RESNA 27th International Annual Confence
Appropriate Technology Project Models In Developing Countries
There has been a recent increase in interest in appropriate technology among rehabilitation professionals. There are many different models for projects in developing countries in use today. Examination of example projects and a description of typical project components will help to illuminate this mysterious activity for those new to it and will help to order the thoughts and views of those who are already involved.
Appropriate technology, developing country, sustainability
Over the past ten years I have had the opportunity to work with creative organizations in places like Sri Lanka, Russia, Bangladesh, Nicaragua, and China. These projects have been focused on design, production, and clinical training in the field of seating and mobility for children and adults with disabilities. Each project has it's advantages and disadvantages depending on the circumstances of that particular project
Mexico 1992 - Two American OT's (Occupational Therapist), one PT (Physical Therapist) and one designer visited a rehabilitation project in the mountains outside of Mazatlan to introduce a seating simulator design and conduct two weeks of training in OT and seating assessment. The local team was grateful for the training but were not fully involved in the planning. This input had a "top down" feel from the perspective of the local team. Involving the local team more closely in the planning and need assessment would make this input much more useful. Many such "mini" projects seem to benefit the trainers more than the trainees. Some of the trainers in this example had their first experience in this type of work and continue to do work in developing countries today.
Bangladesh 1996 - An eight person multi-disciplinary team of OT's, PT's, SLT's (Speech and Language Therapist), designers, and engineers established a base in the capital city of Dhaka from which to operate from for nearly two years. In this time a seating and mobility service was initiated in a nearby rehabilitation hospital. Six OT's, PT's, and engineers were trained in the prescription, and provision of seating and mobility for children with a variety of disabilities. Two OT's were trained to provide SLT services. Products were designed to be produced in batches and modified to meet the individual needs of the users. The local engineers were trained in custom design in order to apply the same skills to other rehab technology needs. A complete training package remained with the local team who were trained and given practice in presenting the training to others. This comprehensive project model was time intensive. There was a high reliance on foreign experts to conduct all aspects of the training. The local team had constant support until the end of the project at which time they were suddenly independent. Besides a follow up review of the results and feedback, there was very little post project support planned. However, it is not uncommon for this organization to apply for follow up funding to upgrade existing projects. The training materials produced on this project were extremely useful to subsequent projects
Nicaragua 2003 - One engineer/OT and one Seating Trainer / Designer worked with a wheelchair factory and a group of eight therapists in training for production and provision of seating and mobility for children with disabilities. The training was planned in two sessions of one month each with three months of independent practice between sessions. The project was planned with a minimum of foreign expert presence and maximized the recourses and skills available in the country. The schedule of this project was strained due to the fact that clinical and technical training were conducted concurrently. This did not allow adequate time for technical training before demands were placed on production by the clinical team. This modular model was efficient in terms of minimizing costs and time of foreign expert trainers. However, planning of discrete training modules would have improved the focus of both clinical and technical training. This project relied on a relatively high skill level of the therapists and technicians receiving the training. Had this high skill level and experience not been available, more training time would have been essential. Unlike the example in Bangladesh, the trainees in this project all held full time jobs. It was expected that the provision of this new service be included in their expanded job descriptions. The long term sustainability of this project is largely dependent on the commitment of the newly trained clinicians and technicians to work together and on the continued support of their superiors. Ongoing support from trainers was included in the project budget and was conducted through E mail.
RESNA 1996 onward - Chesney et al explain that in order to stimulate designs for low-cost, locally-produced wheelchair cushions, an International Cushion Design Competition was started in 1996 by the RESNA special interest group on International Appropriate Technology (SIG 17) (1). Through this competition and other SIG 17 activities many professionals in North America have an opportunity to network with individuals and organizations doing work in developing countries and to make useful contributions at many levels to help alleviate this great need.
Whether the project donates refurbished wheelchairs or sets up local production of wheelchairs, the components of a well planned project remain the same.
Invitation - The active pursuit of assistance by an organization from a country in need can be a good indication of the commitment they will show to sustain these services after the training is complete.
Research - It is best to conduct prior research regarding the need of the beneficiaries, and the human and technical resources available in the country before the project is planned. This presents further opportunity to evaluate the commitment and organizational skills of the inviting organization.
Project Planning - Once the research is complete, the design of the project will include input from experts in each field being trained. Ideally, the experts who are likely to conduct the training will be contributing to the planning of the project.
Funding - With a plan in place and a budget outlined, the funding agency can be approached with a coherent plan including all foreseeable costs. Running costs for the services, once established, will come from beneficiaries to some extent. However, a large portion of the funding will usually come from government contracts as well as foreign and domestic donations. The local team should be supported in developing the skills necessary to pursue these funding sources in order to sustain the service.
Implementation - In order to help the local services become more independent, most project models will include a strong training component. The aim is to have a sustainable service in the country. The goal is to provide the means to achieve this aim by training local experts.
Local Management - One way to support local autonomy is to plan the project from the start to be managed locally. There will be a hand over of responsibilities throughout the project which , depending on the length of the project, may start as early as the planning stages.
Ongoing Support - Independence and autonomy of the local team will not preclude an ongoing support from the foreign experts. It will take some time for the trainees to reach the level of experience of the trainer during which time they should be encouraged to ask for advice and opinions as often as possible.
Regardless of the project model, some factors will always have a great impact on the success of a project.
Key People - A project in Moscow Russia started in 1994 to provide seating and mobility to children with Cerebral Palsy. Natasha Yakovleva received the majority of the clinical training and remained with the service long after the project ended. In 1998, a fter several moves and near termination of the service, Natasha formed Humanitarian Programmes Support Charitable Foundation (HPSCF) which continues to operate today thanks to the dedication and commitment of a very key person.
Trainer / Trainee Relationship - Considering that the real and lasting contribution to the formation of a new field in any country is primarily intellectual, it is not surprising that a mutual respect between trainer and trainee will produce the best results.
Flexible Attitude - Working in a new location will present unexpected challenges. Remaining adaptable with regard to methods and goals is essential. More than usual, forcing a plan, irregardless of the conditions, will only result in frustration for all. Surprisingly, cultural conflict is much less common a problem than ego conflicts between foreign experts. Being the "expert" puts a trainer at risk of exaggerating his/her own importance. Keeping a sense of humor about ones self is invaluable.
Listening - The knowledge that one's purpose is to teach makes it difficult to learn at the same time. Without listening to a patient one cannot properly treat them. Similarly, without listening to a trainee one cannot properly train them.
Special thanks to Beneficial Designs (www.beneficialdesigns.com).
Jamie H. Noon
941 Calle Mejia Suite 317
Santa Fe, NM 87501
EMAIL : firstname.lastname@example.org