PROJIMO: Program for Rehabilitation by Disabled Youth of Western Mexico
by Heather Toporowski, PT
It has been a desire of mine for some time to use my physical therapy
training and experience to volunteer in another country. I have also
been interested in learning Spanish, in order to be able to volunteer
and travel in Central and South America. I have not had any previous
overseas volunteer experience and so I was looking for an opportunity
that would enable me to learn more about the concept and provision of
Community-Based Rehabilitation. I was also looking for an opportunity
that would allow me to volunteer for a shorter period of time, as many
programs require commitments of one to two years.
Through research on the internet, and also through reading a book on
CBR (Disabled Village Children by David Werner), I became aware of
Project PROJIMO, in Sinaloa, Mexico. PROJIMO offers a unique
opportunity for health professionals to combine volunteer experience
with Spanish immersion (via classwork and living with a PROJIMO family).
The program began in Ajoya, a small hill town in Sinaloa, in 1981, with
the advocacy of David Werner, who continues as an advisor. The program
relocated in 1999 because of increasing problems with crime and
violence related to the drug trade. The program moved to Coyotitan, a
small town just over an hour from Mazatlan, which is safer and more
accessible. A second program, the Children's Wheelchair Project,
makes wheelchairs and is located in Duranguito nearby. Several books
have grown out of the experiences, including Disabled Village Children
and Nothing About Us Without Us.
The development of PROJIMO was spurred by the fact that Mexico has no
welfare system and does not have wide-spread free access to health care
or statutory provision of disability aids such as wheelchairs or
artificial limbs. Consequently, it is difficult to find adequate
rehabilitation, counselling and services. Orthopaedic aids and Physical
Therapy are very expensive. The few free services reach only a small
fraction of the children that need them.
The PROJIMO program is a community- based rehabilitation and education
program run by and for disabled people. Many members first came for
rehabilitation or aids and then decided to stay, and learn and work.
Different persons take charge of different aspects: consultations,
record-keeping, accounting and different shop activities, such as
making aids and wheelchairs. It has cooperative, informal organization
and management.
The two main objectives of the program are:
To work with disabled persons and their families to increase abilities and opportunities.
To raise the consciousness of non-disabled persons and school
children to include disabled persons in the life of the community and
"to look at strengths, not weaknesses".
Disabled workers provide therapy, counsel families about how to assist
(but not overprotect) their disabled family member, and teach
activities of daily living, including self-help skills necessary for
living independently. Families are encouraged to participate as they
are able, providing assistance with exercises, making aids, carrying
out daily maintenance and other work at PROJIMO. They also make a wide
variety of adaptive equipment including prostheses, orthopaedic aids,
custom seating, and wheelchairs.
Other activities include teaching in schools to encourage integration
of children with disabilities, and programs for prevention of injuries
in school children.
The intensive Spanish immersion program costs $150 U.S., which covers
the cost of a homestay with a PROJIMO family, and four hours daily of
classes with two teachers who formerly came to PROJIMO for
rehabilitation, and who now are "maestros". Volunteering is very
flexible, and volunteers develop their own schedule for work and
classes with the input of the PROJIMO staff. The centre operates Monday
through Saturday.
When I arrived I was greeted at the Mazatlan airport by Miguel, who is
the PROJIMO driver, amongst his other duties. Coyotitan is a small town
of about 2000 people, inland and in the beginning of the foothills of
the Sierra Madre mountains. The PROJIMO complex is on the outskirts of
town and includes a therapy room, offices, workshops, and rooms for
live-in patients. Surrounding the rehabilitation complex are the homes
of the PROJIMO staff.
Initially, I took four hours of Spanish classes each day, and tried to
fit in volunteer time in the therapy room in both the mornings and
afternoon. As my stay went on, after discussion with my teachers and
with Mary, I cut back my time in classes in order to spend more time in
therapy. They were very supportive and understanding of my choices.
Ultimately, I ended up with 2-3 hours of Spanish classes daily, as well
as spending 5-6 hours per day on therapy activities. Evenings were
spent doing Spanish homework, writing up programs for patients, and
sometimes playing volleyball or football with the village kids. I was
also able to attend some of the school visits and the wheelchair shop
at Duranguito. Other outings included attendance at a Rotary Club
Health Care Fair in Culiacan, a large city about 2 hours away.
I worked with quite a variety of people with different conditions
during my time there: children with cerebral palsy of varying types and
severity, adults with paraplegia, quadriplegia, and hemiplegia,
orthopaedic conditions such as fracture and total joint replacement.
Some people came for appointments as outpatients, and there were also
some people who lived-in for intensive rehabilitation.
Generally Mary would begin the intake when a new patient arrived, and I
would be asked to join in as appropriate. We would conduct an
assessment and develop a plan in collaboration with the patient and
family. At that time also, other PROJIMO workers would participate, if
it became apparent that specialized seating or other aids would be
required.
I worked closely with Maggi and Ines, two therapy workers. They had
much experience and knowledge and were used to working with therapists
in a very collaborative way. The goal was for me to work closely side
by side with the workers so that we could teach each other, in order
that when I left, they would carry on providing therapy with the new
skills and knowledge attained. This is preferable to a therapist
treating patients in an independently and then leaving, without having
built capacity in the program to carry on without the "professionals".
I also assisted by developing several handouts for exercises for
various conditions, as well as helping with artwork for school posters.
Participating in the PROJIMO experience was interesting, rewarding and
also tiring! I learned a lot about the philosophy and experience of
Community-based Rehabilitation, which will prepare me for other
volunteer placements I hope to have in the future. I also found myself
stretched as a physical therapist, as I worked with wheelchair
training, making recommendations about seating and orthopaedic
appliances, and assisting in developing ADL skills. One of my proudest
moments was when I successfully built a splint to enable a patient with
quadriplegia to feed herself for the first time. My ability to
communicate in Spanish also improved as a result of my experience
there- from working in therapy, from my classes, and also from living
with a family.
I would recommend the PROJIMO program to anyone interested in getting
started in Community-based Rehabilitation. It is important to have some
familiarity with Spanish before arriving, as only one or two PROJIMO
staff have very limited English. The other staff, patients, and people
in the community of Coyotitan speak Spanish. I think it would be
difficult to volunteer in a meaningful way without some basic language
skills. I would also recommend reading some of the publications
available from HealthWrights before attending, as I found this assisted
very much in my preparation. Their website at www.healthwrights.org has
the books online, as well as information on the Spanish course, and a
slide show of the custom-made children’s wheelchairs in PROJIMMO. Also,
I would be happy to share more of my experiences or answer questions. I
can be contacted at:
