ECONOMIC AND SOCIAL COMMISSIONFOR ASIA AND THE PACIFICUNDERSTANDING COMMUNITY-BASED REHABILITATION(*)

UNITED NATIONSNew York, 1998ST/ESCAP/1761

Appreciation is expressed to Council of Disabled People of Thailand and DPI Asia Pacific Regional Council printing this publication

Table of ContentsI. IntroductionII. The Multi-sectoral ApproachIII. Programme CriteriaIV. The Components of Community-based Rehabilitation ProgrammesV. Sectors and Roles for the Development and Implementation of Community-based RehabilitationVI. Summary

INTRODUCTION

This publication focuses on understanding community-based rehabilitation (CBR). It does not try to define CBR, as it has become apparent in recent years that CBR defies definition. This is because its simplicity and complexity have led to confusion about what CBR means. The simplicity of CBR has to do with its history of starting with the delivery of primary rehabilitation therapy to people with disabilities in their communities(1). The complexity of CBR is the result of the current concept that CBR programmes should be multi-sectoral (or multi-disciplinary) so that they can provide assistance in all of the areas which are central to improvement of the quality of life of people with disabilities. This complexity recognizes the need for close coordination, collaboration and cooperation between governmental and non-governmental organizations of all types and at all levels.The basic concept inherent in the multi-sectoral approach to CBR is the decentralization of responsibility and resources, both human and financial, to community-level organizations. In this approach, governmental and non-governmental institutional and outreach rehabilitation services must support community initiatives and organizations.For the multi-sectoral approach to CBR to be successfully translated into action, both governmental and non-governmental service capacities need to be improved in most countries of the Asian and Pacific region. Of special importance is improvement of the capacity and skills for facilitating community involvement. Such improvement and related activities must be closely coordinated to ensure the optimum use of scarce resources. In accordance with the multi-sectoral concept, systems are developed, at the community level and among governmental and non-governmental organizations, that interact and reach out to each other.Another factor for the success of the multi-sectoral approach is the empowerment of the community to assume responsibility for ensuring that all its members, including those with disabilities, achieve equal access to all of the resources that are available to that community, and that they are enabled to participate fully in the social, economic and political life of the community. This approach ensures that what is done in the name of CBR actually fits into the reality of the community and is owned by the community.

THE MULTI-SECTORAL APPROACH

The starting point for understanding CBR is the following approach agreed to in 1994 by ILO, UNESCO and WHO(2):Community-based rehabilitation (CBR) is a strategy within community development for the rehabilitation, equalization of opportunities and social integration of all people with disabilities. CBR is implemented through the combined efforts of disabled people themselves, their families and communities, and the appropriate health, education, vocational and social services.This approach to CBR is multi-sectoral and includes all governmental and non-governmental services that provide assistance to communities. Many of the services which can provide opportunities for and assistance to people with disabilities are not traditionally considered relevant to CBR programmes and people with disabilities. Examples include community development organizations, agricultural extension services, and water and sanitation programmes.In the ILO-UNESCO-WHO approach to CBR, the phrase "within community development" is understood to be the following strategy recommended by the United Nations(3):... the utilization, [in an integrated programme](4), of approaches and techniques which rely on local communities as units of action and which attempt to combine outside assistance with organized local self-determination and effort, and which correspondingly seek to stimulate local initiative and leadership as the primary instrument of change.In the CBR context, community means: (a) a group of people with common interests who interact with each other on a regular basis; and/or (b) a geographical, social or government administrative unit.

PROGRAMME CRITERIAThe development and implementation of CBR programmes should be based on the following criteria:1. People with disabilities must be included in CBR programmes at all stages and levels, including initial programme design and implementation. In order to give significance to their involvement, they must have distinct decision-making roles.2. The primary objective of CBR programme activities is the improvement of the quality of life of people with disabilities.3. One focus of CBR programme activities is working with the community to create positive attitudes towards people with disabilities and to motivate community members to support and participate in CBR activities.4. The other focus of CBR programmes is providing assistance for people with all types of disabilities (physical, sensory, psychological and mental); for people of all ages, including older people; for people affected by leprosy; for people affected by epilepsy; and for other people who may be identified by the community as needing special assistance.5. All activities in CBR programmes must be sensitive to the situation of girls and women. This is because in many communities throughout the Asian and Pacific region women are not treated equally. When they are disabled, the problems that they face in life are doubled. Furthermore, women are usually the primary family care-givers for all people with disabilities.6. CBR programmes must be flexible so that they can operate at the local level and within the context of local conditions. There should not be only one model of CBR because different social and economic contexts and different needs of individual communities will require different solutions. Flexible, local programmes will ensure community involvement and result in a variety of programme models which are appropriate for different places.7. CBR programmes must coordinate service delivery at the local level. Community members seldom understand the different roles and specializations that are part of providing assistance to people with disabilities. They tend only to see the problem of disability and only to want access to "one window" for help. They may focus only on where to go and who to see about a specific "problem", rather than understanding the totality of what constitutes a fulfilling life for a community member who has a disability.

THE COMPONENTS OF COMMUNITY-BASED REHABILITATION PROGRAMMES

The components of a CBR programme should include:1. Creating a positive attitude towards people with disabilities:this component of CBR programmes is essential to ensure equalization of opportunities for people with disabilities within their own community. Positive attitudes among community members can be created by involving them in the process of programme design and implementation, and by transferring knowledge about disability issues to community members.2. Provision of functional rehabilitation services:often people with disabilities require assistance to overcome or minimize the effects of their functional limitations (disabilities). In communities where professional services are not accessible or available, CBR workers should be trained to provide primary rehabilitation therapy in the following areas of rehabilitation: Medical Eye care service Hearing services Physiotherapy Occupational therapy Orientation and mobility training Speech therapy Psychological counselling Orthotics and prosthetics Other devices

3. Provision of education and training opportunities:people with disabilities must have equal access to educational opportunities and to training that will enable them to make the best use of the opportunities that occur in their lives. In communities where professional services are not accessible or available, CBR workers should be trained to provide basic levels of service in the following areas: Early childhood intervention and referral, especially to medical rehabilitation services Education in regular schools Non-formal education where regular schooling is not available Special education in regular or special schools Sign language training Braille training Training in daily living skills

4. Creation of micro and macro income-generation opportunities:people with disabilities need access to micro and macro income-generation activities, including obtaining financial credit through existing systems, wherever possible. In slums and rural areas, income-generation activities should focus on locally appropriate vocational skills. Training in these skills is best conducted by community members who, with minimal assistance, can easily transfer their skills and knowledge to people with disabilities.5. Provision of care facilities: often, people with extensive disabilities are in need of assistance. When they have no families or their families are incapable of caring for them, in order for them to survive, long-term care facilities must be provided in the community where they can get the assistance that they need. Moreover, day-care facilities may be needed to provide respite for families who either work or need time off for other activities.6. Prevention of the causes of disabilities:many types of disability can be prevented by relatively simple measures. Proper nutrition is one of the more significant ways of preventing disabilities. Another important area of disability prevention is the detection of disability in young children and intervention early in their development, to minimize the effect of impairment. There are many other areas of disability prevention that are also important. These include activities to decrease the number of accidents in the home, on the road and at work, as well as other initiatives to encourage people to pursue healthy lifestyles over the course of their lives.7. Management, monitoring and evaluation:the effectiveness and efficiency of all CBR programme components, both in the community and in the area of service delivery outside the community, depend on effective management practices. The impact of programme activities must be measured on a regular basis. People must be trained in effective management practices. Data must be collected, reviewed and evaluated to ensure that programme objectives are met. In this way, the success or failure of a CBR programme can be honestly measured.

SECTORS AND ROLES FOR THE DEVELOPMENT AND IMPLEMENTATION OFCOMMUNITY-BASED REHABILITATIONThe initiative to start CBR programmes and to facilitate their development may come from any one of the following groups. However, the effectiveness of CBR and the long-term development and sustainability of any CBR initiative will require the coordination, involvement and collaboration of all seven groups. The seven groups and their suggested roles are as follows:1. People with disabilities: People with disabilities can and should contribute to all levels of CBR programmes in every position within a programme. They know what the effects of local conditions are on themselves. They are likely to have a good understanding of those effects on their peers with disabilities. They also know what impairment really means in the context of their family, community and nation. This knowledge enables them to be very effective members of a CBR team. They can be more effective than non-disabled people as role models for and counsellors of other people with disabilities. People with disabilities have an important role in community education. As community educators, they serve as living examples of people with disabilities who make a significant contribution, provided that they are given the opportunity and the right type of assistance. CBR programmes should also facilitate the development of self-help organizations of people with disabilities at the community level.2. Families of people with disabilities:families have the primary responsibility for caring for all of their members. They are the first line of support and assistance for people with disabilities at the local level. As such, families must be included in CBR programme activities. Where the individual with a disability is not able, for whatever reason, to speak for himself or herself, a family member should represent him or her and should be considered a legitimate member of disabled people's organizations. Members of families with experience in caring for people with disabilities are the people who most often initiate CBR programmes and are, or prove to be, the most effective contributors at all levels.3. Communities:community members should be involved in CBR programmes at all levels because they already know the local environmental conditions, the local economy, the local political situation and how to work with them. They also know about the accessibility, availability and effectiveness of locally available rehabilitation services; who in the community cares enough about other people to become a programme leader or worker; and, which community members have the knowledge and skills for training others in micro-economic activities. They are the people most likely to want to live, work and stay in the community. Community involvement usually requires the agreement and approval, both formal and informal, of the community leaders.4. Governments (local, regional, national):governments have the most important role in the development and sustainability of CBR programmes. Their cooperation, support and involvement are essential if CBR is to cover the total population and be sustainable. They should implement and coordinate the development of the entire programme structure, including the development of the referral system, as well as the activities within the community. They also should provide resources for non-governmental organizations (NGOs) and community activities. Finally, they should ensure that discriminatory legislation is changed and that the rights of people with disabilities are guaranteed and protected.5. Non-governmental organizations, local, regional, national and international organizations:NGOs, including organizations of people with disabilities, are often able to provide resources and skills to facilitate the development of new programmes, especially in areas where none exist. They can develop new approaches to CBR and provide training programmes for government employees, CBR workers, people with disabilities, families, and community members. NGOs are effective in facilitating the development of community members as CBR programme leaders. They are often best able to provide long-term care facilities for those people with extensive disabilities whose families cannot or will not look after them.6. Medical professionals, allied health science professionals, educators, social scientists and other professionals:professionals are often in a position where they can, as trainers and educators, facilitate the development of new programmes by making their knowledge and skills accessible to community members and CBR programme workers. They can also ensure that they support community efforts by making themselves available and accessible on a referral basis. When they are in government service, they can advocate and promote the development of CBR programmes as an effective way to provide local-level services quickly.7. The private sector (business and industry):the private sector has a social obligation to return some of the benefits of its operations to the communities that support it. In the past, this support has largely taken the form of charity. Charity occurs when donors "give" whatever they feel is needed or appropriate to people with disabilities. This approach to assisting people with disabilities is no longer appropriate and needs to be changed. Supporting CBR programme activities eliminates the need for charity. CBR support is a much more appropriate way of directing resources to communities and people with disabilities. By supporting CBR programmes, the private sector receives credit for its social involvement while being guaranteed that its support is put to effective and efficient use. Who but trained, knowledgeable community members would know what is most needed by the people of their own community?

SUMMARY

In recent years a multi-sectoral (or multi-disciplinary) concept of CBR has evolved. That concept emphasizes working with and through the community to create positive attitudes towards people with disabilities, to provide assistance to people with disabilities and to make the necessary changes to the environment and service delivery systems.In response to this conceptual change, CBR is now defined as a community development programme that has seven different components:(i) Creation of a positive attitude towards people with disabilities;(ii) Provision of rehabilitation services;(iii) Provision of education and training opportunities;(iv) Creation of micro and macro income-generation opportunities;(v) Provision of care facilities;(vi) Prevention of the causes of disabilities;(vii) Monitoring and evaluation.The resources, skills and initiatives to start and sustain CBR programmes require the cooperation and collaboration of seven relevant sectors:(i) People with disabilities(ii) Families of people with disabilities;(iii) Communities;(iv) Governments (local, regional, national, international);(v) NGOs, local, regional, national and international organizations, and organizations of people with disabilities;(vi) Medical professionals, allied health science professionals, educators, social scientists and other professionals;(vii) The private sector (business and industry).

foot notes*Prepared by the Working Group on CBR of the Regional Inter-agency Committee for Asia and the Pacific (RICAP) Subcommittee on Disability-related Concerns. ESCAP serves as the secretariat of the Subcommittee. All members of the Subcommittee contributed to the preparation of the document. The Subcommittee, at its fourteenth session in May 1997, finalized and adopted the document to mark the mid-point (1997) of the Asian and Pacific Decade of Disabled Persons, 1993-2002.1.The Alma Ata Declaration of Health for All and its emphasis on primary health care included services for people with disabilities. It is this concept that led to the development of the first models of CBR which emphasized delivery of primary rehabilitation therapy in the community.2.Community-Based Rehabilitation for and with People with Disabilities, 1994 Joint Position Paper, International Labour Organization (ILO), United Nations Educational, Scientific and Cultural Organization (UNESCO) and World Health Organization (WHO).3.See document E/CN 5/291.4.The original definition has been changed from "under one programme" to "in an integrated programme".

Economics and Social Commission for Asia and the PacificUnderstanding community-based rehabilitationUNITED NATIONSNew York, 1998ST/ESCAP/1761Go to the top of this page.|Go to the upper category.

Infomation CenterJapanese Society for Rehabilitation of Persons with DisabilitiesJSRPD22-1,1chome,Toyama Shinjuku-kuTokyo 162-0052JAPANPhone81-3-5273-0796 Fax: 81-3-5273-0615Copyright (c) 2007-2015 Japanese Society for Rehabilitation of Persons with DisabilitiesJSRPDAll Rights Reserved.

Program Pemulihan Dalam Komuniti (PDK)PengenalanProgram Pemulihan Dalam Komuniti (PDK) atau "Community-Based Rehabilitation" (CBR) telah dipelopori oleh Pertubuhan Kesihatan Sedunia (WHO).Jabatan Kebajikan Masyarakattelah terlibat secara langsung dalam penyedian manual dan seterusnya diberi peluang menilai dan mengubahsuai pelaksanaan program ini.Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif dengan kerjasama Kementerian Kesihatan Malaysia untuk menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu untuk melibatkan 55 orang kurang upaya (OKU).Program PDK ini berkembang dengan pesatnya serta mendapat sambutan yang begitu menggalakkan dari masyarakat dari masa ke semasa.Objektif1. Menggalakkan sikap prihatin, berdikari dan rasa tanggungjawab masyarakat tempatan dalam program pemulihan orang kurang upaya (OKU).2. Mengembleng sumber tempatan untuk pemulihan sumber tempatan untuk pemulihan OKU.3. Menggalakkan penggunaan cara yang mudah dan teknik yang diterima, murah, efektif dan sesuai dengan keaadaan setempat.4. Menggunakan infrastruktur organisasi tempatan yang sedia ada untuk memberi perkhidmatan.5. Mengambil kira sumber ekonomi negara dan membolehkannya untuk diperluaskan perkhidmatan yang menyeluruh mengikut keperluan OKUProgram PDK Berteraskan Kepada 3 Model Home Based. Centre Based. Centre-Home Based.Aktiviti PDK Kemahiran motor kasar. Kemahiran motor halus. Perkembangan sosial. Perkembangan bahasa. Pengurusan diri sendiri. Pra-menulis, membaca, mengira dan melukis. Kreativiti - permainan, rekreasi dan lain-lain. Latihan Vokasional. Terapi muzik. Sukan dan rekreasi.Konsep PDK'One Stop Centre'PDK "One Stop Centre'' sebagai "Focal Point'' kerana ianya satu program yang menggunakan pendekatan integrasi komuniti di setiap daerah dan negeri.Melalui PDK "One Stop Centre'', perkhidmatan kepada OKU akan disediakan di satu tempat bagi memudahkan mereka dan masyarakat setempat mendapatkan maklumat, khidmat nasihat dan keperluan semasa serta latihan yang bersesuaian.Peranan PDK "One Stop Centre": Pusat Intervensi Awal OKU. Pusat Sumber maklumat OKU. usat Rujukan OKU. Pusat Pendaftaran OKU. Pusat Advokasi.PDKNetPDKNet merupakan pelaksanaan program IT dan Multimedia bagi membantu golongan kurang upaya seperti kanak-kanak Sindrom Down dan kanak-kanak yang menghadapi masalah pembelajaran.Secara umumnya program ini berfungsi sebagai landasan untuk memperkembangkan dan membantu dalam pemulihan golongan kurang upaya. Selain daripada itu, program PDKnet ini juga diharap dapat menambah pengetahuan dan kemahiran orang kurang upaya untuk mengendalikan program perisian komputer.Program ini juga secara tidak langsung dapat memberi peluang kepada keluarga dan masyarakat mengambil bahagian untuk berkomunikasi dan seterusnya membantu dalam proses pemulihan golongan ini.Untuk capaian PDKNet, ianya boleh dilayari melalui laman webwww.pdknet.com.my

Pemulihan Dalam KomunitiPROGRAM PEMULIHAN DALAM KOMUNITI (PDK)

Syarat Kemasukan:

iHad Umur - Tiada had umur

iiJenis OKU - semua jenis OKU yang mampu dilatih

Ciri-ciri PDK :

iProses pemulihan dilakukan dalam komuniti tempatan

iiIbubapa/ahli keluarga/komuniti memainkan peranan penting

iiiMenggunakan teknologi dan kos yang rendah

ivKaedah pemulihan dijalankan di PDK dan di rumah

vMenggunakan sumber-sumber dan komuniti yang ada

Konsep PDK

iMendekatkan perkhidmatan pemulihan dan intervensi awal untuk OKU diperingkat komuniti tempatan.

iiMemastikan penyertaan penuh dan integrasi sosial OKU dalam keluarga dan komuniti.

iiiMengurangkan penempatan jangka panjang di Institusi Pemulihan yang menyebabkan OKU disisihkan dari keluarga dan komuniti.

ivMenyediakan platfom sesuai untuk OKU membangunkan kebolehan dan kemahiran mengikut potensi yang ada dalam diri.

vMembantu dalam mewujudkan masyarakat penyayang yang prihatin kepada keperluan OKU.

Peranan PDK masa kini:Alternatif kepada pendidikan khas selaras dengan keperluan pendidikan wajib sekolah rendah seperti yang termaktub di bawahSeksyen 3(2) Peraturan-Peraturan Pendidikan (Pendidikan Khas)1997khusus untuk kanak-kanak OKU yang mempunyai ketidakupayaanmoderatedansevere(teruk).Program Pendidikan Khas hanya menawarkan tempat kepada Kanak-Kanak OKU yang berupaya mengurus dirisendiri. Kanak-kanak OKU yang telah menunjukkan peningkatan dalam pengurusan diri akan di pertimbangkan untuk di tempatkan di Sekolah Pendidikan Khas Kementerian Pelajaran.Aktiviti di PDK

iKemahiran Motor Kasar

iiKemahiran Motor Halus

iiiPerkembangan Bahasa

ivPerkembangan Sosial

vPengurusan Diri

viPra Menulis, Membaca, Mengira dan Melukis

viiKreativiti dan Retorik

viiiKemahiran Vokasional

ixSukan Special Olympics

xBakat Istimewa PDK

Pencapaian:

Faedah bagi keluarga dan masyarakat:1.Insiden kecacatan dapat di kurangkanatau kecacatan lebih teruk dapat dicegah melalui intervensi awal dan sokongan keluarga yang dilatih.2.Meningkatkan kesedarandi kalangan ahli keluarga akan potensi anak mereka untuk dibangunkan melalui latihan dan bimbingan.3.Meningkatkan keyakinan komunititerhadap keupayaan yang ada dan menjadikan masyarakat lebih matang dan penyayang

Tuesday, February 15, 2011penubuhan pdk ....FAKTA BENAR TENTANG BILANGAN PUSAT PEMULIHAN DALAM KOMUNITI YANG ADA DI MALAYSIA.

Pusat Pemulihan Dalam Komuniti atau nama singkatannya PDK kini telah menjangkau ke 297 PDK se Malaysia dengan bilangan pelatih yang menerima latihan pemulihan seramai 757 orang .

Bagaimana pdk mula bertapak daripada sebuah PDK hingga menjadi 379 buah PDK di seluruh Malaysia yang memberi manfaat kepada 9,514 orang kurang upaya di seluruh Negara. Persoalan yang sentiasa bermain dalam minda.

PENUBUHAN PDK

Kisahnya bermula apabila Program Pemulihan Dalam Komuniti (PDK) atau "Community -Based Rehabilitation" (CBR) telah dipelopori oleh Pertubuhan Kesihatan Sedunia (WHO). Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam penyediaan manual dan seterusnya diberi peluang menilai dan mengubahsuai pelaksanaan program ini.

Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif dengan kerjasama Kementerian Kesihatan Malaysia untuk menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu yang melibatkan 55 orang kurang upaya (OKU). Program PDK ini berkembang dengan pesatnya serta mendapat sambutan yang begitu mengalakkan daripada masyarakat dari semasa ke semasa.

PDK Batu Rakit merupakan PDK yang pertama ditubuhkan di Malaysia pada tahun 1984. Penubuhan ini adalah inisiatif daripada Jabatan Kebajikan Masyarakat dengan kerjasama Kementerian Kesihatan Malaysia yang ketika itu menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu. Jumlah pelatih PDK sekarang adalah 43 orang yang memulakan sesi pembelajaran seawal jam 8.00 pagi sehingga 1.00 tengahari, 5 hari seminggu.

Dalam memberi pemulihan kepada pelatih, PDK telah menetapkan beberapa objektif:

Mengalakkan sikap prihatin, berdikari dan rasa tanggungjawab masyarakat tempatan dalam program pemulihan OKU.Mengembleng sumber tempatan untuk pemulihan OKU.Mengalakkan penggunaan cara yang mudah dan teknik yang diterima, murah dan efektif dan sesuai dengan keadaan setempat.Menggunakan infrastruktur organisasi tempatan yang sedia ada untuk memberi perkhidmatan.Mengambil kira sumber ekonomi negara dan membolehkannya untuk diperluaskan perkhidmatan yang menyeluruh mengikut keperluan OKU. Antara aktiviti yang dijalankan oleh PDK ialah memberi kemahiran motor kasar, Kemahiran motor halus, perkembangan sosial, perkembangan bahasa, pengurusan diri sendiri, pra-menulis, membaca, mengira dan melukis, kreativiti - permainan, rekreasi dan lain-lain, latihan Vokasional, terapi muzik, sukan dan rekreasi.

PEMULIHAN DALAM KOMUNITI

Pemulihan Dalam Komuniti merupakan satu pendekatan baru yang menekankan penglibatan lebih aktif Ibubapa, keluarga dan komuniti tempatan terhadap usaha mencegah dan memulihkan Kanak- kanak Kurang Upaya, khususnya di peringkat tempatan dalam konteks stuktur perkhidmatan dan rancangan pembangunan yang sedia ada. PDK bertujuan untuk memulihkan kanak- kanak Kurang Upaya supaya boleh berfungsi seperti orang biasa, memberi kesedaran kepada komuniti/ masyarakat setempat bahawa ada segolongan masyarakat yang tidak berkeupayaan perlukan bantuan, memberi pengetahuan, kesedaran pemulihan kepada Kanak- kanak Kurang Upaya, ahli keluarga dan saudara mara terdekat dalam pemulihan dan membentukJawatankuasa bertindak di kalangan ahli keluarga, golongan professional, sukarelawandan komuniti tempatan dalam merancang program.Program ini diuruskan oleh Jawatankuasa PDK yang dilantik melalui persetujuan bersama antara Jabatan Kebajikan Masyarakat Malaysia dalam komuniti setempat. Ianya dianggotai oleh ibubapa/penjaga ahli keluarga golongan kurang upaya, pemimpin setempat, komuniti yang berminat dan penasihat bagi Jawatankuasa PDK ialah Pegawai Kebajikan Masyarakat Daerah dengan dibantu oleh Pegawai dari Kementerian Kesihatan dan Kementerian Pendidikan (Pendidikan Khas).

Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam penyediaan manual dan seterusnya diberi peluang menilai dan mengubahsuai pelaksaan program ini.Pada tahun 1984, Jabatan Kebajikan Masyarakat telah mengambil inisiatif dengan kerjasama Kementerian Kesihatan Malaysia untuk menjalankan Projek Perintis PDK di Mukim Batu Rakit, Kuala Terengganu yang melibatkan 55 orang kurang upaya (OKU). Program PDK ini berkembang dengan pesatnya serta mendapat sambutan yang begitu mengalakkan daripada masyarakat dari semasa ke semasa.

Alamat pengasas pdk Batu Rakit

PDK Batu Rakit9570 Kg. Mengabang,Telipot Batu Rakit,21020 Kuala Terengganu

DEFENISI PEMULIHAN DALAM KOMUNITI

Pemulihan Dalam Komuniti merupakan satu pendekatan baru yang menekankan penglibatan lebih aktif Ibubapa, keluarga dan komuniti tempatan terhadap usaha mencegah dan memulihkan Kanak- kanak Kurang Upaya, khususnya di peringkat tempatan dalam konteks stuktur perkhidmatan dan rancangan pembangunan yang sedia ada. PDK bertujuan untuk memulihkan kanak- kanak Kurang Upaya supaya boleh berfungsi seperti orang biasa, memberi kesedaran kepada komuniti/ masyarakat setempat bahawa ada segolongan masyarakat yang tidak berkeupayaan perlukan bantuan, memberi pengetahuan, kesedaran pemulihan kepada Kanak- kanak Kurang Upaya, ahli keluarga dan saudara mara terdekat dalam pemulihan dan membentuk Jawatankuasa bertindak di kalangan ahli keluarga, golongan professional, sukarelawan dan komuniti tempatan dalam merancang program.Program ini diuruskan oleh Jawatankuasa PDK yang dilantik melalui persetujuan bersama antara Jabatan Kebajikan Masyarakat Malaysia dalam komuniti setempat. Ianya dianggotai oleh ibubapa/penjaga ahli keluarga golongan kurang upaya, pemimpin setempat, komuniti yang berminat dan penasihat bagi Jawatankuasa PDK ialah Pegawai Kebajikan Masyarakat Daerah dengan dibantu oleh Pegawai dari Kementerian Kesihatan dan Kementerian Pendidikan (Pendidikan Khas).

FAEDAH PENUBUHAN PDK

Terdapat banyak faedah dalam kewujudan pusat ini. Ia dapat membantu golongan ibu bapa untuk mendapat pengetahuan secara lebih terperinci cara mendidik anak anak istimewa ini. Dengan adanya pusat pemulihan ini, ibu bapa dapat berkongsi masalah yang dihadapi dengan ibu bapa yang mempunyai anak seperti mereka. Selain itu, kanak-kanak istimewa ini juga menapat pendidikan yang bersesuaian dengan keadaan mereka dan ini dapat meminimunkan kecacatan yang dialami oleh kanak- kanak ini. Apabila menyetai program ini, ia dapat meningkatkan kesedaran kepada ibu bapa bahawa kanak-kanak juga mempunyai kebolehan dan keistimewaan sekiranya di beri peluang untuk mendapat bimbingan dan latihan secara sistematik dan ini akan meringankan ibubapa dari segi jagaan dan latihan serta membantu kanak-kanak menguruskan diri dan berkomunikasi dengan persekitaran. Dengan adanya latihan secara berterusan dan sistematik, anggota badan kanak-kanak dapat berfungsi setelah di buat pergerakan dan dapat berinteraksi dengan rakan-rakan untuk mewujudkan pergaulan positif ini sekaligus dapat memupuk sikap berdikari dalam diri kanak-kanak istimewa ini.

KONSEP PEMULIHAN DALAM KOMUNITI

PDK' One Stop Centre '' sebagai' Focal Point'' kerana ianya satu program yang menggunakan pendekatan integrasi komuniti di setiap daerah dan negeri dan Jabatan Kebajikan Masyarakat memberi komitmen dalam pembangunan Orang Kurang Upaya (OKU) melalui beberapa tindakan iaitu Konvensyen mengenai Hak Kanak- kanak, Proklamasi Penyertaan Penuh dan Penyamaan peluang di Rantau Asia dan Pasifik, Biwako MelenniumFrameworkFor Actoin dan PDK sebagai satu pendekatan altenatif dalam pemulihan OKUMelalui PDK' One Stop Centre'', perkhidmatan kepada OKU akan disediakan di satu tempat bagi memudahkan mereka dan masyarakat setempat mendapatkan maklumat, khidmat nasihat dan keperluan semasa serta latihan yang bersesuaian. Antara peranan PDK ialah Pusat Intervensi Awal OKU, Pusat Sumber maklumat OKU, Pusat Rujukan OKU,Pusat Pendaftaran OKU. Dan Pusat Advokasi.

Salah satu kaedah pemulihan yang diterima pakai oleh WHO dan juga Jabatan Kebajikan Masyarakat Malaysia ialah kaedah Pemulihan Dalam Komuniti (PDK) berasaskan terjemahan asalnya Community Based Rehabilitation System (CBR). Kaedah PDK ini telah dipelopori oleh tiga pakar perubatan dan juga physiotherapist WHO yang terdiri daripada E. Helandar, P. Mendis dan G. Nelson yang telah menghasilkan sebuah manual yang pada peringkat drafnya setebal hampir 300 muka.Jabatan Kebajikan Masyarakat telah terlibat secara langsung dalam penyediaan manual tersebut ini apabila pada tahun 1983 Malaysia telah diwakili oleh seorang Pegawai Kebajikan Masyarakat dan seorang Pegawai Perubatan untuk meneliti draf manual berkenaan dan seterusnya memberikan peluang menilai dan mengubahsuaikan pelaksanaan kaedah ini di suatu Mesyuarat Kumpulan Pakar (Expert Group Meeting) anjuran WHO di Manila.

Hasilnya ialah Jabatan Kebajikan Masyarakat dengan kerjasama Jabatan Kesihatan Negeri Terengganu khususnya, menjalankan satu projek perintis PDK di Batu Rakit berasaskan hasil kajian ke atas profile orang kurang upaya yang terdapat di Mukim Batu Rakit. Kajian itu dijalankan dengan kerjasama semua peringkat penduduk dan Jabatan Kerajaan di mukim tersebut dan melibatkan penduduk daripada sembilan (9) buah kampung sejumlah 17,149 orang.Hasil kajian menunjukkan sejumlah 275 orang kurang upaya dikenalpasti dan merupakan 1.65% daripada penduduk mukim berkenaan.Hasil daripada kajian tersebut telah meyakinkan Jabatan untuk dengan ramainya melancarkan program PDK pada tahun 1984 oleh YB. Menteri Kebajikan Masyarakat ketika itu. Pada peringkat awal pelancaran, Batu Rakit telah dikenalpasti memandangkan mukim tersebut mempunyai faktor-faktor yang sesuai untuk kajian dan juga disebabkan insiden kurang upayaan yang ramai di Daerah Kuala Terengganu ketika itu. PDK ketika di peringkat pelaksanaan awalnya hanya melibatkan seramai 55 orang.

Individu yang terlibat dalam program Pemulihan Dalam Komuniti (PDK) ini boleh dibahagikan kepada beberapa kumpulan:

1. kumpulan pertama Jabatan Kebajikan Masyarakat JKM) yang terdiri daripada pegawai-pegawai JKM bertugas sebagai

a. Penyelaras PDK peringkat negeri terdiri daripada pegawai JKM Bahagian Pembangunan OKU dan kakitangannyab. Penyelaras PDK peringkat daerah terdiri daripada pegawai JKM peringkat daerah

2. kumpulan kedua pula hasil gabungan komuniti yang terdiri daripad

a. Pengerusi - terdiri daripada komuniti setempat / ibubapa pelatih/ pegawai gred Ab. Setiausaha - terdiri daripada komuniti setempat/ ibubapa pelatih / pegawai gred Ac. Bendahari - terdiri daripada komuniti setempat/ ibubapa pelatih/ pegawai gred A dsbd. Ahli Jawatankuasa sekurang-kurangnya 8 orang terdiri daripada komuniti setempat termasuklah ibubapa pelatih

3. kumpulan seterusnya daripada pegawai 2 daripada Jabatan Pendidikan

4. Pegawai daripada Jabatan Kesihatan

5. Pegawai daripada Jabatan Tenaga Kerja

6. BAKTI / kumpulan isteri wakil rakyat

7. Kumpulan Pengurusan PDK yang terdiri daripada penyelia PDK

8. Kumpulan terakhir dalam hierarki ini ialah petugas yang bertugas untuk membuat pemulihan, pengajaran, pengasuhan dan penjagaan kepada kanak-kanak OKU ini. Kumpulan ini yang paling hampir dengan kanak2 OKU kerana mereka sama2 bermain, belajar, dan sebagainya.

Bagi setiap pdk , golongan yang terlibat adalah berbeza tapi ini hanyalah yang paling asas sahaja

CBR: Community Based Rehabilitationin VelloreIntroductionUrban ProjectPartners TogetherVellore CBRActivitiesCBR TrainingFurther InformationContact UsA project looking at Vellore town: its rehabilitation needs and how they can be met.

IntroductionAround 5% of the population of India are thought to have disabilities that may benefit from rehabilitation services to improve their quality of life. The World Health Organisation and United Nations Development Programme have found that a Community Based Rehabilitation (CBR) Programme is the best way to to this for a large population. How that service should be modified in a community with no organised Primary health care, or in an area with a well-developed health care system has not been addressed.This web page describes the CBR services provided by the PMR department in Vellore that have tried to answer those questions. A similar page was written as an academic report and so uses more technical languageCBR: a technical report.Please read which ever you like.TheUrban Project (Vellore CBR)The common problems faced by people with disabilities are: not knowing how rehabilitation can help them, not having the money needed for rehabilitation services as they are too expensive rehabilitation services are provided in a place that is not easy to get to and in a way that is difficult to use there are not enough trained people in India to do the work.The challenge is to find a way to deliver rehab services that works for people with disabilities (PWD) in Vellore and then prove that it works. Community based rehabilitation (CBR) services are one way to do this.

Working together:10 boys make apyramid and all arevisually impaired/blind

Dr Sara runs LCECU clinicsin the centre of town tomake them easier to get to.Partners togetherA different way of doing things in CBR has been suggested that educates people so they know how to sort out their problem: an "educational model".The educational model is different from traditional medical services. Medical services are often seen as being the expert:non-expert model. The healthcare professional such as the doctor is the "expert" about the disease which the patient has. The "non-expert" is the patient who is told what to do by the "expert" doctor. Understandably many people disagree with this model for many reasons!The educational model says that the healthcare professionals have information about the disease and how it can be treated. The patient has information and knows how the disease stops them doing things. Lets put the two together as that way we should come up with a good answer. So the healthcare professionals will pass on what they know, so educating the patients. Together they can find the best way to sort our the patients problems.People with disabilities face many challenges. They often cannot do things due to their disability eg cannot walk. CBR can help people find new ways to do things. The disability has many other effects on their lives. As they cannot walk it is difficult for them to get out of the house. So they cannot get into the community to meet people, shop, go to school or work or be part of any family or community activities. CBR can help people do all these things with their families and communities. People with disabilities are also often "discriminated" against. Many people think they cannot do things that they can do. Many people also looks down on them and will not allow them to do things. CBR looks to find ways to remove this discrimination.ThusCBR is a way within community development for therehabilitation, equalisation of opportunities and social integrationof all people with disabilities.In Vellore we feel that: The rehabilitation services should be more than those found in traditional institution-based services. Institutions tend to provide medical rehabilitation eg provide artificial limbs and mobility aids and teach people how to use them. We would like to give services like "education, vocational training and income generation". The link between rehabilitation services and the culture in which they are is important - what is good in India may not work in the UK. The need to change the way people think about others with disabilities during the training of CBR workers is important.Overall we felt that a community based rehabilitation project was the best way to do this for people with disabilities in India. Starting such a project should look at the culture of the people, involve the community and should fit in with other services that already in Vellore for PWD.The department of Physical Medicine and Rehabilitation (PMR) and the Low Cost Effective Care Unit (LCECU) of Christian Medical College, Vellore, South India have been jointly running a CBR programme in the urban slums of Vellore since 2002. The slum population of Vellore town is 67,174. This project has been covering a population of approximately 23,000.Vellore CBRThis project was set up to show that Community Based Rehabilitation can help people with disabilities in Vellore town through the right assessment, treatment and training. The approach used in the CBR project is an education model which has been found to work in other developing countries. The project uses the WHO training manuals and stresses that people with disabilities need to be able to do things and know about things. People without disabilities must have good attitudes to pwd.The Local Supervisors (volunteers who live in the community) go to classes. They are given the skills they need, including problem solving and how to make use of things they can find near by, plus knowledge on how various disabilities can be treated. They then find people with disabilities in their local area and help them to identify their "felt needs". "Felt needs" are what the PWD wants help with. These needs are then looked at by the Local Supervisors (LS) and PWD working in partnership together to find an answer. The LS act as local rehabilitation resource persons through this education model. The CBR find out what can be bought nearby and what services, colleges and schools there are and set up ways to refer people on to otheres if needed. This should improve the quality of life of PWD.A more detailed break down of the project is given below.Aim:To show that people with disabilities (PWD's) can be helped by suitable assessment, treatment and training in a Community Based Rehabilitation Programme.Objectives:(a) Service Delivery

Surveying Velloretown slums1. To assess what people with disabilities can do as they are found by the Local rehabilitation workers what people with disabilities and their Community think they need from Rehabilitation services2. To demonstrate that this kind of CBR3. Can help people to dress, get around, bath more easily etc. Can improve the physical health and quality of life of disabled persons and their families. Can keep complications as small as possible.4. To enable people with disabilities to learn how to become problem solvers and so to overcome their problems.5. To show that disabled children can be educated in their community. (b) Economic/Money Help5. To help disabled adults to see what jobs they could do.6. To train them in technical skills and work, as near to their homes as possible.7. To train and encourage them in business skills like looking after their money.8. To help people with disabilities settle in their jobs.9. To enable PWD's to become "resource earners rather than being merely resource burners".(c) Training

Training for the rehabworkers usingfun and games!10. To teach the local supervisors how to solve problems.11. To train the local supervisors to use what is available. These resources will include people such as their fellow local supervisors and teachers, plus books like those used on the course.(d) Research12. To study what happens as we set up this pilot CBR project and then use this information to modify the larger project that will follow.13. To follow up people with disabilities at home, in schools and at work - to study the good and the bad, and to learn from them.14. To look at the effect of CBR on the health, social well being and the quality of life of PWD's.15. To look at the good and bad bits, easy and hard, cheap and expensive areas of our rehabilitation services. The services include CBR, general rehab and highly specialist rehab services.The World Health Organisation funded this Community based rehabilitation project for two years. The work started in 2002 and has continued with various sources of funding. A document on Vellore CBR has been published in the WHO India website.http://whoindia.org/EN/Section20/Section23/Section308.htm

Vellore CBRactivitiesAwareness Sessions:

Samuel Nagar childrensinging a songon road safetyPEER to PEER Education:Accident prevention:Children from one of the slum communities (Samuel Nagar) visited a local school (Ida Scudder School) on their Founder?s day. Encouraged by the LS and the team they sung songs, danced and did drama about"prevention of disability through accident prevention".The school enjoyed their visit and were very impressed.The CBR team took part in an Exhibition at LCECU on 9th and 10th December 2004. The pictures and posters looked at problems with General health eg heart problems, life style eg how smoking is bad for you, and what PWDcando.

LCECU ExhibitionLocal school childrentake partat the LCECUExperiencing disabilityby NCC studentsInteraction withcommunity volunteersRole play on roleof volunteersPresenting a plan of actionfollowing a group discussionHealth status monitoringby the hospital staff

Camp participantsenjoying a game

Exhibiting talentsRole play by LSat Filterbed Medunetwork meeting-Look at our strength-Anna Nagar &Samuel Nagar groupLIFESTYLE & HEALTH:Spinal cord injury prevention and management:Spinal cord injury causes people to be paralysed in the legs and/or arms, they also cannot feel anything. This can last a life time.A workshop on "Prevention and management of Spinal Injury" was organised at Voorhees College for members of the National Cadet Corps (NCC) students from local colleges on 11.2.2005. A team planned and organised this programme. The team was from the Rehabilitation Institute and Low Cost Effective Care Unit (LCECU) of CMC including a person with spinal cord injury Mr. Manoharan .Blood Donation;An awareness session on "Blood donation" was given at Samuel Nagar for the community volunteers by the CMC Blood bank staff. Following this meeting a group of youth have come forward to give blood as and when required.Integrated education:A session on the "Role of Teachers" in having disabled children in the normal school was conducted by Mr. Guru Nagarajan for 60 secondary school teachers at Kaniyambadi.Volunteering:A presentation was done at Ida Scudder School. It was on the "role of volunteers" - what can be done as volunteers for PWD in the community. The aim was to encourage volunteering among school teachers and students.A meeting held for volunteers from the community who were in a networking programme to plan to start a forum/meeting called "friends of PWD"SHARING OF RESOURCESReview of a health manualThe CBR team of CMC was asked by the Hesperian Foundation to look at the draft of the "health manual for women with disabilities" before it was published. This was done with Mrs. Usha Jesudassan, a freelance journalist, the local supervisors from the CBR project, women with disabilities from the community and the CBR team members over two days.Focus group discussion on problems of elderlyDr. Sara Bhattacharji & Mr. Guru Nagarajan helped a Focus group to discuss the problems of the elderly in 2005. The group were students from Indra Gandhi National Open University.Training for Tibetan settlements:Mr. Guru Nagarajan helped on two training sessions on "Initiation of CBR in Tibetan Community" at Bylakuppe and Mundgod (Tibetan settlements in Karnataka) by the department of Health, Central Tibetan administration. Ms. Heather Payne from the Christian Medical Association of India (CMAI) and Ms. Kirpa Verghese, CMC graduate also helped.CAMPSGeneral health screening camp:At the request of the community members through one of the Local Supervisors (LS) (cbr worker), a general health screening camp was held in Kagithapattarai. 168 peoples attended the camp. The LS's help in getting everything organised was much appreciated.A special camp for elderly peopleA camp just for the elderly people living in Anna Nagar, Samuel Nagar was held. 43 old people took part in games, focus group discussions and medical screening.NET WORKINGCBR ThiruvizhaA one-day festival for networking PWD in Vellore Town was held at a local school by the LS. 111 persons including 74 PWD actively participated despite heavy rain. Several programmes including indoor games, awareness sessions, a talent show and group sessions were conducted. It is encouraging to note that a number of community volunteers helped to organise the programme. This festival was the first step to shift from individual focussed intervention to group work.Blind leading the blind:Mr. Murugan donateda walking stick toMr. Pattabi.Networking meetings:Following CBR thiruvizha 3 LS have started group meetings of the PWD in their area. The PWD have begun to identify the needs and problems among themselves and are starting to solve these problems using the time, expertise and financial resources found within the group. They have also made use of government and other public or private resources available. The team felt that a series of training sessions on "capacity building" will be useful for improving the organisation of these groups.The team hope to learn the dynamics of rehabilitation needs in the urban community through this project. This project was also designed to be a pilot project for the larger rural project. The full urban project will provide a CBR programme to other areas where there are needs. The department and charitable donations fund the continuation of the project. The experience gained from starting this project has helped to offer training on CBR for WHO fellows and guidance and training for Tibetan settlements at Karnataka State. Training on CBR may be organised if asked foCommunity Based RehabilitationTrainingfor Managers, Co-ordinators and FacilitatorsThe Department of Physical Medicine & Rehabilitation offers a training programme in CBR which is Field based Comprehensive Participatory Integrated ExperientialWho we are? CMC is known for its outstanding and comprehensive health care with a focus on those who are marginalised, as well as for its excellent value based education in health sciences.CMC Home page The Departments of PMR and LCECU offer this training jointly. This training is offered in the context of an existing CBR programme in the poorer areas of Vellore Town.Description of project on WHO website Resource persons for the course will be disabled persons, volunteers from the community, senior medical faculty of CMC from various disciplines like PMR, Psychiatry, ENT, Ophthalmology, Community Health & General Practice; Allied Health Professionals like Physio therapists, Occupational Therapists & Social Workers.Medium:Training will be in English.Who can join?The course is open to professionals in the health / rehabilitation field. This training is open to doctors, nurses, allied health professionals, social scientists, those in GO/NGO sector with an interest in CBR. A minimum of 4 trainees should be available for training.OutcomeAt the end of this training programme the participants would be able to describe the components of a participatory community based rehabilitation programme. list the roles of primary, secondary and tertiary centres. understand the concept of a referral system from community to the secondary and tertiary care centres and back to the community list some socio-economic interventions that can be carried out in the community initiate, carry out and evaluate CBR programme within a particular context. link quality of life of disabled persons and CBR.FurtherInformation:Contact for further details regarding CBR training:S. Guru NagarajanSocial Worker,Rehabilitation Institute,Christian Medical College,Vellore. 632 002, Tamil NaduPhone: 0416-2284554Email:guru@cmcvellore.ac.in