|
|
|
|
Key issues : Cultural issues : Development, Cultural Values and Disability: The Example of Afghanistan
from Development, Cultural Values and Disability: The Example of Afghanistan by Peter Coleridge
Prevalence: In Afghanistan local surveys indicate that probably about 3% of the population of 20 million is disabled. This gives a figure of about 700,000 people. War injuries (mainly from mines) and polio account for about half this number. The other half is composed of people with mental retardation, cerebral palsy, leprosy in certain areas, deafness, blindness, and multiple impairments. As with all disability statistics one must distinguish between incidence (the number who are born or made disabled) and prevalence (the number who survive). 3% is an estimate of the prevalence. It would be almost impossible to measure the figure for incidence in the present circumstances.
Services for disabled people have tended to focus on the provision of orthopaedic aids and physiotherapy. This is because the appalling conditions in most hospitals mean that a limb damaged by a mine explosion will be amputated rather than saved, so amputees are the most visible manifestation of disability in the country. One foreign NGO is working with deaf people and two others with blind people, but that is as far as specialised services go.
The original design of CDAP, written in 1994, was a classic example of an external, non-consultative project formulation, written by three western development specialists from Sweden and Germany who did not visit Afghanistan during the formulation stage. The present project document, written in early 1997, had the benefit of a major evaluation of the programme conducted in the summer of 1996. However, that evaluation did not seek to probe cultural relevance explicitly. This task belongs to ongoing monitoring of the programme, and must be built in to its management and implementation strategy. This means, as stated at the beginning of the paper, that its staff must be trained as social animators, to raise questions, to be objective about their own culture, and not simply to deliver a packaged service.
One senior worker 8 in CDAP has identified what he calls a CBR conflict zone in the programme, where local concepts of disability, culture, poverty, the nature of CBR, and local social values meet. The following paragraphs explore this conflict zone and summarise conclusions that can be drawn so far on whether the programme is in tune with local values and whether it can be used for stimulating and animating a development process that is wider than disability.
We have already identified a number of factors leading to the segregation of disabled people, in particular the importance of being able to marry in order to conform to social norms of acceptance. Where this is impossible, the individual lives in a kind of liminal limbo. Not only may a disabled person not be able to get married, but the presence of a disabled person in a family may affect the marriage chances of other members of the family (because disability is regarded as shameful) and cause resentment towards the disabled person by other members of his or her own family.
Apart from the crucial matter of marriage is it possible to identify other attitudinal factors affecting disabled people in Afghanistan ? It is often thought in the west that disabled people get a particularly rough deal in poor countries like Afghanistan, and extremely negative myths are perpetuated, for example that disabled children are killed at birth. Attitudes to disability in Afghanistan have never been systematically researched, and all one can say at this stage is that anecdotal evidence points in the opposite direction from these myths. In rich countries like America it seems that disabled people get their worst treatment from the wealthy. 'Successful' Americans obviously feel more threatened by disability as a 'defect', and therefore a departure from what they aspire to, than people of lower social status do. Discrimination against disabled people seems to occur, according to American researchers, in direct proportion to wealth. 7 In a country as poor as Afghanistan it may be that there is less discrimination towards disabled people than there is in America. Poverty is a great leveller. On the streets of an Afghan town it is common to see a disabled child being pushed along in a crude cart by other children, with no sense of embarrassment. Amputees are such a common sight that they are accepted as part of the normal scene in a bazaar. The caring and concern shown by both mothers and fathers towards their disabled children, especially the mentally retarded, never fails to impress. The main problem is not neglect but over-protection, under-stimulation, and ignorance of how to help the child develop.
However, this does not mean that it is better to be a disabled person in Afghanistan than in America. It is certainly true that the survival rate of disabled Afghans is low, but this is more likely to be because of the lack of health services, not because their families reject them. There is, for example, almost no treatment for spinal injuries, which means that many paraplegics and most quadraplegics die within a year of injury. Some disabilities are more 'acceptable' than others. Amputees, partly because their ability to communicate and reproduce is not impaired and partly because they may be regarded as having made a sacrifice in war, are easily accepted. Other disabilities, especially congenital ones, are often regarded as a shame, and are largely absent from public view. It is common for parents to claim that their child became mentally retarded after a bomb attack in order to conceal the congenital nature of the disability.
Disability is still generally seen as a medical problem or one brought about by divine punishment or a person's bad luck, which can be removed only through either medical or religious intervention (or both). The quest for a cure has often been protracted, expensive, and hopeless. Such attitudes (by no means unique to Afghanistan) make it difficult for a CBR programme, which offers no cure, to gain early respect.
The notion of empowerment, as described in the section on disability and developmental values above, is very problematic in Afghanistan. The word is inappropriate. In a seminar on cultural values with the CDAP management team already referred to, the word 'empowerment' was rejected by all the participants on the grounds that power in Afghanistan means power over somebody else. It is not regarded as win-win, only as win-lose. One can only be empowered at the expense of another. The group favoured the word 'enablement' instead. But even this is a concept not easily understood in a situation where people may not aspire to individual development at all, imbued with cultural values that are dominated by the need for collective family survival and kin-group solidarity.
The formation of DPOs has brought 'rights' into the consciousness of many disabled people at the village level. By rights they usually mean equal access to what limited services are available, especially health and education. DPOs tend (as elsewhere in the world) to be dominated by men with mobility impairments, which in Afghanistan means amputees. Given that many of these will have been disabled in war and are therefore ex-soldiers they are often forceful, and are not obviously lacking in self-esteem. The main problem is to achieve representation of other disabilities in the DPO.
The attitude of people with other impairments, especially sensory, is often depressed. This is particularly true of women.
CBR by its nature is long-term, time consuming, usually not very visible, and with few material inputs.What is the general community view of a CBR programme? How do they compare it with other aid and development programmes which bring more material benefits? Does a programme lose credibility and value in the eyes of the local community if it is dealing only with 'ideas and paper'? A common response from CBRCs and DPOs, as well as individual disabled people, when asked for their recommendations to improve the programme, is that it should deliver some kind of 'incentive', by which they mean material handout. The employment support element of the programme, which gives skill training and loans to disabled people, is what many adults see as its main value. CBRCs also regularly ask that such loans and training be extended to very poor non-disabled people such as widows.
What status do CBR workers hold in the community? Are they respected for what they do? If yes, is that because others admire them for working with disabled people? Is religion a major motivating factor for them? How far can they be catalysts for wider change in the community? As already noted, the potential for a CBR programme to make a contribution to development on a scale wider than disability rests on these field workers. Their selection and training is therefore of crucial importance. It is worth stressing that the physical energy required to be a CBR worker (MLRW in this programme) in rural Afghanistan is considerable. To cover a population of 15-30,000 they have to travel large distances in extremes of climate on roads which in many cases hardly exist, either on foot or on a bicycle, or in one case on a horse. To keep up the level of visiting required day after day, month after month and year after year, demands a very special kind of commitment. The astonishment perhaps is that a CBR programme works at all under these conditions.
When questioned on their motivation for the job MLRWs frequently report that religion does play an important role, coupled with a desire to serve their community. Getting to know their community brings its own rewards for many, who see their status rise by the fact of having to mobilise people. Employing disabled people as MLRWs presents a problem because of the arduous and physically taxing nature of the job, but a few MLRWs are disabled.
The mechanisms for dialogue with local communities are the individual families, and the CBRCs and DPOs at village and district level. The membership of the CBRCs is drawn from local health workers, teachers, disabled people, parents of disabled children and other interested persons. Sometimes they are congruent with local shuras dealing with general development issues in their own community, sometimes they are independent of these shuras. Disability is not a power issue; it is not something which people fight over. These CBRCs represent neutral territory. Dialogue with these groups is likely therefore to yield a closer reading of what people think and feel about development issues generally, and they can be used as an entry point for such discussions. At the same time their members see their membership as giving them more status in the community than they had before, as well as experience of organising, debating, and deciding. They count for something in their own eyes, and in their own communities. Separate female CBRCs exist in both Taliban and non-Taliban held areas. Disability does indeed open pathways to a different view of development that is not based either on power or materialism.6
For example, the minutes of a CBRC in Herat in January 1998 reveal that over two meetings they discussed the following issues: finding a place to run a vocational training course in tailoring for disabled women, raising the money to provide lunch for the trainees, identifying a skilled person to act as trainer, the lack of textbooks in schools, home schooling for girls, malnutrition in several families. They arranged the training course successfully, and identified women who could provide home schooling for girls. As can be seen, their discussions were not limited to disability issues. They were obviously and justifiably proud of the two achievements of arranging the tailoring course and home schooling for girls. The field worker, who had instigated the formation of this committee, remained in the background, observing and encouraging, a genuine but discreet change agent. Something was happening in this community that was indeed developmental. The word 'empowerment' came immediately to mind in observing this process, even though it may not translate well into Farsi.
Key issues : Cultural issues : Development, Cultural Values and Disability: The Example of Afghanistan
 |
 |
 |
14/07/1999