The picture was taken during the reception at The Houses of Parliament hosted by Rehabilitation International when Marion received her Honorary Conductor status. Marion sent me a personal invitation for this event to share her joy. In my next posting I will write about my work and my meetings with some really special people in Hong Kong.
http://www.disabilityworld.org/04-05_02/children/china.shtmlRemembrance of the late Marion Fang... From Driver to Therapist to Orphanages: Conductive Education Spreads from Hong Kong throughout China
By Barbara Kolucki
"It looks like a typical special school in many ways: lots of children with a variety of physical and other impairments, lots of caring and working adults. One sees some self-help activities, a little speech therapy, physical exercises, etc. But every time I am exposed to Conductive Education (CE), especially in Hong Kong ñ it just gets better and better and I want the world to see and practice what I have just seen.
Conductive Education originated in Hungary in 1945 where its founder, Professor Andras Peto, achieved remarkable results with children and adults with a variety of neurological and physical impairments. It is a holistic and humanistic model where "rehabilitation" is directly linked to function in activities of daily living. It is applied from infancy to adolescence to old age and is based on the philosophy of "unity of mind and body".
The underlying philosophy of Conductive Education (CE) is that it perceives the disabilities of a neurologically-impaired person to be problems of learning. Rehabilitation is therefore seen as an educational task. CE addresses and integrates cognitive, motor, personal care, psychosocial and communication skills ñ these are not addressed one at a time. And these domains are integrated whether one is working with young child in a school/curriculum setting or with an older person in rehabilitation/vocational setting ñ it is one of the few longitudinal systems that practice a life-cycle approach to rehabilitation.
A description of how this works in a Centre for infants and young children in Hong Kong follows. The Jockey Club Conductive Learning Centre in Hong Kong In Hong Kong, I recently visited the Jockey Club Conductive Learning Centre (CLC). Ms. Clare Cheng, a physiotherapist by profession, is the Superintendent.
There are 32 preschool children at the CLC. Some of the children are boarders and go home on weekends. Others return to their families everyday. The goal of the CLC is to reach these children as early as possible as well as to provide a model to their parents and other caregivers of practical, integrated, doable actions that can be facilitated throughout the entire day with their children.
Another goal is to serve as a demonstration centre for professionals who are or will be working with children with neurological impairments. Every single person employed by the CLC is part of the team. Many parents are there at least for part of the time with their children. So one might see a group of eight children, each with an adult nearby, facilitating a physical skill like walking or standing. Each adult is encouraging a child, singing along with them, reinforcing the child's efforts and assisting when needed.
The heart of CE is teamwork and the array of adults involved is quite diverse. They are a mix of a speech therapist, an early childhood teacher, a driver, a physical therapist, the ëamah' (cleaning woman), and a few parents.
Each person is responsible for the success of the CLC and its commitment to children and their families. Each knows not only the schedule for the day but they also understand the philosophy and practice of Conductive Education. So, for example, after the driver makes his rounds, he joins a group of children. And after the children's lunch is prepared, the cook sits with a group of children and adults and facilitates an activity. During the job interview, this unique arrangement is clearly presented as part of every job description.
Everyone works together as a team. And honestly, one could not tell the difference between the driver or ëamah' and the physical or occupational therapist. So what one sees is a lack of labeling of children and staff. One sees staff of every level helping each other out.
Helping a child is not dependent on education level, degree or status. One sees animation in the faces of the adults and the effects of this animation. It is not the physical or cognitive skill being taught it is the look in their eyes as they motivate the child.
One sees life as inter-connected and holistic as it really is and can be. One can see children learning to lift their arms while singing a song about how well they are growing. Or a child learning the "big" words about her or his disability while showing one another how confident and skilled they are walking across a ladder that is lying on the floor.
One sees a very good start in the lives of these children. As Ms. Cheng states "CE is not about controlling movement, but about gaining confidence, self-esteem and greater independence, offering people more control over their lives.
Living it up in London town are Lord Morris, the world's first Disability Minister, Marion Fang of Hong Kong, there to receive her award for introducing conductive education to China, and Lord Ashley, long a parliamentarian specializing in deafness and disability issues.
Spreading the Word in the People's Republic of China
I also had a meeting with Ms. Sheila Purves, Project Director of the Hong Kong WHO Collaborating Centre, that has been promoting Community Based Rehabilitation and CE work in Mainland China. This work was inspired by Dr. Marion Fang and the intensive work of Sister Joan O'Connor, both pioneers of CE in Hong Kong. All three individuals started introducing CE into CBR work in the early 1990s. However, it was formally introduced to Mainland China in April of 1997 with the conception and funding of the "Starter Kit Project."
The aims of this project were to:
Promote understanding of disability and rehabilitation to medical professionals, administrative and front-line staff working with disabled children and their families, both in institutions and communities
Cultivate a key group of local resource persons in China who can reach, consult, and promote Conductive Education and appropriate rehabilitation practice
Train a large group of child-care workers and teachers throughout China, who will gradually build good practice models, where others can visit and learn
One particular target group for CE in China has been children's orphanages, called children's welfare homes. Many infants and young children with disability are often found in these homes. Sheila and her team found that CE was welcomed by the staff. They enjoyed working with groups of children and were soon able to see results in some physical abilities but also in the personalities of the children. The children love the songs and movement; they soon learned each other's names and had little competitions among themselves.
The rooms and children changed ñ from lonely and sad children that were often left in beds or tied to stools ñ to a room full of active, interacting children and proud, if not exhausted staff!
Sheila admits that one of the biggest challenges was to persuade administrative staff that this was worth all the trouble, change and training. Gradually they understood that the whole point is that the CE programme is integrated into the existing daily routine.
This meant that getting out of bed, going to the dining room, using the toilet, brushing your teeth ñ are all part and parcel of "rehabilitation". So nothing ñ and yet everything changed.
Expansion of the model
In some instances, an enthusiastic Director of orphanages and homes for children with disabilities initiated CE after attending a rehabilitation course in the mainland of China or in Hong Kong.
This was the case, for example, at the Beijing Children's Welfare Institute. Director Wang Cheng-guang has motivated staff, upgraded the level of infant and child care and rehabilitation, initiated foster programmes in the community and facilitated numerous courses for the staff.
The foster programme is groundbreaking in China ñ one of if not the first where children with disability as well as non-disabled children are fostered in their communities rather than their only previous option being an orphanage. Slowly, the general population is beginning to understand that children can best grow and develop within the context of a family and where support services and resources come from their local community. This model is being expanded to other provinces and homes throughout the country.
Spin-off projects
A variety of community projects have also spun off from initial CE training in China.
One example in the area of public education enables people in the community to learn about the potential of children and adults who are disabled.
Second, they are learning that early intervention is the best place to start.
And third, they are beginning to understand that often it is not only medicine and surgery aimed at "cures" that are important.
Perhaps, what is as if not more important are actions and integration that eventually leads to greater function in daily life, confidence and preparation for school and work.
A Starter Kit Project has been initiated to help "kick-start" rehabilitation activities in children's welfare homes/orphanages. Too often, Purves said, enthusiastic staff attended short courses on CE but then returned home to little support and understanding. This "kit" was a package of different levels of training and technical support.
When Purves identified a particularly active student, the Hong Kong team visited the welfare home and discussed the possibilities of starting rehabilitation activities with that home's administration. The action plan might contain follow-up visits to work with staff and children for several days, mainly to trouble shoot and upgrade the programmes. It included leadership awareness seminars and perhaps trips to other sites and to Hong Kong. Sample toys, small pieces of equipment or mobility aids were donated as samples to be adapted and locally made.
The key to the success of this venture was that training courses alone were not enough. Ongoing support and encouragement, follow-up visits, communication with others also struggling ñ all of this is essential. Purves says that it is "just like watering and fertilizing seeds in order to see them grow and blossom".
Local adaptation encouraged
The most exciting thing about this project is that each programme is adapted according to its own needs, ability of staff and the situation of the welfare home. The rehabilitation programme is successful because of the local staff and not due to pressure of an outside agency. And the children and the staff are developing together.
This project addresses not only the staff at these centres but also reaches out to families and communities wherever possible. The primary information that is shared is what is central to early child care and development. This is that infants and children are learning from the moment of birth and that it is within the context of the child's daily routine where opportunities for learning and development take place. Regardless of disability, each child needs and has a right to explore, practice and achieve competence in a range of skills that promote their physical, emotional, cognitive and social domains.
Outcomes and Impact
A recent review by Ms. Sheila Purves, of the CE work thus far, lists the following outcomes and impact:
The courses have led to 12 on-going CE programmes for children with cerebral palsy and mental handicap.
Over 680 participants have been trained from over 21 provinces in the country.
Caregivers and parents have seen changes in the children including improvement in movement abilities, daily living activities, communication and social skills.
Caregivers and staff also indicate increased confidence, self-esteem and independence.
A nucleus of excellent workers has been cultivated, where local people become "expert" and take pride in the children's efforts and achievements.
Mutual help networks of front-line workers communicating and learning from each other have been promoted.
Anecdotally, the CE and related training and efforts have made an impact on everyone. One doctor relates "I only think about diagnosis and impairment, but this course made me realize how important communication is in the lives of our disabled children and the many different ways we can relate to each other". And then there are the many local families who for the first time are willing to take in a young child with a disability as a foster child.
On-going international collaboration
Consultations from colleagues in Hong Kong and Hungary continue. There is on-going training and field-visits based in Hong Kong and supported by the Hong Kong Society of Rehabilitation under the direction of Ms. Mabel Chau. CE efforts for school-aged children and adults with disability have become the priority in many cities in China. CE, together with the overall philosophy of Community-based Rehabilitation and empowering people who are disabled has come a long way in this vast country.
The future includes more CE dreams for Hong Kong and Mainland China. Quality as well as quantity are part of this dream. But the underlying vision is to help provide children and adults with disability living in the community with equal access to services and activities as their neighbours -- and to do so in holistic, integrated and comprehensive approach that is the philosophy of Conductive Education.
Note: The field of rehabilitation in Hong Kong is replete with pioneers who have gained national and international recognition. First and foremost, Professor Sir Harry Fang, Director of the Hong Kong WHO Collaborating Centre for Rehabilitation, was recently awarded the Gold Bauhinia Medal in 2001 by the Government of Hong Kong Special Administrative Region (SAR). This award is on par with the Knighthood conferred on Sir Harry Fang in 1996. Professor Sir Harry Fang was also honoured in 2001 by the International Paralympics. He was awarded the Paralympic Silver Order by the President of the Games for his work in the Asian Region in Athens, Greece in December 2001. He is also the Charter Life Patron Member of Rehabilitation International.
Two other long time leaders in the field of rehabilitation in Hong Kong, the Asia-Pacific Region and the world were presented with similar prestigious awards by the Hong Kong Government. Mr. M.B. Lee, SBS, MBE, JP and Dr. York Chau, SBS, MBE, JP were awarded Silver Bauhinia Stars. These medals were presented in July 2001.
Dr. Marion Fang, Vice President of the Hong Kong Society for Rehabilitation introduced Conductive Education to Hong Kong in the 1980s. She, together with Mrs. Anita Tatlow, Sister Joan O'Connor, Miss Clare Cheng and Miss Elsie Yu, worked to adapt CE to the Hong Kong community and to train rehabilitation professionals to use this innovative and effective approach with children and adults with a variety of physical disabilities. Dr. Fang is also responsible for expanding the reach of CE to China. On September 13, 2001 in London, Dr. Marion Fang was conferred Honorary Conductor by the Board of the International Peto Institute for her contribution to the development of Conductive Education in the homeland and internationally. She was also awarded the Silver Bauhinia Star in 1999.
Ms. Clare Cheng, superintendent of the Conductive Learning Centre was also awarded by the Board of the International Peto Institute for her work in Conductive Education.
In June of 2000, Ms. Sheila Purves, P.T./O.T., and Project Director of the Hong Kong WHO Collaborating Centre for Rehabilitation was awarded on the Queen's Honour List (UK) an MBE (Member of the British Empire) for her outstanding contributions to the field of rehabilitation in Hong Kong and China. Ms. Purves is a Canadian citizen who has worked in Hong Kong since 1983.
There is no doubt that there will be more women and men, disabled and not, who will be added to the ranks of these outstanding leaders in the field of rehabilitation.
Note: The author wishes to especially thank Ms. Sheila Purves, Ms. Mabel Chau and Ms. Annie Kwok for their assistance, review and support in writing this article."
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The cards are designed by Amanda Elliott senior Conductor, one of the first graduates of the National Institute of Conductive Education. Now available to order!
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