Disability and rehabilitation in rural Jamaica

Persons with disabilities, and existing and potential modes of rehabilitation in the developing world, have yet to attract the attention they deserve from within the medical community or among health care researchers. It is estimated that about 10 per cent of the population, or 450 million people, are disabled (World Health Organization?WHO? 1984). There is remarkably little in the way of descriptive or empirical studies on cultural patterning of disability and rehabilitation, and there is a similar dearth of published information describing international rehabilitation services. The specific objectives of this research are: (1) an ethnographic description of a community based rehabilitation (CBR) project; (2) a description and analysis of the beliefs and behaviors held by or exhibited by the families of disabled children as they relate to disability and rehabilitation; and (3) an analysis of the issues and problems associated with a CBR program in a low-income, rural environment.^ The research for this book was conducted in St. Catherine parish, Jamaica. Eighty-one caretakers of disabled children who are participants in a community based rehabilitation program known as the 3D Project were interviewed. The development of community based rehabilitation coincides with all increasingly universal support of a community approach to all health care and is similar to other primary health care (PHC) models in that it involves measures taken at the community level to use and build upon the resources of the community. It is based on practical, scientifically sound, and socially acceptable methods and technology made universally available to individuals and families. CBR is expected to be low cost and highly accessible to the local people. With regard to the three salient theoretical domains that were the focus of this research: stigma, health beliefs and behaviors, and adaptation, the conclusions for this poor rural population are:. 1.^ Although negative conditions exist, it appears that disabled children are not particularly stigmatized at the household level. Nevertheless, societal stigmatization and apathy do exist. As a result, disabled children are not being prepared to fully integrate into Jamaican society. 2. There is a range of variation of beliefs and behaviors with regard to disability and rehabilitation. The concept of intracultural diversity is supported. 3. This population has adapted their cultural belief systems and actual behaviors to match their material realities. That is, it would appear that people who have a disability, and their caretakers, have demonstrated "contextual accommodation." 4. Community based rehabilitation programs, based on the primary health care and community participation principles enumerated by the WHO are theoretically sound and practically attainable in Jamaica.^ CBR conceptualizes a means by which the positive aspects of the culture of rehabilitation can be transmitted to the community level. The 3D Project is a sound model from which to draw on when developing new programs.