TITLE REHABILITATION TECHNICIAN STUDENTS’ TRAINING IN COMMUNITY BASED REHABILITATION IN MALAWI

MESSAGE Methods to improve training of Rehabilitation technician students in Community Based Rehabilitation

Executive Summary
Rehabilitation Technician Students are being trained in Community Based Rehabilitation (CBR) in Malawi. This training seems to be inadequate. This document highlights methods to improve training of Rehabilitation Technician Students in CBR in Malawi.

First and foremost, improving the approach of training is a key for effective student training in CBR. These areas include a comprehensive curriculum, use of appropriate appliances, methods of conducting health talks, inclusion of field visits and using audio-video teaching aids.

Another area is improving students’ welfare so as to create an enabling environment for learning during CBR placement. The document also highlights the importance of good accommodation, provision of basic needs and allowances and promotion of a good health environment for students.

Finally, improving the students’ attitudes towards CBR will enhance their training. Bad altitudes affect learning. Students’ roles should be evaluated and they should be accorded a chance to express their views. These areas highlighted above may greatly improve training.

Introduction
Rehabilitation Technician students are being trained in CBR in Malawi. This prepares them for their CBR placement. However, their training seems to be inadequate in some aspects. This is evidenced by the constraints that students experience and express after their placement. This article is intended to highlight methods to improve CBR training.

Improving the approaches of training is a key for effective student training in CBR. New models of training should be studied, developed and adopted. These models, while acknowledging their roots in medical practice, should move beyond the "bare-foot doctor'’ approach and investigate community and empowerment models. Disability must become the major focus (John Paterson 2000). Its effect on community integration and how it may lead to handicap should be highlighted. Knowing this improves the way students will approach persons with disabilities (PWDs).

The lecture content on CBR should be comprehensive. These new curricula could begin with a study of disability in the community. At present, most curricula focus on studying the cause of disease and rehabilitation of people with various types of impairments (physical, intellectual, etc.). While the study of handicapping conditions is an important part of CBR training, educators and managers must remember that the uniqueness of CBR is firmly based upon the first word in their title, that is, community (John Paterson 2000).

On the other hand preparing students on ways of using locally available resources in making appropriate appliances prepares them for the placement. CBR emphasizes the use of appropriate and locally available resources. There are certain materials that are universally available. Some of these materials are wood, paper and scrap metal. The students should be taught on how to use them in a community setting. For example, use of paper to make simple appropriate assistive devices. They should not only know how to make them, but also how to use them.

Similarly, educating students on methods of conducting health talks within the community is important. This helps them communicate effectively to clients. These methods will include focus group discussion, presentations using posters and community lectures at different centers in community (churches, schools and clinics).

Some creative students choose to run programmes in their clients’ homes educating them, their families and neighbours on the causes and prevention of disability. This could be the most effective way of getting people in the village thinking and talking about disability. The groups are often smaller and people find it easier to share thoughts and ideas about disability (Monique Baxter 2002).

Giving students a practical experience before the actual placement builds their confidence. This can be in the form of field visits. Field visit sessions are essential from the very beginning of any training programme so that participants can put into practice what they have learned in the 'classroom' (Elizabeth Henley et al 2000). A Field visit provides a practical lesson to students on CBR. Field visits should not only encompass areas on CBR. They should include other stakeholders and their involvement in CBR.

Another area that may improve students understanding is the use of audio/video teaching aids on CBR. These contain highlights of CBR in community, and are effective during theory sessions, and in transmitting the message before the field visits.

Further more, improving students’ welfare creates an enabling environment for learning during CBR placement. Key areas are accommodation and basic needs (food, toiletries, good housing etc). Students will need enough space, well constructed rooms, good beds and beddings, good toilets, adequately furnished kitchens and good ventilation. These small things if not present could sidetrack students from their learning.

In the same way, providing allowances helps the students cope with day-to-day expenses. This may seem not true if the school provides all the necessities. However, there are certain expenses that schools may not be able to provide. For example, expenses on things like toiletries. The school may not provide these. On the other hand, this helps students to learn to take care of themselves during the placement and that is part of learning.

Similarly, the health of a student may affect his/her education, particularly during placements far from home. The school should actively be involved in ensuring that the students’ health matters are looked into, and ensure that students are living in healthy environments, and that they are provided with help e.g. transport to good hospitals in cases of illness. Students should be provided with mosquito nets or any preventative measures that might be necessary to that area. This is helpful because in most cases students are sent to areas where they do not have relatives to assist them in case of such emergencies. Therefore they are dependent on the school. Subsequently, improving students’ attitude towards CBR improves their training.

Students’ attitude should be evaluated in order to develop areas of inadequacy. Although CBR education would be expected to have an influence on attitudes, this has not been observed, perhaps because CBR training sites do not usually included detailed objectives for the acquisition of attitudes in their curricula. However, there is a strong sense of support for attitude training. The predominant strategies for attitude training are the mentoring role of CBR educators. The students' field experiences may also be a strategy to help improve their attitude (John Paterson 2000).

The students’ role in CBR should be defined and discussed. This accords them an opportunity to express their views. The roles are diverse and include the actual hands on to being role models to the community. In most cases what is emphasized is the provision of rehabilitation services. This is not enough, therefore other social roles must also be emphasized.

Mzota Robert Kabibwa
Physiotherapist Dip PT, B. Sc. PT.
Physiotherapy Tutor
Rehabilitation Technician School
Malawi Against Physical Disability (MAP)
P. O. Box 256 Blantyre Malawi