The prospect of living with a debilitating injury or illness can be quite daunting for many, particularly for young people whose capacity not only to engage in their accustomed activities, but also to achieve their life goals, has become restricted by the limitations of their disability. Young adults with spinal cord injury, acquired brain injury, stroke, and other neurological disabilities such as cerebral palsy and neuromuscular dystrophy, belong to a sector that represents one of the most challenging fields of rehabilitation in Qatar.
This sector is the main target group for the award-winning Community-Based Rehabilitation (CBR) project team at Rumailah Hospital (a member of Hamad Medical Corporation or HMC), which carries out a unique, holistic approach to addressing the needs of people with disabilities at the community level, and to advocating their rights.
“CBR provides the link between HMC’s rehabilitation services and the opportunities in the community,” said Zvjezdana Zafa or Jiji, as she is known to both colleagues and clients. Jiji, who has been a dedicated community occupational therapist for 13 years, led the CBR team when the project, entitled Community-Based Rehabilitation in Qatar: How it Positively Influences the Lives of People with Disabilities, won the 2011 Sultan Bin Abdulaziz Humanitarian City Award for Excellence in Rehabilitation Services. The award was granted at the Arab Health conference in Dubai in recognition of the team’s contribution to the field of rehabilitation services for the people of the region. (Recently, the CBR Program has also been shortlisted for the Arab Achievement Awards.)
On an ordinary day, the multidisciplinary CBR team – which consists of an occupational therapist/team leader, another occupational therapist, physiotherapist, nurse and social worker – would be conducting home environment assessments, giving recommendations on how to make areas such as bathrooms, kitchens and entrances simpler and more suitable for someone with disability, and training the client in instrumental activities of daily living. The team also conducts job evaluations, learning about the client’s skills, education and interests and assisting him or her to find employment, as well as working with prospective employers to ensure accessibility in the workplace.
“Having a job is very important as it gives economic security. It is also a requisite if our clients want to get married and have families,” Jiji pointed out. “With young clients who are still at school age, we work with schools to make sure they are suitable in terms of accessibility, as well as the readiness of the students and teachers to accept our clients.” The CBR team also looks for ways for clients to spend leisure time, such as through sports or arts and crafts.
But the CBR team’s role extends beyond the clinical aspects of rehabilitation. “We need to include empathy for people with disabilities. We need a lot of creativity and flexibility to effectively deal with the challenges of our clients in terms of being integrated into life within the community,” said Jiji. “We also need to work not only with the clients but also with their families and the community, as well as the government, in order to find ways to integrate them.”
“CBR visualizes that people with disabilities be as independent as possible in all aspects of life and participate fully in society, instead of being treated as patients,” said Alaa El Din Gomah, a physiotherapist and member of the CBR team. Alaa has worked with people with disabilities for 37 years – an entire lifetime, he said. “Because our clients can spend several months in acute treatment and rehabilitation, they need a lot of support so they can return to the community and continue their education, find employment, or find their place in sports. We help them to maximize their capacity, to use what they have to lift themselves and become more independent. We encourage them to continue life.”
With Alaa’s aid, Mohamed Salem, a 35-year-old Qatari, related his story as a client of CBR. Mohamed was born with cerebral palsy, and as a child was mistakenly categorized as “mentally retarded”. At age 8-14 Mohamed was brought for treatment to Rumailah Hospital, and with CBR was able to complete secondary school through distance learning – obtaining the regular certificate instead of the special certificate usually granted to people with disabilities. Mohamed also started playing sports at the Qatar Sports Federation for Persons with Special Needs, and went on to play in the Guangzhou 2010 Asian Paralympic Games, earning a bronze medal.
Mohamed is now attending community college to qualify for university in two years, learning how to start his own business, and planning to get married. “The CBR team got me the proper equipment so that I can come and go, encouraged me to complete my studies, and helped me get a job as a typist at the Supreme Council of Justice. They helped me to gain self-confidence and feel like a normal person. I became closer to the community,” said Mohamed. “I was away from the light, and they brought the light to me.”
“We believe that institutions are not the best solution for people with disabilities, because they become segregated from the community. We look for options to promote their integration into mainstream life,” Jiji explained. Promoting greater acceptance by the community is one of the biggest challenges facing CBR in Qatar, but in general the local environment has changed considerably within the past ten years – thanks in part to the team’s involvement in promoting multi-sectoral collaboration among the government and private sectors. CBR has been the leading force in Qatar in regard to ensuring that the rights of people with disabilities are upheld, particularly those outlined in international documents such as the United Nations Convention on the Rights of People with Disabilities.
“Now we see many more people living with disabilities outside in the community. The accessibility has improved, they are being integrated in schools and employment, they are having their families, and their voices are being heard,” said Jiji. The team was also involved in workshops in aid of the drafting of the Qatar Access Strategy, advocating with the Qatar Society of Engineers to promote accessibility in roads and infrastructure.
Nasser, another client, was driving towards Doha when he met an accident and sustained a spinal cord injury. After his treatment in the UAE, he came back to Qatar, depressed because he could no longer walk, and could not finish his university education. “The CBR team explained to me the rehabilitation process, and advised me on what to do in various aspects. Instead of lying at home for weeks as I was doing previously, I learned to be involved in the community and to start a new life.”
Nasser eventually went back to university and obtained a degree in Hospitality, but found it difficult to get employment. “Some employers think that people in wheelchairs not only cannot walk but also cannot work, but this is not true. We can still think and use our hands, and we can still manage. Our disability is not a barrier for us. Many people in high positions cannot walk.” Aided by the CBR team, Nasser was finally hired by HMC. He became senior supervisor for its Customer Care Department, and has since been promoted. “Life is beautiful,” Nasser said. “People living with disabilities must believe that they can still use what they have to live a full life.”
“Last year we organized the Gulf Disability Week, and we made sure that people with disabilities like Nasser were with us in the organizing committee,” said Jiji. The CBR team believes that people with disabilities are the best advocates for themselves – not only as partners but as leaders in the movement for their integration. The team hopes that CBR, an evolving concept, will gradually take a much larger and more active role in advocating the rights of people with disabilities, particularly in view of Qatar’s National Development Strategy for 2011-2016.
Mohamed Idris, another client, also shared his story with the help of Alaa. Mohamed worked as a steel designer before he sustained a spinal cord injury from a car accident, spent some time in intensive care, and became too depressed to go outside. “Jiji encouraged me to become part of the community again, and to continue life,” Mohamed said, relating how the CBR team brought him to visit different places such as malls and museums, and assisted him to learn computer skills so he can continue work as a designer. A cheerful, energetic young man, Mohamed now moves around on his own in his electric wheelchair, and is attempting to set a world record for a letter for world peace by people with disabilities.
“We encourage our clients to be independent while also being available to give them support and advice whenever they face any obstacles,” said Alaa. “It is very challenging, but it gives me a sense of satisfaction to be able to make someone happy and more self-confident.” “It is a joy for us to be able to help our clients achieve their goals, and regain their dignity,” added Marcelo Carmen, an occupational therapist who is also part of the CBR team.
“Some of our former clients remain in touch and share their successes with us,” Jiji said, relating the story of Ahmad, who was a football player before a spinal cord injury confined him to a wheelchair. The team assisted Ahmad to get a job in a well-known furniture company, and to start playing sports for people with disabilities. “He called to tell me how happy he was that he was doing sports, and that he was going to Dubai for a championship. Ahmad found a new motivation, proving that if one door closes, another one opens.”
Another former client, Abdulrahman, had been reluctant to be discharged from the hospital, fearful of the challenges that await him outside. After undergoing CBR, he continued his studies in the United Kingdom, and is currently a champion in athletics. He helps encourage and advise other clients who are facing difficulties. “Abdulrahman is one of those who inspire and empower me, having completely turned his life around from being just an ordinary young man who loved fast cars and led a carefree life,” Jiji said with pride. “He has become a true inspiration to other people who are living with disabilities.”