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BRIEF REPORTS

INFLUENCE OF CULTURAL FACTORS ON THE PRACTICE OF CBR IN THE NORTH WEST FRONTIER PROVINCE OF PAKISTAN

Farhat Rehman*

Pakistan is an Islamic country, with its own history and cultural heritage. The North West Frontier Province is one of the four provinces of Pakistan, inhabited by the Pathan tribe, which has a distinct set of traditions and customs. They are different from other tribes in Pakistan in their language, attire, social systems and so on, but have Islam as the common binding force. The customs and traditions are followed religiously by every Pathan, in spite of noticeable social change over the years in this region. The life of a tribal Pathan is governed by unwritten codes of behaviour, which are held sacrosanct by them for ages, and which embrace all their activities from the cradle to the grave. One of the most valued traditional marks of social status in this tribe is the practice 'Purdah' or the seclusion of women from public and social life. Generally men perform the tasks outside the walled dwellings, while women perform the tasks within, going out only to fetch water, fuel, or for a rare social outing in a family function. The Pathan women wear a veil covering them from head to foot on occasions when they go outside the family dwelling to attend family functions such as marriages and funerals, or to visit a relative. However, they remain unveiled inside the family quarters where they live, eat and sleep. There are reports that the women insist on receiving injections through their heavy veils when they visit a doctor. In family functions, men and women are usually segregated, attending separate festivities in different parts of the house. In the larger towns of this province, Pathan women attend higher education and enter professional life in purdah at all times, when they are outside their home. Purdah is thus a central part of the Pathan's life, influencing diverse activities of the society.

CBR IN NORTH WEST FRONTIER PROVINCE

Many welfare organisations are working in the North West Frontier Province carrying out CBR interventions for different disabilities among children. There are a few organisations amongst them, working outside the large towns of this province. In this community, where the use of purdah restricts the interactions of the different sexes, CBR strategies as conceived internationally in many other parts of the world, can become unsuccessful. A report of the CBR experience in Punjab, another province in Pakistan, where the CBR staff who made home visits were badly treated by the family, illustrates this point (1). Strangers visiting homes of the people are not readily accepted and often mistaken for door to door salesmen, meter readers of the electricity board, or beggars. Apart from the differences due to purdah restrictions, the Pakistani society is different in many other ways, such as in the patient's preference to go to the healer to receive medical intervention, rather than the healer visiting him to attend on him. In common with many other areas of Pakistan, services are valued more if they are paid for and obtained from institutions.

EXPERIENCES OF THE REHABILITATION CENTRE FOR THE PHYSICALLY DISABLED (RCPD) IN CBR

RCPD was started in 1985, to help the rural women around Peshawar, in the North West Frontier Province. This centre not only undertook rehabilitation of disabled children, but also gave training to the parents and caretakers of the disabled children in the skills of managing them in their homes. Most of the staff were volunteers and the centre worked for four hours in the afternoons everyday. In 1990, RCPD started Primary Health Care classes for the mothers coming to the centre. They also started training in basic disability related interventions. Later RCPD also added family welfare (family planning) education for the mothers. Although the latter topic is quite a sensitive issue both religiously and culturally, it was conveyed as a disability issue, stating that if a mother had more children, she had a higher chance of having a disabled child, and less chance of caring for the disabled child successfully, because of the additional burden. Mothers took great interest in these classes which were conducted as group discussions with the help of slides, charts and videos. RCPD also had a few seminars on various topics related to disability. During the group meetings with the local communities before these seminars, mothers were requested to participate in them. The community members who attended these group meetings were all male, and promised to motivate some females to attend. But not very surprisingly, there was not a single female participant present during these seminars. The experience of RCPD in the North West Frontier Province points to the fact that for many years to come, it may not be possible to provide disability awareness or skills transfers to a mixed group of male and female consumers from a common platform.

In 1992 RCPD started an outreach programme and extended its area of work to 68 different towns. Both male and female members of the community attended these outreach camps. During these camps RCPD had to arrange for the strict use of purdah at the registration desk, waiting area, examination place and the home management unit. It was clear with this experience that in order to train mothers about disability and to guide them to care for their disabled children at home, some special arrangements with strict use of purdah has to be made.

Since 1997, RCPD initiated disability related seminars for mothers. These seminars were conducted exclusively for female members of the community and male members were not allowed into the compound where these seminars were conducted. Registration of the participants, training sessions, distribution of training packages and even distribution of drinking water and tea, were carried out by female volunteers. The seminars were arranged in a closed compound, and no male staff were allowed to enter the building. These changes in procedures for the seminars produced drastic differences in the results. In one village 220 mothers attended the seminar instead of estimated 120. In another, 180 attended instead of 100,and in a third village 250 attended when 120 were expected. In a seminar at RCPD, 177 attended instead of the 100 expected. In most centres there was not even enough place for the mothers to sit, and they remained standing during the seminar.

CONCLUSION

The experience of RCPD highlights the fact that cultural factors are as important as any other factors in influencing the outcome of CBR. In a purdah observing province like North West Frontier Province, one has to modify the interventions to suit the traditions and customs prevailing in the region to produce the desired change. Some of the changes in procedure introduced by RCPD are female-to-female training methods used at RCPD and its sub-units. During out reach programmes, arrangements are made for exclusive mothers' training programmes, and for seminars and workshops only for women throughout the province. In the context of 3 % literacy amongst rural women in the North West Frontier Province, it is preferable that all educational activities are carried out in the spoken language, without using written material.

Because free interaction of men and women is not permissible due to traditional norm of seclusion of women in this society, millions of disabled children and their mothers cannot be left unassisted. The experience of RCPD suggests that if CBR is planned and practised with due respect to the centuries old traditions and customs, it can be quite successful.

*Rehabilitation Centre for the Physically Disabled, P O Box 201, G.P.O, Peshawar, Pakistan.
Phone : 0521- 277663.

REFERENCES

1. Jaffer R, Jaffer R. The WHO-CBR Approach. Program or Ideology : Some lessons from the CBR experience in Punjab, Pakistan, in Thorburn MJ and Marfo K (Ed) Practical Approaches to Childhood Disability in Developing Countries; Insights from Experiences and Research, 1990




Title:
ASIA PACIFIC DISABILITY REHABILITATION JOURNAL Vol. 10 @ No. 1 @ 2000

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