Braille Monitor                                                                                May-June 1986


Rehabilitation and Development of People with Disabilities

An International Perspective on Some Present Challenges and Future Prospects

by Rami Rabby,
Consultant in Human Resources
Presented at the
Vocational Rehabilitation Seminar
Bogota, Colombia, October 2, 1985

(This address was printed in Vital Speeches of the Day, December 1, 1985.)

May I begin by expressing my deepest appreciation to Mr. S.I. Niwa, Chief of Vocational Rehabilitation Branch of the International Labour Office, for inviting me to present this paper. I am particularly gratified that he asked me to do so at a vocational rehabilitation seminar which is run in conjunction with the Abilympic, an event which, perhaps more than any other international disability-related event, is designed to highlight and focus the world's attention on the abilities of disabled people rather than their inabilities, their skills and strengths rather than their shortcomings and weaknesses, and their innate capacity for producing and contributing rather than their culturally perceived role of draining resources and seeking assistance.

Having lost my sight completely at the age of eight, while living in Israel, I underwent my initial training as a blind person in residential schools for blind children, and specifically at Worcester College for the Blind, in Worcester, England.

At that school the teaching staff took great pains to inculcate into me and my fellow schoolmates not only the assumption that, as a group, we were as competent as normal, sighted children of the same age but also the expectation that we must compete on a genuinely equal footing with those sighted children. Whether in academic examinations or in athletic competitions with the sighted, it was made absolutely clear to us that, while our operating methods and techniques might be different from those of our sighted counterparts, the performance goals and standards which were set for us might be strictly and uniformly maintained, for the blind and sighted alike.

So, for example, whereas when taking public examinations, all examination questions were given to us in Braille rather than in print, and whereas we were each required to dictate our essays, calculations, and translations to an amanuensis, we all took those examinations at exactly the same time as all sighted students in England did, and were given no extra time to speak of, just because we were blind. Similarly, whereas in rowing races against sighted crews, our cox (or navigator) would call out the required rhythm for our oar strokes (something which the members of the sighted crew, who can watch each other's movements, do not normally ask their cox to do), we were always expected to win and were given no allowances whatsoever.

It was only after I graduated from the relatively safe and carefree environment of the residential school for the blind that I began to encounter what I later came to recognize as the principal problem facing people with disabilities -- namely, the negative attitudes, prejudicial treatment, and outright discrimination of a society which tends to consider the disabled as helpless, incompetent, unsafe, and necessarily dependent.

While I was at Oxford University studying French and Spanish, I applied for an Assistant Teacher position at a lycee in Lyon, France, only to be rejected because the school principal could not conceive how a blind person would be able to find his way safely throughout the building, which was then undergoing remodeling and renovation. After graduating from Oxford University, I applied to many British companies for a management trainee position in personnel administration, and was repeatedly rejected because, so I was told, "No blind person has ever done this before," until I finally was offered a management traineeship by the Ford Motor Company of Britain. When I applied to study in the United States for a master's degree in business administration, many American business schools told me that a blind student would not be able to cope with the case study method of management education, which involved in-class analysis of business problems. However, the University of Chicago Business School did accept my application. Then, when I arrived in the United States and tried to check into New York City's Grand Central YMCA for my first night, the manager refused to let me have a room because, he said, his insurance company would not cover him for the added risk which would inevitably be incurred by having a blind person on the premises overnight.

These experiences of mine, as well as countless similar experiences of my fellow disabled, impelled me, 17 years ago, to join the National Federation of the Blind of the United States, and convinced me that the most effective remedy for society's negative notions and behavior toward people with disabilities lay in the hands of disabled people themselves. Certainly, each one of us individually can do much to demystify the phenomenon of disability in the public's mind and to educate those around us to our essential normality. However, it is through collective action--in the legislatures, in the courts, in the communications media and, perhaps most importantly, amongst ourselves--that I believe we can achieve the greatest results.

I have given you this selective account of my own background for a purpose. Very often at international gatherings concerned with the rehabilitation and development of the disabled, it is claimed that the disabled in the industrialized nations are far better off than the disabled in the developing nations. While, it is always admitted, there may exist "pockets of poor conditions" in the industrialized countries, the disabled in those countries are generally in a class by themselves and bear no comparison with the disabled in the developing countries.

Of course, in one sense it is very true. There is no doubt that in the industrialized nations the level of social security disability benefits, for example, is much higher than it is in the developing nations; public funding of disability prevention measures is much greater; government expenditures for social services are far higher; and a much larger proportion of these nations' tax base is spent on education and training of the disabled, employment-related technological devices, library services, special transportation arrangements, special housing accommodations, etc. From the point of view of these overall financial and statistical yardsticks, the industrialized nations are considerably better able to demonstrate a social obligation toward people with disabilities, to create special programs to take care of these human casualties, and to discharge the community's responsibility to the less fortunate within it.

What I would question, however, is whether those overall financial and statistical measures have anything to do with genuine rehabilitation and development, and whether disabled individuals in the industrialized countries do, or should, ever stop to ponder how much happier their lot may be when compared with the lot of disabled individuals in the developing countries. After all, what does it matter to disabled Scandinavians, for example, that they receive rich government disability benefits if the private sector employers in the Scandinavian countries refuse, as is so often the case, to hire them just because they are disabled, even though they may be well qualified? What does it matter to disabled West Germans that they are sent for training in impressive rehabilitation centers if at the conclusion of the training, West German employers refuse, as is so often the ease, to hire them and prefer instead to take the alternative offered to them by the government--that is, to pay a levy for the provisions of yet more training services for the disabled and the building of yet more rehabilitation centers? What did it matter to me that I had a bachelor's degree from Oxford University when I was excluded from so many American business schools who told me that a blind person would not be able to cope with the ease method of study used in their master's degree programs? What does it matter to those disabled Britons employed in sheltered workshops that they are holding entry level manual jobs when so many of them are qualified for professional level and intellectually more demanding occupations?

The point is that disabled individuals in the industrialized nations measure their progress not against the progress of disabled individuals in far off developing countries but rather against the progress of their non-disabled counterparts in their immediate environment. The point is that the proper criterion for successful rehabilitation is not simply whether disabled individuals are employed or not, but rather the extent to which they are employed in accordance with their potential as whole persons without regard to the disability, and the degree to which they assume a positive attitude toward their disability, avoid lowering their expectations, adopt a healthy self-image, and refrain from using their disability as a convenient excuse and a cop-out for not at least trying to achieve what others with the same disability have achieved.

When progress by the disabled is measured in these terms, and when rehabilitation is viewed in this light, we can surely see that the frustrations are no smaller and the process of self development and rehabilitation is no less taxing for the disabled individual in the industrialized nation than they are for the disabled individual in the developing nation. To the international researcher and analyst of public policy and social programming for the disabled, there may seem to be a vast gulf between the United States and Latin America, between Europe and Africa, between Canada and the Middle East, between Australia and the Indian subcontinent, and between New Zealand and Southeast Asia; but to disabled persons in all those countries and continents, it is the immediate context that counts, and to every disabled person, the wall of prejudice and the lack of self fulfillment are equally devastating. It is not surprising, therefore, that the International Labour Office was able, in June of 1983, to adopt its Convention 159 --(on vocational rehabilitation and employment of disabled persons)--and to make it applicable and meaningful to all countries and to people with disabilities everywhere.

If we are to understand what true rehabilitation is, we must begin by understanding the substantive difference between the word "disabled" and the word "handicapped." It is my contention that blindness, deafness, or paraplegia, for example, are personal characteristics, just like being black, young, female, Colombian, Jewish, Spanish-speaking, college-educated, etc. Each of these personal characteristics necessarily describes only one facet of one's individuality. Being deaf no more defines a whole person than does being Colombian or Moslem or female. Why then are blindness, deafness, or paraplegia generally regarded as "handicaps" while being Colombian or Moslem or female are not?

Actually, every one of our personal characteristics--physical, mental, or otherwise--can be either a limitation, or an advantage, or be of no consequence whatsoever, depending on what specific objective we are trying to achieve, at any particular time. So, for example, blindness may preclude a blind person from looking at the stars but not preclude him from studying the theory of astronomy; similarly, being male may preclude a man from giving birth to a child, but not preclude him from raising that child. The real handicap confronting the disabled arises when myths, misconceptions, and negative attitudes, including both the public's and those of the disabled themselves, restrict their opportunities and stunt their motivation far beyond the relatively narrow limitations imposed by their disabilities. Just as John F. Kennedy would probably not have been elected President of the United States before 1960 because of his Catholicism, so people with disabilities suffer tremendous prejudice and discrimination in employment, education, housing, and other life activities because of society, including the disabled themselves, so often believes that a disability is all-embracing and totally crippling.

This conception of people with disabilities as essentially normal and equal members (each having his/her advantages and disadvantages and his/her assets and liabilities) of a pluralistic and multi-faceted society removes that artificial distinction between the "handicapped," on the one hand, and "non-handicapped," on the other, which is implied in that terribly condescending but very often quoted phrase, "Those less fortunate than we." This conception also helps us view disability more broadly, as a social phenomenon alongside sex, race, or ethnic origin and not merely as a clinical phenomenon for which only a medical cure is possible.

If the real handicap facing people with disabilities is the tendency to assume that if one is disabled, one is necessarily helpless, dependent, and capable of equal productivity; then it follows logically that the first and primary goal of rehabilitation is to help the client de-condition his mindset and rid himself of any negative notions, self-doubts, insecurities, or lack of motivation which may be associated with the presence of the disability. A second, though no less important, purpose of rehabilitation is to train the client in those practical "disability" skills, those alternative techniques which will enable him to circumvent his limitations and to live and work as independently and productively as his non-disabled counterpart. Included among these skills (but by no means limited to them) are, for example: (a) for the blind, efficient Braille reading, use of a white cane for easy and confident mobility, and fluent operation of a speech output computer; (b) for the deaf, proficiency in sign language or lip reading and the effective use of a hearing aid; and (c) for paraplegics, quadraplegics, amputees, and people with cerebral palsy, easy manipulation of a wheelchair, mouth stick, and one-handed typewriter or computer keyboard.

The appropriate atmosphere for effective rehabilitation to take place should be one of constant tension, with the rehabilitation teacher or instructor continually "pushing" the client, urging him to do more, to do better, to learn new skills, to try new activities and experiences, to test his limits, to accomplish what he may not have originally thought possible, given his disability, and always to do so intensively and independently, using a problem solving approach rather than simply following the rehabilitation teacher's instructions. This atmosphere and this regimen are essential for the client if he is to come to believe emotionally as well as intellectually that he is a competent first-class citizen who, with the use of alternative techniques and a positive self-concept, is able to participate fully in and contribute equally to the economic and social life of his community. On the other hand, a relaxed atmosphere and an easy-going regimen can only lead to passivity, discouragement, submissiveness, and a gradual slide into a life of comfortable dependency where the disabled client would rather have others do for him what he could, with training and motivation, so easily and willingly do for himself.

The third, and again no less important, objective of rehabilitation is to bring the client to a clear understanding of how society's stereotyped attitudes toward the disabled, and categorical assumptions about them, often result in discriminatory treatment and how he, as a disabled victim of such prejudice, can counter it both on an individual basis as well as collectively as a member of a self-help organization of people with disabilities.

In providing rehabilitation services to people with disabilities, it is crucial that both administrators and professionals always be on the lookout for any negative messages which they may inadvertently be sending to their clients. For example, at a rehabilitation and training agency serving the deaf, it would be appropriate for a significant number of competent deaf individuals to be appointed to the agency's governing body. Otherwise,' there is a clear danger that deaf clients of the agency would subconsciously assume that if one is deaf, one is necessarily not intelligent nor politically savvy enough to handle matters of policy, finance, and fund raising or make decisions regarding sensitive issues of personnel management. Similarly, at a center or hospital providing services to paraplegics, quadraplegics, and amputees it would be appropriate for qualified individuals who have those same disabilities to occupy senior executive and professional positions. All too often this is not the case, either in the developing or in the industrialized nations. One particularly outstanding example of a negative message conveyed by rehabilitation professionals themselves can be found in the blindness rehabilitation system. Throughout the world 99.9 percent of agencies serving the blind do not permit otherwise qualified blind persons to train blind clients in the effective use of a white cane. The assertion is that it would be unsafe for a blind person to do so, Yet, in the United States three progressive and enlightened agencies for the blind have proved, beyond a shadow of a doubt, that blind persons can train blind clients in cane travel skills, and that they can do so safely and effectively. The experience of one of these agencies was reported in the May and July, 1985, issues of The New Beacon, a magazine of the Royal National Institute for the Blind, in England. Unjustified concern for safety, as in this instance, has unfortunately triggered a good deal of prejudicial and discriminatory treatment of all disability groups. We would do well to take a second look at our attitudes on this issue and, I hope, modify our thinking and practice accordingly.

Four more brief points should be made about the nature of effective rehabilitation.

First, whenever possible, disabled clients undergoing rehabilitation should be trained in groups rather than individually. Most newly disabled individuals naturally find the onset of disability a very frightening and isolating experience. If it can be arranged for them to progress through their training in the company of others who are struggling with the same predicament, they will inevitably gain comfort and inspiration from the mutual exchange of ideas, sharing of experiences, commonality of emotions and interests, and joint problem solving. Together, they will reinforce each other's self confidence and, most importantly, they will know that they are not alone. This, too, is why rehabilitation clients should always be encouraged to join organizations of people with disabilities and participate fully in their activities. In a very real sense, the best rehabilitation takes place when people with disabilities interact among themselves, make their own decisions, and administer their own membership organizations; in other words, when they are in control of their own lives.

Second, every effective rehabilitation program should make full use of what, in the terminology of the social sciences, are called "role models." These are successfully employed disabled people who have already completed their rehabilitation and achieved a normal, productive, and contributing status in the community. Either through formal lectures or in informal discussions, these role models cannot help but provide encouragement to the rehabilitation clients and naturally serve as tangible proof to newly disabled individuals of what they could, with training and motivation, become.

Third, in recent years, particularly in the industrialized nations, there has surfaced a tendency to look to today's high technology (and specifically to computer technology) as a panacea for all the ills of the disabled. Just listen for a few moments to some of these computer advocates, and you might think that no disabled person ever achieved anything of note, either in the workplace or outside it, before the advent of the computer. Clearly, this is not true. At the heart of the rehabilitation process has always been, and will continue to be, the breaking down of the disabled individual's internal attitudinal barriers and psychological insecurities which I have described earlier. In the workplace the computer, like any other machine, is a tool which can assist marvelously in carrying out certain operations rapidly and efficiently, but it is nothing more than that! Actually, I believe that in one sense the computer presents a real danger to people with disabilities. We must be extremely careful not to be deceived into thinking that, in the future, the only jobs for which disabled people may be qualified are those which bind them, segregated and isolated, to a computer. In the past and still today we have tended to channel paraplegics into stationary desk-bound occupations, the blind into manual or telephone-related occupations, and the deaf into graphic arts work or noisy printing press operations. It is high time that we began to view workers with disabilities as whole persons, able to fill jobs that require great mobility, heavy interaction with non-disabled colleagues, and intensive, face-to-face contact with the general public.

Fourth, and again in recent years, there has been a tendency in some industrialized nations for rehabilitation professionals to refer disabled clients for work to prospective employers too early and, in effect, to expect the employer to participate actively in the final stages of the rehabilitation process. I believe this is an unhealthy development. Employers certainly do have a responsibility to reach out and make a special effort to recruit qualified disabled workers, to make reasonable accommodations to workers' disabilities, and to instruct their non disabled personnel how to treat disabled candidates and employees in a receptive and nondiscriminatory manner. However, private sector employers, certainly, are in the business of manufacturing products and selling services at a profit, and should only be expected to consider job-ready clients for employment. Disabled workers should be permitted to enroll in all the regular skills training programs offered by employers to their non-disabled employees, but they should not be referred to employers before they are attitudinally ready for work and before they have perfected the "disability" skills which will enable them to compete on an equal footing with their non-disabled counterparts.

Whenever government policy-makers and social programmers discuss rehabilitation, sooner or later the question is asked: "Is rehabilitation economically beneficial?" Numerous studies have been conducted comparing the benefits and costs of rehabilitation. Most of these studies list the following as benefits:

a. Discounted present value of all direct wages and salaries paid to the disabled person following rehabilitation;

b. All fringe benefits paid to the disabled person following rehabilitation;

c. All public assistance payments saved because of the disabled person's rehabilitation;

d. Value of all household tasks performed after working hours by the disabled person; and

e. Value of all increases in productivity by the family of the disabled person, which result from his/her assuming a share of household tasks.

The studies list the following as costs:

a. All direct and indirect costs incurred by the agency providing the rehabilitation service;

b. All direct and indirect costs incurred by parties other than the agency. (For example, the costs incurred by the prospective employer in removing architectural barriers or purchasing specialized equipment prior to the date of employment.)

c. Value of public assistance payments received by the disabled person during rehabilitation;

d. Value of wages, salaries, and fringe benefits foregone by the disabled person during rehabilitation; and

e. Costs for rehabilitation services incurred by the disabled person himself/herself.

Even though these studies invariably conclude that the benefits of rehabilitation outweigh its costs, my own interest in these economic models for rehabilitation is frankly little more than academic. The real issue is a broader social and human one. Since I believe that people with disabilities represent appreciating assets rather than disposable commodities, it seems axiomatic to me that society should invest public and private resources in the disabled so that they may have the opportunity to achieve their fullest potential as human beings and to contribute as equals to the growth and advancement of their communities. In this respect the purpose of rehabilitation is surely no different from that of any educational, instructional, or training endeavor.

However, this does not mean that I have no concern for the cost effectiveness of rehabilitation programs and services. Actually, there is one area of rehabilitation service delivery where in recent years there has been, I believe, tremendous wastage of resources. I am referring to the purchase of assistive devices in general and to the growing interest in employment related and education related computer equipment in particular.

Faced with an ever-increasing rate of technological change and development, many rehabilitation professionals have not been able to keep pace with the constant flow of new products into the market, let alone be in a position to intelligently evaluate the appropriateness and usefulness of this or that device for specific client needs and situations. As a result, many counselors have often been pressed, on the basis of a quick demonstration or a salesman's promises, into purchasing computerized and other devices which, after actual testing in the workplace or in the educational setting, were found not to serve their intended purpose. At times the myth that "the more technologically sophisticated it is, the better it is," is so captivating that both the rehabilitation professional and the client opt for a "high tech" solution to a work related or study related problem where a "low tech" or even a "no tech" alternative would have been just as effective, if not more so.

In addition, manufacturers of high technology devices for the disabled have tended, quite naturally, to go to market with integrated computer systems that are "specifically designed for the disabled'--systems which (given the relatively small market involved) are usually very expensive. Quite often the very functions claimed by the manufacturers for these "specially designed" systems could have equally well been performed, with perhaps minor adaptations by much less expensive, off-the shelf components bought from a regular retailer who serves the mass market, Unfortunately, the vast majority of rehabilitation agencies do not possess the technological expertise required to know either what off-the-shelf items are available on the market of how they might be adapted for effective use by people with disabilities.

Finally, I would like to express a hope and a wish about future Abilympic events.

As I said at the beginning paper, the idea behind the Abilympic is the most exciting I have encountered in international work with people with disabilities. More than any other event it shows disabled people engaged in activities which are not only income- producing for themselves but which add to, rather than take away from, the gross national product of the countries they represent.

Since this, I believe, is only the second Abilympic in history, it is natural that the skills demonstrated in the contests tend to be either manual, machine-based, sedentary, or performed in isolation from other workers. Let us make a special effort to include in the next Abilympic contests which will highlight people with disabilities also practicing professional level and administrative skills, skills which require mobility and intensive contact with others.

For example, why should we not consider contests which will demonstrate teaching skills, selling skills, the persuasive skills of lawyers who argue cases in court, mathematical computation skills, the leadership skills involved in the chairmanship of meetings, public speaking skills, writing skills, the problem-solving skills involved in the mediation and settlement of disputes among workers, interpreting and translating skills, and automobile driying skills, to mention just a few.

All these skills are already practiced by people with disabilities, and not only in the industrialized nations. Their inclusion in the next Abilympic will serve to motivate and inspire disabled people everywhere, will educate and enlighten prospective employers to a wider range of abilities among the disabled, and will demonstrate the ultimate in full participation and integration of people with disabilities in the workplace and in society.