Tuesday, 6 November 2007

CONDUCTIVE EDUCATION – ON TOP OF THE WORLD

And an awful lot to learn 
Trainer in Conductive Education, community-based rehabilitation project, Lhasa, Tibet Autonomous Region, China (Job advert on Internet)
Just another job? On the contrary, this advertisement poses important questions about the ever-widening internationalisation of Conductive Education.

CE and the developing world


I have long contended that fundamentals of Conductive Education represent an ideal means for developing ways of thinking of practical services in the developing world. Conductive Education demands no expensive, hard-to-maintain hi-tech equipment, depending instead upon the one resource that the development world lacks and the developing countries have in limitless abundance, a plentiful supply of inexpensive labour. After all, did not András Pető first develop Conductive Education in a country that was at the time in straightened circumstances?

From this initial proposition of Conductive Education’s considerable potential for countries in the first stage of creating humane and effective services for disabled children and adults, and their families,an enormous step still has to be made from the present situation to what might potentially be developed.

First, we have a Conductive Education situated firmly in the developed countries, with ideas and practices to suit – and even within this context, available in most of those countries only to more prosperous and articulate families. We should also remember that the expression ‘Third World’ was coined at the time of the Cold War, to cover those parts of the world (most of it!) not actively engaged in that conflict. In some respects, socially and economically, the former Soviet Block is still struggling to catch up and some of what is written below about the situation of Conductive Education might also apply there too – though perhaps in a particular way. This is too big a side issue to cover here.

So how to apply this approach to the desperate needs of the myriad disabled amongst the world’s poor.

There are obvious meta-problems. There are often economic and political barriers to implementing anything in such contexts. Developing countries are mainly poor and traditions of public service are often poorly established. Then, looking back at the history of developed societies when we were evolving our own health and education services and their specialised wings, one sees a typical historical sequence over the last century-and-a-half. Family-based (as opposed to residential) services for physically disabled children tend to appear fairly late in the process, and their widespread uptake has to await provision of universal basic education and health care. We cannot expect newly developing countries to buck such priorities.

I am not sure the best expression to use here: not knowing any better I use the broad term ‘developing countries’. ‘Third World’ seems to have dropped out of fashion and anyway it is fairly meaningless now that the world is realigning. Some refer to ‘the South’ as opposed to ‘the North’ but developing countries are not confined to the Southern Hemisphere and not all developed countries are in the Northern one.

Whatever term is used, developing countries constitute no monolith, representing a broad range of different levels of economic development, its dynamic and its present potential – never mind their myriad cultural and other social dimensions. Further, within a given country there will be in varying proportions, the poor, an emerging middle class and an elite, with their own distinct notions of how to meet the perceived needs of their families.

These broad social and historical factors, and possibly others too, are essential background to formulating schemes to transfer Conductive Education out from the developed countries that currently host it.

Problems for Conductive Education

Whatever Conductive Education’s ultimate potential as a basis for understanding disability and founding services in the developing world, the general problems outlined above have been enough to confine Conductive Education's remarkable internationalisation  largely to the developed countries. This is not to ignore the interest and enthusiasm of parents, professionals, NGOs and other bodies situated in developing countries, who have spotted this potential for themselves, particularly through Conductive Education’s dynamic presence on the Internet -- confusing and inaccurate that much of this presence may b!e Much of this enthusiasm remains unsatisfied  as it has in most developed countries – leaving ready ground for unsatisfying displacement activity. 

There are three major, interrelated issues.
  • First is articulation of what constitute the fundamentals of Conductive Education. This runs far deeper than, for example, ‘good practice guides’ based upon what is done at a particular time, in particular social contexts. By definition such guides are not transferable in either time or space, even sometimes over a surprisingly short time or to different circumstances within a single society. Such formulated models may prove of  limited benefit when crossing between different societies within the developing world. They may be of even less help, perhaps to the degree of being actively misleading, when they cross between societies that differ more radically. The opening statement to this posting stressed that it is the fundamentals of Conductive Education that are at issue here, not some of the ‘Conductive Education as she is spoke' that has evolved to match the constraints and opportunities of existing niches in developed societies. Identifying such fundamentals has not as a whole featured in Conductive Education’s transfer between developed countries – to the detriment of everyone involved, such transfer being often based upon upon frustrating attempts at literal transposition of established ways of working, and/or upon unconvincing explanatory ‘principles’ that miss the fundamental point.
  • The second, and this is in no way unique to Conductive Education, is to find ways to exist and develop in new contexts without committing the perennial foreign-aid error of imposing existing forms of service rather than working towards ways of synthesis with new cultural realities. At the same time, Conductive Education is not value-free. Its identifying principles include belief that people can and must change, and that this is done as a result of human agency, through a single, unified agent (the conductor) where motor-disorders are concerned. Synthesis with indigenous ways of doing and thinking cannot mean subordination of conductive values and practices, where for example these include passive-defeatist understandings of human potential and a determined atomisation of human learning to reflect existing ('multi-disciplinary') service structures. Again, there is little by way of a model of satisfactory achievement in this respect to be found in the story of Conductive Education’s spread across the developed world.
  • Third of course is the overriding imperative that any ‘technology transfer’ involving Conductive Education should maintain the essence of the conductive approach. If Conductive Education aspires to recognition as a pedagogic or rehabilitative technology – and to all the advantages that accrue from this – then of course its defined technology has to be there from the very outset of transfer. There is no point in passing on to poor countries some sort of pseudo-CE, unjustifiable ‘principles’, a simulacrum – what the unkindly call Mickey Mouse – however sincere the beliefs and motives with which this is undertaken. It should be an important guiding principle to all such transfer, be this  in Conductive Education or of anything else, that the poor do not deserve the second rate. Again, Conductive Education has spread amongst the developed countries without showing  much ability to deal with this problem.
The experience of the developing world in dealing with such issues offers little in the way of a pointer to guiding more radical transfers, across greater economic and social divides. Just perhaps, however, better-handled transfers of Conductive Education to the developing countries, if these can be arranged, might help make the processes involved more explicit and therefore offer something from which everyone could learn and benefit.

The process of transferring Conductive Education across Europe and onwards to ‘Europe overseas’ has hardly been an example of cultural sensitivity or technical efficiency. Nor have most of us in the developed countries much to show by way of Conductive Education spreading to all strata of our own sometimes highly stratified societies (how many of the thirty-odd conductive programmes in the United States, for example, are black- or Hispanic-led?). Hardly a good experiential base for considering how to make the far greater jump to the circumstances of the developing world – or even for the future of Conductive Education in the developed world if it continues to proceed merrily along the same old paths.

Internationalisation of Conductive Education to date has shown little inclination to consider possible lessons to be learned from comparative education or technology transfer. Perhaps the sheer unfamiliarity of transfer to, say, Tibet or Sub-Saharan Africa, might prompt a wider view of issues that the whole conductive movement has been unthinkingly involved in. Perhaps.

Limited experience and knowledge

Despite personal enthusiasm to break Conductive Education free of its current narrow social-economic milieu my own practical experience of this has been very limited. Over the years I have had visits from and discussions with all sorts of people who would have liked to establish conductive projects in developing countries. For the most part these projects have come to nothing, falling in most cases at the hurdles of lack of money and lack of institutional support.

I was involved, however, nearly ten years or so ago with a project that did nearly make it, proposed and planned in some degree of practical detail in collaboration with the Spastics Society of Chennai (formerly Madras) in Southern India. This had a lot going for it, institutional support and the same sort of powerful, informed, parental steer that had been so important in driving the spread of Conductive Education in the developed countries. There was the recognition that progress would be long-term and set within a developmental strategy that stretched all the way to creating an Indian version of conductor-training, related to what would be by then evolving Indian modes of practice. There was even sufficient funding in place to initiate the pilot stage of this work, providing for a couple of conductors to work together on what were, by Indian standards, princely salaries. The whole scheme fell at very the starting line. It fell because at the time, at the end of the nineties, there were simply no conductors to be found willing to countenance salaries that princely merely by the standards of the developed world. Those who were involved with conductive education at that time will know what I mean.

Ten years is a long time in the internationalisation of Conductive Education and many conductors today are of a different mould, with many expressing regret that they do not have the chance of working in such a project. Unfortunately that particular moment is past.

(Actually, Tsad Kadima, the Israeli Association for Conductive Education, followed up with a fortnight’s workshop in Chennai the following year, but that is hardly the same) and there is still no Conductive Education in India. Yet.)

So my personal involvement in attempts to introduce Conductive Education to the developing world has been reduced to the level of a spectator in a spectator sport

There have been other attempts to establish conductive programmes in that huge range of circumstances subsumed under the term ‘developing countries’. Tsad Kadima established a scheme in collaboration with the Palestine Red Crescent but that blew away with the first Intifada. There were three conductive summer schools in Cairo but these have not led to anything more permanent. Something is astir in the oil-rich Sheikhdoms of the Gulf. The first conductive project there, the Conductive Education School of Kuwait, has caused its fair share of excitement in the conductive world. Proper understanding of those particular circumstances must await the dust’s settling. Notwithstanding, linked conductive projects are envisaged in Saudi Arabia, Bahrain and the Emirates. There was also to be something in Iran but this vanished into the mysterious Pető zone, a black hole from which traditionally no light has escaped, and nothing further of this project has been heard.

I am not sure whether to include Mexico as a developing country in this respect. Development of the conductive centre there has been outlined in Recent Advances in Conductive Education – read it and judge for yourself. Also in Recent Advances is an account of the development work that led to establishing a centre in Brazil. There is no question about Brazil’s being a developing country – but like many other such it is a diverse one. The European-style conductive service now running in Florianópolis in the Brazilian state of Santa Catarina might hardly serve the needs or disabled children and their families in the favelas in say Rio and São Paulo.

Then there is the experiment in Sizanani Village in South Africa where conductor Zsóka Magyárszéky has been working for some three years. I have before me as I write Adri Vermeer’s recent book Health Care in Rural South Africa: an innovative approach, waiting for me to review it for the upcoming issue of Recent Advances in Conductive Education. I will not therefore deal further with this here.

Witness to the potential enthusiasm amongst the new breed of conductors to go out and be conductive pioneers are two committed individual personal programmes. In their final years undergraduate training at the National Institute of Conductive Education, Stephanie Driver and Hannah Davies undertook practical field work and wrote their dissertations on feasibility studies for developing conductive programmes in Vietnam and the Dominican Republic respectively. Supervising these projects provided me with sharp reminder of Conductive Education’s potential for human benefit in most unfamiliar social and economic contexts, and of the need to adopt radical and questioning approaches in order to develop culturally appropriate conductive practices. Now qualified, both are working their divergent professional paths towards finding situations to realise their aspirations.

There may well have been other conductive projects in developing countries that I have missed here.

On a very different scale, and not involving any conductors at all, there is China, as ever a very special case and one that might affect us all, in respect to Conductive Education as everything else in our lives. This too is far big an issue to deal with here – and, as far as Conductive Education goes anyway, possibly not directly related to what is happening in Tibet. This too, therefore I shall be addressing elsewhere.

And there is something else that I do not know whether should be included here, the series of programmes run by Hungarian Baptist Aid (HBAid), a religious body involved in humanitarian aid and international development. A specialty of HBAid is a programme that it calls FLAME (standing for ‘function, language, and movement education’), describes as ‘adopting the famous Hungarian Pető method [and] prepared by our staff in several countries of the world’. For the sake of sustainability, in addition to direct work with the disabled, FLAME field projects also involve training for local staff. This ‘FLAME’ is apparently unconnected with the long-established conductors’ programme of the same name at Treloar College in England. The Baptists’ work, like much else in Conductive Education, remains undescribed and direct enquiry has elicited no response. Since 1997 HBAid has applied this programme in an impressive and growing number of developing countries: Albania, Algeria, Cambodia, Former Yugoslavia (Kosovo and Serbia-Montenegro), Iraq, Jordan, Mongolia and Vietnam, with training material published in local languages (at least in Khmer and Vietnamese). But how ‘conductive’ is it and have conductors been involved in its formulation?

And so to Tibet…

The advertisement that prompted this discursive posting is for the position of 'Trainer in Conductive Education', in Lhasa in Tibet, published on the website of Handicap International Belgium (HIB), a large international aid organisation based in Brussels. This very informative website provides the information from which information of the Conductive Education project planned there, and commented upon below, has been extracted and ordered. Here is a taster 
Specifics: high altitude (3600 m); weather conditions difficult, cold in winter; accommodation in a hotel; social isolation, rare entertainment and difficulty travelling out of the city (permits required).
One could hardly think of a job in Conductive Education more justly deserving of the over-used description ‘challenging’!

See the Notes and References at the end of this posting for further access to this advert.

Handicap International Belgium

HIB is the Belgian branch of the much larger Handicap International. This is a non-governmental organisation specialising in disability, non-governmental, non-religious, non-political and not for profit. Since its inauguration in France in 1982, seven other divisions have been created: in Belgium, Switzerland, Luxembourg, the United Kingdom, Germany, Canada and the United States.

HIB works in a number of countries. It has been active in Tibet since 2000, in collaboration with the Tibet Disabled Persons Federation, a semi-governmental organization. In that time activities have included a community-based rehabilitation project in Lhasa City and an orthopaedic workshop, developing a Tibetan Sign Language and a physiotherapy project. The community-based rehabilitation project currently provides social and physical rehabilitation services to children from Lhasa City, including home visits, activities at a community centre and encouragement of support for social integration through school inclusion. It organises disability-awareness sessions, and trains village doctors. Eight rehabilitation workers work full-time on the project, plus a programme manager, a team-leader and a technical advisor.

Children benefiting from this project mainly have cerebral palsy, the after-effects of polio, clubfoot, hip-dislocation, spinal-cord injury, muscular dystrophy, cognitive delays and/or behaviour problems. There also appears to be preponderance of children with physical disabilities served by HIB’s other activities.

The rehabilitation workers and physiotherapists (their backgrounds are not clear from the advert) have been trained on various subjects, and the majority of their clients are children with cerebral palsy. As a result these workers ‘have acquired today quite strong knowledge and experience on different methods used to improve the functionality and the integration of those children’.

So where does Conductive Education come in?

HIB would like to widen the types of services offered and the kinds of methods used, to provide better quality and more varied treatments and services 
Therefore we thought that training in Conductive Education, adapted to the local situation (no day-care centre but a rehabilitation centre and a community centre), would allow them to provide other kinds of services (such as group activities) than the services they are currently providing (that are, at least in the Rehabilitation Centre, more centred on individual treatments).
Group activities are already organized by the rehabilitation workers and volunteers in the community centre but a proper training would allow them to organize those activities in a more formal and probably efficient way and also provide them with better-defined boundaries.
For the physiotherapists of the rehabilitation centre, Conductive Education would bring a wider approach (more holistic approach or a ‘life style) on the management of cerebral palsy than what they were trained so far. Training them on such a method would complement well their current knowledge and fill some of the gaps left by their past trainings.
So far so good. It is at this point that issues such as raised earlier in this posting are vital background to practical planning. The post as advertised indicated how seriously such matters have been considered by this major aid organisation.

What will be required of the 'Trainer in Conductive Education'?

The advertised position of Trainer in Conductive Education is for work with the community-based rehabilitation and physiotherapy projects, to the trainer will do¸ train the eight rehabilitation workers in the community-based rehabilitation and two of the physiotherapists, in the following 
  • theoretical basis of Conductive Education (history, definition, principles, advantages)
  • practical training to organise and run group activities for children with cerebral palsy
  • practical training on organisation and conduction of group activities for adults with other kinds of motor disorders
  • organise a final test.
Along with this the successful candidate will also have to 
  • design equipment for (presumably local) production, purchase and adapt local equipment and ‘provide support for room adaptations’
  • produce (or make available) reference and training material on Conductive Education (in English)
  • write an end-of-mission report, to include explanations and comments on the organisation of the training and recommendations for further development of the services provided by the two projects (equipment, organization, training…)
And who will do all this? The advert makes this clear too: ‘A professional (PT, OT, teacher, educator) specialised in Conductive Education’. One knows what the first three of these are. ‘Educator’ is less obvious, but probably represents a too-ready translation from the French educateur, someone a bit like a British nursery nurse or youth worker but more highly trained (akin to a Russian vospitatel’ or a German Sozialpädagog). No matter, it is hard to know how any of these four professional backgrounds could meet the extraordinary high requirements of the job in the most ideal of circumstances.

But perhaps maximal knowledge is not so important, since the total duration of the mission is planned to be only two months…

So, what to make of this?

I have to admit to contradictory personal reactions – some plus, some minus.

Plus. How wonderful it is that a big organisation so eagerly embraces Conductive Education as a means to achieving its goals, an organisation dedicated to the vision of ‘a world in which all forms of disabilities can be prevented, cared for or integrated, and in which the rights of people with disabilities are respected and applied’. How different this is from so much of the world of ‘disability’ in the United Kingdom.

Minus. What possible vision of Conductive Education is this project based upon? Where did HIB get this vision? From HBAiD? Are the substance and the practice of Conductive Education really so reduced in the eyes of the world that they seen to be applied and transmitted with some apparent ease?

Plus. All the same, something that HIB must have read or heard has suggested that Conductive Education would be a progression from what it already provides in Tibet, offering ‘a wider approach… than what they were trained so far… fill some of the gaps left by their past trainings.’

Minus. But how on Earth can this be reconciled with scraps of something or other provided by professions with no revant training in this approach themselves?

Plus. But what a wonderful opportunity, even at this late stage (applications formally close at the end of this week) for an adventurous and imaginative conductor to go out and start exploring what might potentially be achieved in that context, in the only place properly to do so – in practice. Please somebody apply, convince HIB that if it’s really Conductive Education that is wanted then conductors have something to say about this. Go to Tibet and get stuck in – learn from your inevitable mistakes and then share what you learn for the greater good.

Minus. What extraordinary circumstances in which to expect anyone to do all this! It is altogether impossible to train people to do and be what the job requires – never mind do all the other things – in anything like the time specified, even under optimal circumstances. And these circumstances are hardly optimal. Consider the demands of acclimatisation (cultural as much as physical), possible sickness, altitude fatigue (3600 meters above sea level – that’s 12,500 feet), unforeseeable language problems, and the inevitable need to discuss, discuss, discuss if there is to be any real communication of Conductive Education. All within two months!

One could go on batting such arguments back and forward but to what purpose? If HIB finds some one to take up this position then the project will presumably go ahead. One must wish well for the Tibetan children and their families and everybody else involved – but this is not to detract from this to fear the implications for Conductive Education. After all, Handicap International is a large organisation and, if the conductive project in Tibet is deemed a success when implemented in the manner intended, what other such ‘Conductive Education’ schemes might be mounted elsewhere in the world?

A problem for Conductive Education in the developed world has been that its introduction often meets opposition from existing professions and institutions – turf wars in which the newcomer is inevitably in the weaker position. Perhaps Conductive Education might fare better in countries without entrenched services and practices. Against this it should be said, however, that existing models of thinking about disabled children and their families, and constructing intervention services, are already knocking at the doors of the developing world. There is unlikely to be a tabula rasa anywhere and the best that one might hope is a narrow window of opportunity. Further, as the project in Tibet suggests, Conductive Education might arrive in a new country to find itself already defined, erroneously, with bitter situations already well known in more advantaged contexts waiting to be reenacted…

Conductive Education at the roof of the world? Invigorating waymark along the worldwide expansion of Conductive Education – or urgent alarm call to alert to new dangers ahead, and do something about them?

­­­­­­­­­­­­­­­­­­­­­­Some onward links

The Tibet project


Handicapped International Belgium:

HIB's Tibet project, the job and how to apply:

Brazil

For reflections around Conductive in Brazil, see Leticia Kuerton’s  blog:
The early development of this project:
Kuerton, L. (2007) Hungary, Mexico, England and Brazil: one family’s experience of Conductive Education, Recent Advances in Conductive Education, vol. 6, no 1, pp. 3-6.

South Africa

The Conductive Education project at Sizanani Village

Vermeer, A., Wijnroks, l., Zsóka Magyárszéky, Zs., Mbethi, N. (2006) Effects of Conductive Education in a home for children with developmental disorders, Recent Advances in Conductive Education, vol. 4 no 2, pp 9-20

Vermeer, A, Templeman H. (eds.) (2006) Health Care in Rural South Africa: an innovative approach, Amsterdam, VU University Press

Mexico and Kuwait

For brief reports of establishing the Mexican centre and setting up the Kuwait school see:

Millan, M., Gaja, S. (2006) Bringing CE to Mexico, Recent Advances in Conductive Education, vol. 4 no 2 pp 21-23

Szatmáry, J. (2006) Conductive Education School Kuwait: a paradigm of reality. Recent Advances in Conductive Education, vol. 4 no 2 pp. 32-32

FLAME

Hungarian Baptist Aid’s FLAME programme:

1 comment:

  1. Andrew,

    I would like to post a question under the doubt about `developing countries`.

    Nowadays i think that we need to mention of WHAT we are talking about. I mean: what is under development? Economy? Sociality? Environment ? Racism? Technology ? Self-care ? Human relations ? Love ? Terrorism ? School needs ? Health system ? People worries ? Biology care? Education?

    I am sorry to post you in this way, but with the globalization of the information we might know, it is hard to decide WHO is a developing country.

    This is a history point of view. To be mature in a way someone need time to try. And we cannot block the hope about starting, independent WHERE you are.

    Top of the world is where I am happy and developing my best life.

    Leticia Kuerten
    Brazilian

    ReplyDelete