Three Books: Noticing a Third World of Disability
Reviewed by N.D. Wyteman
 

Brigitte Holzer, Arthur Vreede & Gabriele Weigt (eds) (1999)
Disability in Different Cultures. Reflections on local concepts.
Bielefeld: transcript Verlag.
http://www.transcript-verlag.de/ts408.htm
isbn 3-933127-40-8. 387 pp. softback. 58 DM. [c. USD 30.00]

Ronnie Linda Leavitt (ed) (1999)
Cross-cultural Rehabilitation. An international perspective.
London: W.B.Saunders (Harcourt Brace).
http://www.hubk.co.uk
isbn 0-7020-2245-4. xi + 413 pp. softback. UKP 25.00

Emma Stone (ed) (1999)
Disability & Development: Learning from action and research on disability in the majority world.
Leeds: Disability Press (Department of Sociology & Social Policy,
University of Leeds, Leeds LS2 9JT, UK).
http://webserv1.leeds.ac.uk/sociology/dru/book4.htm
isbn 0-9528450-3-2. ix + 294 pp. softback. UKP 15.99 + p& p.

Colossal media energy has gone into buttoning up the 20th century and consigning it to history. Amidst the ballyhoo, none of the sound-bite historians remarked any significance or hopeful augury in the publication in 1999 of the three useful collections listed above, on disability, culture and rehabilitation in the world's economically weaker regions. The efforts described, the research reported and issues discussed in these books might yet come to be seen as a turn in the long, slow tides of human self-knowledge.
 

Historic disability references

As far back as the 3rd millennium BC some ancient civilisations recorded religious and legal notes on disablement, yet it was hardly identified as an issue of 'national concern' until some European censuses began to differentiate disabled people in the 1840s.The latter period also saw the first exporting of European rehabilitation techniques to Asia and Africa, in embossed religious materials for blind readers. Development of 19th century formal services involved some mutual visiting and exchanging of skills between Europe and North America. Yet the impetus for coordinated international action is usually seen as coming later, in the need for rehabilitation of large numbers of disabled servicemen after the 1914-1918 World War.

In the late 1920s the League of Nations collected the results of a global survey on blindness and service provisions, but more detailed developments awaited the end of the second bout of global warfare. In the 1950s, blind activists Clutha
Mackenzie and John Wilson began producing trenchant reports on countries across Asia and Africa. American information-gathering and international activity also increased in the 1950s, with an emphasis on assistance for production of prosthetic and orthotic devices. Describing that period of US involvement in international disability aid, Nora Groce (1992, p.60) noted "a disproportionate emphasis on high-tech, medically-oriented approaches to rehabilitation", regrettably ignoring indigenous culture and practice and the existing resources of local communities.
 

Exporting Eurocentric Methods

Such a trend was not inevitable, as appears for example in an enthusiastic report from the influential Wilson (1957) on an African village school integrating the blind children of the locality with full ecological appropriateness; and a few similar reports through subsequent decades, some from American Peace Corps volunteers sharing their rehabilitation skills in developing countries. Yet the imported high-tech, local- culture-unfriendly trend was predictable, in that it followed a deeply ingrained pattern of exporting Eurocentric methods, technologies and ideologies in the development of agriculture, health and education services. Dissatisfaction with the poor results of this well-intentioned but questionable practice grew in the 1970s and 1980s, along with other important and conflicting trends and responses.
 

Introducing CBR

One of the responses to counter high-tech exporting was the WHO's scheme for Community-Based Rehabilitation, piloted in 1974 in South America and during the 1980s in Africa and Asia. Even this, while mainly low-tech and aiming to incorporate refinements of indigenous practices, was soon clothed with ideological remnants of Nordic socialism. While attractive to some development agents on the local scale, it has seemed less convincing to Health and Welfare Ministries, especially as the socialist world edifice began to crumble in the late '80s. Negative ambience grew in the '90s with an increasing postmodern distrust of global schemes and grand, romantic metanarratives. For the same reason notions of 'inclusive' education for all children, vigorously hyped by UNESCO, have encountered sceptical smiles and token compliance. The concurrent trends of resurgent Asian and African indigenous cultures, the international Women's Movement, and the emergence of strong organisations of urban disabled people in some economically powerful countries, have greatly complicated the picture and increased the number of vocal stakeholders in the disability development field. This is the complex, rapidly evolving situation investigated by the three books under review. The balance and ambit of the authors are interesting. Leavitt's team is dominated by people with a background in physical therapies, now lecturing in North America and here covering a very wide range of topics in pursuit of culturally-sensitive inter-disciplinary practice. Stone pulled together senior British disabled activists, development program managers, and six recent or current doctoral candidates researching disability services, cultures and politics in Asia and the Middle East. Holzer, Vreede and Weigt's book (H-V-W) derives from a multi-limbed international conference on disability, culture and practice, with contributions from anthropologists, sociologists, educationists, therapists and public health specialists, some with disabilities, all with experience in Asia, Africa or South America. From these different origins the three books present 79 chapters, with very little duplication.
 

Highlights of three books

Among these 79, a few give little more than a position statement from an organisation or information service, or make a brief sketch of a neighbouring field, e.g. 'Poverty and Health' (Rebecca Reviere & Kevin Hylton, in Leavitt) and 'Self- Determined Living in Germany' (Ottmar Miles-Paul, in H-V-W). Several are primarily concerned with disability in migrant groups and ethnic minorities in Europe and North America e.g. Mustapha Ouertani, Maya Kalyanpur, and Kerstin Merz-Atalik (all in H-V-W); Helen Masin, and Catherine Marshall & Sharon Johnson (both in Leavitt). The majority of chapters report in more detail from a wide variety of developing countries. A small selection is sketched below.

Ina Roesing has studied the Kallawaya culture, at an altitude above 4000 metres in the Bolivian Andes, during 15 years. In Stigma or Sacredness: Notes on dealing with disability in an Andean culture' (in H-V-W), Roesing reports and discusses the lives of villagers having various impairments which evoke different social reactions from those familiar in modern Europe. She cautions against too simplistic an opposition between 'modernity' with an emphasis on individual profit, and 'traditional society' with greater concern for collective wellbeing - there are some gains and losses for disabled people in each social environment. The insights of the anthropological visitor were much sharpened while being accompanied on one trip by a fellow German professor, Reinhardt Ruedel, who was cordially welcomed in the remote and inaccessible village once he had demonstrated that he could enter and leave a hut unaided, in his wheelchair.

A Senegalese traditional healer and spirit practitioner who is also a western-educated medical doctor, Erick Gbodossou, provides unusual insights while `Defining the role of religion and spirituality in the lives of Persons with Disability in the Fatick region, Senegal, and the Mono region, Benin', (in H-V-W). His francophone text is here given in English, but neither language seems really adequate for bridging the North-South and scientific-religious worlds straddled by Gbodossou. "The notion of disabled person, that is a diminished person, is a notion that does not exist in African tradition, at least in the geographical areas the study deals with." Gbodossou provides the 'insider voice' that also knows the outsider's language - as essential a counterbalance to European anthropological notions as a companion using a wheelchair in an Andean village.

A similarly heroic bridge is thrown across cultures and disciplines by Alison Callaway, in 'Translating theory into practice in a different cultural context: a bilingual approach for deaf children in China', (in Stone). A physician who learnt Chinese during several years teaching in a medical college in China, Callaway here reports on her recent PhD in Deaf Studies. (She remarks that her signed Chinese is still basic - but somehow one knows that she makes a wonderful cup of tea...) The oral approach dominated the first century of formal education for China's deaf children. In recent years this has been slightly mitigated by state promotion of Sign-supported Chinese, using a centrally standardised sign language. Yet the indigenous sign languages are still considered to be "inimical to effective education, but also limited and inferior in relation to spoken language." The experimental bilingual class for young deaf children with which Callaway was involved is thus building across several diplomatic and theoretical fault lines.
 

Linking fieldwork to research

Ray Lang reports on his doctoral fieldwork, in 'Empowerment and CBR? Issues raised by the South Indian experience' (in Stone), pointing out that these two trendy terms have had little practical linkage. Lang is becoming known as a British disabled activist who avoids sociological jargon and aggressive sloganising - perhaps as a result of the wider perspective gained from cross-cultural studies. Here he discusses the pros and cons and many meanings of 'CBR', showing some of the ways in which it is being captured for the renewed empowerment of professionals, and suggesting ways to avoid the imbalance.

Practical field problems also preoccupy the doyenne of the CBR world, Marigold (Molly) Thorburn, writing on 'Barriers to successful CBR in Jamaica', (in Leavitt). Thorburn and colleagues have engaged for over twenty years in service development with families having disabled children. They are rare, in the CBR world, in having maintained a spirit of scientific and participatory enquiry throughout their development work and in reporting the results critically and objectively in both academic and popular media. When Thorburn states that "Further research will be essential for CBR if one believes that CBR is the main strategy for Third World (and other?) countries to provide rehabilitation services to reach more people", it is not a call for another cosy grant to sustain ivory tower theorizing, but is prompted by an intimate acquaintance with the complex, multi-dimensional nature of the demands, the issues and the resources with which ordinary people are grappling in the villages and small towns, far from urban academies.

Some of the issues raised by Lang and Thorburn are tackled in a chapter by Estelle Schneider and Hector Segovia, `Development of community rehabilitation in Nicaragua: training people with disabilities to be trainers', (in Leavitt). Here the American physical therapist meets a founder of the Organisation of Revolutionary Disabled, in a conflict-torn environment. The sub-headings roll like floods of righteousness: Changing Views of Disability; Responses of People with Disabilities; From Philosophy to Action; Development of the Concept of Training Promoters; even Where Are The Women? (!) However, Schneider and Segovia avoid getting trapped in their slogans. The exigencies of their situation demand ingenuity and innovation while adapting indigenous knowledge to modern problems.
 

Reflecting on Methodology

Many of the academic authors make formal bows towards the gods of methodology and the hazards of anthropological observation, but presumably they have squared their consciences years ago and are not about to break forth in confessional mode. That is left to a non-academic aid program advisor, Sue Stubbs, 'Engaging with difference: soul-searching for a methodology in disability and development research', (in Stone). Stubbs took an opportunity, which many development agents feel a need for after some years of fieldwork, to catch up with the reading for which there is never time at the battlefront; and to put her own study project under a reflective searchlight. Not surprisingly she left that party disenchanted, demanding to know 'Has literature anything to do with authentic knowledge?' and whether research is 'Exploitation or Emancipation?'.

A more sophisticated enquiry into The Meaning Of It All comes from one of the disability world's few professional philosophers, the genial Henri-Jacques Stiker, whose cross-cultural travels have been historical rather than geographical. Stiker suggests `Using historical anthropology to think disability' (in H-V-W), and ranges widely around 20th century schools of disability thought and research disciplines. For anglophones who have previously struggled with the complexities of Stiker's ideas in French, his translated chapter here will make a more attractive and comprehensible introduction to ways of reflecting on disablement, beyond the 'Anglo-Saxon' camps.
 

In conclusion

Each of these worthwhile and moderately priced softbacks has benefitted from editorial devotion beyond the call of duty. Leavitt gives in-text photographs, resource lists, section introductions, a detailed professional-level index, and the production quality of a big international publisher. Stone also provides section summaries, discussion points, a reading list and simple index, within the means of the low-volume, not-for-profit Disability Press. Holzer, Vreede & Weigt lack an index, but score cross-cultural points for translations of interesting work by authors who normally appear only in German or French.
 

References

Groce, N.E. (1992) The U.S. Role in International Disability Activities: a history and a look towards the future. New York:
Rehabilitation International et al.

Wilson, John (1957) Blind children in rural communities. In:  Proceedings. The Second Quinquennial Conference...of Educators of Blind Youth, Oslo, August 1957. World Council for Welfare of Blind.