Ede And Ravenscroft Prize

An Account of a Summer Working Journey to:
The Centre for the Rehabilitation of the Paralysed in Bangladesh
Part-funded by The Ede and Ravenscroft Prize
by Helen Tunney
(First Year Social Psychology, Loughborough University) Summer 2000

The Centre for the Rehabilitation of the Paralysed (CRP), Savar, Bangladesh

The Centre for the Rehabilitation of the Paralysed provides treatment and rehabilitation for people with different types of paralysis. The hospital, staffed with fully trained nurses, doctors, physiotherapists and occupational therapists, deals mainly with disability caused by spinal injury or disease, although outpatient clinics include treatment for cerebral palsy, polio, stroke and accident victims etc.

In addition to hospital treatment CRP houses a Special School for children with cerebral palsy, and offers both the children and patients the opportunity to undertake a wide range of activities, including horse riding, sports, training in agriculture, animal husbandry and crafts.

The Centre was set up by, and is still run by Valerie Taylor, a trained physiotherapist who in October 1969 was sent to East Pakistan by VSO. She found that the treatment and long term outlook for people with spinal injuries was appalling. Until 1976 there were no Bangladeshi physiotherapists and in 1978 there was only one physiotherapist per nine million people, this in a country where even today 1 in 10 people are handicapped in some way. She campaigned to set up a treatment centre and initially began with just six beds. CRP now has hospital inpatient facilities for a hundred patients and is set in 13 acres, at Savar, about half an hours drive north west of Dhaka. As well as the school there is a small ‘village’ for rehabilitation purposes and a guest house (where I stayed).

Unlike most other agencies, CRP has always had a policy of accepting people from all walks of life who would like to volunteer for up to three months. Volunteers without any specific training or skills usually observe the activities going on, before discussing and deciding where they can be of most use, forming timetables on an individual basis. Tasks include assisting with nursing, helping bed bound patients, physiotherapy, in the OT dept, with income generation projects, setting up and supervision of sports (from games of ludo or darts to basket ball or pony riding), or arranging outings. The teaching of English to students, patients and staff is also very much in demand.

Bengali is the official language of Bangladesh and although there is always someone around who can speak English, some local language is always helpful and the Centre holds daily Bangla classes to help with this. Bangladeshi women wear a sari or a shalwar kameez (long tunic and baggy trousers), and to be culturally sensitive as a female volunteer the advice was to " always keep shoulders and bottoms covered - wearing long loose fitting tops with loose trousers or ankle length skirts". Prior to departure I went to visit the Asian part of Leicester and carefully chose two outfits - both shalwar kameez (I felt a bit nervous of attempting a sari!). As I would be in Savar during the summer and therefore the monsoon season, I was advised that cotton would be essential. It was!!


Extract from E Mail 25th June

"Is very hot and humid here, but the rain when it breaks through is great and refreshing. There is an English girl on a gap year, here until Friday. She is showing me the ropes a bit. People are so, so ridiculously friendly its untrue. Went to Sonibar yesterday with one of the older volunteers. Two hours on a hot bus, but great to see the country some more. When we got there I found it had a museum which many middle class (as much as this exists) take day trips out to. All were fascinated by me as a Western specimen (!) and crowds gathered, queuing up to take photos ! All exceedingly crazy as I am red, sweaty and very unglamorous besides these gorgeous people ....felt rather bemused at the whole situation!

Transport is all mad, mad, mad, just like in photos..… polluted and more. The Centre for the Rehabilitation of the Paralysed (CRP) is a fantastic place perhaps two miles down a long muddy dirt road, am already sure there is plenty of potential for me to do a number of things. I have begun some art with patients, and doing exercises with the cerebral palsy kids as well as just chatting /playing /singing etc. with bed-bound patients. Many (especially the men) can speak some English, a few very well (my Bangla is still very, hmmmm basic!).

Extract from a letter home 28th June

It is Thursday, so I have just finished my week - my first working week here - with half a day - phew! The water has decided to stop yet again (somewhat ridiculously for such a wet country, I agree!) so I haven’t had a shower...yeeegh ! The electricity is also temperamental, generally cutting at least five or six times each day. To be honest I quite enjoy this, as it adds a certain dramatic flair to everyday life...you haven’t lived until you’ve showered by candlelight!

Rickshaws are great contraptions too, far more intimate and air friendly than cars. The roads - apart from the main highway - are almost entirely mud, so if one chances to be out after the rains, it’s a dive job to escape from the spray of these little psycho - pedalled machines!

Savar town itself is something of a grim spot. You pull up somewhat bone shaken and bodily bounced, glad that the little rickshaw has got you there in one piece. Your next challenge is to actually get from the road to the restaurant or wherever you’re planning to go. If you’re stranded on the wrong side of the road - well I wash my hands of you! Savar takes the concept of street markets to new heights. All I can think about when I am amongst it all is how everything is inside out! The street world takes life and twists it like an origami creation, so what you thought you knew and understood so well becomes constructed in a way you never before quite imagined. Hundreds upon hundreds of little stalls, often lit at night by single candles, crowd the side of the roads. Men squat behind barricades of vegetables, tea-towels, plastic combs, baskets or shoes - whatever you can think of - I’ve even seen heaps of twitching hens. Getting anywhere involves a lot of hopping, darting and dashing. Pavements have not yet been invented and the sewers are open, so one gets around by jumping from stone to stone and trying to avoid the slunge! Thank goodness Mum took the legs of my blue trousers up!

CRP (Centre for the Rehabilitation of the Paralysed) itself is an amazing place. I have infinite admiration for Valerie Taylor, in managing to set up such a spot, especially when everything here inevitably runs on "Bangla Time". They have all sorts of things going on. I help out in the CRP school a fair bit. Most of the kids here are entirely sound mentally, just dreadfully twisted up in other respects. I spend quite a lot of time individually with Poppy, Valerie’s adopted daughter. She is pretty badly affected with spastic cerebral palsy, and her limbs never stop twitching and flailing about. Even speaking is an effort, and walking impossible. It is wise to keep a distance from her if you are eating as (much to her horror) her arms have been known to send neat hook punches to the unsuspecting eater, which is as inconvenient and messy as it is amusing. She is bilingual, speaking fluent English, which is good as it means the volunteers can be good company for her. She gets very lonely squirming on the sofa all afternoon once school is over, but is happy for hours if you stay and read her story books. Poppy has enough motor control (relatively speaking) in her left foot to allow her to operate a specially adapted computer. The other day she announced, somewhat haughtily that she plans to study physics at Oxford University!

Indeed, as in Poppy’s case, a major problem on the wards is simply boredom and the subsequent depression it leads to. Some patients are on ‘bed rest’ which means just that for maybe 3 or 4 months, with generally no real hope of full recovery. As some of the physios have explained to me, spinal cord injury is permanent, It is a sad fact that while in the male ward there are a large number of family members living in with patients, for company, care, support etc. there is not one family member who lives in at the female ward. Almost all of the women have been divorced and are unlikely to see their children again. This is not necessarily out of cruelty, but rather practicality (ruthlessly so) as almost all the patients here come from poor families whose livelihood is dependent on working the fields in manual labour. The unsuitability of their lives to physical handicap, plus the urgent desire for sons has been known to mean remarriage for the husband within a few weeks.

Some of the paraplegics and quadriplegics are terribly young, and the most tremendously sad stories are behind almost every patient. For all this, I never cease to be amazed at the freshness and energy which so many of the patients exude despite the most horrendous circumstances. ‘Lovely’ was ten when she fell out of the top floor of the factory she was working in. She has now been entirely paralysed for four years. Usually she works and lives at CRP’s women’s centre where she was taught to read and write, supporting herself by selling mouth paintings. Presently she is on the ward as she has a chest infection, and being unable to expand her chest sufficiently to cough, is really quite seriously ill. Never a word of complaint though, just the most radiant of smiles and gentle conversation. A lot of the patients accept their condition as being the will of Allah. The faith that their suffering has some meaning greater than they can understand enables many of them to be extraordinarily resilient. One of the most profoundly optimistic and deeply joyful patients is Shilpy. She is also fourteen, and was paralysed when working as a maid she slipped and fell in the bathroom. She is a skinny little thing, and has no family or relatives left alive. Often when I come in to see her each morning she will be lying there in bed, radiant and stunning having made herself up with crimson lipstick and thick eyeliner. Bangles clatter around her wrists and she laughs in easy delight. It strikes me one day that she is probably getting more attention here in hospital than she has ever known before in her life. Peoples expectations in life are not so high here, happiness when it arises is simple and immediate. Little Julicker is another patient who finds it preferable to be here. She is an energetic imp and her mother was unable to look after her, so Dhaka’s mother Theresa home has looked after her for a number of years. However preferring it here, she has a terrible habit of pulling her bandages off and aggravating her pressure sores in order that she is ill enough to stay. Recently discovered that her feet were going rotten which she either neglected to notice or mention. As for the rest of the time, well..… she is a real little madam who commands people about, throws things on the floor, hides medicines, then throws her head back and laughs in absolute glee. She is on one of the long trolley beds, so she can trundle around the wards poking her nose in everywhere. Julicker was about eight when she was injured, she was up a tree stealing mango’s when some boys spied her and shook the tree . . . Mango tree’s appear to have been the cause of injury for many people (though I think its only Julicker who was actually stealing them!). Other causes include road traffic accidents, spinal TB and carrying heavy loads on their heads. As I look out of the window now there is a construction site with women wrapped in elegant saris toiling barefoot with flat caps and perhaps eight bricks piled up on their heads - mad. Approximately 10% of the entire population here is handicapped in some way.

So, anyway, always plenty to be doing, games of ‘Connect Four’, nattering with those better at English, helping out with the sports from five to six each evening, trying to get the cogs moving for a big, big art project I want to set up - six 1.5 m paintings/collage/murals depicting village life, festivals etc.. which the patients can both participate in creating and which will hopefully cheer up the wards and trigger good memories etc. when finished. I have also been taught how to do some basic physio exercises with bed rest patients and once Liz leaves I will take over ‘walking’ (this involves patients being strapped to a supportive frame in standing position - aiming to prevent total muscle wastage) and doing ‘weights’ (hand bars for those on bed rest.) This is actually great fun as we usually put some nice Hindi pop on the radio, then make the exercise into little horizontal dance routines - which is hilarious, especially when I am commanded to sing English songs for the ward instead! Yes, the Bengalis are most definitely a race with a knack for conjuring humour into every situation. Me, being highly diligent and conscientious was recently attempting to increase my Bengal vocabulary, and some of the occupational and physio students were giving me a hand. To do this I repeated the words they gave me several times over trying out the correct pronunciation, when suddenly they were all clutching each other in wild states of amusement and refusing to tell me the meaning of what I had just proclaimed to the world in general...students!

One patient has a sprightly father who is a tiny man with a long beard and lots of energy. Whenever he sees me he licks his lips and rolls his eyes most suggestively, Apparently he has seven wives and would quite like to add me or any other dozy young volunteer he can get to the collection!

Extract from E mail 6th July
Mad busy week, working - ten hours a day from 8.00am - 8.00pm, so am feeling quite justified at being pretty knackered.

Lots of patients have fevers and typhoid at the moment, which is wretched, especially when the hospital electricity goes off too so there aren’t even any of the all essential fans to cool them.

It was announced this week that the female ward desperately needed an assistant physiotherapist. After a 30 minute crash course I was slotted into this role- my back is now really sore from bending over some very low beds!

Extract from E mail 13th July
Work this week has been, as ever, hectic, exhausting and exhilarating. Mainly doing physio in the female ward as before. Further to doing leg and head massages have managed to get many patients doing weights to keep their arm muscles strong (especially important for the paraplegics). This is great as usually we manage to get some Hindi music going and make it into a little bit of a dance routine ..amusing for all! Big problem to tackle too is depression on the female ward. Unfortunately, due to language barriers the most I can help there is with distraction and a bit of ignorant, empathetic hand holding. Of course the best cure for this is when someone gets a restoration of some motor movement. Even just sitting up can be tremendously inspiring for a person after months of being horizontal. A further problem with this is the hideous, hideous pressure sores that all too often develop. Having helped dress a few of these sores .… was able to quite conclusively decide that I am not cut out to be a nurse.

Extract from E mail 20th July
Great week at CRP. A number of the girls finished bed rest, first sitting, then progressing up and into a wheelchair. There is going to be a lot of work next week getting them standing or even walking on frames, with splints and metal bars. On the down side, the very end of the week finished badly, with little Shilpey came down with a really bad fever, and was finally diagnosed (when her temperature reached 106) as having typhoid, and worse, having had it for a week undiagnosed and untreated ....pretty stressed about her, as I had kind of taken her under my wing ....I, favourites ...never!!

First Impressions of Dhaka, from diary kept whilst in Bangladesh

.....Early morning in Dhaka. Quiet everywhere, as quiet, clear and bright as a new scrubbed child, a layer of it slicked over every filmy sleeping surface of the streets. Empty roads roll and twine through the haze, netting buildings and bodies around the edges of a grey sightless world. My rickshaw pans slowly past, seat creaking as I shift, white hands stirring on my lap. I look and look, feel surprised I don’t disturb the folded sleepers with my stares. The sleepers are everywhere, there is an innocence and intimacy in catching them in the early hours like this. I almost feel guilty, as though I snared a bird lost and removed in the delight of its own song. There is no pretence here. They like back in corners, arms extended bare and slack over slumbering children. Flailing cripples flaunting and pressing their mutilations on you in daylight hours lie here now, bodies still, only absence proclaiming their loss. These people have nothing more. Its fact, scattered simply as breadcrumbs to sparrows.

This is a city of many moods. They skip across its surface like pebbles over a lake, spilling tides of ripples, then sinking into a haze of obscurity. Wherever I am here, I find it hard to get away from thoughts of digestion, of fluids being secreted and substances drawn up. A constant state of regeneration. I watch a glass eyed cow swaying besides a flimsy tinned hut. It balefully regards the world, jaw rhythmically sliding from side to side. I find myself thinking how perfectly this action sums up Dhaka. Its a very real place, very textural, it winds around your tongue and gets stuck in your teeth, makes your gums sore but somehow slices open new pores, passageways and cavities.

The sky billows her skirts, heaves a weary sigh then slumps leaden over the city. It begins to rain. Heavy drops, long hung and waiting, fall, exploding with touch. Feet lift in a saturated panic, bright saris lift and tuck as bare feet dip and hop. Crowds gather under overhanging tarpaulins, trying to keep errant limbs tucked dry beneath them. Vegetables float by the side of the road, peelings and grime diluted and washing in tidal bands across the street. Blue plastic is thrown over pavement stalls. Rickshaw wallahs pedal with a new intensity, water carving deep rivets down already well wrung and sweated faces. In night rain they become magnificent charioteers, chasing from glistening kerosene lit pools in a glittering spray of star spangles. I notice a man curled foetus like in the burnt out cave of an engine extracted lorry. His arm swings easily up, loosening a catch so that the bonnet falls closed. Very clever! I watch water slide down the pane of the bus window and think how liberally life is ladled here. We all tumble slide and skelter shoot our brief way before the ground quickly laps us up. Coal chip children spring savage but laughing through barefoot street games. Somehow this all seems right that this is how it should be. I never expected to feel that.

I stayed at CRP until mid August when my visa ran out. I then started the second part of my plan. This was to backpack around northern India and Nepal. To summarise my route exceedingly briefly, I headed North from Bangladesh, travelling mostly by train, though sometimes by bus, visiting Darjeeling and Sikkim. I then went West through Nepal and visited both Kathmandu and Pokhara. Returning into Northern India I went to the city of the dead - Varnasi, on to Agra and the Taj Mahal and then down into Rajasthan to Jodpur and Udaipur. Many experiences along the way.....!

E mail 4th Sept.
...I am becoming sick of being in this unreal plastic tourist world. Seems something of a joke, and somehow all the same, just different touts jumping at you with slightly different bits to shove up your nose. Sick of being just a money machine. Sometimes just walking along the pavement you have to step over people sleeping there, children, beggars, old, the lot. Seem to have become terribly short sighted because sometimes I just can’t see any further than that. Not so sure I want to buy, (even at a ‘special price’) any glasses.

You know, that work in Bangla was the best thing I have ever done in my life. Never told you about the heroin addiction clinic in Dhaka that I visited did I? The youngest child there was seven years old. Sooooo . . hope this doesn’t sound too dreadfully pious ( though really don’t care if it does). I’m going from here (which is Udaipur in Rajasthan) to Calcutta. I want to spend the last few weeks - which it will be by the time I get there seeing if can give Mother Theresa’s folks a hand. They may be overrun with idealistic 20 year olds, but hopefully if nothing else I can scrub a few sheets ....!

Nice logical route I know… but hey ho, never expected to feel quite this strongly about this. So there you go, back to burbling in Bangalese! ( had better start brushing it up again!)

E mail 12 Sept.
Well ......am working a.m. in orphanage for physically and mentally handicapped kids, then p.m. in home for dying and destitute. Both Ma T. homes. Did first day today, its quite tiring work in lots of ways but definitely the best decision I made to come here! Calcutta.… so poor- 200,000 live on the streets here (half of which are kids) but wow..… I know its cliché, but this whole city really does have a certain ‘je ne sais quoi’..… little groups sitting about in the evenings playing cards, playing instruments, people cooking, sleeping, eating and washing in the streets everywhere. So nice not to be a tourist (totally!) and have already made a really sound group of friends from amongst the other volunteers. Great decision and worth the slog of getting here (so far, anyway!)

E mail 16th Sept.
... There is actually plenty to be doing too, as in both places there are a lot of people, and also beyond the basics of keeping people cleaned, washed, fed, and medicined up etc., there is also something of a need for some individual attention. Never really know how much that is worth, but suspect that for all the distances there are between people they are actually the smallest when someone is dying. Language becomes somehow irrelevant, just the motion or rhythm of language and sound can be comforting. The ‘Home for Dying and Destitute’ is probably the closest I have been to a camp of Auschwitz victims. Simple things though ......little girl, maybe ten years, lying on a bed, bag of empty bones moaning and scratching at her skin, just sat and held her and softly sang till she slept. Possibly never felt quite so profoundly human.

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