|Disabled Village Children - A Guide for Community Health Workers, Rehabilitation Workers, and Families (Hesperian Foundation, 1999, 676 p.)|
|PART 2: WORKING WITH THE COMMUNITY: Village Involvement in the Rehabilitation, Social Integration, and Rights of Disabled Children|
ADAPTING THE HOME
The kind of adaptations needed in the home will partly depend on the kind of disability a child has, the severity of the disability, and the age and size of the child. Adaptations for a child who is blind are very different than those for a child who is paralyzed and uses a wheelchair. A child who is completely dependent will need aids and adaptations to help the family care for him and move him-especially as he gets older and heavier. However, the disabled child who can do a lot for herself may be helped by adaptations that make self-care and work in the house easier.
The kinds of adaptations needed will also depend on the local living situation, style of house, and customs. For example:
A simple ramp may work well for a wheelchair entrance to a house near ground level
Ramp can be made of wood or of dirt or rocks, perhaps covered with a thin laver of cement (1).
A system of ropes and pulleys may be the best way for a person with strong arms to lift herself without help to a house on stilts
The lift can be made with a platform so that the whole wheelchair can be lifted. But if the house is small and people cook and eat at floor level, it may be best to leave the wheelchair outside
Adaptations for the child who is learning to walk and balance
These can be fixed to the walls and furniture. If necessary, pathways with rails can be put up so that the child can walk with support almost anywhere in the house and also outside to the latrine (toilet) or garden.
Before attaching hand rails firmly test the child with a temporary rail at different heights to find out what works best. As the child grows you may need to place the rails higher. Or you may want to remove rails little by little to help the child improve her balance and walk more independently
Where floors are of dirt, hand rails can be mounted on upright
Hand rails of different height form a ladder on which the child can pull to standing (1).
pole to help child stand up at table (2)
chair with crossbars for child to climb up on (3)
high stool with climb-up poles for kitchen work (4)
For the child who only rolls or crawls some kind of straw mat or rug will help protect her knees and skin and will help her stay cleaner (if floors are of dirt)
Easy-to-turn door handle for child with poor hand control.
Door handle at low height for crawling child (or high if you do not want her to go out alone) (1).
Water jug and cup near floor for older child who can only crawl (2).
The model home in PROJIMO is a guesthouse. It has features that make it easier to care for a disabled person, or for a disabled person to care for herself and do housework. Visiting families can find out what is useful for their child and can adapt their own home.
Here PROJIMO workers split wild cane to make screens to keep out the animals
Home adaptations for wheelchair riders
For almost any disabled person-but especially those who use wheelboards or scooters with small wheels, the floor should be as smooth and firm as possible (but not slick or slippery). Packed, smoothed clay-and-cow-dung surfaces (as used in India) work well. Cement is even better for long-lasting use of a trolley or wheelchair. Although expensive, a smooth cement floor makes getting around a lot easier.
Make all doorways extra wide. Remember, your child will grow and may need a bigger, wider wheelchair.
In a house that already has very narrow doorways, be sure the wheelchair you buy or make is narrow enough to fit through easily. Most commercial chairs are much wider than necessary, especially for a child.
Try to avoid any rise or bump at the doorway. If it already has a raised sill and you cannot remove it, build a small ramp to go over it. (This will be of special help for children with weak arms and hands.)
BATHROOM OR OUTHOUSE (LATRINE)
Be sure the room is big enough for a wheelchair to turn around in easily.
A wheelchair without armrests or with a removable armrest (1) is best for transferring to the toilet.
(2) hand rail on far side from wheelchair
(3) toilet seat the same height as seat of wheelchair.
(4) bathing stool same height as wheelchair, with metal frame and woven plastic or rubber strips of car inner tube.
(5) towel on low rack
(6) washstand at height just above knees of wheelchair rider
For a wheelchair rider, a curtain (7) is often easier to open and close than a door.
(8) wide doorway
The stove, work areas, and tables should be as low as possible, but high enough so that the legs of the wheelchair rider can fit under them
CAUTION: If the wheelchair has high fixed armrests the tables and oven will have to be higher. Or the wheelchair will have to approach from the side, in which case the table should be lower.
The cooking and eating area in the model home at PROJIMO has a lot of adaptations
BED OR COT
The bed or cot should be the same height as the wheelchair for easier transfer
Cot height can be adjusted by drilling new holes and changing the position of the bolt (1).
One or more hanging bars or other supports (2) may help the child to transfer or to sit up in bed.
WASHING AREA (outdoor)
Outdoor washing area at PROJIMO - designed for work from a wheelchair
IMPORTANT: Before building fixed-height stoves, tables, and wash areas, set up something temporary to figure out what works best. Remember that the child is growing, so try not to make things too fixed or permanent
ADAPTING THE COMMUNITY
In many villages, disabled persons have a hard time going places because streets or paths are rough, rocky, or sandy. Also, there may be high steps for getting into stores, the cinema, and even the town meeting hall, school, and health center
A village rehabilitation program can encourage the villagers to make it easier for disabled persons to go places and to participate in community activities
For example, ask storekeepers to build ramps so that wheelchairs can enter their stores. Disabled persons and their families can promise to give their business to those who cooperate in this way, and if necessary, can boycott (refuse to buy from) those who do not
In Ajoya, Mexico, the rehabilitation team convinced store owners to build ramps so that the wheelchair riders could enter the stores. The store owners provided the materials and local masons volunteered the labor
The more gentle the slope of the ramp, the easier it is for a wheelchair rider to go up it
One or more ramps can be put parallel to the edge of the raised area. Be sure to leave large level platforms for turning.
Addition of hand rails will add safety and make going up ramps easier for persons who walk with difficulty
HOW STEEP YOU MAKE THE RAMP DEPENDS IN PART ON WHO IT IS FOR
Very steep slope of 1 to 6
Only possible with electric wheelchair or with help. Rarely possible for rider alone. Chair may tip backwards
Fairly steep slope of 1 to 10
Possible for riders with strong arms, strong paraplegics
Gentle grade slope of 1 to 14
Possible for average riders and strong quadriplegics. This is the best slope for public buildings and rehabilitation centers
Improvement of walkways and trails
Community work parties or groups of schoolchildren can organize to help fix up smooth, hard-packed pathways through the village so that crutch users and wheelchair riders can go places more easily.
Also, if possible, easy-to-use pathways can be set up so that disabled children and adults can get to play areas, bathing areas, and family work areas.
HAND RAILS (or ropes)
When placed along steep trails, these may permit children who are blind, who have balance problems, or who have difficulty walking to reach areas such as swimming or fishing holes
In one village a rehabilitation team together with some of the village children improved the steep trail down to the river, so that disabled children would have a chance to play and swim.
The health workers of Project Piaxtla built this ramp so the wheelchair riders could come into the clinic easier. (Photo: John Fago)
A narrow wood ramp with sideboards lets this child pull himself up it on his skateboard.