ISPO An Asian Prosthetics and Orthotics Workshop '98 in Japan Final Report

Papers

PROSTHETIC & ORTHOTIC TRAINING FOR COMMUNITY-BASED- REHABILITATION WORKERS IN MALAYSIA

Zaliha Omar

Summary

The structure of training programmes for Community-Based-Rehabilitation (CBR) workers varies greatly amongst providers of CBR services in Malaysia. There is no accreditation system for individual training programmes. The curriculum for training of these workers does not include Orthotics and Prosthetics.

Introduction

CBR was first introduced in Malaysia in 1984 by Mrs Padmini Mendis when she trained nine staff of the Social Welfare Department in rural Terengganu. The concept of home-based programmes for individuals with disabilities soon became popular amongst several voluntary organisations. Today, the World Health Organisation's (WHO) CBR approach has been adapted by the Social Welfare Department, voluntary organisations as well as the Ministry of Health. There arc no fewer than 170 CBR projects throughout Malaysia.

At a workshop on CBR that was organised by the Ministry of Welfare Services and the British Voluntary Services Overseas in 1989, the WHO definition of CBR was adapted so that it could be applicable in Malaysia. The key points in CBR that were adapted were:

• Ensure the involvement of persons with disability, their families and community in actions taken at the home and community level.
• Prevent possible complications resulting from disabilities.
• Ensure acceptance and integration of persons with disabilities in the family and community.
• Make available assistance to families of persons with disabilities.
• Use local resource materials to make aids and appliances for persons with disabilities.
• Assist persons with disabilities to achieve their maximal potential so as to live as independently as possible.
• Ensure prevention of disability through awareness programmes and counselling.

Prosthetic and Orthotic Services Within CBR

Very simple orthoses can be made by CBR workers but it is only very rarely done. Most of the time the orthoses and prostheses, when required, are obtained through referrals to Hospital. Kuala Lumpur, the three university hospitals or the "Mobile Orthotic and Prosthetic Services" provided by about five private prosthetic and orthotic companies throughout Malaysia.

Training of CBR Workers

By and large, training of CBR workers varies greatly amongst providers of CBR services in the country. The largest group of CBR workers i.e. from the Department of Welfare, undergo a one-week basic training with subsequent ad hoc training programmes. The Department has developed a guideline on staff and administrative matters which CBR workers can adhere to.

Training of CBR workers amongst voluntary organisations varies greatly depending on their staff composition. The spectrum is very wide ranging from professionally qualified staff like occupational therapists, physiotherapists, speech therapists, social workers, special educators, etc. to minimally qualified individuals. The training in CBR itself is also very varied ranging from an Advanced Certificate course in community services to customised CBR training as well as on-the-job training.

Prosthetic and Orthotic Training for CBR Workers

The structure of training of CBR workers is not standardised. At the moment there is no system of accreditation of the individualised or the ad hoc on-the-job training programmes. The topic "Orthotics and Prosthetics" is not in the curriculum and is not always included in these programmes. Even if it is, the subjects are mentioned only in passing and merely confined to familiarisation with simple orthotic and prosthetic terms.

Conclusion

Though the exact numbers of people with disabilities requiring orthoses and prostheses are not known, a substantial number must be in need of them. Considering that CBR is the most accessible rehabilitation service for anyone with a disability, it therefore seems most appropriate to equip CBR workers with a basic knowledge of orthotics and prosthetics as well as skills for the use of very simple ones. The focus should be on orthotic and prosthetic management of disability stressing prevention and promotion of use, as well as ensuring usage in early intervention programmes.

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Commemorating the Mid-Point of Asia and Pacific Decade of Disabled Persons
ISPO An Asian Prosthetics and Orthotics Workshop '98 in Japan Final Report
- Papers : The Training of CBR Education for Prosthetics and Orthotics in Malaysia -

Editors:
Eiji Tazawa
Brendan McHugh