Teaching physiotherapy in Colombo, a workshop in Indonesia & contact with WHO

Excerpted from Memories that Linger: My journey in the word of disability
by Padmani Mendis

Knowing how to teach using the scientific method gave me confidence in my work. It was during my time at Guys that participatory and learner-centred teaching came to be used in pedagogy. Helen, our tutor, had made sure we knew these well. I now had the chance to use them with responsibility to benefit my students.

They responded well. With the first course that I started using these approaches, all the students passed the final examination, not a usual occurrence at the school. Examiners, included as well as physiotherapy tutors, medical consultants specialised in certain areas. With this batch of students, I had helped Mrs. Thera Fernando, Senior Tutor, to introduce a Community Field Training Module into the curriculum in the second year. The University of Colombo, Department of Community Medicine, our neighbour, gave us permission to use their field training area for our students.

This was the Ethul Kotte Medical Officer of Health or MOH area. On Friday mornings for twelve consecutive weeks our students in pairs visited ten homes within a specified area. On visits, they studied the health of members relating that to their socio-economic situation. Included was a focus on finding those who had mobility problems.

After a break for lunch, in the early afternoon session back at the school, we had a discussion of their findings and what they may do about it. We focused on the advice they would give the family. A record of all this they kept and were assessed on it. This was the first occasion that student therapists and even I, for that matter, had exposure to what community living for this, the poorer segment of our urban society, was like.

Embarking on an International Career

Now at last I really enjoyed working as a physiotherapist in Sri Lanka. Perhaps because I was teaching it. But this would not be for long. I would soon have the opportunity to use this knowledge and experience and journey on to something even more rewarding.

The memories of these new opportunities I would have I will start sharing with you in the next section called “Three Pioneers in Geneva”. In this section I have recalled how my work for the World Health Organization or WHO came about. And how I helped WHO to develop a new strategy for rehabilitation which came to be called Community-Based Rehabilitation, well-known as CBR.

CBR was more successful than one could have imagined. The demand for it grew and I was called upon to visit an ever-increasing number of countries for follow-up, monitoring, evaluation, planning, teaching, and expansion of this strategy. I was required to spend more time in these several roles continuing my journey in disability over the next few decades to promote the global development of CBR for disabled people.

To do this and to balance it with my home life with Nalin, I gave up teaching at the school in 1981. I would miss my students and my colleagues.

How My Work for WHO Came to Be

The year was 1978. I was teaching at the School of Physiotherapy of the Ministry of Health in Colombo. My colleague and boss Thera Fernando had just been nominated by the Department of Health to attend a meeting on Disability and Rehabilitation organised by the World Health Organisation or WHO to be held in Solo, Indonesia in December of that year.

Since she had attended the previous meeting on the same subject in Indonesia, she suggested to the department that I be nominated instead. Very unusual in those days when competition was rife to grab any and every trip abroad. But she was an unusually unselfish person.

Named first was a medical specialist in rheumatology and I was the second nominee. We were to travel together to Indonesia. As pre-workshop preparation, WHO called for two documents which would then be presented at the workshop. One was a Situational Analysis of Disability and Rehabilitation in Sri Lanka and the second was a Plan of Action to introduce what was then called Disability Oriented Rehabilitation to improve the lives of disabled people. Being the junior nominee in a hierarchical health sector the task of preparing these two documents fell on me.

And did I not carry out the task with joyful enthusiasm! As I shared with you, I had returned from the UK and Denmark a few months earlier having followed a two-year diploma course on the teaching of physiotherapy in London and having obtained some practical experience of it in London and Denmark. Well-versed in objectives, strategies, activities, plans of action, monitoring, evaluation and anything and everything else that goes with that, I was up to the task.

The Situation Analysis and the Plan of Action were prepared. So were presentations that were to be made in Solo. This was through the use of transparencies and overhead projectors, long before the advent of computers and multimedia equipment.

I started sharing my memories with you in my belief that I was, since my birth, blessed with good fortune. Some 40 years later, I believe it was that same good fortune that brought me face-to-face with Dr. Einar Helander at this meeting in Indonesia. Dr. Einar Helander had come from WHO, Geneva to facilitate the workshop. He was in charge of the Disability Prevention and Rehabilitation Programme at headquarters. This meeting led to my participating as a co-pioneer of Community-Based Rehabilitation or CBR for the World Health Organisation.

Interruption – Why Disabled People?

Before going further, you may wonder at my use of the description “disabled people”. There is a demand from many Disability Groups and Movements that they be referred to as “persons with disabilities”. It is mandatory now in the UN system that they be called so. There are however scattered groups and individuals, including disabled people, who see this differently and I am one of those.

People who have disabilities are, first and foremost human beings like you and me. They are that part of humanity that have been made disabled by society. Society does so primarily by considering them to be some other kind of human being, essentially different from us who are “normal”.

Society stigmatises them; by seeing only what they cannot do and not what they can do or have the capacities and potential to do; by not providing within our societies facilities that would enable them to do what they can do as human beings. That which would enable them to enjoy their rights as human beings. That which would enable them to carry out their role as citizens – such as adapting education systems with relevant legislation to meet the needs of all children and youth which will then include those who have disabilities participating alongside their peers; adapting transport and public spaces so that all people can use them, be they young or old or have disabilities, and so on.

By not doing these things it is we who disable them. It is not the fault of those that are born with or acquire disability at some point in their life. It is Society that creates disability.

Changing this first and foremost requires an acceptance that this is the fact, that this is the truth. Then only can we bring about change in our beliefs and attitudes so that we accept them as one of us; so that we make a change in our systems and services to enable them to access their right to share in the benefits of being a member of our families, of our communities and of global society; so that they could play their part and take responsibility within these as we do.

This is a Vision. But until we are well on the path to reaching that vision, Society will continue to be responsible for their situation. Society will continue to create disability. They will remain disabled people.

Back to Solo, Indonesia

The first day of the workshop in Solo was a novel experience. Thirty or so participants from the South-East Asian Region of WHO were present. Proceedings began with the customary round of introductions. I was floored when I realised that all bar one were medical specialists. Most in orthopaedic surgery, a few in rheumatology which was a relatively new speciality at the time. And yours truly was the only physiotherapist.

But I had youth on my side together with confidence because I had prepared for the workshop. Sri Lanka’s presentation was to be in the afternoon. I had handed over to my senior partner all the documents for presentation and briefed her on them. The time came for presentation, Sri Lanka was announced.

And lo and behold my senior partner got cold feet. She pushed the papers towards me with the words, “You present.” I tried to persuade her but her feet stayed cold. So I carried out my duty. That I had done so successfully was clear by the barrage of questions that I was asked at the end of the presentation.

And the challenge issued to me by the most senior orthopaedic surgeon of them all and the most eminent of the eminent. And what is more, from India – from the most prestigious rehabilitation institute in Bombay. This was, “We will see how Sri Lanka is going to do that.” Well I am happy to say that over the next few decades Sri Lanka did do a lot of that. Some of which I hope to share with you later in my memories.

Over the next few days we had many small group exercises, problem solving and plenary discussions. On the third day Dr. Helander called me aside and asked me whether I would have dinner with him. That evening we took two “Cyclos” which you may know as cycle rickshaws. I had been carried in a rickshaw to school when I was quite young. I was then staying with my cousins and the “rickshaw coolie” was sent for when their car which usually took us was not available. We had now progressed from man power to pedal power.

We went to a pleasant Indonesian restaurant. Einar, as he insisted on being called now, asked about me and my life back home. I asked about him and his family. And then he sprang a surprise on me. He asked me seemingly as a matter of course whether I would “do some work” for him. I thought perhaps that he would ask me to do some writing for him while sitting at home. Of course I agreed. There was no more talk about the subject for the rest of the week. I returned to Colombo content that I had made my contribution.

But many years later, when we were friends and colleagues working on a common agenda, I asked him about that workshop in Solo. I questioned him as to why he asked what he did and selected me without knowing me, for the pioneering work that he, Gunnel and I did together. He said it was because, “Every time I came round to your group you were challenging those eminent medical men.” Further, he said that I was, “doing it so very politely in a way that made them accept you.”

He did not refer to respect. But respectful I was, taking heed of their age and experience. If I had not done so, they would without doubt have crushed me to a pulp.

An Unexpected Invitation

Time passed. It was now a day in February 1979. I had just recently celebrated my 40th birthday with my family. The postman came as usual in the morning. Unusually though there was a letter indicating on the envelope that it was from WHO Geneva. I wondered, “What is this about?”

Soon to find out that it was from Einar, inviting me to come to Geneva for three months and undertake a short-term consultancy. I would be required to carry out a task preparing a Manual for implementing “Community-Oriented Rehabilitation”. My co-consultant would be Ms. Gunnel Nelson from Gothenburg, Sweden. He would work with us as well. I was expected in Geneva on May 15.

What excitement! With an increasing heart beat I ran next door to where my parents-in-law lived. Reading the letter, they shared my excitement and were oh so happy for me. In that excitement I remember saying foolish things to them – things like, “What on earth is community-oriented rehabilitation?” and “But I don’t know how to write a manual”, “What is a manual?” And I could hardly wait until Nalin came home from work to show him this marvellous letter.

That workshop in Solo marked a turning point in my life. It took me to an invitation to WHO Headquarters in Geneva to be a Consultant on the Disability and Rehabilitation Programme.