Hence, a mother or health technician
must stimulate a child by physically helping him or her to use each object
in an appropriate way, and by limiting objects to a small quantity (two or
three at a time).
6. Waiting for his or her Turn
Prior to learning how to communicate, a child must learn early on to take
his or her turn in a dialogue, even when this dialogue is built upon only
signing and gesturing, and that these turns build sequences of turn taking
with other people. Stimulation can be achieved through games with balls, building
blocks and towers, and other activities where the child is helped to perceive
the nature and predictability of the activity.
7. Purposeful or Goal-Oriented Communication
When a child starts using words to communicate, there must be not only a reason
to talk, but a structure of words to express his needs and desires. Then the
child will realize that his behaviour has a value in making things known and
can be used in a positive way to achieve goals. Generally, the autistic child
communicates needs and immediate desires through crying or manipulating the
adult.
A child can be stimulated by taking his hand so he/she can show (denote) what
is wanted by pointing a finger while stating the goal to be achieved. Thus,
a child can be stimulated through gesture and verbal requests to achieve what
he/she wants.
Author's Contact
E-mail: hahn.aguilera@entelchile.net
Early Intervention with Young, Multi-Disabled, Blind Children in Poland
By Gisa Paul-Mechel, Programme officer, Christian Blind Mission International (CBM), Germany
In 1991, Blindeninstitutsstiftung Würzburg entered into a partnership
with the Southern Polish Association of Blind People in Chorzow, as well as
with the Polish Association of Blind People in Warsaw.
Following several visits, the partners worked out a programme to set up the
first school for blind children with additional disabilities in the south
of Poland. A pledge was obtained from Christoffel-Blindenmission for financial
support of this programme.
Between 1992 and 1994, experts from Blindeninstitutsstiftung Würzburg
held three 1-week training courses per year at the Polish school, the main
focus being on practical work with the multi-disabled blind children there.
Three teachers from Poland sat in on seminars for 2 months each year in Würzburg
and passed on the knowledge they had obtained to their colleagues at the Polish
school. Parallel to this, special teaching materials and items of equipment
were provided for low vision training, music therapy and sensory integration
of blind and partially sighted children.
The very intensive contact with the Polish teachers rapidly led to the urgent
demand throughout the country for further training to be carried out for educators
from all teaching institutions working with blind children in Poland. At the
time, teachers at schools for blind and visually impaired children had no
possibility of obtaining further training in that country. The Polish teachers
felt it was important to integrate forms of therapy and care so far applied
mainly in the West into the educational work at Polish schools for blind children.
After the Polish Association of Blind People had conveyed this wish to Christoffel-Blindenmission,
a teacher-training programme was worked out.
Components of training
A choice of further education components was included in a 3 to 5-year plan,
embracing all special fields which had previously not been available in Poland:
- The visual system: physiology, diagnostics, low vision devices and non-clinical
therapy
- Visual stimulation, low vision training
- Perception enhancement in blind and partially sighted children with additional
disabilities, basal stimulation, theory of sensory integration, the Affolter
concept
- Theory and practice of sensory integration
- Behavioral problems
- Sensorimotor development according to Piaget
- Work with parents
- Orientation and mobility, daily living skills
- Organizational conditions for working with blind and partially sighted children:
early intervention, mobile assistance to blind and visually impaired clients
(following the Bavarian model)
- Study trips seminars at Würzburg and other Bavarian institutions
The instructors involved in the teacher-training programme came from all over
Germany and were accredited specialists in the above-listed fields. The programme
was managed and coordinated by representatives of the Blindeninstitutsstiftung
in Würzburg and the Southern Polish Association of Blind People.
Outcomes
Twenty weeks of further education were provided from 1993-1997, 18 of them
in Poland and 2 in Würzburg. The courses were attended by educators and
co-workers at 19 schools or advisory centres providing support to blind and
visually impaired children in Poland.
Meanwhile, the former participants of the further education programme in Poland
have formed a network through which they pass on the special knowledge they
have acquired to other teachers and therapists in their country.
All those who took part in the programme went back to their communities and
convinced the local authorities to set up Early Intervention Centres. Christoffel-Blindenmission
agreed to finance the material required to equip these centres.
The Early Intervention Centre in Chorzow, for example, provides services to
50 partially sighted and blind children aged 0-7 with additional disabilities
from villages and towns in the Silesia region. The plan is to expand services
to cover 105 children.
The aims of these early intervention programmes are:
- to support inclusion of the family and the child into the community and
to prevent social isolation;
- to prepare for pre-school and school and to train the parents;
- to provide medical care and rehabilitative therapy to prevent the disability
from becoming worse and to generally improve the health of the child;
- to raise awareness in the community about the situation of children with
multiple disabilities and their families.
Partnerships
The programmes in Poland are coordinated by a foundation of the Southern
Polish Association of Blind People:
- Regionalna Fundacja Pomocy Niewidomym, 41-500 Chorzow, ul. Katowicka nr
77, Poland
- Blindeninstitutsstiftung Würzburg is responsible for special programmes
on behalf of blind people with additional disabilities in Bavaria, Germany.
- Christoffel-Blindenmission/Christian Blind Mission International is an independent
aid organization of Christians of various denominations, dedicated to serving
eye patients, blind people and people with other disabilities in the developing
world and in Eastern Europe. CBM/CBMI operates through Regional Offices in
Africa, Asia, Latin America and Europe. In 1999, approx. 1,100 projects were
supported in over 100 countries. The Head Office is in Bensheim, Germany.
Contact:
Gisa Paul-Mechel
CBM Christoffel-Blindenmission
Nibelungenstrasse 124
Bensheim, D-64625 Germany
Tel:49 6251-131-215; Fax:49 6251-131-165
E-mail: Gisa.paul-mechel@cbm-i.org
Philippine Organization of Disabled Adults Provides Services to Children with
Disabilities
Due to lack of services provided by the government, the National Federation
of Self-Help Associations of Disabled People (KAMPI) is operating an innovative
program offering rehabilitation services to disabled children in the poorest
rural areas of the Philippines. With assistance from the Danish International
Development Agency and the Danish Society of Polio and Accident Victims, KAMPI
has developed a rural rehabilitation network that serves approximately 3600
children, ages 0-14.
A unique feature of the program is that since the beginning of the program
in 1995, staff have learned that since most of the children come from very
poor families, there is a great need to help them increase their "caring
capacity." Therefore, the program has begun to provide skills training
to parents so that they can increase their income and KAMPI President Venus
Ilagan reports that this strategy is having visible results.
Other positive results of this intensive program include: more than 440 children
who have received rehabilitation services are now being integrated into the
regular school system; and targets for levels of service in phase 1 of the
program (1995-99) were exceeded by nearly 40%. Attention is also being paid
to interventions to keep disabled children and their siblings in school as
long as possible, since a large number of children from poor families drop
out of school after just a few years in order to help earn a living. Phase
2 of the project has now been approved for continued international funding
through 2003.
The program, called Breaking Barriers for Children, is the first effort by
disabled people's organizations in the Asia Pacific region to address the
increasing need for early intervention and rehabilitation of children with
disabilities. The KAMPI Federation is composed of 236 grassroots organizations
of people with a wide variety of disabilities.
For more details, contact:
KAMPI
Unit 701 Merchants Square Condominium
1386 E. Rodriguez Ave
Cor. Mabolo St
Quezon City 1112 - Philippines
Email: bbc701@surfshop.net.ph
Family Support for Children with Visual Impairments in the Czech Republic
By Terezie Hradilková, Director of the Association for Early Intervention, Czech Republic
The Association for Early Intervention is a non-governmental organisation, comprised of six regional Early Intervention Centres around Czech Republic. The centres, located in Prague, Liberec, Èeské Budìjovice, Brno, Olomouc and Ostrava, provide services for blind children or those with residual vision ages 0-4 and children with multiple impairments ages 0-6. Also, as part of their mission, the centres inform the general public as well as the specialists about issues concerning children with visual impairments.
Goals
The Early Intervention Centre helps the parents to assist their children
in the development of their skills. The Early Intervention Centre makes it
possible for the parents to get acquainted and to establish a peer relationship
with other families. The Centre's staff is prepared to help parents in difficult
situations, providing its services free of charge.
The programs developed in the Centre is based on the idea that parents have
to make decisions related to their children, but the assistance and information
services provided can help them to make the right decisions. These services
involve education, health-service and social programs for children with visual
impairments. The staff helps to evaluate the children's educational needs
and prepare them for integrated education.
Children obtain information mostly by means of eyesight. The blind and partially
sighted children should learn as soon as possible to use their other senses
and, through them, to get the fullest possible idea of the world. If there
is any residual vision, it is necessary to get the child into the habit of
using it.
We help the parents to: 1) understand their children's behaviour and development;
2) to make it easier for the children to find their place in their own family
and their neighbourhood; 3) prepare the children for a special or integrated
pre-school program.
Children with visual impairments can learn daily living skills if we apply
some appropriate and well-tried methods. As our motto says: "Everything
is possible, even if sometimes in a different way."
The Centre also facilitates contacts between the families, bringing them together
in the form of training courses, weeklong programs and parents' support groups.
Staff and services
The Early Intervention Centre employs a number of professionals to work with
families bringing up infants and toddlers with vision impairments. In order
to offer the best possible services, every one of the counsellors also has
another specialization, e.g. orientation and mobility, visual stimulation,
social consultancy, daily living skills, care of children with additional
impairments, psychology or physical therapy.
The Early Intervention Centre works in close collaboration with a number of
specialists such as psychologists, physicians, physical therapists, and toy-maker.
The Centre provides information services in the area of early care of children
with visual impairments. It collects and translates literature concerning
early intervention as well as the problems of impaired children from all over
the world, and puts into practice a project of instructive and educational
video programmes.
The Early Intervention Centre provides services such as: regular home visits,
recommending and lending suitable toys and special aids; organizing day-long
lectures on various subjects (e.g. daily living skills, educational issues);
week-long courses for the whole families every six months and once a year
specifically for children with multiple impairments; lending specialized literature,
through video projection, forwarding informative materials as well as keeping
a newsletter.
The Early Intervention Centre is financed by the Department of Health of the
Czech Republic, as well as by voluntary donations, allowances obtained from
the local authorities, international foundations and other sponsors.
The Centre participates in the educational Hilton - Perkins program and it
is a member of the International Council For Education Of People With Visual
Impairments (ICEVI).
For more information, contact:
Association for Early Intervention
Haštalská 27, 110 00 Praha 1,
Tel: 420 2 2482 6860
Fax: 420 2 2482 6858
E-mail: ranapece@braillnet.cz
Webpage:: http://ms.anet.cz/~srpcunsEarly
Intervention against Pressure Sores for Children and Adolescents who Use Wheelchairs
A Simple Pressure Relief Cushion
A pressure relief cushion is a critical part of any wheelchair and the following
design for a simple one was developed by Motivation, a British-based group
that supports local wheelchair development in 13 countries in Asia, Latin
America and the former Soviet Union.
To make this cushion Motivation has successfully used materials available
in most developing countries, although some supplies may be found only in
major cities. Main materials are: different types of foam glued together with
a strong contact glue (sometimes used in making shoes). The cushion cover
can be made with any strong waterproof material and should fit the cushion
well without pulling it out of shape.
The foam cushion must fit the wheelchair seat well-it should not be so loose
that it slips or so tight that it bends out of shape. Test a cushion by pressing
your knuckles into the top layer-with a good cushion, you should not feel
anything hard pressing through.
The top layer should be made of softer foam than the other layers and be comfortable
to sit on.
The middle layer should be a medium density foam that bears up under pressure
and does not flatten or "bottom out."
The bottom layer should be a firm base of dense foam to support the other
two layers.
Protecting Skin from Pressure Sores
Good skincare is vital for wheelchair users, especially those who have had
a spinal cord injury. After a spinal cord injury a person loses all or some
sensation and movement in their limbs and does not have the same ability to
protect themselves from skin damage as they did previously.
Normally when a person sits or lies in the same position for a long time,
they start to feel uncomfortable and move or change their position. A wheelchair
user may not be able to feel this discomfort-the warning message telling them
to move is lost and this makes their skin more vulnerable to damage.
What Are Pressure Sores?
A pressure sore is caused by continuous pressure on the skin. This pressure
results in the blood vessels being squeezed shut so that the blood cannot
reach the skin. After a short time, if the person does not move to relieve
the pressure, the skin can become injured and will begin to die. Bruises,
cuts, grazes, spots and blisters all weaken skin and make the body vulnerable
to pressure sores.
The first signs are the appearance of a red or darkening patch. If the pressure
continues, an open pressure sore can form. The sore may start on the skin
and work in or it can start in deep near the bone and gradually work its way
to the surface.
Causes of pressure sores include: staying in one position too long; not sitting
on a cushion; grazing or rubbing the skin when moving on or off the wheelchair;
burns to the skin; insect bites; or knocking feet on the wheelchair footplates.
If there is a mark on the skin, however small, it is important that pressure
is kept off the affected area until the mark clears completely. Even if the
mark appears to be clearing, continue to keep pressure off until it disappears.
A person with a pressure sore on the buttocks should not use the wheelchair.
Instead, they should lie on their side or stomach in a bed or stretcher on
wheels.
Pressure sores can threaten a person's life and health. Time spent in bed
rather than a wheelchair means losing valuable time at school or work.
Preventing Pressure Sores
- Make sure the wheelchair fits. The seat should be wide enough for the user
to get in and out comfortably, but not so wide that they cannot reach the
wheels to push. The front of the seat should stop just a little in front of
the calves so the user does not have to sit slumped into the chair as this
could cause pressure sores on the lower back. The footplates should be adjusted
to the correct height so that the user's feet rest comfortably on them and
the whole of the thigh rests evenly and comfortably on the wheelchair cushion.
- Always sit on a cushion-never sit only on the seat base of the wheelchair.
- Avoid sitting on or resting against hard objects. In particular, make sure
the wheelchair has no parts sticking out that may rub against legs, buttocks
or sides. Do not sit on objects left in pockets. Avoid tucking objects down
the side of the chair as they may push against the skin causing pressure.
- Try to keep moving. A wheelchair user should relieve the pressure on their
buttocks every 20 or 30 minutes, depending upon how active they are. They
should lift themselves up, pushing on the wheelchair rests or lean forward
to let their blood circulate freely.
- Do not rest feet on the sides of the footplates and be especially careful
to avoid resting on any nuts or bolts.
- Take care to avoid burns. Watch out for heated surfaces, including heaters,
radiators, hot water containers, waste pipes under sinks and washbasins etc.
- Check skin regularly for any red marks, using a mirror for any parts of
the body that are difficult to see.
Reaching Deaf Afghan Children
Following is a summary of an article that appeared in Inclusion and Deafness, a 1999 report listed in the Resources section.
Providing services to disabled children or any vulnerable group in Afghanistan
is a daunting challenge for international NGOs: of the estimated population
of 17 million, nearly one third are estimated to have been killed, disabled
or displaced by the last 20 years of continual conflict. Serve (Serving Emergency
Relief and Vocational Enterprise) is a British charity, founded in 1972, mainly
focusing on East Afghanistan.
SERVE's Hearing Impaired Project (SHIP) was established in 1992 in Peshawar,
Pakistan in response to growing needs of deaf Afghan refugees. Funded by CBM
and Radda Barnen, the project was then relocated to Jalalabad in Afghanistan.
Services offered now include: a school for approximately 60 deaf children;
three deaf clubs for adults, providing literacy and sign language classes;
and an apprenticeship programme with master craftsmen resulting in employment
for 30 deaf men.
The SHIP CBR programme has identified more than 80 deaf children, ages 5-12,
in 10 villages and none have attended school. SHIP is training the existing
teachers in sign language and has set up one class for deaf children in each
village.
In the current regime, the female deaf population has no access to education
or employment due to gender discrimination. The compulsory wearing of the
veil makes signing or lip-reading impossible and females are restricted to
their own homes. Some experiments are underway where a class of deaf girls
can sometimes be held in the home of a female teacher.
In 1998 a revised book of Jalalabad regional sign language, featuring 1200
signs, was published.
Success Story: Integrated Kindergartens in Laos
Following are a few highlights from an article, "Experiences in Provision for Children with Disabilities using the Kindergartren Sector," which appeared in the innovative UNESCO publication, First Steps: Stories on Inclusion in Early Childhood Education, described in the Resources section. These highlights only touch upon the results and do not do justice to the article which explains the intensive training, and sea change of attitudes that were necessary to successfully implement this programme.
In 1992 in a cooperative venture with the Lao Ministry of Education, the
National Centre for Medical Rehabilitation in the capital city of Vientiane
opened a small school for children with sensory impairments. In all, 27 deaf
children and 10 blind children enrolled. The centre was staffed by retrained
physiotherapists and was the first ever special education available in the
country.
One year later, Sapanthong Primary School in Vientiane became the first primary
school to include children with disabilities. In 1995, six more primary schools
and four kindergartens became inclusive and in September 1996, a further six
kindergartens and seven primary schools opened their doors to pupils with
disabilities.
This pilot project was unusual as it involved uniting three distinct but related
concepts-school improvement, education for all and early intervention. Strategies
employed included: adoption of a more child-centred teaching approach, use
of home made visual aids, greater involvement of children, improved interaction
in the classroom, wider variety of activities, on-going assessment, improved
planning and recording, and, above all, a new attitude in which children's
differences were acknowledged and teachers took responsibility for the learning
going on in the classroom.
The rationale for early intervention is that there is clear evidence that
it can be very beneficial for children with special needs. When early intervention
is available, children with disabilities do not undergo the additional problems
caused by social isolation, the lack of stimulation and training, and the
resultant frustration of parents and caregivers.
The rationale for using kindergarten as the appropriate interval for intervention
is its emphasis on and understanding of the all-round development of the child,
encouraging attention to be paid to individual needs. Furthermore, there are
no problems with discrimination by other children at this age. The small but
effective kindergarten system in Laos was perceived as having improved methodology,
positive attitudes toward parent involvement and a strong emphasis on child
development principles-all three factors that are known to help pave the way
for inclusion and early intervention programmes.
Example of results
Sonthong has Down syndrome and on admission to kindergarten in October at
age 5, he spent much of the day on the floor. He took no part in any activities
and seemed to have little awareness of what was going on. He could not feed
himself or go to the toilet alone. By June, he was fully integrated in the
class, taking part in morning exercises for parents during Children's Day
celebration. This entailed a long series of complicated movements and singing
of the national anthem in which he joined with enthusiasm. Of all the people
there, perhaps only his mother and teachers were really aware of what he (and
they) had accomplished.
Evaluation
Kindergarten staff recognise the relationship between school improvement and
integrated education and see the new tasks as deeping their general teaching
skills. Families and communities have very much welcomed the program, as previously
they were quite isolated and feeling unable to help their children. With access
to school and a personal relationship with the teacher, attitudes have changed
and many families are working hard alongside their children. Communities have
seen the positive changes in the children and families and become very supportive-there
is no feeling that these children should be "somewhere else."
Book Series for Families of Young Disabled Children in Developing Countries
There are an estimated 140 million children with disabilities in less-developed countries. Most of them are poor and do not have access to specialized services. How these children are helped and encouraged during their first years of life has a powerful effect on their future development. The Hesperian Foundation is developing a series of six books on how to assist children under five who have disabilities. Each book will focus on a different disability and will help parents and caregivers:
" assess the extent of their child's disability;
" learn about child development and how disability affects the different
areas of their child's development;
" stimulate their child's development with specific learning activities;
" understand what causes disability, and how it can be treated and prevented;
" work with other parents and community members to improve services for
children with disabilities
Each book will be about 150 pages long, written on a 5th grade reading level,
and heavily illustrated. The books will initially be published in English
and Spanish. We are planning to produce books on: blindness/vision impairments,
deafness/hearing impairments, cognitive delays/mental retardation, emotional/behavioural
problems, multiple disabilities, victims of war/armed conflict
As with all Hesperian book development, the Early Assistance Series books
are being written collaboratively, involving parents' groups and organizations
in developing countries as well as our Hesperian team. We field-test every
chapter, revise, and field-test again.
Our first book in the series, on blindness and vision impairments, is almost
ready to go to press. The book on deafness and hearing impairments will be
ready for its first round of field-testing in a few months. We are always
looking for parents' groups who are interested in reviewing and trying out
activities in the book chapters. Please contact us if you are interested in
being involved or if you would like more information.
Contact:
Doreen Greenstein
Early Assistance Series
Hesperian Foundation
1919 Addison Street, suite 304 Berkeley
California 94704 USA
Tel: 510-845-1447; Fax: 510-845-9141
Email: earlyassist@hesperian.org
Lessons With a Child Who Is Blind
"Lessons With a Child Who Is Blind" is a new book documenting a
case study of one of 10 children receiving intervention from the first to
the sixth years of life as part of a research project. The author was the
home teacher of the child and also managed the research project. He wrote
letters to the parents after each home visit in which he tried to give advice
on appropriate interventions for their daughter. These letters, sent once
every 2 weeks, provide a detailed chronological account of the idiosyncrasies
of development and early intervention in a child who is blind. They are supplemented
by reports from the parents in which they talk about their childrearing worries
and disappointments, but also their joys and achievements. Further comments
on each stage of development and on parent counselling are also included.
It is recommended reading for all persons who are interested in gaining an
insight into the life of a child who is born without sight. The case study
was part of a 12-year research project carried out at the University of Bielefeld,
Germany. Its goal was to assess the special aspects of infant and preschool-age
development in children who were congenitally blind and to offer support to
parents in their efforts to rear their child and encourage appropriate development.
Author
Michael Brambring, PhD, Professor of Clinical Psychology and Rehabilitation
Department of Psychology, University of Bielefeld, P.O.B. 10 01 31, 33501
Bielefeld, Germany. Tel.: 49-5-21-1 06-43 45.
e-mail: m.brambring@uni-bielefeld.de
Book orders, English edition
The book "Lessons With a Child Who Is Blind" can be obtained for
$20 (US) from the Blind Children's Fund, 4740 Okomos Road, Okomos, MI 48864-1637
(USA). Tel.: (517)347-1357 fax: 517-347-1459; Email blndchfnd@aol.com
Action Opportunities in Childhood Disability 2000
" Global Conference on Early Childhood Development
Washington, D.C., USA, 10-11 April 2000. Contact: Mary Eming Young, Early
Childhood Development Team, Human Development Network Education Group, World
Bank; Tel 202 473 3427; fax 202 522 3233; website www.worldbank.org/children
" Global Campaign Launched for Right to Education
Ten years after the UN Convention on the Rights of the Child guaranteed education
for all children, the promise is still a distant dream. Over 125 million young
children, most of them girls, never see the inside of a classroom. Another
150 million children receive schooling of such low quality and high cost,
that they dropout soon after they start. A Global Campaign, bringing together
organisations working in 180 countries, has been formed to mobilise public
pressure on governments to fulfil Article 28 of the Convention, which calls
for compulsory and free primary education. Some of the leading groups of the
alliance are Education International (world organization of teacher unions),
ActionAid, the Global March against Child Labour, the South African NGO Coalition,
the Campaign for Popular Education (Bangladesh) and the Brazilian National
Campaign for the Right to Education.
Contact: Richard Langlois, Campaign Coordinator, Education International,
155 Bd Emile Jacqmain, 1210 Brussels, Belgium; Tel 32 2 224 06 55; fax 32
2 224 06 06; email global.edu.campaign@ei-ie.org
" International Abilympics 2000 Adds Children's Contests
Prague, Czech Republic,
13-18 August 2000
The International Abilympics was founded during the International Year of
Disabled Persons (1981) in order to provide people with disabilities exposure
to work opportunities and to demonstrate their vocational skills to employers
worldwide. After successful events in Asia and Latin America, the Abilympics
will be held in Europe for the first time in 2000.
Also for the first time, Abilympic events are being organized for children
and youths with disabilities to encourage them to envision a future that includes
work. Skill contests for youths will be held in the areas of cane technology,
bookbinding and brush making; and for children in the areas of ceramics and
embroidery.
Contact: Frantisek Fabian, Executive Director, IA 2000 Organizing Committee,
c/o TILIA, V Haji 4, 170 00 Prague, Czech Republic; Tel 420 2 808 664; fax
420 2 802 237; email abilinfo@abilympics.cz; website www.abilympics.cz
" RI 2000: XIX World Congress of Rehabilitation International on theme,
"Citizenship and Diversity in the New Millennium"
Rio de Janeiro, Brazil, 25-29 August 2000
The concept and application of inclusion, the role of special schools in the
new millennium, innovative research, new approaches in CBR and rehabilitation,
and preparing disabled children for independent living are just a few of the
sessions that will feature new developments benefiting children with disabilities.
To submit a paper or inquire about registration, contact: C & M - Congresses
and Meetings- Rua Marques 3/10, 22260-240, Rio de Janeiro, RJ, Brazil; Tel/
Fax: 55-21-539-1214; Email: cm@cxpostal.com.br; Websites: www.rehab-international.org/information/riopics.htm
& www.ri.org.br
" 6th International Congress on Including Children with Disabilities
in the Community
Edmonton, Alberta, Canada, 23-25 October 2000
These congresses are held to provide opportunities to: review international
declarations related to children with disabilities, exchange information about
ways countries are working towards inclusion in their local communities, and
strengthen the participation of civil society in public policy. The conference
is hosted by the Canadian and Alberta Associations for Community Living, with
support of several Canadian government departments. Represented on the International
Steering Committee are UNICEF, PAHO, OECD and several U.S. government departments.
The hosts have announced that in keeping with past Congresses, they hope to
have each participating country send a team of delegates representing families,
community and government.
Contact: Zuhy Sayeed, Chair, Canadian Organising Committee, Canadian Association
for Community Living, Kinsmen Bldg., York University, 4700 Keele St., Toronto,
Ontario, Canada M3J 1P3; Tel 416 661 9611; TDD 416 661 2023; fax 416 661 5701;
email childcongress@cacl.ca
Resources - Early Intervention
Books, Videos, Organizations & Networks
- "First Steps: Stories on Inclusion in Early Childhood Education" is a compilation of case studies prepared by UNESCO's Special Needs Education Division. Contact: UNESCO, Special Needs Education, 7 Place de Fontenoy, 75352 Paris 07 FRANCE; www.unesco.org
- "Including Your Child", prepared by Susan Gruskin and Kim Silverman with Veda Bright. Contact: U.S. Department of Education, Office of Educational Research and Improvement, Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, USA.
- "The Effectiveness of Early Intervention", edited by Michael J. Guralnick, Ph.D., 1997; An excellent professional book that examines the research regarding the effectiveness of early intervention programmes for infants and young children with disabilities along with recommendations for "second-generation research" on the topic. Twenty-five chapters cover everything from preventive intervention, the effects of intervention with children who have various types of disability, specific program factors and influences on early intervention and suggestions for future research. Contact: Brookes Publishing Co., P.O. Box 10624, Baltimore, Maryland 21285 USA; www.brookespublishing.com
- "An Overview of Young People Living with Disabilities: Their Needs and Their Rights", is a working paper prepare by Nora Groce, Ph.D., from Yale School of Public Health, in collaboration with the Child Protection an Health Sections of the UNICEF Programme Division. Contact: UNICEF HOUSE, 3 UN Plaza, New York, NY 10017, USA; Fax: 1 (212) 824-6480
- Education Update, Vol.2, Issue 4, Oct/99, prepared by the Education Section of the UNICEF Programme Division, presents articles concerning inclusion and access for children with disabilities around the world. Contact: UNICEF TA-26, 3 UN Plaza, New York, NY 10017, USA; Fax: 1 (212) 824-6481; E-mail: Efurniss@unicef.org
- Kiddies Rehab International: A foundation to support people working in with
children with disabilities in developing countries. Volume 1, No. 1 was on
the topic of Early Childhood Development and the importance of play for children
with disabilities. Contact: P.O. Box 557, 1796 ZH De Koog - Texel, The Netherlands.
www.kiddiesrehab.org
- European Children in Crisis for children with learning difficulties. A multimedia training pack with a 28 minute video by the BBC on dyslexic young people in the European setting, showing the devastating effects on the individual and society when the problem is ignored, and offering key principles for remedial help; a guide with articles by leading European experts on the dyslexic brain, assessment, bilingualism, culture shock and teaching methodology; and a Web site with extracts and useful addresses that is regularly updated. Contact: European Children in Crisis (ECIC) asbl, 1 rue Defacqz, box 18, B-1000 Brussels, Belgium. Tel/Fax: + 32 (0)2 537 48 36; E-mail: ecic@ecic.be; www.ecic.be
- Animated Early Child Development Videos is a series of four animated videos and guidebooks on early child development produced by UNICEF under the guidance of Dr. Cassie Landers. The cover normal child development and include practical suggestions for parents and caregivers. The videos are available in English, French and Spanish. Contact: UNICEF, Division of Communications, 3 U.N. Plaza, New York, N.Y. 10017, USA. www.ecdinfo.com
- "Where there is no nursery school" is a video with practical information for parents and caregivers working with a pre-school child with a disability. Contact: Prof. Roy McConkey, School of Health Sciences, University of Ulster, Newton Abbey, Co Antrim, BT37 0QB, N. Ireland, U.K., Fax: 44 1232 368202. Email: rmcconkey@ulst.ac.uk
·- Healthlink Worldwide (formerly AHRTAG). A long-established international information resource on appropriate technology and rehabilitation, working for the improvement of health of poor and vulnerable communities by strengthening the provision, use and impact of information. Publisher of CBR News and booklets of technical drawings of simple devices. Contact: Farringdon Point, 29-35 Farringdon Road, London EC1M 3JB, U.K. Tel 44 171 242 0606; Fax 44 171 242 0041; E-mail info@healthlink.org.uk.
- EENET (Enabling Education Network) is an information-sharing network aimed at supporting and promoting the inclusion of marginalised groups in education worldwide. It publishes a newsletter, one of which so far addressed Early Intervention Programmes. Contact: EENET, Centre for Educational Needs, School of Education, university of Manchester, Manchester M13 9PL, U.K.. www.eenet.org.uk
- Caring for Orphans with Disabilities in Cambodia, issued in 1999 by Disability Action Cambodia/Redd Barna Cambodia. Email Contact: info.rbc@bigpond.com.kh
- Crin Newsletter, issued by the Child Rights Information Network, a global group of organizations supporting children's rights. Contact: CRIN, 17 Grove Lane, London SE5 8RD, U.K. Tel 44 171 703 5400; fax 44 171 793 7626; Email: crin@pro-net.co.uk; web: www.crin.ch
- Inclusion & Deafness, report of a 1999 international seminar held by Enabling Education Network at University of Manchester. Report available from EENET, Centre for Educational Needs, School of Ed., University of Manchester, Oxford Road, Manchester M13 9PL, U.K. Tel 1611 275 3711; fax 161 275 3548; Email: eenet@man.ac.uk
Websites
- The World Bank webpage on early child development: www.worldbank.org/children
- National Information Centre for Children and Youth with Disabilities, a U.S. national information and referral centre. www.nichcy.org
- "The new language of toys: Teaching Communication", by Sue Schwartz,
Ph.D. and Joan Miller, Ed.D., Contact: The Dragonfly Toy Company www.dftoys.com
- "Entertaining and Educating Babies and Toddlers". Contact: Usborne
Publishing: www.usborne.com
- Parents Helping Parents. www.php.com
- Family Village. www.familyvillage.wisc.edu
Example of Early Intervention Initiatives in Latin America
- Research on the Special Educational Needs in Children with Linked Cerebral
Palsy and Deafness-Blindness in Cartagena, Colombia. The REI Foundation for
the Wholesome Rehabilitation I.P.S. of Cartagena, Colombia is developing a
study to find special teaching solutions to facilitate the education of children
less than five years old that suffer linked cerebral palsy and blindness-deafness,
and includes the participation of their families. The Foundation is interested
in establishing contacts with individuals and organizations interested in
the subject to exchange experiences and create dialogue. Contact: Fundación
REI, A.A.1415 Cartagena de Indias, Colombia. Tel/fax: 57-5-66 97 881;
E-mail: rei@reymoreno.net.co
- Rehabilitation in Newborns. Centre for Child Rehabilitation CRIAS. (Centro
de Rehabilitación Infantil CRIAS). Viña del Mar, Chile. A project
that incorporates a Physiatrist, a Physical, and an Occupational Therapist
within a Newborn Unit at a general hospital setting. It was formed to evaluate
and research early malformations and especially in the psychomotor aspects
among a neurological high risk population; and to perform an timely intervention
in children who require it.
Contact: Centro de Rehabilitación Infantil CRIAS, 14 Norte 571, of.
511, Viña del Mar, Chile. Tel/Fax: (005632)69 88 66;
E-Mail: delgibar@entelchile.net
- Developmental Issues: Prevention in its Three Levels. The Centre for Stimulus
and Early Learning (El Centro de Estimulación y Aprendizaje Temprano,
CEyAT) is developing an inter-disciplinary approach project in the areas of
Health and grass root level Social Promotion. It will take place at different
times, stages, and intervention levels: Early, Secondary and Tertiary Prevention.
The Centre's goal is to promote human aspects, increasing all structural aspects
of development such as bio-neurological maturation, psychological build up
and cognitive development. Contact: Alejandra Ramborger, Centro de Estimulación
y Aprendizaje Temprano (CEyAT), 11 de Mayo 1035, CP:6300, Santa Rosa, La Pampa,
Argentina.
Tel: 02954- 426171
- How to understand Development from an Early Stimulation Standpoint: Project developed by Centro Crianza. It deals with issues in training and development in childhood. It takes place in Córdoba, Argentina. Contact: Centro Crianza, Prof. María de las Mercedes Rigo. Paraná 525 B1 Nueva Córdoba (5000) Córdoba, Argentina. Tel. (0054351)4280496; Fax: (0054351)4282570; Email: centrocrianza@arnet.com.ar ; Web: usuarios.arnet.com.ar/centrocrianza
- Early Stimulation in Public Hospitals: Current Issues in La Plata, Argentina. Diagnostics and treatment of problems related to development. To be held at Ibarra Hospital, La Plata. Contact: Marila Terzaghi, Hospital Ibarra, Calle 8 y 67, La Plata, Buenos Aires, Argentina CP 1900. Tel: 021-57-3497; E-mail: rome@satlink.com.
- Early Stimulation - Train with FAC's Childhood Team. Hands on training developed by team in charge of caring for 0 to 7 years old children who suffer non-progressive neurological pathologies or pathologies that are not genetic related. The team is multi-disciplinary and works in the Rehabilitation Division at the Brazil's Universidad de São Paulo's Medical School Hospital de las Clínicas. Contact: DMR- c/o- Dra. Linamara Batistella. Rua Diderot, 43, Vila Mariana, São Paulo, SP, Brazil, CEP: 04316-030; Tel: 55-11-549-0111; Fax: 55-11-549-7501; E-mail: dmr@hcnet.usp.br.
- Prevention and Care Program (NAR) for the Newborn with High-Risk Psycho-Neuro-Sensory Problems, Ecuador. The Program's goal is to prevent problems in childhood development and mental disabilities in newborn with high-risk psycho-neuro-sensory situations. The program is free to 0 to 7 years old children at the Ecuadorian Health Ministry Hospitals in Quito, Guayaquil, Cuenca and Manta. Contacts: Programa NAR, Calle Eustorgio Salgado s/n, La Paz, Bolivia; and Programa NAR, Ciudad Universitaria-Univ. Central- Fac. De Psicología, P.O. Box: 17-097333, Quito, Ecuador. TEL/FAX: 593 02 558226; E-mail: narecua@uio.satnet.net
Hong-Kong
- Jockey Club Rehabilitation Engineering Centre (REC), Hong Kong. Established in 1987, the Centre is an academic unit with a service component within the University. REC offers services in prosthetics and orthotics (P&O), motion analysis, special seating and assistive technology. Contact: Dominic P.K. Cheng, Rehabilitation Engineering Centre, The Hong Kong Polytechnic University; Email: rcdpkc@inet.polyu.edu.hk or check under the heading Rehabilitation Services and Devices on the Web: www.polyu.edu.hk/rec.
United States
- The Centre for International Rehabilitation (CIR) is initiating a collaborative
effort with relevant academic, charitable, governmental and non-governmental
organizations to develop an early detection and intervention program for children
from birth to age five in low-income countries. The overall goal of the project
is to develop a strategy for improving the health of children with disabilities
by developing a unique approach to their identification and management within
the rehabilitation continuum. The project will mobilize community organizations
interested in early screening and intervention for infants and young children.
Contact: PALM/Center for International Rehabilitation - c/o: Dr. William Kennedy
Smith, 351 East Huron, Chicago, IL 60611, USA. Tel: 1(312) 926-0013; Fax:
1(312) 9267662; Email: k-haasen@nwu.edu; Website: www.banmines.org
ONE IN TEN
Volume 20 - 1999
Recent issues of One in Ten, in English, French and Spanish can be found on the RI web site, www.rehab-International.org
EDITOR
o Rosangela Berman-Bieler
email: rbbieler@aol.com
PROJECT SUPERVISION
o Gulbadan Habibi
Project Officer, Child Protection Section, Programme Division, UNICEF
email: ghabibi@unicef.org
o Barbara Duncan
Director of Communications, RI
email: bjdnycla@aol.com
UNICEF HOUSE
3 UN Plaza
New York, NY 10017, USA
Fax: 1 (212) 824-6480
REHABILITATION INTERNATIONAL
Dave Henderson
Secretary General
25 East 21st Street
New York, NY 10010, USA
Fax: 1 (212) 505-0871
email: risecgen@aol.com