Our first project was started in late 2005 on the tsunami affected islands of Andaman and Nicobar of India. The disabled population lacks access to education, enterprise, and community. There are no trained teachers or therapists. Sangha developed an initiative to begin training trainers in the field of rehabilitation. In July 2006, an 11 member group with 9 specialists visited Port Blair to begin a 10 day multidisciplinary training program and to make a needs assessment of the local resources and disabilities. This talented group included:

1. Dr. Jose Rafols, Occupational Therapy, Florida International University

2. Dr. Paula Madrid, Trauma Psychology, Columbia University

3. Penny Peacock, Hearing Aid Specialist and Audiologist, HEARUSA

4. Hassan Akmal, Public Health, Columbia University

5. Raji Doraiswamy, Physical Therapy

6. Valarie Moser, Teacher of Visually Impaired, Orientation and Mobility, Lighthouse of Broward

7. Dr. Gaelynn Wolf Bordonaro, Art Therapy, Emporia University

8. Alexandra Leal, Documentary videographer

9. Dr. Hina Sharma, Internal Medicine and Pediatrics, Sangha, Inpatient Clinical Solutions

The training was extremely successful and was continuously attended by 200 interested people over the 10 day course. Mornings were a 3 hour block of lectures given by our panel and the afternoons were multidisciplinary assessments where the parents and child rotated through Pediatrics, Hearing evaluation, Vision Evaluation, Psychology Evaluation, Art Therapy Session and Evaluation, Occupational Therapy Evaluation and Physical Therapy Evaluation. Six hearing impaired children were fitted with hearing aids, six children were given and trained to use wheelchairs, all visually impaired children were trained and given walking sticks and over 250 children were thoroughly assessed. These children came from all the surrounding areas of Port Blair and a significant group of 50 children were brought from Little Andaman by ActionAid to be evaluated by our team.

After the initial training, a consensus was reached that:

1. There are no local resources for disabled children

2. There is very poor documentation of existing disabled population

3. Lack of teachers both for ‘normal’ and special needs children after the tsunami

4. Limited local access to medical care

5. Significant social stigma against disabled population

6. No vocational track for disabled population

7. Poor preventive and primary health care

It has been shown that community stakeholders can be taught basic skills in physical therapy (PT) and occupational therapy (OT) and can significantly impact activities of daily living (ADLs) which are bathing, dressing, feeding, toileting, and transfers, as well as, independent activities of daily living (IADLs) which are using telephone, housekeeping, transportation, managing money, shopping, food preparation, laundry, and managing medications. These are important parameters that can be measured pre and post training to evaluate a program’s effectiveness.

Our goal was solidified into a culturally adapted curriculum which would include PT and OT, but would also encompass Speech Therapy (ST), Teacher of Visually Impaired, Teacher of Hearing Impaired, Nursing, and Public Health. Just as importantly, in this community traumatized by the tsunami, as well as disability, we would include Psychology and Art Therapy

Telemedicine and Sangha's Rehabilitationist Program:

Telemedicine is an emerging concept both for developing and developed countries. Florida International University (FIU), our lead University, is at the forefront of telemedicine and is also a member of the Internet2 consortium. Telemedicine would allow the students being trained in the Andamans to receive an international education remotely.

FIU also developed the concept of a Rehabilitationist curriculum which would include all of the areas discussed above, PT, OT, ST, Nursing, Public Health, Teacher of Visually Impaired, Teacher of Hearing Impaired, Art Therapy, and Psychology.

This curriculum would involve transmission of stored information but would necessitate real time reciprocal broad band transmission to teach the active lessons, demonstrate live sessions with patients and critique student techniques live with patients. This live concept is integral to the training and is the key component which would make it as successful as live classroom training.

Physical Therapy Training Session #2 and Dr. Ronnie Leavitt:

Dr. Ronnie Leavitt, Physical Therapy from the University of Connecticut conducted our second training session over 7 days in Port Blair.

This program allowed us to obtain even more information. Once again, there were lecture series in the morning but this time assessments were made in the homes of the disabled children. Dr. Leavitt traveled to 300 children’s homes over the 7 days and was able to not only assess the children and their physical environment, but their family and social support as well. She also taught the families to make rudimentary adaptive equipment from the materials around them.

Sangha selects its first class for our Rehabilitaionist Program:

We also selected our first class of 25 Rehabililtationist students from 80 applications. It was an extremely competitive selection and all the applicants were profoundly affected by the need for trained Rehabilitaionists for the disabled population on the Andaman and Nicobar Islands and were deeply enthusiastic. Sangha will continue its on site training sessions (Art Therapy will rotate through in June, OT in July) and will begin transmission of its stored curriculum. The current class of 25 rehabilitationist students has begun collecting baseline data on the number and type of disabilities. The geographic areas and communities were divided and each student had an assigned zone for which they would collect data, perform health surveys and would then treat the disabled children and adults as they receive training from the Rehabilitationist teachers. They have assessed 800 disabled persons so far in and around the municipality of Port Blair. We are also measuring baseline ADLs and IADLs. We will then be able to measure the change after the students have worked with these disabled persons and thus have an objective measure of the effectiveness of our program.

Both the US-based Universities and India based Universities and NGOs will be sending rotating groups of students to train and learn with our Rehabilitationist students. Our program goals are:

1. Collect baseline data on number and type of disability

2. Train rehabilitationist students to be community rehabilitationists

3. Train parents and care providers to work with their children

4. Train and work with local resources to build adaptive equipment

5. Share all training programs and resources with other programs in South Asia and America

6. Build awareness in the local government about disability and the need for trained personnel

Primary Care Clinic:

Sangha is working directly with the Director of Health Services (DHS), Dr. Sadasivan, to begin a Primary Care Clinic. This clinic will be housed at our Institute and will be aimed at Women’s Health Care. By focusing on women, we will be able to elevate the care of the whole family.

Initially, three Gynecologists working for the DHS will rotate through our clinic twice a week. Sangha will provide the medical equipment and the medications. These medications will be consistent with the local medical environment to prevent resistance and improve compliance.

Telemedicine will be used for two distinct purposes:

1. Increase capacity for the local physicians by providing continuing medical education. This will be provided both by U.S.based physicians

and India based organizations such as CMC-Vellore and Artemis

Health Sciences in Gurgaon.

2. Live remote sessions with the local women and different health care practitioners like social work, public health, nursing, etc. to promote individual and community health knowledge. These sessions must be interactive live sessions to promote exchange of knowledge.