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Report on CRP
CRP is the only organization of its kind in Bangladesh, a country with a population of 140 million. The World Health Organization (WHO) estimates that 10% of the population in Bangladesh is disabled. The Centre for the Rehabilitation of the Paralyzed, commonly known as CRP, was founded in 1979 by a small group of Bangladeshis and a British physiotherapist, Valerie Taylor. Miss Taylor came to the Bangladesh (then known as East Pakistan) in 1969 as a volunteer physiotherapist, and was appalled at the lack of facilities for the disabled and the often poor diagnosis by local doctors. The situation for the disabled was worsened in the aftermath of the 1971 Independence War, after which Bangladesh won its independence from Pakistan. After many years of disappointments and setbacks, CRP was opened in 1979. The premises were two cement storerooms in the grounds of a Dhaka hospital. The capacity soon grew from 4 patients to about 50.
CRP focuses on a holistic approach to rehabilitation, recognizing that all aspects of the rehabilitation process are vital for its success: Physical rehabilitation, Psychological rehabilitation, Economic rehabilitation and assistance in securing micro-credit loans, planned discharge.
CRP’s headquarters is in Savar with an additional three functioning sub-centers throughout Bangladesh. CRP-Gonokbari is a residential vocational re-training centre for disabled women and girls, CRP-Gobindapur is a centre for out-patient and community based services in Sylhet Division and CRP-Mirpur is a thirteen-storey centre in Dhaka which provides medical, therapy and diagnostic services in addition to having several floors available for rent. In addition to its work providing rehabilitation services for disabled people, CRP’s academic institute, the Bangladesh Health Professions Institute (BHPI), has pioneered the training of relevant health professionals in Bangladesh. Courses are run up to BS.c. Honours Degree level and affiliated with renowned institutions including Dhaka University and the Bangladesh State Medical Faculty. Some courses are the only ones of their kind in the country. BHPI is a national resource of Bangladesh, without which the quality of health services throughout the country and the future of vital health professions would be seriously compromised.
People throughout Bangladesh are touched by the work of CRP. Community Based Rehabilitation (CBR) projects operate in 13 districts of the country. Accident and disability prevention programmes include research components and aim to educate vulnerable groups on safe working and living practices. Advocacy and networking activities bring CRP’s work to the attention of relevant officials and promote improved co-ordination among the many organization with which CRP works. Awareness raising and publicity campaigns inform the population of relevant issues and attempt to break down the barriers, superstitions and stigmas which prevent disabled people from enjoying equal rights and opportunities. CRP is the only organization of its kind in Bangladesh, a country with a population of 140 million. The World Health Organisation (WHO) estimates that 10% of the population in Bangladesh is disabled.
Though CRP is the only one of its type organization in Bangladesh there are many NGO and nonprofit organizations in Bangladesh who are working for the social welfare. So there is competition for funds and volunteers. To check this competition and provide better service to the target audience CRP adopting various marketing Practices. This report contains all these marketing practices of the CRP- a Non- Profit organization.
CRP- Center For Rehabilitation
of the Paralyzed
Attracting Human Resources: Staff, Volunteers and boards
Working with third parties
CRP-Center for Rehabilitation of the Paralysed
Founded in 1979 in response to the desperate need for services for spinal injured patients, the Centre for the Rehabilitation of the Paralysed (CRP) has developed into an internationally respected organisation. CRP focuses on a holistic approach to rehabilitation, recognizing that all aspects of the rehabilitation process are vital for its success:
R Physical rehabilitation: through medical and therapeutic interventions and the provision of appropriate mobility aids
R Psychological rehabilitation: through counseling and sharing of experiences
R Economic rehabilitation: through vocational re-training and assistance in securing micro-credit loans
R Planned discharge: for a successful reintegration into the community, ensuring that the home environment is as safe and accessible as possible and that local residents are educated about disability, its causes and consequences
The holistic nature of CRP’s work is reflected in the fact that its work covers several areas of development including human rights, poverty alleviation, health care provision and education.
History of CRP
The Centre for the Rehabilitation of the Paralysed, commonly known as CRP, was founded in 1979 by a small group of Bangladeshis and a British physiotherapist, Valerie Taylor. Miss Taylor came to the Bangladesh (then known as East Pakistan) in 1969 as a volunteer physiotherapist, and was appalled at the lack of facilities for the disabled and the often poor diagnosis by local doctors. The situation for the disabled was worsened in the aftermath of the 1971 Independence War, after which Bangladesh won its independence from Pakistan. After many years of disappointments and setbacks, CRP was opened in 1979. The premises were two cement storerooms in and CRP’s current headquarters were developed. From the original green-field site an extensive range of facilities has been developed to include world class treatment for spinal injuries, ground-breaking therapy services, an academic institute the grounds of a Dhaka hospital. The capacity soon grew from 4 patients to about 50. CRP moved premises twice more before 1990 when land was purchased in Savar which is pioneering the teaching of new professions, workshops, an inclusive school and recreational facilities.
The holistic nature of CRP’s work is reflected in the fact that its work covers several areas of development including human rights, poverty alleviation, health care provision and education. CRP’s headquarters is in Savar with an additional three functioning sub-centers throughout Bangladesh. CRP-Gonokbari is a residential vocational re-training centre for disabled women and girls, CRP-Gobindapur is a centre for out-patient and community based services in Sylhet Division and CRP-Mirpur is a thirteen-storey centre in Dhaka which provides medical, therapy and diagnostic services in addition to having several floors available for rent.
In addition to its work providing rehabilitation services for disabled people, CRP’s academic institute, the Bangladesh Health Professions Institute (BHPI), has pioneered the training of relevant health professionals in Bangladesh. Courses are run up to B.Sc. Honors Degree level and affiliated with renowned institutions including Dhaka University and the Bangladesh State Medical Faculty. Some courses are the only ones of their kind in the country. BHPI is a national resource of Bangladesh, without which the qualities of health services throughout Bangladesh are touched by the work of CRP. Community Based Rehabilitation (CBR) projects operate in 13 districts of the country. Accident and disability prevention programmes include research components and aim to educate vulnerable groups on safe working and living practices. Advocacy and networking activities bring CRP’s work to the attention of relevant officials and promote improved co-ordination among the many organization with which CRP works. Awareness raising and publicity campaigns inform the population of relevant issues and attempt to break down the barriers, superstitions and stigmas which prevent disabled people from enjoying equal rights and opportunities.
CRP is the only organization of its kind in Bangladesh, a country with a population of 140 million. The World Health Organization (WHO) estimates that 10% of the population in Bangladesh is disabling the country and the future of vital health professions would be seriously compromised.
Valerie Taylor O.B.E.-The Lady Behind CRP
Valerie Taylor, from Buckinghamshire, England, first came to Bangladesh with Voluntary Service Overseas (VSO) in 1969 to work as a physiotherapist in Chandragona Hospital, near Chittagong. At that time Bangladesh was still known as East Pakistan, as a result of the partition of India after British rule ended in 1947.
Her stay was interrupted by the 1971 War of Independence, after which Bangladesh became an independent state, no longer governed from Pakistan. This war was particularly vicious and cost the lives of approximately 3 million Bangladeshis. During the war Valerie was evacuated, but returned to Bangladesh in September 1971, two months before the war ended.
She was very aware of the need for rehabilitation services for the disabled. This In 1973 Valerie returned to England to attempt to raise funds to establish a rehabilitation centre for disabled. She stayed in England for two years before returning in 1975. It took another four years before CRP was able to admit its first patients in 1979. During this time, Valerie worked in the Shaheed Surawady Hospital in Dhaka and it was in the grounds of this hospital that CRP had its first premises, two cement storerooms which were used to treat patients. Was able to admit its first patients in 1979. During this time, Valerie worked in the Shaheed Surawady Hospital in Dhaka and it was in the grounds of this hospital that CRP had its first premises, two cement storerooms which were used to treat patients.
Through all the various moves from one premise to another, Valerie has continued to work tirelessly for the benefit of CRP. Even today the light in her office can be seen burning till late in the evening. Valerie is also legal guardian to two disabled girls, Joyti and Poppy, who live with her in her house. Despite officially taking a backseat role at CRP some years ago, Valerie remains the driving force behind the running and development of CRP. In 1998 Valerie was awarded Bangladeshi citizenship by the then Prime minister of Bangladesh, Sheikh Hasina.
Vision, Mission & Objectives
Vision- to ensure the inclusion of the disabled people in the mainstream society.
Mission– to promote an environment where all disable people can have equal access to health, rehabilitation, Education, Employment, the physical environment and information.
Objectives– CRP’s objectives are:
ü To provide treatment, rehabilitation and support services focusing on physical, emotional, social, psychological and economic aspects.
ü To promote the development of skilled personnel in health care and rehabilitation in the country and the region.
ü To develop sub-centers in different parts of the country to expand the services for disabled people in collaboration with other organizations (NGO’s, Government, self help organizations and private sector).
ü To organize and promote programmes for the prevention of disability.
ü To develop programmers for disabled children, focusing on early identification, therapeutic interventions and education.
ü To promote advocacy and networking on disability issues focusing on equalization of opportunities for disabled people through the removal of physical and social barriers.
ü To promote empowerment of disabled people through community based services in collaboration with other organizations and social institutions (NGO’s, Government, Self help organizations and private sector)
ü To promote empowerment of disabled girls and women, focusing on confidence building, education, Vocational Training and employment.
ü To raise awareness about disability issues nationally, regionally and internationally.
ü To conduct research consistent with the vision, mission and overall objectives of CRP.
ü To promote sports and recreational opportunities for disabled people.
ü To promote collaboration opportunities nationally, regionally and internationally to share experiences and expertise.
CRP’s headquarters are in Savar, approximately 25km from Dhaka, the an extensive range of services for disabled people as well as CRP’s academic institute, the Bangladesh Health Professions Institute (BHPI) and CRP’s inclusive school. Capital city of Bangladesh. Set in around 13 acres of land, the centre comprises
CRP moved to Savar in 1990 after eleven years operating from different premises in Dhaka. In addition to the infrastructure necessary for CRP’s work, CRP-Savar has been expertly landscaped and provides a peaceful and relaxing environment which is such a vital component of the rehabilitation process. . Many different types of trees and flowers are in bloom in different seasons so there is always a colorful display of flora. Sports and recreational facilities are used by CRP’s patients, staff and students of BHPI. A large multi-purpose hall provides facilities for cultural events, conferences, meetings, sports events and patient activities.
Services which are located at CRP-Savar include:
ü 100-bed hospital for spinal injuries
ü Operating theatre for spinal and orthopedic surgery
ü Physiotherapy Department for in-patients and out-patients
ü Occupational Therapy Department for in-patients and out-patients
ü Halfway hostel where patients prepare for returning to their home community
ü Social Welfare Unit assisting with a variety of issues for CRP’s users
ü Metal workshop which produces wheeled mobility aids and other appliances
ü Wood workshop which produces furniture to order and a range of toys
ü Special seating workshop for individually crafted seating units for disabled children
ü Orthotics and Prosthetics workshop which produces assistive devices for disabled people
ü Paediatric Unit with residential and out-patient care for disabled children
ü William and Marie Taylor School which provides inclusive education in an enabling environment
ü Bangladesh Health Professions Institute (BHPI) which trains the health professionals of tomorrow
ü Administration area ensuring the smooth and transparent operation of CRP
ü Prosthetics workshop which produces assistive devices for disabled people
ü Paediatric Unit with residential and out-patient care for disabled children
ü William and Marie Taylor School which provides inclusive education in an enabling environment
ü Bangladesh Health Professions Institute (BHPI) which trains the health professionals of tomorrow
ü Administration area ensuring the smooth and transparent operation Orthotics and of CRP
Designed to enable CRP to increase both its level of service and its financial sustainability, CRP-Mirpur is an exciting 13-storey centre in Dhaka City. Construction of this centre was completed in 2004 although limited services have been in operation since 2003. Construction of the centre was made possible through the generosity of the Kadoorie Charitable Foundation in Hong Kong, which funded 50% of the construction costs.
CRP-Mirpur was designed with accessibility in mind. A wheelchair access ramp provides access from the ground floor to the fifth floor. Garden areas are visible from every floor and the innovative use of light and space provide a special ambience.
CRP currently occupies the lower 6 floors of the building where it operates world class medical, therapy and diagnostic services. Additional services include a paediatric unit, post-stroke rehabilitation unit, operating theatres, and conference and catering facilities. The upper seven floors, totaling around 70,000 square feet, will provide income generating capability for CRP either through renting to tenants or utilization for commercial purposes by CRP. All services at CRP-Mirpur are operated on a commercial basis with a view to making the maximum contribution to the operating costs of CRP-Savar.
The out-patient physiotherapy treatment given at CRP-Mirpur includes patients with various orthopedics conditions, neurological conditions and paediatric conditions. The most common treatments are for back pain, neck pain, osteoarthritis, sports injury, stroke and cerebral palsy. The physiotherapy department at CRP-Mirpur is well-equipped and qualified therapists provide services under the supervision of foreign experts. Out-patient occupational therapy services at CRP-Mirpur include treatment for stroke, head injury, hand injury, cerebral palsy and children with developmental disorders. Both physiotherapy and occupational therapy are key components of the post-stroke rehabilitation unit.
The first floor provides diagnostic services of the highest standard. A newly installed, state-of-the-art x-ray machine complements the fully equipped pathology laboratory.
The paediatric unit enables parents or careers of disabled children to learn how to maximize their child’s postural and functional capabilities. The unit provides similar treatment to the paediatric unit at CRP-Savar – expanding this important and highly sought after service to Dhaka city residents. To arrange an appointment for any of the services offered at CRP-Mirpur.
Location & Map for CRP Mirpur
Situated fifteen kilometers from CRP’s Savar headquarters, CRP-Gonokbari is a residential vocational training and independent living centre for disabled women and girls. The situation for disabled women in Bangladesh is especially difficult. They have to cope with the obstacles relating to their disability along with the everyday obstacles in a patriarchal society like Bangladesh. It is often the case that if a woman becomes paralysed, her husband will take another wife, leaving the woman to look after herself and her family with no support. If a woman can earn a living through the skills learnt at CRP-Gonokbari her chances of successful re-integration into their community and acceptance by her family increase dramatically.
The main hostel at CRP-Gonokbari accommodates up to twenty-eight women and girls, giving them the chance to learn the necessary skills to be able to cope with life and their disability when they return to their community. Vocational training courses include:
ü Shop keeping
ü Shoe making
ü Fish and medicinal plant cultivation
Further education is also provided along with training in basic living skills. Together, this training gives the residents of CRP-Gonokbari the opportunity to live as independently as possible after leaving the centre and returning to their community.
In 2003, CRP in the area. Received a gift of two plots of land in Manikganj, approximately 30km from CRP-Savar. This was a gift from Mrs. Rehana Mahbub in memory of her late husband. CRP is currently developing plans for the use of the land in Manikganj which provides enormous potential for the expansion and improvement of CRP’s services
At Gobindapur, in the north-east of Bangladesh, CRP runs a small centre which provides out-patient and community based services. Physiotherapy and occupational therapy are provided in a specially built clinic within the 13 acre property. Conditions treated include stroke, cerebral palsy, back pain, neck pain and arthritis. In addition organize disability awareness workshops in schools, colleges, and government and non-government organizations to this, the staff from CRP also undertake clinics at the local Upazila Health Complex and conduct home visits. Outreach work for disabled people in the community through CRP’s Community Based Rehabilitation (CBR) programme is co-ordinate from CRP-Gobindapur and training courses are run for CBR workers. Occupational therapists and physiotherapists, Madrasas (Islamic colleges) and, local clubs.
Another important feature of CRP-Gobindapur is its base for student placements in Community Based Rehabilitation (CBR). Occupational therapy students undertake month-long placements in the third year of their BS.c. Honours Degree course. Students learn vital skills in treating and advising patients in their village environments. In addition to the therapy services offered at CRP-Gobindapur, three bungalows can be rented by guests who want to enjoy the peaceful surroundings. The bungalows are situated in a secluded hilly area, surrounded by tea gardens and rubber plantations. This makes it an ideal location for relaxation and a safe environment for children. The guest house facility is one of CRP-Gobindapur’s income activities.
Services of CRP
The hospital at CRP-Savar is the only hospital in Bangladesh that specializes in the treatment of spinal cord injuries. The 100-bed hospital receives over 350 admissions as in-patients each year. Admissions are normally due to traumatic paraplegia, traumatic tetraplegia and conditions caused by disease, but exclusively for the treatment of spinal injuries or illness affecting the spine. Some patients are managed conservatively, whilst others require surgical intervention. The majority of patients arrive a long time after their accident or illness, when complications are difficult to manage.
Specialized nursing care is a vital part of the treatment of paralysed patients. CRP has a highly skilled nursing staff complemented by input from foreign volunteers. The nurses are engaged to look after the patients’ physical condition. This includes bladder neuropathy, bowel and pressure sore management. Pressure sores are the main complication for paralysed patients. Special dressing techniques are required to aid wound healing as well as treatment for infection and blood transfusions if necessary. Pack beds are used, which are designed to relieve pressure from the wound area. Improved diet is offered with additional nutritious foods and vitamin supplements.
Measures are taken in order to prevent pressure sores developing. Two hourly position changes are necessary. Special pressure relieving mattresses are used when available and ensuring a high standard of hygiene is also important. Specific staffs have responsibility for giving health education and advice to patients on pressure sore prevention as well as bladder and bowel management.
Another common complication is urinary incontinence. Many patients are admitted with an indwelling catheter or condom device. The best management for these complications is self administered, clean intermittent catheterization. The paraplegic patient is taught how to introduce the clean catheter themselves and careers of the tetraplegic patient are taught the same technique. The aim is to control incontinence by emptying the bladder at regular intervals and by using medication which works on the bladder muscle.
An out-patient service is provided by CRP six days a week, where patients can be referred to other services provided by CRP, such as pathological tests, x-ray, physiotherapy, occupational therapy, for mobility aids and health education. Some patients with spinal injuries are admitted to the in-patient department for treatment or surgical interventions. Surgery is performed in the operating theatre at CRP two days a week. Several different surgical procedures are carried out at CRP including spinal fixation, surgery on spinal tumor and club foot.
The pathology laboratory is equipped with the some modern items of equipment such as a biochemistry analyzer and ELISA reader for HIV testing, Hepatitis B and C and other sexually transmitted diseases. A radiology unit carries out over x-rays for in-patients and out-patients and is staffed by a team of experienced staff members.
Physiotherapy is a crucial element of the rehabilitation process and covers a diverse range of approaches such as manual therapy, vertebral therapy, exercise therapy, and electrotherapy. The service is provided in both in-patients and out-patients. Out-patient services are provided at CRP-Savar, CRP-Mirpur and CRP-Gobindapur. Physiotherapy can help individuals of any age who have a physical problem in an acute or chronic stage including:
ü Musculo-skeletal conditions
ü Neurological conditions
ü Paediatric conditions
ü Cardiopulmonary conditions
Over the years, CRP has developed its physiotherapy out-patient services by opening new centres, such as CRP-Mirpur, and by undertaking countrywide campaigns to promote the physiotherapy services offered by CRP. The nationwide campaigns allow CRP to give presentations about physiotherapy to professional groups.
CRP continues to host student placements in the Physiotherapy Department, both for students of the BHPI (the academic institute of CRP and for students form overseas. A professional development programme has also been put in place for intern students. The Physiotherapy Department also supports a large number of research projects conducted by final year BSC Honours students from BHPI.
Occupational therapy has grown out of the need to understand the relationship between people and their occupational roles in relation to their health and well being. The goal of occupational therapy is to rehabilitate and reintegrate people who have difficulties in their daily activities such as self care (eating, dressing and bathing), work and leisure. An occupational therapist treats those people who have physical, psychological, cognitive and social deficits. Occupational therapists use purposeful activities, therapeutic exercises, sensory and motor stimulation, skills transfer/retraining, special assistive devices and environmental modifications to undertake the treatment of a patient.
In-patients are treated through a variety of individual and group therapy programmes for achieving functional independence, hand therapy, wheelchair skills training and sports activities. Out-patient services treat different types of neurological and orthopedic conditions and learning difficulties. Splints and different adaptive equipment for out-patients, in-patients and for children referred from the Paediatric Unit are made in the Occupational Therapy Department.
A vital component of the occupational therapy at CRP is the Work Rehabilitation Programme. Returning to paid work is considered one of the most meaningful measures of rehabilitation. CRP’s innovative Work Rehabilitation Programme is conducted by the Occupational Therapy Department. The programme was established in 2002 with the support of the United States Department of Labor (USDOL) to help people with a spinal cord lesion to return to their previous work. Each month, 2 patients are chosen to be involved. The physical skills necessary for their work are identified and therapy is targeted to these skills. In addition, adaptations to the physical workplace environment are made by the therapist. A follow up visit is conducted in their workplace to assess the progress of these interventions.
As well as in-patient and out-patient facilities at CRP-Savar, the Occupational Therapy Department also provides services to the Paediatric Unit, Community Based Rehabilitation, Inclusive school, Special Seating Unit, Halfway Hostel and outreach and mobile clinic programmes-
Speech and Language Therapy
Currently there are no fully trained Speech and Language Therapists working in Bangladesh. CRP has introduced a 4-year BS.c (Hons) degree in Speech and Language Therapy, affiliated to Jahangirnagar University. The first therapists should graduate in 2008, and CRP will then begin to offer a regular service.
Speech and Language Therapists work with adults and children who have difficulties communicating with others. These difficulties may have different causes such as:
R Physical problems (hearing impairment, cleft palate)
R Neurological damage (Cerebral Palsy, Stroke, brain injury)
R Cognitive damage (making it difficult to learn language)
Communication difficulties can affect all aspects of life. Children can find it difficult to learn at school and form relationships. They cannot express themselves and so get frustrated and angry. For adults it is equally devastating. They often have to give up their job, they may feel isolated and get depressed, and become a greater burden on their family and the health services.
Therapy includes working directly to promote speech and language as well as educating families, teachers and employers about the needs of people who find listening, talking, reading and writing difficult. In many cases, individuals are taught to use a mixture of ways to communicate (gestures, picture books, symbol boards as well as speech) to make communication more effective.
Speech and Language Therapists also help people who have difficulties chewing and swallowing their food. Many people who need help with their communication also have problems with eating and drinking. Problems in this area can lead to dehydration, malnutrition, chest infections and premature death. The stress caused to the individual and family is enormous
Telemedicine is the process whereby expert medical advice is accessed through the use of communication technology. on the needs of the user and the system chosen, telemedicine can include the use of e-mail, the internet and the transmission of digital still or video images or real time video or teleconferencing. Depending Telemedicine can be used if medical expertise or simply a second opinion is sought. As medical science is growing at a very fast rate, the telemedicine facility at CRP can be used to help various health professionals to keep up to date. This is especially useful in less developed countries such as Bangladesh, where access to facilities, specialized equipment, etc may be limited.
The telemedicine system installed at CRP in July 1999 was the first of its kind in Bangladesh. This was made possible by the support of the Swinfen Charitable Trust in the UK. CRP uses telemedicine for patients who require a second opinion from consultants in the UK. CRP is fortunate to have access to consultants in the UK with a variety of specialties including from the Royal Hospital, Haslar, who very kindly agreed to provide consultation free of cost. Consultants within Bangladesh are invited to provide and receive telemedical consultation for their patients through the telemedicine link at CRP.
Specialties available at the present time include:
ü ENT (Ear, Nose and Throat)
ü General Surgery
ü Obstetrics and Gynecology
ü Occupational Therapy
ü Plastic Surgery
ü Spinal and Orthopedic Surgery
Most of those suffering spinal injuries are from poor backgrounds and work as manual laborers. Many patients at CRP will be unable to return to their previous employment after suffering paralysis. If a spinally injured person cannot earn a living to support his or her family, the physical and emotional rehabilitation at CRP will be of little value. To address this need CRP runs vocational training projects which aim to enable trainees to live financially independent lives.
CRP’s Madhab Memorial Vocational Training Institute works comprehensively in assessing the needs of a potential trainee, securing a place in an appropriate course and assisting with job placements on completion of the course. Courses currently offered are:
ü Certificate course in computer applications: This is three- month course is affiliated to the Bangladesh Technical Education Board.
ü Electronics repair: This four-month course equips students with the skills to repair a variety of household electronic items, e.g. televisions, radios, video recorders. Most trainees will establish small businesses on completion of the course.
ü Tailoring: This three-month course trains students in all aspects of the tailoring trade. Experience has shown that this course is very relevant to the needs of disabled people with many trainees starting their own businesses.
ü Shop Management: This is a one-month course which ensures that the trainees understand how to manage a small shop, keep stocks and do simple calculations.
The percentage of trainees who gain employment or establish small businesses is very high. Recently, CRP also began offering vocational training to disabled people whose need for re-training are identified by Community Based Rehabilitation (CBR) workers. Post training follow-up is an important part of assessing the impact and continuous development of the programme. This is done through home visits and by sending questionnaires.
As part of its commitment to holistic rehabilitation, CRP produces a wide range of wheeled or non-wheeled mobility and assistive devices. A metal workshop produces three models of wheelchairs which have been specially designed for local conditions. A model of tricycle with detachable front wheel is also produced. One of the wheelchair designs is called the “low trolley” which enables users to participate in tasks like cooking or laundry washing which take place at ground level in rural Bangladesh. All items are made with low-cost, locally available materials to ensure that, should something go wrong, it can be repaired quickly with minimum outlay. The designs are very sturdy and thus able to withstand the uneven conditions often found in Bangladesh. Walking frames standing frames, back slabs and special Stryker frame beds are among other items made in the metal workshop.
Adjacent to the metal workshop is CRP’s special seating unit which provides assessment and specialized seating for disabled children. Some seating units are also produced for adults. The seats aim to enable the user to maintain his or her seating posture which improves breathing, swallowing and the development of fine motor skills. Three sizes of special seat are produced for children. Each user is first assessed by a qualified occupational therapist after which the seat is made to each child’s exact requirements. Follow-up ensures that as each child grows, the seat is suitably modified.
A British based charity, Motivation, provided invaluable assistance and training in the design and production of special seating units and mobility aids. One of the newer medical divisions at CRP Savar is the Prosthetic and Orthotics (P/O) department. The department was set up in 2005, but it has taken a number of years to get it up to full speed. This was due to CRP awaiting the return of the staff that had been sent to India to be trained in Prosthetics and Orthotics, they now have returned in the last year (2008).
The department was set up with the technical and financial support of the International Committee of the Red Cross – Special Fund for the Disabled (ICRC – SFD) with modern instruments and materials. This allows the department to manufacture a wide range of Outhouses, from the simple arch support-to-support fallen arches in the feet, to the more complication of bilateral jointed KAFOs (calipers) to allow person with disabilities to stand and walk. In Prostheses they manufacture from partial feet, below knee artificial limb to the complex above knee amputation replacement prosthesis. The department sees a wide range of disabilities especially children with club feet, CP, congenital disabilities and teenagers that have been affected by Polio as a child. Many of the amputations of the lower limb are due to the high incident of (RTA) road traffic accidents and accidents at work due to the appalling health and safety at work record the country has. The department is a vital link in the rehabilitation of the disabled person at CRP and works closely with the Occupational Therapy, Physiotherapy, and medical departments in achieving this goal.
In the near future we are going to set up a Prosthetic and Orthotics satellite clinic at CRP Mirpur, as at the moment the patients have transport and financial problems getting to Savar for this service. The setting up and starting of the first Prosthetic and Orthotics training course in Bangladesh, this we hope will happen in 2010.
The main function of the Paediatric Unit is to run a two-week residential programme designed to integrate children with cerebral palsy into family and community life. To achieve this, children participate in physical and psychological therapy and careers/mothers are educated how to care for the child and made aware of disability issues and rights. Children are referred to CRP for an initial assessment with a qualified therapist, either through other institutions or CRP’s Community Based Rehabilitation programme. Depending on a child’s condition, an appointment is then made for treatment and rehabilitation at CRP or to join the two-week residential programmes.
After admission, the children are assessed in order to produce an individual treatment plan. According to the plan, the mothers/careers are taught physical movement and child management skills. Every morning there is group therapy, a hand function session and an individual session with a physiotherapist and an occupational therapist. Other components of the programmes are health education, disability awareness programmes and a group visit to the nearby National Martyrs Monument. After completion of the treatment period, a written home plan is devised and handed over to the families and a follow up appointment is made. A recent and popular addition to resources available is the playground which includes typical playground equipment such as standing frames, slippery slide, hammock and a sandpit.
CRP has two education facilities housed at its Head Office in Savar. These are:
R The Bangladesh Health Professions Institute (BHPI)
R The William and Mary Taylor Inclusive School
Issues- CRP work with
Perceptions of disability in Bangladesh
In Bangladesh, physical limitations are often not the most difficult obstacles a disabled person needs to overcome. Attitudes to and perceptions of disability are often even more challenging. As with many Southern countries, there is little awareness in Bangladesh of disability, its causes and consequences. Many ‘traditional’ views on the subject still prevail, especially in rural settings. Disability is often seen as a curse from God, inflicted as retribution for the sins of the disabled person’s parents. Many believe that disability is infectious and that having a disabled person in the house will bring on an ‘evil wind’ after which others will be infected with this condition. Treatment for spinal injuries and other disabling conditions is often based on superstitious methods and too little work is done in raising awareness about disability or educating people about how disability occurs and how to prevent it. Children rarely mix with disabled friends. The segregation of disabled children prevents stigmas being removed performed by untrained village doctors in settings which are neither hygienic nor appropriate. This maltreatment often causes further injury or aggravates the condition of the patient. Avoidable complications are a common consequence of treatment by unqualified practitioners.
CRP runs innovative awareness raising projects which aim to break down the barriers of prejudice and misunderstanding. Some projects are direct, for example, holding meetings at schools and colleges, while others are more subtle. CRP has produced or co-produced two feature films which aim to raise awareness about disability and generate a greater degree of knowledge and acceptance of disabled people. Both films emphasized the talents of disabled people in either artistic of technical areas. These films are screened in free film showings in areas covered by CRP’s Community Based Rehabilitation (CBR) programme.
Care for paralysed patients Pressure
Patients admitted to CRP often arrive with complications as a result of spinal cord injury. The most common complication is the prevalence of pressure sores caused by inappropriate care and treatment either at home of in medical establishments. Pressure sores are areas of injured skin and tissue, usually caused by sitting or lying in one position for too long. This reduces the blood supply to the skin and the tissues under the skin, causing tissue to die and a wound to form.
Paralysed people are especially vulnerable as they are less able to change position and sensation of touch, pain and temperature is frequently impaired or absent. Bony parts of the body are most at risk including heels, hips, elbows, the base of the spine and shoulder blades. Left untreated, pressure sores can become infected leading to severe damage. If the infection spreads to the bone surgery may be required. Infected pressure sores can ultimately be fatal. CRP has developed an effective system of treating pressure sores which involves:
R Relieving the pressure with postural turning
R Early treatment if bacterial infection is present
R Removal of all dead tissue
R Ensuring adequate fluid and nutrition intake to assist healing
R Maintaining good skin care
R Patient education to avoid further sores developing
To increase the knowledge of medical staff in other medical institutes, CRP provides training to nurses and doctors in effective pressure sore management and methods of preventing the development of pressure sores. Around 95% of pressure sores can be prevented through a holistic approach to skin care. Appropriate treatment and inter-disciplinary teamwork can lead to the complete healing of the sore. The methods CRP uses for pressure sore prevention and treatment are simple but have been proven to be effective and within the means of most patients.
Accessibility in Bangladesh
Article 21 (2) of the Universal Declaration of Human Rights, which was adopted by the UN General Assembly in 1948, states:
“Everyone has the right of equal access to public service in his country”. Despite this, disabled people in Bangladesh face immense difficulties in accessing services, facilities and opportunities. There are a number of reasons behind the poor accessibility in Bangladesh; however, probably the root of the problem is lack of awareness of disability and the needs of disabled people. This results in disabled people being marginalized and excluded from mainstream society. They are rarely consulted or considered when planning infrastructure or services. Without understanding disability and the needs of disabled people the situation cannot radically improve – to solve a problem it first needs to be understood.
Accessibility is often seen only in terms of physical infrastructure. It is obvious that many disabled people are not able to enter buildings, cross busy roads, get on or off buses or trains or use public facilities. Thus, one can say that disabled people are denied access to transport and freedom of movement. However, the problem extends beyond that which is immediately apparent. If a disabled person cannot travel to or enter a health complex he or she is also denied healthcare. If the same applies to educational institutions he or she is denied access to an education. If the same applies to a workplace he or she is denied access to a source of income. Even if a building is designed to enable a disabled person to enter, his or her mobility may still be restricted. Light switches may be out of reach, sinks and mirrors too high, lifts and ramps unavailable or doorways too narrow to pass through.
Additionally, even if a disabled person is educated, healthy and qualified to do a job, the prevailing attitudes to disability will often prevent him or her being considered for that post. The same can be said of training and financial or credit opportunities. Accessibility in all its forms remains a matter of equal rights and opportunities.
Unsafe working practices in Bangladesh
Many patients who are admitted to CRP with spinal injuries have suffered work related accidents. Unsafe working practices are often the cause of avoidable spinal injury. One of the most common and dangerous working practice is that of carrying heavy loads on the head. It is not unusual for loads to exceed 50kg. Should the load shift while being carried this can lead to serious and often irreparable cervical spinal damage. A load can shift easily if the carrier stumbles on uneven or slippery ground, for example when carrying a sack of rice down a gangplank of a boat and over slippery the mud of the river bank. It is common practice to carry loads on the head in Bangladesh, both for women and for men. Work on construction sites is also fraught with danger. Heavy loads of cement or brick aggregate are often carried to upper floors using precarious bamboo ladders. Items such as wheelbarrows or hood for carrying bricks are rarely used.
Accidents while picking fruit are also common. Many spinal injuries are sustained falling while harvesting fruit from trees. Construction workers are also at great risk of falling from heights due to lack of safety equipment like harnesses or mechanical equipment which avoids workers subjecting themselves to high risk work. CRP is conducting research into manual handling techniques in an effort to establish safer ways of handling and moving goods and promote the use of safer working practices in the country.
Road safety in Bangladesh
As is the case in most developing countries, road traffic accidents in Bangladesh result in many people suffering spinal injury and paralysis. CRP is committed, not just to the treatment and rehabilitation patients with spinal injuries, but also to raising awareness about causes of injury and researching and implementing measures to prevent accidents occurring. Thus, it was a natural development for CRP to begin a campaign to prevent road accidents.
Statistics from the Road Safety Cell (RSC) of the Bangladesh Road Transport Authority (BRTA) show the annual fatality rate in road accident in Bangladesh is 85.6 per 10,000 vehicles which compares to rates of below 3 per 10,000 vehicles in most developed countries. The cause of road traffic accidents are, however, multi-faceted and will take years of concerted and co-ordinate effort to address. Overloaded or unroadworthy vehicles, lack of awareness of safe road use, poor traffic management and law enforcement and poor driver training are among many reasons for the high levels of road traffic accidents. Indeed, at a road safety seminar hosted by CRP the Honorable Minister for Communications, Barrister Nazmul Huda, told that around 70% of drivers in Bangladesh have no legal driving licenses.
In response to the high numbers of accidents CRP started its “SAVAR ACCIDENT PREVENTION ZONE” campaign in 2000 using the main west-bound highway leading out of Dhaka – close to CRP’s headquarters in Savar – as its focus. Despite, or perhaps because of its good state of repair, this is one of the most dangerous stretches of road Bangladesh. Accidents occur on a regular basis involving overloaded trucks and buses, passenger cars, smaller modes of transport and pedestrians. The campaign involves awareness raising activities at schools, colleges, bus stands and with transport companies and associations, lobbying of relevant bodies and the erection of 32 road safety signboards along the 20km stretch of highway through Savar sub-district. The work done by CRP to prevent road traffic accidents is a small, but important part of numerous projects undertaken by government, non-government and civil society organisations to attempt to address the problems of road safety.
Rights- CRP Aware of
Community Based Rehabilitation (CBR)
Community based rehabilitation (CBR) is a strategy within community development for the rehabilitation and equalization of opportunities for disabled people into mainstream society. CRP has operated a CBR programme since 1994, working in collaboration with the government Social Services Department. A total of 116 Upazilas (sub-districts) in twelve districts (Tangail, Moulvibazar, Gazipur, Narayangonj, Camilla, Manikgonj, Mymensingh, Khulna, Barisal, Chittagong, Rajshahi and Dhaka) are now included. The local programme in each Upazila is owned and managed by a Upazila Action Group Implementation Committee (UAGIC). The Upazila Nirbahi Officer (UNO) acts as the chairperson and the Upazila Social Services Officer (USSO) as member secretary. Other members include representation from the local community, voluntary organisations and disabled people themselves. The CRP representative acts as the Local Action Group coordinator.
The programme includes:
ü Self Help Groups
ü Awareness Raising and Disability Prevention
ü Mobile Clinics
Self Help Groups
Self help groups have been established in areas covered by CRP’s CBR programme. The purpose of the Self Help Groups is to enable disabled people to combine their skills and resources and influence their own development. The establishment of Self Help Groups was started in response to needs which were identified in discussions between CBR workers and disabled people in the community. Areas in which the participants felt marginalized or excluded included:
Access to medical services
Access to education
Accessibility to public places and transport
Availability of appropriate vocational training programmes
Availability of employment opportunities
Availability of mobility aids
Consideration of the rights of disabled people by policy makers
These problems are addressed through activities which have a strong emphasis on training and capacity building. Training is provided by CRP and other institutions. For example, CRP provides training to self help group leaders and local government officials. In this way both sides understand the needs of disabled people and can work together towards common goals. Self Help Groups’ objectives are designed to increase the sustainability of the organisations:
R Economic sustainability: the training given to beneficiaries will enable them not only to live economically independent lives but also to pass on those skills to other disabled people. Promotion of equal rights encourages education and employment opportunities for beneficiaries.
R Environmental sustainability: the promotion of a more accessible and enabling environment for disabled people including access to buildings and transport infrastructure is a key component of the project and links directly to both economic and social sustainability goals, e.g. employment opportunities
R Social sustainability: members of self help groups join together to promote equal rights and opportunities. Their joint voice is louder – and more sustainable – than individual voices.
Awareness and Prevention
The aim of the awareness and prevention campaign is to raise awareness within the community about disability issues and help the community to identify and best utilize the contribution disabled people can make. The awareness and prevention campaign parishads, local organisations and bus, train and locations are schools, colleges, bazaars, clubs, union launch/ferry terminals.
Aims and objectives are:
1. To provide access to medical and therapy services
2. To provide CBR workers with a referral service
3. To increase awareness on disability issues
4. To provide financial support to disabled people from low income backgrounds
5. To advise on mobility aids
6. To advise disabled people, including members of Self Help Groups
Mobile clinics are arranged at a community location with direct assistance from the local government administration at Upazila level. A multi-disciplinary team including doctors, nurses, physiotherapists, occupational therapists and health workers are available for consultation and limited treatment.
Other CBR activities are:
R Training for UAGIC members, group leaders, Local Action Group co-ordinates, CBR workers and other NGOs
R Referral Services
R Home Visits
R Supply of Mobility Aids
R Promoting Inclusive Education
R Identifying those requiring vocational training
R Promoting the Leadership of Disabled People
Development of Self Help Groups
Segmentation, Targeting &
Positioning in CRP
Attracting Human Resources: Staff, Volunteers and boards
Working with third parties’
The behavior of the target audience is influenced by various drivers- Benefits, Cost, Others and self- efficacy. Together these factors are known As BCOS model of Behavior Drivers. This model is as following-
Benefits: what the target market get from CRP like Psychological Rehabilitation, Economic Rehabilitation, Physical Rehabilitation.
Costs: cost is what the customers are sacrificing for achieving what they want. Like time, energy etc.
OTHERS: others are the people of the society. Who have considerable impact on the behavior?
Self Efficacy: self Efficacy is simply the individual’s belief that he or she can actually make the behavior happen.
Good marketing starts with the target audience that determines success. Thus the first element to be set out in any marketing strategy is the organizations approach toward market targets. However, target audiences come in many different shapes and sizes and a fundamental problem for marketing managers is how o deal with this complexity. Treating all customers the same may achieve economies of scale, but it ignores the diversity that what is offered never really meets any one target audience needs very well. However treating everyone as unique individual deserving customized attention has been historically too expensive and impractical for most nonprofit situations.
There are a great many ways in which a given market can be divided for purposes of marketing strategy. In determining which way one ought to proceed, the manager should first consider why segmentation is to be carried out.
|Age, income, sex, place of residence, Status change, Family life cycle, social class.||Past behavior
Þ Purchase quantity
|Inferred measures||Personality , psychographic / life style, values||Beliefs, perception BCOS drivers, stage in decision|
Base in segmentation is are given below;
From the above segmentation bases CRP segment the market through objective general measures. Objectives measures are those that can be verified by individual observer. General variables are those that might apply to any exchange. Most commonly used objective general measures are – demographic segmentation and geographic segmentation. CRP does not use the demographic variable in segmenting the market .CRP’s market can be segmented though geographies bases. In geographic segmentation the market is divided into different geographical entities, As CRP’ conducted its activities in various region of the country so it can be said that here geographical segmentation is used .
Market segmentation reveals the market segmentation opportunities facing the organization. The organization must next decide how to target these segments. There are four broad strategies choices:
Undifferentiated (mass marketing:)
The organization can decide to go after the whole market with one offer and marketing mix, trying to attract as many consumers as possible. It treats the audience as an aggregate, focusing on what is common in the needs of consumers rather than on what is different. Undifferentiated marketing typically defended on grounds of cost economies. The lower cost is often accompanied by reduced target audience responsiveness to failure of the organization to meet individually varying needs.
The organization can decide to go after several market segments, developing an effective offer and marketing mix for each. There are two basic options. One involves create fundamentally different offering for each chosen market segment. Another option is to take an existing offering and position it differently to different segment.
The organization can decide to go after one market segments and develop the ideal offer and marketing mix. It occurs when an organization decides to divide the market into meaningful segments and devote its major marketing effort only to one or two segments. This is often referred to as niche marketing.
This is the case where a marketer seeks to reach almost everyone in the market but through some form of information exchange is able to customize the offering to the individual. Technology in particular the internet – has allowed the marketer to adopt their strategies to individuals who seek out their offerings.
From the above discussion it is clear that CRP use differentiated marketing. CRP go several market with its various offering that are-Medical Care, Physiotherapy, Occupational Therapy , Speech and Language Therapy ,Telemedicine, Vocational Training, Education etc. from the two basic option of differentiated marketing CRP use the first option. That is creating different offering for each chosen market.
Nonprofit organization is in competition. Many non profit managers would like to believe otherwise or think it is not nice to compete. But it is a reality. In an important sense, the marketer needs to know where the marketers offering resides in the target audiences mind and what association the audience has with it. This set of perceptions is collectively referred to as offering’s positions.
Once the organization analyses the perceptions that target audiences hold about a specific behavior or perhaps about the organization itself as well as perceptions of its major alternatives, the next step is developing a positioning strategy. To repeat: effective positioning involves
Building upon present strengths; Avis capitalized creatively on what would appear to be a week second – place status with it’s “we try harder” positioning. In a similar manner, a hospital with only limited facilities could emphasize its concern with delivering good care in concentrated market of very important practice areas.
- Searching for a niche; if every hospital in an area under staffs its emergency room and users interns and residents to treat most patient there, an innovative hospital could position itself as having an emergency room that treats every one quickly and personally, and with the highest quality medical staff.
- Repositioning the competition: Wendy’s Hamburger chain challenged the opposition by asking “where the beefs”? A hospital that emphasizes high touch personal treatment could develop a positioning strategy that portrays competitor as high –tech sterile environments treating patients as serial numbers.
Center for the rehabilitation of the paralyzed (CRP) positioning itself by building upon its present strength. By offering differentiated services to various target customers CRP try to build upon its present strengths
Developing and Organizing Resources
Attracting Human Resources: Staff, Volunteers and boards
Working with third parties
There are three sources of funds for a nonprofit organization
I. Donations and Grants
i. Major individual Gifts
ii. Corporate and Corporate Foundation Donations
iii. Non- Corporate Foundation Grants
iv. Cause Marketing Proceeds
i. Sales of Principal Products and Services
ii. Revenues from unrelated Enterprises
iii. Membership Dues
CRP uses all of these methods for financing their programs. CRP’s work is financed from four main sources:
I. Donations from overseas or Dhaka-based representatives of foreign agencies
II. Donations from local sources
III. Income from commercial projects
IV. Contributions from services users
CRP is fortunate to have a large base of supporters overseas. Often these supporters have visited CRP and got to know the work it does for and with disabled people. Friends of CRP groups have been established as registered charities in the UK and in Germany. Together, these groups contribute substantially to CRP’s operating costs as well as being a convenient way for supporters in Europe to donate funds to specific projects. Crucially, these groups provide a sustainable source of funding as their sole purpose is to provide support for CRP.
Large donor agencies also provide avenues of funding for CRP. Currently CRP receives funding through DANIDA (Denmark) and the United States Department of Labor, Liliane Foundation (Netherlands) and Kerk in Actie (Netherlands). Agencies in Dhaka with overseas links also provide funding. These include CIDA (Canada), British High Commission, German Embassy, Australian High Commission and Manusher Jonno.
Recent years CRP has made much progress in increasing its financial self-sustainability. As CRP-Mirpur continues to develop the percentage of CRP’s operating costs generated from its own project will continue to increase. Despite this, the nature of CRP’s work means that donations are required to continue to provide such comprehensive services. CRP receives funding from many different sources, from both within Bangladesh and overseas.
The following is a list of major donor organizations:
ü Friends of CRP-UK
ü Friends of CRP-Germany