Success & ABILITY
India’s Cross-disability Magazine
April - June 2012
Rs. 30
Where there is a wheel…
Moving ahead after spinal cord injury
RUCHI’S PICKLES AD
Editor: Jayshree Raveendran
Deputy Editor: Janaki Pillai
Associate Editors: Seena Raveendran, Eleanor Davis
Senior Designer: RG Kishore Kumar
Cover Illustration: K.K.Rath
Illustration:Pradeep Soni
Correspondents:
India:
Bangalore:
Gayatri Kiran Ph: 09844525045
Ali Khwaja Ph: 080 233302000
Hyderabad:
Sai Prasad Viswanathan Ph: 0810685503
New Delhi:
Abhilasha Ojha Ph: 9810557946
Pune:
Saaz Aggarwal Ph: 9823144189
Bhubaneshwar:
Dr. Sruti Mohapatra Ph: 0674 2313311
Bhopal:
Anil Mudgal Ph: 0755 2589168
KATHUA (J&K)
Manbir Sambyal Ph: 233914
ANANTNAG (J&K)
Javed Ahmad Tak Ph: 01936 211363
USA
Malathi Rajagopal
10247, Fairway Drive, Ellicot City, MD 21042
Anindya Bhattacharyya
Helen Keller National Center, Sands Point, NY 11050
………………………………………………………….
PUBLISHERS: Ability Foundation
EDITORIAL OFFICE: New no. 4, Old no. 23,
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without the prior written permission of Ability
Foundation. Ability Foundation reserves the right to
make any changes or corrections without changing the
meaning, to submitted articles, as it sees fit and in order
to uphold the standard of the magazine. The views
expressed are, however, solely those of the authors.
Contents
7 Stanzas Blaaze's call for a better world.
9 Milestones Rahul Cherian gives us an insight
on the recent happenings in the Civil Aviation
Ministry.
11 Spotlight Changing stereotypes – the
glittering CKA Awards Night.
Cover Feature
18 The First Step Dr. Ketna Mehta defines
the process of spinal cord injuries.
21 Awareness Moving ahead after spinal
cord injury – an overview.
25 Therapy Centres Focus on the three
premier rehabilitation centres.
35 Mind Matters :On overcoming the trauma
of spinal cord injury.
38 Centre Spread A glimpse of ramps from
across the world
40 Body Basics Making your body work for
you.
47 Contacts Some SOS spinal injury centres.
49 Standing Ovation Meet S. Ramakrishnan,
the quintessential humanitarian.
51 Life's Like That Nitin Goyan on making the
best of what life offers.
55 On The Move Hand operated cars for
wheelchair users.
57 Relationship When we follow our heart
and soul, a wheelchair becomes insignificant.
59 Life & Times Sruti Mohapatra, the beacon
of light in the disability sector opens up to us
on life in a wheelchair.
63 Following A Dream Find your occasion,
the 'heart' way: Sanam Rabadi Karunakar
writes.
66 Outdoors: To live, to love, to laugh, to
move the 'Salil way.'
70 Flipside To buy or not to buy: that is the
question
THE SAVERA
FONDUE AD
FROM THE EDITOR’S DESK
Friends,
Putting this issue together has been an eye opener in more ways than one. Seeing my friends with
spinal cord injuries, who go zip, zap, zoom on their wheelchairs... it's hard to fathom, the degree of
pain or the extensive and excruciating time taken for rehab that each one of them has had to
undergo. Yet, each one of them, no matter what their choice of careers, has shown the world at
large, a genuine testimony of courage and a widespread declaration of the beauty of life.
This besides, the sense of cross country camaraderie, and the strengthening of friendship that the
compiling of this issue brought in its wake, has been especially significant. This issue would not have
been possible without Ketna Mehta. As the Founder Trustee of Nina Foundation, and Editor &
Associate Dean, Research, We School of Management, there must have been abundant demands on
her time. Even so, she has been marvellously responsive and enthusiastic from day one. My sincere
thanks too, to Vaidyanathan, Salil Chaturvedi and Scott Rains for shelling out precious time to lend a
hand. Above and beyond, Ketna's statement that the making of this issue is “history being made” as
no one has ever tackled such a comprehensive and cohesive compilation of articles on Spinal Cord
Injury before, makes this issue truly a collector's item . This, for me – is not merely the icing on the
cake, but extra cream atop the icing as well.
As Salil beautifully put it, the wheelchair is “a set of wheels attached to a chair, not just a chair
attached with wheels”... and therefore in the true fashion of wheels, they must roll. There's a whole
philosophy of life packed in those words... towards a life meant to live, love and laugh!
We also present you with an observer's perspective of our CavinKare Ability Awards – that very
eloquently reflects – on the extent to which we have succeeded in changing the perceptions of other
people about people with disabilities.
More... when you scan through the rest of the issue, it becomes increasingly clear that people with
disabilities are today, ever more, coming into their own – a brave new breed – with heads held high
– justifiably demanding rights and privileges. A case in point is the widespread protest, questioning
India's civil aviation department for its irregularities, insisting on customer satisfaction on travel
services and accessible options. There's been quantum shift from segregation to inclusion which has
paved the way, towards a better level of social and economic participation.
Of course, we all know, there are numerous things that are still so uncertain, as also huge struggles
ahead, but suffice to say that this generation of people with disabilities is on the threshold of a very
exciting voyage towards inclusive and accessible opportunities in all spheres of life – which, unlike in
the previous generation – seem much more achievable and obtainable today than ever before. So,
let's see what it will take, to get us to the next step!
What do you think?
Jayshree Raveendran
j.raveendran@abilityfoundation.org
GRUNDFOS AD
GUEST EDITORIAL
Jayshree is an excellent insightful friend and very, very convincing too! When she decided to do a
complete feature on spinal injury and invited me to be the Guest Editor I readily accepted – work
load notwithstanding. How could I miss being part of creating history in print journalism with the
first ever issue focused on spinal cord injury, and that too with a twist! A positive, optimistic,
motivating saga of spinal injury!
Why should our readers read and be interested in spinal injury? There are three strong reasons:
Spinal injury leading to a permanent disability, paraplegia and quadriplegia, can strike anyone,
anytime, anywhere. We have known people getting spinal injury while eating a sandwich at a stall,
under the tree and the branch falling on him. Or standing at the bus stop and a vehicle crashing into
her or a simple fall from a height or stairs inside the house, while riding, drinking, paragliding or,
simply slipping... THUD... the vertebrae in the spinal cord snaps the nerves and from the spot of
injury the person is paralysed. It transforms a person's life suddenly, drastically. Thus we all must be
aware about the various aspects of spinal injury.
We generally see a person on a wheelchair, walker, calipers or crutches. But there is more to spinal
injury than just this visual image. It is an extremely difficult condition to accept, overcome and
manage because it affects the bladder, bowel, fertility, respiration, intestinal muscles, digestion,
skin, bones, muscle tone, sensation and mobility and muscle power. If this has happened to
someone we know, each of us has a role to empower them to get on with life.
Holistic Rehabilitation is the only key to survival and continuity for a good quality of life. In the USA,
for a quarter of a million population with people with spinal injury, there are 93 Commission on
Accreditation of Rehabilitation Facilities (CARF) model rehab centres teaching each and every aspect
of the “New Life”. Inter alia activities of daily living like transferring, breathing, eating, working,
kitchen training, car simulation for driving, crossing the road on wheelchair, and swimming – in short
everything to lead a near-normal life, falls under the purview of Rehab.
In India (1.5 million population, with an increase of 20,000 each year, 2.28 per hour people with
spinal injury), there are only two comprehensive world class rehab centres covering all the six levels
of rehabilitation, namely: Physical, Psychological, Vocational, Social, Recreational and Spiritual.
Believe it or not, in our financial capital, Mumbai (300 p.a. population with spinal injury), which
boasts of two rich stock exchanges, there is no comprehensive world class spinal injury rehab centre.
Road accidents, falls and adventure sports are changing the profile of the new Indian with spinal
injury – they are young, educated and with higher purchasing power. There is a rich resource of
wealth creators, tax payers and the nation’s builders amongst this population.
So what can you do? We hope this informative and motivating feature on spinal injury will excite you
to get interested, involved and inspired as we believe each of us has the power and potential to
nurture and encourage a friend with spinal injury.
Let's reach out today!
Dr.Ketna L.Mehta
Email: Ketnam@gmail.com
SUOLIFICIO
CHENNAI AD
STANZAS
BlaaZe is a renowned rap artist and a playback singer. He was one of the lead singers / lyricists in the
Oscar winning film, ‘Slumdog Millionaire’ and is a frequent voice in A.R.Rahman's sound tracks. With
over 20 years of experience in the music industry, BlaaZe has rapped with many world renowned
singers. He recently brought out India's first Hip-Hop 'protest' album, ‘Time for Gandhi.’ BlaaZe is
known to write lyrics that have a powerful message underlying that foot-tapping rap, which earned
him MTV's Youth Icon Award, recently.
ONE CRY
(to care for the future)
-
BlaaZe’
one cry
is all it takes to make a tear drop
one cry
is all it takes to make the heart stop
one cry
to send the angels down down
one cry
to make the world stop spinning round
one cry
to share with the homeless
one cry
to give hope to the hopeless
one cry
so tomorrow in peace we live
one cry
to learn to give and to forgive
Success & ABILITY APRIL – JUNE 2012
7
STANZAS
one cry
for the children of the world
one cry
for every boy and girl
one cry
for the scars on their feet
one cry
why they're working the streets
one cry
for the dying trees
one cry
for environment please
one cry
for the vanishing tigers
one cry
i pray the rhyme to guide us
one cry
to value life in my society
one cry
to see the poverty that bothers me
one cry
to make peace over the border
one cry
to stop life getting harder
one cry
to stop evolution
one cry
to reveal the illusion
one cry
to keep your head up high
one cry
to stand up with pride
one cry
for a fairytale ending
one cry
to go back to the beginning
one cry
for mandela's twenty-seven years
one cry
for the sins of my peers
one cry
to turn the grey skies blue
one cry
to bring the truth to you
one cry
to care for the future
Success & ABILITY APRIL – JUNE 2012
8
it takes just 'one cry'
to care for the future
Success & ABILITY APRIL – JUNE 2012
9
MILESTONES
TURBULENCE IN THE AIR
-
RAHUL CHERIAN
In February of this year, Jeeja Ghosh, a teacher with cerebral palsy, was ordered to be deplaned by
a SpiceJet pilot in Utprabh Tiwari. In the discrimination that this so blatantly reveals, the act recalls
an incident in Montgomery, Alabama, in 1955. On December 1st, Rosa Parks, an African-American
woman, was asked to surrender her seat on a bus to a white person, in accordance with the racial
segregation law applicable to public transportation system. She refused and her arrest led to the
Montgomery Bus Boycott, which ended only when the US Supreme Court held that the law was
unconstitutional.
Disability rights activists have been campaigning for years for the government of India to take clear
steps to recognise the full rights and freedoms of persons with disabilities and remove the
attitudinal and environmental barriers that prevent their full and effective participation in society.
For the disability rights movement to succeed, government must be convinced that PWDs do indeed
have the same rights and freedoms as everyone else. However, its actions appear to show that it has
yet to make up its mind. The government has, somewhere at the back of its mind, realised that
persons with disabilities have different demands, but is not wholly convinced of the legitimacy of
these demands. A study of Article 15 of the Constitution, highlights one of the possible reasons why
it has not taken a stand. It states: “The State shall not discriminate against any citizen on grounds
only of religion, race, caste, sex, place of birth or any of them.” It is obvious that there is no apparent
constitutional bar on discrimination on the grounds of disability. Admittedly, at the time the
Constitution was drafted, disability rights were not the hot topic that they are today. Let us however
bear in mind that the Constitution has been amended 96 times, including twice after India ratified
the UN
Success & ABILITY APRIL – JUNE 2012
10
MILESTONES
Convention on the Rights of Persons with Disabilities in 2007, but no change has been made to
prevent discrimination on the ground of disability. The constitutions of several countries, including
Canada, South Africa and Sri Lanka, have specific non-discrimination provisions relating to persons
with disabilities, but India has not followed suit. When the Constitution itself is unclear about where
disabled persons stand in relation to something as fundamental as non-discrimination, no wonder
then, that the nation has not taken a definite stance on disability rights. This lack of clarity translates
into actions in relation to disabled persons, including with respect to air travel.
Jeeja Ghosh's incident is an example of the manifestation of this confusion. On May 1, 2008, the
Directorate General of Civil Aviation issued a document as part of the Civil Aviation Requirements
(CARs), entitled the Carriage by Air of Persons with Disability and/or Persons with Reduced Mobility.
One of its objectives was to establish “regulations for the protection of, and provision of assistance
to disabled persons and persons with reduced mobility travelling by air in order to protect them
against any form of discrimination and to ensure that they receive all possible assistance with due
respect and dignity.” As per Clause 4.1 of the CAR, “No airline shall refuse to carry persons with
disability or persons with reduced mobility.” However, the CAR does not prescribe the consequences
of non-compliance by airlines. The CAR also requires all airlines to run sensitisation programmes for
assisting passengers with disabilities. However, it is silent on the exact nature of these sensitisation
programmes, thereby leaving the scope of training to the discretion of individual airlines. As is
evident from Jeeja Ghosh's experience, the training given, if any, is sorely inadequate. It can be
safely assumed that if the pilot was properly sensitised on the requirements of persons with
disabilities, and there were adverse consequences on non-compliance, airlines would comply with
this document.
There are several other fundamental flaws with the CAR which stem from a lack of basic
understanding of the very nature of disability. For example, it assumes that only persons with
reduced mobility require assistance for air travel and does not provide for assistance to persons with
hearing impairment, low vision, autism, etc, who have no mobility problems.
After a spate of recent incidents relating to discrimination against persons with disabilities by airlines
and the consequent media uproar, the Ministry of Civil Aviation constituted a Committee to relook
at the CAR PWD with the objective of amending the same to make it more comprehensive and also
to prescribe an effective complaints redressal mechanism. This Committee includes representatives
from the Ministry of Civil Aviation, the Director General of Civil Aviation, airlines and the Airports
Authority of India. It has four members from the disability sector, namely, Shivani Gupta from the
Disability Rights Group, Anjlee Agarwal from Samarthyam, Shekhar Borker, board member of the
National Trust (Ministry of Social Justice and Empowerment) and me.
By the time this article is printed, we would have submitted our report to the Ministry on the next
steps to be taken to amend the CAR PWD. The thrust of our report is to identify deficiencies and
make suggestions for improvement of the CAR PWD; propose changes in the allocation of
responsibilities between the airline and airports based on international best practices; provide
details of the training and sensitisation programmes to be conducted, the accessibility of airports
and the ingredients of the complaints redressal mechanism.
This is a golden opportunity for the disabled sector to work with the Ministry of Civil Aviation to
solve the problems faced by persons with disabilities, particularly due to the leadership of Asok
Kumar, Joint Secretary, Ministry of Civil Aviation, who is extremely receptive as well as sensitive to
our problems.
Success & ABILITY APRIL – JUNE 2012
11
Inclusive Planet Centre Of Disability Law and Policy
Rahul.cherian@inclusiveplanet.com
Success & ABILITY APRIL – JUNE 2012
12
SPOTLIGHT
THE NIGHT OF THE 10TH CAVINKARE ABILITY AWARDS
Right from the time our CavinKare Ability Awards were initiated in 2003, throughout the last ten
years, our goal has always been to change the public perceptions about people with disabilities, to
break stereotypes, to celebrate the diversity of humankind and to spotlight on the treasure trove of
capabilities and talent that exist amidst disabled persons. Thus this year in 2012, for us, it was an
equally beautiful event, other than the intensified emotional value as this was the tenth year of the
Awards. We were nevertheless, struck by the extent to which we had succeeded in achieving our aims
and the impact our Awards had on the audience which has been so lucidly brought out in Shantha
Gabriel’s article.
Success & ABILITY APRIL – JUNE 2012
13
SPOTLIGHT
Yet again, I eagerly awaited the invite in February and yet again, made my way well ahead of the
start of the event to a good central seat in Sir Mutha Venkatasubba Rao Concert Hall, on Saturday,
February 18, 2012 for the 10th CavinKare Ability Awards.
Yet again, over the next two hours I was riveted to my seat (now, that isn't exactly true and you will
soon see why), watching sheer grit, courage, determination, beauty and ability unfold themselves on
the world's stage as Mastery Award recipients, followed by the Eminence Awardee were led to the
tastefully decorated stage of the auditorium, whilst interesting video-clips contextualised their
achievements, glorious citations were read out and cheques were presented... and the audience –
then beginning to fill out, almost invisibly swelled to jam-pack the auditorium – burst into fresh and
ever-louder applause each time an award was announced.
Yet, there was much that was not 'yet again'! This was a very special year for Ability Foundation and
CavinKare, a splendid celebration of a stupendous achievement of a life-giving initiative that started,
not one or two, but ten years ago. Initiating a venture itself is the difficult first step but sustaining it
through a sheer labour of love, driven by a dream to dispel stereotypes and celebrate diversity; to
foster in society an awareness of inclusion and a need for integration, and that too across the nation,
for over a decade, is a movement that demands our respect, our active contribution, our humility
and paradoxically, our pride as well, along with our heartfelt tribute to the pioneers and the many
bodies that work closely to help realise a proud moment for India. I am sure this was the note on
which the evening ended not just for me, but for all who gathered to witness an evening's
programme, the orchestration of which was marked by class and style.
The release that evening of the Success & ABILITY magazine, Jan-March 2012, along with a CD was a
significant value add-on. That each one of us could hold a free copy of this treasure of learning, in
our own hands at the end of the day, was a gift to cherish. The editorial that dwells on the “magic in
the CavinKare Ability awards” could not have expressed the spirit and purpose behind this journey,
which is “all about milestones covered, about mindsets changed...”, better than in the reflections of
Jayshree Raveendran. Her opening remarks on the achievements of the winners, the
acknowledgement of support from CavinKare and Team Ability and the task that will always lie
ahead of us, was a strong assessment of how far we have come on the road less travelled. Jayshree's
was a speech that was truly passionate and yet free from sentiment: positive and not maudlin.
The evening was a celebration of not just the award winners of 2012 but highlighted through a wellpaced flashback, scenes of joy from the past decade of awards. For those who had the privilege of
sharing this experience every year, this was a refreshing glimpse of familiar faces and for others, it
offered a time to pause and reflect on how individuals had overcome every kind of disability, to win
against all odds, a place for themselves, with the support of their families and their caring friends, in
a society that is slowly beginning to awaken to the strength of their ability.
Yet... a third difference this evening from previous years' was the sequencing of the programme
itself. Every award was followed by an artistic performance and this proved to be a clever
arrangement. It provoked our curiosity and interest in the
Success & ABILITY APRIL – JUNE 2012
14
SPOTLIGHT
entertainment even as it heightened the expectation of seeing the award winners on stage.
SignSpeak – the latest work of Sri Lanka's first contemporary dance company 'nATANDA' – where
sign language has been used as the embodiment for developing gestures, poses and movements.
The impact of ten months of training of young hearing impaired people in contemporary dance was
excitingly visible both for the dancers and for the audience. The former, bursting with the freshness
and vitality of youth, with not a trace of inhibition, caught up in the rhapsody of pure freedom,
swept across the stage in white: gliding, holding, letting go, boldly stepping to the front and dreamily
moving behind in silhouette. And I, as part of the audience, was stunned by the sheer beauty of this
concept, where an exceptional piece of contemporary dance had evolved in quest of new 'mudras'
originating from sign language. With every piece that unfolded on stage from nATANDA, I was
fascinated by the distinctive choreography that blended ballet, yoga, Kandyan dance and other
forms, all in a smoothly coordinated symphony of movements. I was not convinced that not being
able to hear was a disability!
Azeem Bolar from Bangalore received one of the three Mastery Awards this year – a young man
who had suddenly became 100% visually impaired and a hemiplegic, and had taught himself to walk,
talk and write...all over again... and is today, one of the most sought after and preferred counsellors
in Bangalore. As we heard more and watched him receiving the citation, the audience rose as one to
give him a standing ovation. This spontaneous acknowledgement of honour from the 'able'
audience, not just for Azeem but for every awardee, was truly heart-warming. I dare to hazard a
thought here: I was surrounded by a group of predominantly young men, who looked engrossed and
thoughtful. This group stood up even before the last word was read and I think this led the rest of
the audience to do the same. Particularly I thought then, there was great hope for our country
amidst the youth of the country. If my memory is correct, such a repeated standing ovation for
every winner was not a wave that could have passed through the audience in their earlier years.
So instead of being riveted in my seat (as I said earlier) for the entire length of the programme, I
found myself standing up again and again, to loudly cheer and acknowledge the achievements of
Bhavna Botta who, born with athetoid cerebral palsy, is a strong willed young entrepreneur from
Chennai, running her own venture, Saahaagika - one of Chennai's first boutiques to sell only ahimsa
and organic silks. Her method of communication is unique – through an 'eye-pointing' chart. A
meaningful silence spread through the audience when, as we
Success & ABILITY APRIL – JUNE 2012
15
SPOTLIGHT
drew closer to the end of the programme and the winners expressed their responses, we could read
and see Bhavna's outpouring of joy and gratitude.
Yet more... there was ARTICULATE dance group from Bengaluru – a special significance for both
CavinKare & Ability Foundation. Not only had Buse Gowda and Guru Prasad performed with Revathy
(whose MC role year after year adds not just the right tone of glamour to such an event but whose
spirited presence and conviction lends an infectious enthusiasm to the evening's gathering) and with
Jayshree Raveendran at the first anniversary of Ability Foundation way back in 1997... Buse Gowda
was also one of the recipients of the very first CavinKare Ability Mastery Award in 2003. It would be
impossible to know unless told, that these vigorous dancers - employing the motifs of Kalaripayattu
of Kerala and the Thang-Tha of Manipur in the display of martial arts in Khadganaman: items
requiring great precision and robust leaps with swords held in their hands & exacting harmony and
perfect synchronisation- were dancers who had never known the world of sight!
The massive waves of joy and exhilaration that rolled over us as each piece of the evening unfolded
itself was indeed overwhelming. We were witness to a celebration of the remarkable achievements
of those who were challenged in different ways and there was not a minute to pause and get our
breath. The organisers had so meticulously planned and timed the entire evening that there was no
slack moment, no falling behind, no waste of words. The rich and rapid flow of the evening was in
the characteristic style of Ability Foundation: restrained and yet full, deeply daunting and muted. We
had to let the waves wash over us.
Riitesh Sinha, with severe cerebral palsy, whose small town was extremely reluctant to admit him in
school, held a spectacular record first class in all his exams (entirely mainstream schooling and
college) and a Masters in Information Technology. He had overcome rejections galore especially at
school and dependence on others for mobility. He developed and crafted the Trike himself, so he
could commute independently. Riitesh working as a software programmer and a computer trainer in
Karnal is today employed in Haryana Government Service. His other passions lead him to learn and
propagate yogic 'mudras' for the benefit of people with cerebral palsy. When the young man with
the most friendly and charming smile came in to receive his award, how could we not have stood up
to applaud?
Yet, amidst all this swinging enjoyment of fine balance between Mastery Awards recipients and
scintillating dancers' performances, I knew the best was yet to come. The 2012 Award for Eminence
was given to Mohammed Iqbal from far away Leh-Ladakh. With hardly any formal education, and
practically no movement of the body, he had not only educated himself but had dedicated his life for
the wellbeing of other disabled persons and to change their image from 'receivers' of
Success & ABILITY APRIL – JUNE 2012
16
SPOTLIGHT
society to the 'contributors' to society. As the president of People's Action Group for Inclusion and
Rights (PAGIR),whose initiatives included ‘Himalaya on Wheels’ (a first of its kind in India, promoting
inclusive and accessible travel) and “Jungwa Shrugskyob” (waste to resource initiative). The audience
who rose to applaud him this time, rose as a humbled single body to salute a man, who could not
rise, but who had yet risen beyond everyone else. Those who listened intently to the Chief Guest's
remarks understood it for what it was: the voice of the Government of India... represented by
Cabinet Minister Mukul Wasnik, Minister for Social Justice & Empowerment.
The responses of all the awardees made it even more evident that they were not prepared to rest on
their laurels: they had many more miles to go in their journey to spread joy in the lives of others like
them.
It was a collective cry of appreciation when we heard the Minister refer to policy changes soon to be
announced in our Equal Opportunities and Diversity Bill. A telling comment from him (from his
participation at the Awards for the second time) as well as the others on the dais, was the inspiration
and charged motivation on the extent of responsibilities to be done, after witnessing the CavinKare
Ability Awards. Time to reflect, to introspect, to think ahead and to accomplish.
The audience also had the privilege of knowing the view point of the members of the Jury for the
manner in which Team Ability had captured the nominees on video and the manner of selecting the
recipients... We therefore could witness some of the passionate arguments of Mohini Giri and A R
Rahman, to mention just two of the eminent panel, as they decided on the awardees.
As with the Oscar night that treats all guests to the world's most lavish spread of drinks and dinner,
the CavinKare Ability Awards night too had a great spread on the menu (minus the alcohol, of
course!). Guests jostled against each other, everyone vying not just for the food but to have a word
with the awardees as well. This reminded me of my husband, Gabriel, and I having a word with one
of the winners of 2011. A word and a smile with Babli Gambhir: the girl with the 'golden hands' and a
thought had become possible as Babli found herself, for the first time, outside of her own little Jaora
in Madhya Pradesh. Gabriel and his team in the north east enabled her to fly to Tura in Meghalaya
and Imphal in Manipur, to run short-term training courses in beauty services and basics in her styling
for women. In her own words, "The CavinKare Ability Award gave her wings to fly", and following
this, today she has several other awards.
Such is the impact of the Awards night; that it jerks some to an awakening, it brings consciousness to
some; it compels some to reflect; it inspires some to spring to action; and overall... it is for all... a
humbling experience. If the Oscar night shimmers in beauty and acknowledges brilliant talent, so too
does the CavinKare Ability Awards night. It honours achievement and an almost divine beauty of a
wholly different kind, a kind of beauty that haunts and lingers, deeply moving the spirit. It does India
proud to offer this to the world.
Success & ABILITY APRIL – JUNE 2012
17
COVER FEATURE
WHERE THERE IS A WHEEL, THERE IS A WAY
5000 years ago, Egyptian physicians categorised spinal cord injury as “an ailment not to be treated.”
Thereafter, throughout human history, and indeed
Success & ABILITY APRIL – JUNE 2012
18
COVER FEATURE
up to World War II, it was believed that a spinal cord injury meant certain death at worst, and a
lifetime of struggle at best. The world over, so much has changed since then. From better emergency
care, treatment and rehabilitation, so much has been done and so much more that we can do after
spinal cord injury.
The spinal cord is a collection of nerves that runs from the bottom of the brain down the back. It can
truly be called the ‘messenger of the body.’ It’s the spinal cord that is responsible for messages from
the brain to the rest of our body: relaying messages to our arms and legs to move, messages
controlling the functions of heart, lungs, bowel and bladder and, messages controlling touch, pain,
temperature and position. This being so, it is not difficult to see that an injury to the spinal cord has
a huge impact on the body and its functioning.
The spinal cord itself is encased in, and protected by, the bones in our neck and back called
vertebrae, which make up our backbone .When we refer to someone as being the backbone of
something, indicating strength and support, it is with good reason... because it’s the backbone that
protects what is precious to our bodies... the spinal cord. Besides, the spinal cord is very sensitive to
injury and, unlike other parts of the body, does not have the ability to repair itself.
Fact is, a spinal injury can happen to anyone at any time- ‘unexpectedly’ and in unforeseen
circumstances, at work or at play. India has the highest rate of people with spinal cord injury with
numbers amounting to over 15 lacs.
This notwithstanding, it is a harsh reality and sobering truth that even today, in India, there are only
two world class, state of the art spinal injury centres. It is also a sobering fact that it is mainly lack of
awareness that remains a key problem. Not to mention attitude.
Terms like ‘Complete Spinal Cord Injury’. ‘Incomplete Spinal Cord Injury’. ‘Quadriplegia’ or
‘Tertraplegia.’ ‘Paraplegia;’ what do they mean? How much do we really know about spinal cord
injury? What is a spinal cord injury anyway? What are the implications for rehabilitation? How have
the people with spinal cord injuries who lead productive fulfilling and inspiring lives, achieved this?
To inform, interest and inspire is as always the aim of Success & ABILITY; and therefore, this special
feature on spinal cord injury... Read on, be informed, get interested and be inspired!
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COVER FEATURE
THE FIRST STEP
THE JOURNEY TOWARDS REHABILITATION
-
DR.KETNA L MEHTA
Spinal cord injury is a high cost disability leading to drastic changes in an individual's life. Due to the
many changes in the life of a person with spinal injury, emotional and psychological support too
become an essential factor. Additionally, the financial impact of spinal injury is ex-tremely high as it
leads to lengthy and recurrent hospitalisation, medical complications and extensive follow up care.
Today, worldwide there are about three million people with Spinal Cord Injury (SCI) with India having
the highest number of cases, over 15 lacs with an increase of 20,000 cases every year. China comes
second in line with 4.5 lacs and USA with 2.5 lacs. With such a soaring rate of SCI in our country, it is
critical to look at rehabilitation as a sure way to put life back into the person's life and spirit
TYPES OF SCI
SCI can be divided into two broad categories etiologically: traumatic injury and non traumatic injury.
Traumatic SCI
Traumatic injuries are by far the most frequent cause of injury in the adult population and are
caused by road traffic accidents (RTA), falls or gunshot wound, domestic and work-related accidents,
sports injuries, self-harm, assault or complications following surgery, e.g., corrective surgery for
spinal deformity, like scoliosis.
Non traumatic SCI
Non traumatic injury in the adult population results from disease or pathological influence. Factors
that influence life expectancy are age at injury, level, and extent of neurological injury. Infection of
the spinal nerve cells (bacterial and viral), cysts or tumours pressing on the spinal cord, interruption
of the blood supply to the spinal cord (causing cord damage), congenital medical conditions that
affect the structure of the spinal column, e.g., spina bifida.
WHAT DOES THIS REHAB PROCESS INVOLVE?



A highly qualified team of specialist doctors, therapists, caregivers and, most of all,
the cooperation of family members.
A continuous process of education to do the right rehabilitation for that specific case
as no two cases are alike.
Ensuring the active participation of the patient in the entire process.
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THE FIRST STEP




Acceptance of the new condition with intensive and regular physiotherapy for
muscle tone-up, to avoid muscle wasting, spasms, conjectures, etc. In addition,
training on living with the mobility aids like calipers, crutches, walkers, etc.
Occupation therapy such as transfer from wheelchair to bed, toilet seat, etc. Helping
oneself to work in different types of environment becoming adept in handling
appliances like computers, writing instruments, etc.
Self catheterisation: getting used to urinary tract infection (and learning to avoid
those), intake of adequate fluids, wholesome diet filled with fibre for proper bowel
movement, maintaining regular time for meals.
Maintenance of hygiene, managing activities like self driving, learning new skills for a
job, recreation, going in for regular checkups to avoid complications, knowing one's
legal rights and concessions available as people with disabilities.
Most often, people come home after surgeries without actually going through the processes
mentioned above and therefore are likely to bounce backward.
There are only two centres in India which have facilities on par with world class standards:
ISIC, (Indian Spinal Injury Centre) in New Delhi established by Maj HPS Ahluwalia and the
facilities at CMC, Vellore established by Dr.Mary Verghese. It is a deplorable fact that the
rehab centres in India and the growing numbers of SCIs are not in proportion. In total there
are today, 28 centres with 900 beds.
The health care segment is a Rs 1500 million industry and India spends only 5% of the GDP
for health in comparison with 15% GDP spend in USA. There is an imperative need to scale
up the rehab centres to world class standards more so, with the increasing number of cases
in our country.
LEVELS OF REHABILITATION
Education and Counselling by a physiotherapist
A person with spinal cord injury requires extensive physiotherapy to gain strength, lost
muscle tone and to become largely functional again. During the treatment a physiotherapist
plays a vital role in bringing about a positive approach towards the treatment. A caring
touch, constant reassurance and reaffirming from the physiotherapist can work wonders in
developing a positive approach as well as looking at the brighter side of life. The nature of
treatment is explained to the patient, and it is important to have patient compliance and
stress on the importance of regular exercise.
TEAM WORK CYCLE
The condition and the likely outcome are informed to the patient. A team approach which includes
the physiotherapist, the occupational therapist, the social worker and patient as well, is necessary to
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promote not only physical independence but also economical independence and social acceptance.
The relatives and person with spinal injury are as much a part of the team as
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THE FIRST STEP
the professionals and must be consulted at all times, because eventually, it is they who will have to
share the responsibility for the successful attempts towards an independent life. In the case of the
most severely disabled persons the relatives may be able to undertake nursing care at home with
suitable instructions and with the necessary equipment.
A physiotherapist must know the patient's strengths and weaknesses as well as mental and
emotional stability. He must accordingly plan up a treatment program. No false hopes should not be
given to the patient. Instead, all the possibilities and outcome should be discussed and explained.
The aim of physiotherapy will differ in relation to the level of the spinal cord injury. Physiotherapy
can help reach and maintain maximum physical potential and help in the management of other
aspects of the condition.
Having a spinal cord injury is a life changing event for both the patients and their loved ones. The
aim of the entire team should be to make the treatment sessions effective and enjoyable. All you
need to explain to the patients is that they need to give it a try, work up ways and means, ask for
help whenever required and not to lose hope and calm; all they need to have in their mind is that
they need to reach their goal. There is just a need to stimulate that all-important urge to live and
reignite the fire for setting goals and achieving these in a manner possible.
Life can be made simpler and viewed with renewed interest, if a spinal cord injury patient is made
to, DREAM, IMAGINE, BECOME and ACHIEVE. What we face in our life is never in our hands,
But how we deal with it is in our control.
The author is founder trustee of Nina Foundation
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AWARENESS
SPINAL INJURY IN INDIA
----AN OVERVIEW----
HARVINDER SINGH CHHABRA
To give millions of people world-over all the hope and courage, two men revolutionised the way the
world saw the section of spinal cord injured persons during the Second World War. Sir Ludwig
Guttman and Sir George Bedbrook tirelessly demonstrated and argued that with proper
management, patients with spinal injuries could lead near normal lives. The attitudinal shift lead to
the launch and gradual growth of spinal injury centres in many developed countries.
In the last two decades in India, and many other developing countries, have witnessed watershed
moments in the disability sector, particularly in the area of spinal cord injuries. These included
setting up of dedicated spinal injury centres that focus attention on spinal injury management.
Epidemiology
Numbers are tough to gauge, but in India, numerous pilot studies have estimated that incidence of
spinal cord injuries is roughly 20 per million population. In developed nations, it is anywhere
between 20 and 50 per million population. The causes are aplenty but the top two can be dubbed as
road traffic accidents and the injuries caused while falling from heights.
According to a study I conducted, the demographics of spinal injuries in India differ significantly from
those of other countries. There is a lower mean age and percentage of geriatric population. There is
a much larger number of males, paraplegics, those with complete injuries, those married at the time
of injury and those suffering injuries due to road accidents involving two wheelers and falls.
Management at Site and Transfer to Centre
Emergency medical care is very important in the management of spinal cord injuries (SCI). At the site
of accident the spinal injured should be extricated with first aid treatment given by trained
personnel. Evacuation to the nearest major accident and emergency centre should be done by
trained personnel using an appropriate mode of transport (road, helicopter or aircraft). After the
patient is stabilized, he/she should be shifted to a definitive centre specializing in the management
of spinal cord injury.
Pre hospital management has not been given due emphasis in India. Although there has been some
effort by the government and NGOs to set up these services in some cities through Centralised
Accident and Trauma Services and
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AWARENESS
Highway Road Traffic Patrol, there is still a lot more still needs to be done.
Acute Management
Acute management involves management in the emergency room, comprehensive evaluation,
surgical or conservative management and management of complications.
Patients with SCI managed conservatively, need to be in bed for a specified duration during which
time, they require meticulous care.
Bladder Management
Proper statistics are not available but experts generally feel that improperly managed neurogenic
bladder is still one of the most common causes of morbidity and mortality in spinal injured in India.
The high expenses involved with use of disposable catheters for clean intermittent catheterisation
may be partly responsible for this. However, it has been clearly demonstrated that even though
disposable catheters are desirable, reusable catheters, cleaned with soap and running water and
stored in a clean cotton bag, are also a suitable, affordable and practical option. Thus the issue may
not be just the costs involved, but mainly the awareness amongst the patients and the
professionals.
Rehabilitation
The major goal of rehabilitation is to make the individual as independent as possible in his/her
activities of daily living and to get him/her back to a near normal life style. This requires specially
trained staff and team effort. The rehabilitation team includes the spinal injury consultant, nurse,
physiotherapist, occupational therapist, orthotist, psychologist, peer counselor, social worker, and
vocational counsellor.
Rehabilitation should be done according to the environment to which the patient has to return. For
example, if the patient has to go back to a village and is rehabilitated according to an urban setting,
the program is bound to fail. The rehabilitation team should plan the goals in consultation with the
patient and the family and regularly monitor the achievement of goals.
Wheelchair clinic, use of assistive technology and educational classes for patients and care givers are
all important components of rehabilitation as are sexual counselling, fertility clinics, peer
counselling, psychosocial counselling and sports and recreational therapy.
However, in India, very often the patients are provided acute management and are then sent back
home without the comprehensive rehabilitation that is so vital for the management of the patient.
Sexual rehabilitation is a very important but neglected field, especially in India, where talking about
sex is thought to be a taboo. Up to 50% – 60% success rate is possible in the field of fertility for
spinal cord injured but services in this field are not well developed in India.
Psychosocial Rehabilitation
Spinal cord injury has major consequences psychosocially not only for the patient, but also for the
whole family. Hence psychosocial counselling by psychologists, social workers and peer counsellors
is important for the patient as well as the whole family.
Such services are not well developed in India. Even otherwise people shirk from consulting a
psychologist since this is considered a stigma in a large section of the Indian society. However, strong
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family support and religious beliefs can lessen incidence of psychosocial problems in the Indian
spinal
cord
injured
population.
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AWARENESS
Vocational Rehabilitation
Unless the rehabilitation process involves making the individual an economically productive member
of society through vocational counselling and training, the job is incomplete. This assumes
importance, especially since most of the spinal injured are the sole or important bread earners for
the family and are not able to go back to the same vocation after injury.
The joint family system can reduce the stress on the patient with regard to return to a vocation. This
is especially prevalent in the rural areas of India where the majority of the population lives. The
strong family support often helps the spinal injured to return to the vocation which is common to
the whole family.
Home Modifications and Reintegration into the Community
A pre-discharge home visit is important in order to suggest home modifications. Follow-up home
care services help to detect complications, if any, which will facilitate the person to return to a
normal life style and reintegrate into the community.
These services are poorly developed in India. Further barriers in the environment prevent the spinal
injured from moving around freely both in the community and at the work place. There has been an
endeavour by the Government to provide a barrier- free environment, but we still need to go a very
long way in this, especially considering our predominantly rural population.
Follow-up
A lifelong regular yearly follow-up is mandatory. Follow-ups can help to detect and prevent
complications. In developed countries there has been a dramatic reduction in mortality due to
decreased urinary tract complications. Instead now pneumonia, non-ischaemic heart disease and
septicemia are the leading causes of death.
In developing countries however, mortality is still mainly due to urinary complications. Follow-ups
by the patients are poor due to financial and other constraints.
The dictum “Prevention is better than cure” is very relevant in spinal cord injuries and a very strong
focus should be given on it. This could be done by public awareness programs and implementing
legislation which can help prevent accidents in various sectors such as transport, agriculture,
industry and sports.
Strategies for prevention have to be different in developing countries like India due to differences in
prioritisation, epidemiological differences, differences in population distribution (urban vs. rural),
differences in available resources and differences in mindset of the population.
Stem Cell Therapy
Though pre-clinical trials have shown a good potential for cellular therapies in spinal cord injury
there is no documentary proof as of now, that any form of cellular therapy definitely improves
outcome in management of human spinal cord injury. There is a need to conduct proper clinical
trials. However some experimental therapies have been introduced into clinical practice without a
clinical trial being completed. It is unfortunate that this is also prevalent across India. Moreover
undue hype by the media and claims by professionals have a profound psychological effect on the
spinal cord injured and interferes with their rehabilitation.
Miscellaneous
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In India problems like financial constraints, patients not reaching definitive institution, late
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AWARENESS
presentation by patient and paucity of trained manpower are the most common factors that hinder
management. In addition, lack of adequate facilities at the definitive institution, the psychological
factors, illiteracy and inadequate patient education are the other factors that hinder their
management during hospitalisation. Inadequate rehabilitation, a barrier-ridden environment,
difficulty in availing of the assistance offered by government/other agencies, inadequate community
awareness, financial barriers, lack of availability of assistive technology and irrational beliefs are
factors hindering integration into mainstream society. Strong family support, religious beliefs,
community support and support from spouse are the positive factors in Indian Society.
The last two decades have seen a renewed interest in India to improve services for spinal injured.
Most aspects of management are being looked into and there is a growing government – NGO
cooperation in this regard. With these developments, things are soon bound to change for the
better.
In a Nutshell
Spinal injury management is probably the most challenging and expensive as compared to that of
any other ailment. It requires multi disciplinary team management.
Prevention, first aid at site, evacuation from accident site, ventilatory management, adequate
rehabilitation, fertility, vocational training, pre-discharge home visit for modification, follow up
home care service, follow up in hospital, integration into community and barrier free environment
are the neglected areas of spinal cord injury management in India. The long list of neglected areas
suggests that the ailment is still given a low priority.
However the scenario is likely to change in the coming years with a growing interest in the medical
and paramedical professionals, service providers, policy makers and community in general.
The author is Chief of Spine Service and Medical Director, Indian Spinal Injuries Centre, New Delhi.
The 4 E’S of SCIprevention
Education: Educating the laymen about the possibility of SCI from the various acts they indulge in.
Enforcement: These strategies identify opportunities for injury prevention that can be legislated for
the protection of all the citizens. Examples include seat belt or car seat laws, stop lights at the
dangerous intersections or railroad crossing gates.
Engineering: It is an effective way to reduce the impact of energy transmission across the host by
design. For instance, better head protection from better-designed helmets limits the effect of the
injury.
Economic Incentives: When purchase costs act as a barrier and when voluntary participation is
necessary to achieve compliance, economic incentives can serve to provide access to prevention
devices, such child restraint seats.
- DR. HIMANSHU DOSHI
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THERAPY CENTRES
PREMIER REHABILITATION CENTRES
CHRISTIAN MEDICAL COLLEGE(CMC), Vellore
-
S. VAIDHYA NATHAN
When Raghu Naidu stepped into his fields to till the land, there was much amazement and some
amusement. He was no ordinary farmer. Wearing full-length calipers, he used his crutches adroitly
to manoeuver in the slushy and loose sand and plough his fields. This was not a one-off. He had been
at it for more than 25 years.
Naidu's exemplary life as a farmer despite a spinal cord injury rested firmly at the Mary Verghese
Institute of Rehabilitation (popularly know as just Rehab in the Bagayam campus of Christian
Medical College, Vellore). Therapists, doctors and social workers had visited his village, understood
his requirements and then proceeded to train him to be able to take care of his lands.
Nestling in a verdant setting, India's first rehabilitation centre for spinal cord injury can be easily
mistaken for a resort. Once you step in, the life-changing work done here by the team on a 24x7, 365
days basis, dawns on you in a no-frills setting. Service fills the air and it is always service with a smile,
be it doctors, nurses, therapists, social workers, assistive devices staff or the support crew.
Underpinning the service is the unconditional acceptance. Dr. Suranjan Bhattacharjee, a specialist in
Physical Medicine and Rehabilitation (PMR) and now Director of CMC, Vellore, explains the concept:
“There has to be an unconditional acceptance of whoever comes for healing. We must treat each
person who comes for healing as an embodiment of the divine. We must be human about mistakes
that may happen. We must bring sensitivity back, as, when a society becomes insensitive to its own
pain, it starts to feed on itself.”
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THERAPY CENTRES
Nothing exemplifies this more than a touching example from 1990. The old guard at Rehab recalls
fondly how Dr. Bhattacharjee restored a dog that had been picked up from a gutter outside the
campus, that had suffered a spinal cord injury and ensured that it lived comfortably. Unconditional
acceptance means it matters not, to this day, even if a person does not have the monetary resources
to support his/her programme at Rehab.
It was here that Raghu Naidu picked up the pieces of his life in the mid-eighties. As did Bharathrajan,
a former athlete, who went through a protracted phase of depression. His occupational therapist,
Shobha, spent long years chatting with him and slowly drawing him out of his predicament. In this
endeavour, she was going beyond the call of her duty; a fairly routine occurrence at Rehab over the
years.
Bharathrajan today works in the police department and has two children. His daughter sports the
name of his occupational therapist in a gesture of love and gratitude. Several thousand have passed
through the portals of Rehab and the PMR since the basic steps set by Dr. Sarvapalli Radhakrishnan,
the then President of India, in 1963. A visionary, Dr. Mary Verghese was the bedrock for these pathbreaking initiatives, from her wheelchair.
Using a completely need-based approach with the patient at the forefront, meant that Rehab was
emerging as a different setting right from its early years. A comprehensive approach means that
patients get quality care for a variety of issues under one roof – an important part in rehabilitation of
a spinal cord injured person, given the constraints in mobility and the multiple physical challenges.
When Manoj, aged six, arrived at Rehab in August 2010, his smile grabbed attention, as Team Rehab
set out to map his rehabilitation and likely outcome. A holistic approach that takes care of the
physical (strength, mobility and activities of daily living), psychological, social and economic aspects
is central to the care offered here.
Given his high level of injury, the initial thinking was that Manoj might not be able to walk again. The
team decided to keep the approach flexible and observe how he evolved as the rehabilitation
proceeded. Manoj picked up the bits with gusto with his physiotherapist and occupational therapist.
He was soon walking using a walker. Given his age, it was no surprise that the wheelchair was almost
a plaything for him, as he taught tricks to his older peers at Rehab.
Manoj's family came from an economically disadvantaged background. So at every stage, this aspect
was taken in cognisance with the team of social workers who were the anchors for his rehabilitation
program. Today, Manoj is in school with the support of community-based groups. His rehabilitation
was not just about him, but his dad, too, as his uplift is critical to Manoj's future. Here too CBR and
bank support have acted as a boost.
Dr. George Tharion, Head of the PMR Department in CMC Vellore, stresses the teamwork ethic:
“A key factor to how Rehab has evolved is the team. Rehab is about a group of people with varied
skills working together for a common cause. In Rehab, everybody is willing to run the extra mile to
work as a team. Collective wisdom and interaction has strengthened what we do. As you work
collectively, it means astronomical strength. Strength does not add but grows in geometric
proportion when people work together.”
According to Dr. Tharion, the teamwork assumes greater importance as Rehab requires a flexible
approach. “It is not a place where you can go and put protocols. The same problem may have to be
managed differently and tailored to suit the needs of different people.”
To be in Rehab is to be in a mini-India, cutting a swathe through religion, caste, language and
differences in educational, work, social and economic backgrounds. They are all left behind, as
families and friends rally in a manner that inspires confidence in the support system for persons
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undergoing rehabilitation. You get a good idea of what makes India tick. The beautiful chapel inside
Rehab
is
practically
a
multi-religion
pray
spot.
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THERAPY CENTRES
Many like Manoj, who come from economically disadvantaged backgrounds, get free treatment and/or
support from sources identified by the social workers. There is a simplicity about the place that may lull
you into a view that outcomes may not be significant. But that is as far as you can go from the truth.
Even as Rehab has widened its ambit of work to care for persons with brain injury, stroke victims and
children with special needs, this simplicity has been retained in it entirety. Quality rehabilitation is about
touch, smile, understanding and interaction, which you get in abundance, and less about fancy, expensive
devices. This has been a key factor in ensuring Rehab's services are within reach for one and all.
Dr. Tharion emphasises that keeping costs down is a constant task. “Even when we expanded, we found
that the cost has to be low to improve reach. The dream was also, that we are able to provide the best
care at the lowest possible cost. It is always a challenge to get relevant, not necessarily high-end
technology, at the lowest cost. Money can buy many things, but does not mean reach. Our facility had to
be accessible and available.”
There are many lessons to be learnt just by observing what is happening to others around at Rehab. You
will find somebody lying in a split mattress or prone in a trolley for many months due to bedsores. You
will see how constrained and time-consuming the process is for them. You know that avoiding bedsores is
the cornerstone of your life, as only then can you sit, stand, walk, work and be active in the community.
Suddenly the importance of all the precautionary steps that the nurses and therapists have been telling
you becomes all too clear. There is a constant learning process for other issues that persons with spinal
cord injury face, especially in the areas of bladder and bowel management. Constantly broken Tamil,
Hindi, Bengali, and English are deployed to augment the learning process.
In the midst of growth and change, the ethos set by Dr Mary Verghese has been nurtured carefully, as
that is what makes Rehab flow smoothly amidst acute day-to-day challenges.
Looking ahead, Dr. Tharion feels there is much scope for enhanced community-based activity, use of
emerging technology to help augment what especially persons with high level spinal-cord injury could do
and in helping in the development of quality centres in other parts of India.
He also strongly believes that the emphasis on walking as the rehabilitation goal will remain.
“The emphasis on making patients walk still holds true, as we found many years ago that patients who
were rehabilitated only on a wheelchair had more complications if they are sent home, especially in the
villages. Architectural barriers are enormous even today. We found that persons who walked even a
short distance survived more and their social acceptance and success was much better as they were able
to go out more from one point to another.”
At Rehab, patients gather in the expansive verdant spaces abutting the State highway or around the pond
that is at the centre of the facility in the evenings. There, they share their experiences or even just hang
around, bonds build that provide strength and confidence. Every time they pass by the montage of Dr.
Mary Verghese, there is an additional dose of inspiration.
Every time patients see a person completing the rehabilitation program and going home, hope springs
eternal and rests in first hand evidence that restoration is possible from the wrecked state in which most
come. Few would have imagined the difference Rehab would make to their quality of life. This, in a
nutshell, is the core of this world-class centre offering service with a smile.
The
author
is
co-founder
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of
Spinal
Care
India.
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THERAPY CENTRES
DR.MARY VERGHESE: ‘Innate ability to inspire’
DR. SURANJAN BHATTACHARJEE, Director of Christian Medical College, Vellore, knew Dr. Mary
Verghese – a paraplegic due to a road accident in 1954 and the first specialist in Physical Medicine &
Rehabilitation (PMR) in India – in a variety of roles as a student, intern, doctor, friend, and as the
person who carried forward her pioneering work. His reflections:
If Dr. Mary Verghese were not courageous and brave, PMR centre in Bagayam would not have
happened.
She had vision. She was able to recognise that perhaps even this accident had a purpose, way of
helping others and a belief that she was not doing this alone.
She had perseverance. She had for most part, lived in America. There for her eating, dressing and all
other activities of daily living would have been western. She had to adapt herself. She did so, with
great determination.
In those early days, her example was so outstanding, that she drew a lot of support by inspiring
others.
The magical part of this work was that she never had to tell patients that life is possible after a spinal
cord injury. They could see she was diagnosing, treating and also operating on them from a
wheelchair.
She set up the Indian Association for Physical Medicine & Rehabilitation by roping in professionals
from Kolkatta, Kerala, Bombay, Delhi and Vellore and was its first president .
Dr. Mary Verghese also realised that she had to help allied health professionals. She trained her first
occupational therapist and a physical therapist and trained volunteers to do a variety of tasks.
She recognised that there was a need for a postgraduate program in this specialty for medical
professions and set up the Diploma in PMR in CMC. Her own experience in struggling with physical
challenges gave authenticity to the plans she made for Rehab.
We were lucky that the PMR department and Rehab were started by somebody, who was not just
intelligent, brave, persevering, visionary and skilled with her hands, but who also knew what
patients needed and made them available.
She was also particular about costs, “We cannot be expensive”, she emphasised.
Her courage is the most abiding memory. She was a lady, and in the fifties when she had her
accident, women were becoming more independent. But still had a restricted role in society. She
took on a leadership role despite her physical disability and did so well. She had the ability to inspire.
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THERAPY CENTRES
PREMIER REHABILITATION CENTRES
INDIAN SPINAL INJURIES CENTRE(ISCI)
-
HARVINDER SINGH CHHABA
MAJOR HPS AHLUWALIA is the Chairman of Indian Spinal Injuries Centre (ISIC). He is also the brain
behind it. He was in the first Indian team that scaled Mount Everest on 29th May 1965, but became a
tetraplegic due to a war injury exactly four months later during the IndoPak war. It was perhaps
during his rehabilitation at Stoke Mandeville Hospital in the UK, that he dreamt of recreating similar
facilities in India. He has had a distinguished career and has had several major achievements, which
include authoring 14 books, and tenures as Chairman, Rehabilitation Council of India and President,
Indian Mountaineering Foundation, leading the Central Asia Cultural Expedition tracing the Marco
Polo Silk Route through intricate parts of China and more. DR. H S CHHABRA, Medical Director of
ISIC, interviews him on his unending drive to contribute to the society.
What made you think of establishing Indian Spinal Injuries Centre (ISIC)?
Four months after climbing Mount Everest, I was severely wounded in the Indo-Pak war. The
scenario of spinal cord injury management had not evolved in India at that time. No one could even
tell the difference between quadriplegia and paraplegia, let alone its treatment. The general
perception then, was to keep the patient on maximum bed rest with minimal movement of any
limbs – the exact opposite of what was actually beneficial! There was no attempt to rehabilitate a
person, or to care for the person’s emotional well-being! Bed sores and Urinary Tract Infections
were rampant and mostly taken for granted. I was moved from one hospital to another as doctors
were baffled by the extent of my injury.
After struggling for two and a half years in various hospitals, we heard of Stoke Mandeville Hospital
in the UK. This hospital in Aylesbury, was specially designed to cater to Second World War patients
and had a long waiting list. With the help of friends and the Government of India, I was finally sent to
Stoke Mandeville Hospital for treatment. I arrived broken in body, but not in spirit. I was determined
to rebuild my life, against all odds.
It was a life changing experience for me! Over the years, I visited Stoke Mandeville Hospital many
times for my checkups. Every visit reinforced my conviction that India desperately needed a centre
like this. Sir Ludwig Guttman, the founder chairman of Stoke Mandeville Hospital inspired me to
follow my dream, while Dr.Walsh, his successor and my physician, motivated and helped me design
and establish my dream project. I was really fortunate to get financial assistance from the
Government of India and the Government of Italy.
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What do you think were the biggest challenges you faced when establishing ISIC?
Perhaps the biggest challenge that I faced while establishing ISIC was to convince those at the helm
of affairs that somebody who was not a medical professional, who was him self a wheelchair user
could dream of building a medical facility. In fact I was blamed for trying to "build a castle in the
desert.”
The other challenge was to convince people that a spinal injury centre was required and that it could
be financially viable. ISIC is one of the very few spinal injury centres in the world that is not
dependent on the insurance or the government and has, not only been able to break even, but also
save enough to meet its expansion plans and replace its equipment.
Finding motivated and committed personnel and training them adequately in spinal injury
management was another big challenge. There were hardly any trained personnel in spinal cord
injury management in India and no training facility.
What has been the role played by ISIC in establishing rehabilitation services for
SCI in India?
Indian Spinal Injuries Centre began as a dream in my heart – a dream of offering people with
disabilities a new hope for a better life. My dream was to build a world class spinal injuries hospital
with complete facilities for medical, surgical and rehabilitative care. At that time, there wasn't a
single such hospital in India!
Today, the Indian Spinal Injuries Centre is a landmark healthcare institute on par with the best in the
world. We continuously strive to make a difference, upgrade quality and bring about awareness of
health and disability conditions amongst our patients and society. ISIC is one of the most advanced
Spine, Orthopedic and Neuromuscular surgical centres in India. It provides comprehensive medical
care of the highest international standards and conducts some of the most advanced surgeries
performed anywhere in the world. It has revolutionised the diagnosis, treatment and rehabilitation
of patients with spinal cord injuries.
The Centre provides state of the art facilities for the care of all types of spinal ailments. It has a
dedicated team of trained and acclaimed spine surgeons, supported by cutting edge medical and
surgical technology.
At ISIC, serving the needs of society and of people with disabilities in particular, has been a part of
our corporate culture. From the very beginning, our vision was beyond merely setting up a hospital.
Our aim was to build a more inclusive society; to bring people with disabilities into mainstream life;
provide them with the best medical and surgical treatment anywhere in the world, rehabilitate them
with a complete regimen to help them lead a better, more fulfilled life.
We take pride in introducing the true essence of the term 'Rehabilitation and SCI Management' to
Indians and making it accessible to one and all in the country. The rehabilitation department is
considered the core element of our hospital. It offers complete facilities of physiotherapy,
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occupational
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therapy, wheelchair training skills, assistive technology, prosthetics and orthotics, vocational
training, dancing and sports therapy. Our solar heated hydrotherapy unit is considered our unique
selling point as it is the only one of its kind in India and the largest in Asia.
The centre has also played a major role in the field of education and human resource development
in the field of spinal injuries. The ISIC Institute of Rehab Sciences runs various prestigious education
programs including fellowship in Spine Surgery, Post Graduation in Orthopaedics, Rheumatology,
Anesthesia and Hospital Management as well as Masters in Physiotherapy, Occupational Therapy
and Prosthetics & Orthotics. The Institute was the first in India to offer Masters in Prosthetics &
Orthotics and second in India for fellowship in the Spine Surgery Program.
ISIC has also played an extensive role in the field of research for spinal cord injuries. It has not only
pioneered various clinical research programs but has also set up basic research facilities. It has
successfully conducted and published the first Indian Council of Medical Research approved trial in
the country in the field of stem cells for human spinal cord injuries.
As spinal cord injury is more prevalent in weaker sections of society, we reserve 10% of our total bed
strength for patients who belong to below the poverty line category. There is no discrimination
between the services provided to persons who receive free care and those who pay full fees.
The ISIC model is economically sustainable, equitable and replicable; it has also become a popular
brand name in rehabilitation programmes at both national and international levels. We take pride in
rehabilitating thousands of persons with spinal injury every year.
In recent years, we at ISIC, have begun to play an active role in raising awareness on the rights of
people with disabilities to safeguard their interests, prevent unfair discrimination and ensure justice
for them. We are also fighting to ensure representation on any committee that is formed to look
into legislation for persons with disabilities, in a spirit of 'nothing about us, without us.’
What do you think are the main reasons for the success of Indian Spinal Injuries
Centre?
I attribute the success of our institute to three main factors; first of all, the inspiration from Mount
Everest to always reach for the highest; secondly, the extraordinary dedication and hard work of our
exemplary team of medical specialists and all our staff, who continue to help us maintain the highest
standards; and thirdly, the strength and courage I see every day, in the eyes of our patients – some
of whom have travelled half way across the world. They are life's real heroes – people who continue
to teach us, that there is no such thing as disability. The only barriers are those that exist in the
mind.
What plans does ISIC have, to further develop rehabilitation services in India?
Indian society is undergoing a significant and valuable re-assessment of its understanding of
disability. There is a paradigm shift in our approach: from a medico-social model to a rights-based
approach towards persons with disabilities. While the old paradigm viewed persons with disabilities
as “defective and in need of fixing”, the new paradigm perceives disability as a “natural and normal
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human
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The
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focus now is on adjusting the environment and not the person. ISIC has played, and will continue to
play, a leading role in advocacy in this field.
The 12th Five Year Plan foresees the establishment of 20 additional Spinal Injuries Centres across
India, based on the ISIC model. ISIC would hopefully play a leading role in it as it has done in the
setting up of Regional Rehabilitation Centres at Bareilly, Jabalpur, Mohali and Cuttack. Of course ISIC
will continue its work in the field of human resource development and research in the field of spinal
injuries.
Through the setting up of Spinal Cord Society, ISIC has facilitated knowledge sharing amongst
medical and paramedical professionals all over India. We are now in the final stages of launching the
South-Asian Council on Spinal Cord Injury (SCSCI) as a new initiative.
What is the source of inspiration for all your achievements in life?
My life has been a long journey of extreme ups and downs…of hope and despair and of aspirations
and achievements. Every experience has taught me a valuable lesson and helped me shape my
philosophy of life but my main source of inspiration has been "The Everest.” I would want to recount
here an event which perhaps had the most affect in moulding a positive philosophy in life. It was the
last leg of our climb to Mount Everest. The morning of 25th May dawned bright, but chilly. There had
been a big avalanche over Camp III. I rushed outside. It was a frightful sight. The camp, with its
colorful tents - luckily unoccupied at the time - had been completely wiped out. While there was no
loss of life, we had lost something as precious. The cylinders of life-sustaining oxygen, which we had
so carefully conserved and stored in the camp, had been buried under the avalanche. With them
too, it seemed, had been buried the hopes of our summit party reaching the top.
The leader had no option but to call off the final assault, as without oxygen, it was doomed to
failure. A search seemed pointless, as who'd ever heard of bottles being dug out from under six feet
of snow? But we did not want to give up and persuaded the team leader to allow us to try
recovering the cylinders even though it seemed an impossible task.
After six hours of digging, worn out and depressed, we could not go on like this much longer. For
renewed hope we turned to God: the Sherpas, a religious lot, were already praying. Before long, to
our utter surprise my axe hit an oxygen cylinder. A few more whacks in the thick snow and we soon
located another and yet another. What a moment of supreme happiness! It was at this stage that I
felt a fierce determination flow into me – nothing could stop us from reaching the summit.
People look on you as a role model. What is it that you have learnt in life and
would want to share with people?
As I look back at life, it is nothing but power of the mind that matters the most. Each man carries
within himself his own mountain, with its own cliffs, crevasses – fearful, sheer and unfathomed,
which he must climb to attain a fuller knowledge of himself. The physical act of climbing a mountain
has a kinship with the ascent of that inward spiritual mountain which every man has to climb
sometime or the other.
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Scaling Mount Everest and setting up ISIC have taught me a powerful truth:
Life is all about conquering the other summit – the summit of the mind.
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THERAPY CENTRES
PREMIER REHABILITATION CENTRES
The MILITARY HOSPITAL, Kirkee
-
GENERAL KULDIP SALGOTRA
The Indian armed forces have a well planned comprehensive management plan for all spinal cord
injured persons. The plan covers everything – from injury to full rehabilitation. The initial treatment
is done at designated neurosurgical centres spread all over India. These centres are located at
Srinagar, Udhampur, Chandigarh, Delhi, Lucknow, Calcutta, Pune, Mumbai and Bangalore. After the
initial management at these centres, which includes surgical stabilisation of spine, those with
paraplegia/ quadriplegia are transferred to Military Hospital Kirkee, for further treatment and
rehabilitation. Following the full rehabilitation of the patients, they also have the option of joining
paraplegic rehabilitation centre, Kirkee, Pune as permanent members.
Established as a 400-bedded hospital on January 7, 1949, the Military Hospital, Kirkee is one of the
largest and best equipped spinal cord injury centres not only in India, but in whole of South East
Asia.
The 30-bedded spinal cord injury centre was inaugurated on November 13, 1968, with the transfer
of 20 persons with
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paraplegia from Command Hospital (Southern Command). The Paraplegic Rehabilitation Centre for
paraplegics of all the three defence services was set up near the Military Hospital, Kirkee, Pune in
1974. The facility has been expanded twice since then, and currently has 109 beds, including 83
single and 26 married quarters. The present strength of this spinal cord injury centre is 80 beds. A
dedicated team of orthopaedic surgeons, affiliated neurosurgeons, urologists, trained nursing
officers and other paramedical staff makes it a full-fledged spinal cord injury rehab centre. Major
physiotherapy centre and occupational therapy centre provide the necessary back up facilities for
physiotherapy and occupational therapy, which are very essential for the final rehabilitation of spinal
cord injury patients. In India, this Centre holds the record of having managed the maximum number
of persons with spinal cord injury. This Centre has pioneered the management of spinal cord injury
patients and rendered yeoman services to thousands of people.
After the medical and rehabilitative treatment at Military Hospital Kirkee, there are those who
require extended rehabilitation services to prevent other complications. Thus, the Paraplegic
Rehabilitation Centre for paraplegics, of all the three defence services was set up near the Military
Hospital, Kirkee in 1974.
The centre has an indoor sports complex that provides facilities for table tennis, throw ball,
badminton and a stage with PA equipment for entertainment programmes and conferences. The
area for outdoor sports has a covered basket ball-cum-tennis court and facilities for providing field
and track events.
Subsequently, there is aftercare and medical aid including free boarding, lodging and financial
rehabilitation to such paraplegics/tetraplegics of three defence services after they are discharged
from Military Hospital, Kirkee.
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MIND MATTERS
PSYCHOLOGICAL ASPECTS & COPING MECHANISMS
-
MAYA KISHORE
Spinal cord injury is a devastating and life-changing experience that can happen to anyone at any
time. The extent of the impact that this has on the person and his/her family depends on several
factors like personality of the individual, the extent of physical incapacitation, socio-economic status,
age, etc.
The sudden and unexpected onset of the disability also comes as a big shock to the affected persons,
and it is natural that they start counting their losses first and start living in the past. They begin
questioning the medical team; barraging them with all their doubts on their physical status.
Therefore, extreme caution must be exercised in revealing the right facts to them at this stage.
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MIND MATTERS
“I was driving my bike, enjoying a pleasant conversation with my friend. The excitement made me
rev-up the accelerator. I never noticed the speed. Speed had always thrilled me. By the time I realised
that I was speeding towards a truck, it was too late and I was almost underneath it and soon became
unconscious. Three days later, when I woke up, I was lying in a hospital bed. I saw my mother's
swollen, tearful face. Suddenly, I felt a shooting pain in my back. I tried to move. I realised that my
legs were like logs of wood - too heavy to lift. I asked the nurse when I would be able to move on my
own. The prolonged silence made me very angry. I started yelling. This continued for a few days.
Slowly I realised that I have to remain this way for a long time, probably throughout my life. I started
thinking that I had spoilt not only my life but that of my family members also. At that moment, I
questioned God: “Oh God, please tell me what crime I've committed that you punish me like this.
Please take away this sinner. I don't want to live anymore.”
Situations and reactions as these occur to everyone who has suffered spinal cord injury. The physical
pain, the agony, the level of dependence and the financial losses make them think so. During the
process of coping, they go through different mental states.
In this sensitive phase of spinal cord injury, the person and family are in the dark. They experience a
very big shock and a sense of helplessness. This grief can be interpreted as depression. Before
developing into depression however, the person goes through feelings of loss, fear, insecurity, guilt,
anger and anxiety. The anger towards oneself and towards the others around can result in
aggressive behaviour. They start believing that the doctors treating them are responsible for their
disability. They do not want to cooperate with the professionals and sometimes use harsh words to
insult them. If the anger is towards the self, they withdraw from food, physical hygiene, etc. They
sometimes go to the extent of harming themselves with self inflicted wounds. At this stage, the
person has to be taught Anger Management. Various techniques to express anger can be useful at
this stage. Trauma counselling also can be useful in order to deal with the fear and the feeling of
loss.
The person may start questioning the team for the period of time required for recovery. Along with
that begins self- questioning and questioning God. As the team can't answer the questions directly
or can't commit to a time span, he/she begins to lose faith in them. The search for cure starts at this
point. They approach every astrologer, quack or even those who practice black magic. This not only
ends in great financial losses but also adds to the level of depression. Reality can be revealed to
some extent depending on the patient's and the family's condition. Support from the peer group is
very useful at this stage. The counsellor has to encourage the patient to express his/her emotions. A
good atmosphere has to be maintained for catharsis.
Many spinal cord injury persons expressed that, when they were in the hospital, they thought they
were the only ones in this world to be in such a tragic situation and this thought created a feeling of
jealousy towards other people who are able to walk and
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move on their own. Jealousy also results in developing self-pity. Sibling rivalry can reach its peak and
result in various attention-seeking behaviours. Behaviour modification techniques can be helpful for
the patient.
These feelings of fear, anxiety and insecurity tend to increase during the transition period from
hospital to rehabilitation centre. This manifests as Irritable Bowel Syndrome, severe aches and pains,
sleeplessness, loss of appetite, aggressive behaviour and so on. At times like these, various Stress
Management Techniques have to be used to ease out these negative emotions. Relatives can be
invited to attend the various therapy sessions or group activities so that they can be briefed about
the rehabilitation programme.
The patient transferred to the rehabilitation centre without proper preparation may come with a lot
of unrealistic expectations about recovery. spinal cord injury persons always expect a miracle in their
life and expect 100% recovery. Most of the cases expressed that they saw themselves walking in
their dreams. At the rehabilitation centre, they are suddenly exposed to a group of people with the
same problems. The sudden realisation that it is incurable and one has to live with disability is too
much. This gives way to defence mechanisms such as denial. The “why me?” question nags him/her.
“Am I a big sinner, that God has punished me?” This can lead to withdrawals from communication,
hygiene and sleep disorders and has to be dealt with extreme sensitivity. They have to be helped to
use the right coping mechanisms. Relaxation, meditation and yoga are used to relieve stress and
deal with problems in realistic ways.
Teenage spinal cord injury persons also feel ashamed at becoming wheelchair users. This is the age
for hero-worship and positive peer group influence all round. The fear of non-acceptance by peers
and negative body image can force them into refusing the use of a wheelchair, which in turn can
result in denying oneself the use of assistive devices in the ambulatory stage. Here, positive
reassurances can help the person make better adjustments.
Various sexuality issues also have to be counselled along with the spouse. Marital disharmony and
rejection by the spouse can cause severe depression or suicidal tendencies.
The spinal cord injury person also needs help in socialisation and inclusion within the community
and society.
A spinal cord injured person thus goes through various stages of shock, denial, repression, anger,
anxiety, depression, bargaining and finally, adaptation. Counselling, therefore, has to be begun right
at the ICU itself. One has to be helped to realise oneself, develop self confidence and a positive self
image, to accept and enjoy the right to live and right to choose appropriate methods for his/her
integration into a new world. All the team members have to be informed and their participation has
to be ensured for complete and successful rehabilitation.
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RAMPS? OR CRAMPS!
Ten super examples of (c) ramps that people on wheels have to put up with which may bring
on a grin or grimace on your face.
Our thanks to Scott Rains for these pictures
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BODY BASICS
PHYSIOTHERAPY MANAGEMENT
-
DHRUV MEHTA
Spinal cord is the main life line of nerves; the communicating column between the brain and the rest
of our body. Our nerves make our diaphragm and intercostal muscles of respiration work, our hands
and legs move, make us feel the different senses of touch, pain, pressure, temperature, joint
position, control our bladder and bowel and sex function. Injury to the spinal cord (which is well
protected inside the vertebral column of 33 vertebrae), causes paralysis/weakness of arms, trunk,
lower limbs, breathing difficulty, loss of sensations; the bladder and bowel control is affected,
temperature regulation and sexual function are affected.
If all four limbs are affected, the person is referred to as having tetraplegia or quadriplegia.
When the thoracic and lumbar spinal cord is affected, affecting the trunk and both lower limbs, but
not the upper limbs, the condition is known as paraplegia.
In India, there are over 10,000 people who acquire spinal cord injury each year. About 8,000 of them
have paraplegia and an estimated 2,000 have tetraplegia.
Management of spinal cord injury is multi disciplinary team work, requiring the intervention of the
SCI emergency medical team, the spine surgeon, the neuro surgeon, intensivists, nurses,
physiotherapists, occupational therapists, urologists, plastic surgeons, counsellors, the orthotists,
assistive technology specialists, the family and the care-givers.
Here, the role of a physiotherapist is extremely
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vital. Physiotherapists are concerned with the restoration of functions: the movement skills needed
for daily living in the indoors and the outdoors and whilst travelling. Physiotherapists work for the
optimisation of movement skills, since total restoration of function is not possible.
The physiotherapist becomes a friend, a guide and motivator and a catalyst, instilling positive
optimism both with the SCI person and with family and carers, thus enhancing and giving assurance
on the quality of life. The physiotherapist, along with everyone concerned, sets collectively realistic
goals that can be achieved.
Thus, the physiotherapist is involved in the entire process of this optimisation/restoration of
functions right from the intensive care unit, to the step down to the ward and the physiotherapy
department where the active rehab begins. Physiotherapy happens at all levels – at home, in the
community, leisure and sports, commuting, inclusion at school, college, work place and so on.
The broad aims of a physiotherapist are:
a) Teaching deep breathing exercises:
1. Diaphragmatic and thoracic exercises to prevent atelectasis, pneumonia and chest complications.
2. Spiro meters, inhaling and exhaling exercises through balloon blowing, whistles, blowing balls and
other enjoyable activities.
3. Teaching huffing and coughing to remove secretions from the lungs, recommending some
positions of postural drainage in consultation with doctors.
b) Teaching movement exercises:
These are to ensure flexibility of joints, movement of ankles is particularly important right from the
initial stages and to prevent clots and deep vein thrombosis, which further prevents other
complications.
c) Prevention of pressure sores:
Physiotherapists teach families the safe way of turning on the sides of the bed every two hours.
They also teach the person to inspect their bodies twice each day completely, using a
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long handled mirror to see the body parts.
The physiotherapist guides in using the proper bed/cushion which relieves pressure to some extent
(this could be a water bed/cushion, air, gel, foam, even coir, low cost cardboard or soft cotton).
Physiotherapists also teach weight relieving manoeuvres of two hourly turning in bed: sitting up with
legs straight, legs bent, turning onto the stomach, lying on the sides with blocks and to do push ups
from the wheelchair.
They teach good nutrition, measures to prevent moisture from urine, sweat, soaked clothes, creases
in clothes and bed linen, and the discomfort of being near hot, sharp objects which might damage
the skin.
d) Strengthening:
To strengthen the working muscles, initially active movements are done and later resistance is
added with weights, springs, pulleys and thera bands. Particularly the arms and the trunk are
focused on to make bed mobility, shifting, transfers, standing up and walking, easy, as also
manoeuvring the wheelchair. The physiotherapist has to be very careful in strengthening. It has to
be very gradual as many people may have weak bones (osteopenia and osteoporosis).
e) Transfers-/ Sitting Balance:
This very important skill makes a big difference in restoring the confidence and joy of living for a
person with SCI. Once sitting balance gets better, shifting with good elevation by the person with SCI
or with assistance is done in bed to move sideways, up and down. Transfers are done from bed to
chair initially. Level transfers are done for a person with tetraplegia using a transfer board. Also, in
our Indian context as much daily activity is done at floor level, transfers are done from wheelchair to
floor. Later transfers from wheelchair to vehicle are attempted.
f) Wheelchair training:
Physiotherapists teach wheelchair skills, of propulsion, on level surfaces, transfers from wheelchairs,
staying active whilst sitting, doing pressure relief manoeuvres, taking care of posture and alignment,
learning to handle the different parts of the wheelchair. Next comes manoeuvring the wheelchair
on gentle inclines, outdoors over gravel and uneven surfaces, going through doors and, in and out of
the toilet. Advanced skills of falling and getting back into the wheelchair are also taught by the
physiotherapist. Those who have mastery over these skills also teach how to use a tricycle outdoors.
Also, along with the person with SCI and the family, the physiotherapist chooses the wheelchair best
suited to individual needs without compromising on safety, comfort and function. In selected
instances two wheelchairs may be needed, one each for indoors and outdoors. A physiotherapist is a
resourceful person who guides the person with SCI and their families on the purchase of manual or
motorised wheelchairs, or gets them linked up with trusts and foundations that support the
purchase or loan of these aids and appliances.
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g) Orthosis:
Working closely with doctors and orthotic engineers, the physiotherapist works at giving necessary
support /stability to the neck, mid and low back; either with a hard cervical collar, or other types of
spinal frames/corsets, knee-ankle-foot orthosis or ankle foot orthosis, etc. Along with orthosis, the
physiotherapist judiciously decides on the process of the parallel bar walking, walking with walker as
well as walking with different types of crutches.
h) Gait training:
The physiotherapist first makes the person with SCI stand on a tilt table, slowly achieving full
verticalisation. Compressive bandages to the legs and an abdominal binder will help during this
process of achieving full upright standing. A physiotherapist, while he/she emphasises the benefits
of standing and walking ,to make bones strong, let the bladder and bowel work well, prevent
calcium washout, prevent renal calculi, stretch muscles, elevate mood, has to be realistic and work
with the person with SCI whether it is practical and realistic and safe, or wheelchair mobility is a
better option.
i) Pain & Wound management:
Physiotherapists also assist in the management of wounds by giving ultraviolet radiation, infrared
rays as also ultrasound therapy and ice cubicle stroking all of which are done with utmost aseptic
precautions.
Persons with SCI, develop pain in the neck, shoulder, wrist, and fingers because of constant
wheelchair propulsions, transfers, use of crutches and other assistive devices. Physiotherapists treat
the pain by transcutaneous nerve stimulation, ultrasound, infra red and, in selective cases,
shortwave diathermy to neck/shoulders, does neural mobilisation, myofascial release and massage
to relive pain and adhesions. While giving heat modality the therapist sees that sensations in that
apart are intact and is vigilant that overheating of the tissues does not happen.
j) Caring for the carers:
For the first 3-6 months and in some instances for longer, persons with SCI will need assistance for
movement and physiotherapy. Thus the physiotherapist has to train the carers, the family members
and attendants/helpers as well, in proper techniques of mobilisation, strengthening, lifting and
transfers.
k) Bladder training:
Transurethral electrical stimulation may help in detrusor contraction and voiding, credes maneuvermanually pushing
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down on the bladder is taught, as is bladder stimulation by suprapubic jabbing.
l) Sports:
A physiotherapist trains and motivates the person with SCI to take active interest in sports –
especially ball games, racquet sports and wheelchair sports and to participate in annual meets in the
city or outside where paraplegic sports are conducted. These keep one's aerobic capacity tuned and
rebuild confidence.
In short, a physiotherapist's role is very vital at all stages of rehabilitation. The therapist is cognizant
and prevents negative effects of cardio-respiratory de-conditioning, prevents pneumonia,
atelactasis, deep vein thrombosis, pressure sores, contractures and deformities, renal calculi,
osteoporosis, postural hypotension through graduated exercises, verticalisation slowly and weight
bearing. The therapist strengthens all innervated muscles, keeps up the mobility in the joints where
active movement is not possible, enhances bed mobility skills, and transfers with/without assistive
devices. He/she improves dynamic sitting balance, wheelchair skills indoors and outdoors, for getting
in and out of vehicles and weight relieving manoeuvres. A therapist teaches walking with lower limb
orthosis, with modified walkers, crutches, indoors and if possible outdoors.
Besides supporting the person with SCI to develop functional independence in attaining motor skills,
the therapist cheers, boosts the morale, raises the spirit, and infuses positivity in the person with SCI
and their families and care-givers. Physiotherapists emphasise on independence for daily living
movement skills, not just walking, staying active, but also in engaging in sports such as swimming,
racquet sports, table tennis, throw ball, cricket, wheelchair riding each day, as well as going out in
morning sun, which enhances ones well-being and quality of life, and to say yes to life and joyful
living.
The author is an Associate with Nina Foundation and also professor at MGM School of Physiotherapy
in Navi Mumbai
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Rs. 360
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16
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COVER FEATURE
CONTACTS
SOME REHABILITATION CENTRES IN INDIA
THE 24 HOUR HOTLINE NUMBERS:
Nina Foundation
Spinal Injury Association India
09769680820
240/11 Shankar Sadan, Sion(East)
Mumbai 400 022
1800 425 1210
Headquarters: Mary Varghese Trust,
Bagayam, CMC, Vellore.
WEST
PARAPLEGIC FOUNDATION, MUMBAI
T-1, Old Barracks of L.T.M.G. Hospital,
Next to V.G.P. Showroom, Sion ,
Mumbai 400 022.
Contact: 022- 24071671 / 24033669 / 24092216
Email: paraplegicfoundation@yahoo.com
HELPERS OF THE HANDICAPPED, KOLHAPUR
233/6 E, Atmaram Apartments,
Gen. Thorat Marg, Opp. Hind Nagar Society,
Tarabai Park, Kolhapur Maharashtra - 416 003.
Contact: 0 231- 268 0026/652 1294
Email: klp_crusade@sancharnet.in
PARAPLEGIC FOUNDATION
Sanjeevan Deep, Plot No.4, Sector 18,
Near Mulund-Airoli Link Flyover, Airoli,
Navi Mumbai 400 708.
Contact: 022- 27795859
Email: paraplegicfoundation@yahoo.com
ARMY HOSPITAL, KIRKEE
Armed Forces Medical College, Wanowrie,
Pune, Maharashtra- 411 040.
Contact: 020 – 26026010
CHESHIRE HOME, MUMBAI
India Bethlehem House,
Opposite Canossa High School, Chakala,
Mahakali Caves Road, Andheri East, Mumbai 400 069
Contact: 022- 28324515
Email: m_cheshirehome@indiatimes.com
CIVIL HOSPITAL, AHMEDABAD
Near Asarwa Meghaninagar,
Ahmedabad, Gujarat - 380 016,
Contact – 079-22683722
NINA FOUNDATION
240/11 Shankar Sadan, Sion(East) Mumbai 400
022
Tel: 022 - 24071952
Website: www.ninafoundation.org
Email: ninafoundation@gmail.com
SPINAL REHABILITATION CENTER, AHMEDABAD
STAVYA Spine Hospital & Research InstituteTM
Nr. Nagari Hospital, Nr. Hindi Rashtrabhasha
College, Mithakhali, Ellisbridge Ahmedabad,
Gujarat. Contact: 079- 26568174/ 26565757
Email: admin@spinehospital.in
ALL INDIA INSTITUTE OF PHYSICAL MEDICINE
AND REHABILITATION, MUMBAI
Haji Ali, K. Khadye Marg, Mahalaxmi, Mumbai,
Maharashtra – 400 034
Contact: 022- 23544341/ 23544342
Email: dr_athani@hotmail.com
SHRI SARVODAYA (BIDADA TRUST), KUTCH
Bidada, Tal. Mandvi Kutch,
Gujarat - 370 435
Contact – 02834- 244143/ 244444
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drbdathani@gmail.com
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COVER FEATURE
CONTACTS
EAST
SOUTH
SHANTA MEMORIAL REHABILITATION CENTRE
(SMRC), BHUBANESWAR
89gf U-3, Chandrasekharpur, Bhubaneswar,
Orissa 751 023.
Contact: 0674-230 0274.
CHRISTIAN MEDICAL COLLEGE (CMC) , VELLORE
Ida Scudder Road, Vellore – 632 004
Tamil Nadu.
Contact: 0416-2222102, 2281000
Email: princi@cmcvellore.ac.in
REGIONAL SPINAL INJURY CENTRE, CUTTACK
S.C.B.Medical College Campus, Cuttack, Orissa
753007.
Contact: 0671 – 2612607
ANDHRA MAHILA SABHA, CHENNAI
12, Durgabai Deshmukh Road,
Chennai - 600 028.
Contact - 044-24938311
Email: amstour2000@yahoo.com
NIRTAR, SWAMI VIVEKANAND NATIONAL
INSTITUTE OF REHABILITATION TRAINING AND
RESEARCH, Cuttack Olatpur, P.O.Bairoi, Dist.
Cuttack, Orissa-754 010
Contact: 0674 6655 555/0671-2805552
E-mail: nirtar@ori.nic.in
APOLLO ASHA, CHENNAI
190, Poonamallee High Road, Chennai - 600 056.
Contact: 044-26480500
NATIONAL INSTITUTE OF REHAB TRAINING AND
RESEARCH, CUTTACK
Olatpur, P. O. Bairoi, Cuttack, Orissa – 754 010
Contact: 0671-2805552
E-mail: nirtar@ori.nic.in
THE ASSOCIATION OF PEOPLE WITH DISABILITY
(APD), BANGALORE
6 Cross Hutchins Road Hennur Main Road,
St. Thomas Town Post Lingarajapuram,
Bangalore - 560 084 Karnataka.
Contact: 080-25475165 / 25470390
Email: ablehand@vsnl.com
NORTH
INDIAN SPINAL INJURIES CENTRE (ISIC), NEW
DELHI
Sector C, Vasant Kunj,
Opp. Vasant Valley School,New Delhi – 110 070
Contact: 011 42255201 / 42255202
E mail: info@isiconline.org /
appointment@isiconline.org
SRI VENKATESWARA INSTITUTE OF MEDICAL
SCIENCES (SVIMS), TIRUPATI
Alipiri Road , Tirupati-517 507.
Contact - 91-877-2287152 & 2286131
E-Mail: svimshosp@yahoo.com /
bvengamma@yahoo.com
REGIONAL SPINAL INJURY CENTRE, PUNJAB
Sector 70 SAS Nagar, Mohali, Punjab
Contact: 0172-2676037
Email: dpgmcc@yahoo.com
NATIONAL INSTITUTE OF MENTAL HEALTH AND
NEURO SCIENCES, NIMHANS, BANGALORE
Director / Vice Chancellor NIMHANS
Hosur Road Bangalore,
Karnataka - 560 029
Contact: 080-26995001 / 5002, 26564140
Email: vc@nimhans.kar.nic.in
HOPE SPINAL HOSPITAL, PATNA
Maurya Colony, Kumhara Patna, Bihar.
Contact: 0612 – 2686226
COMMAND HOSPITAL, CHANDIGARH
Chandni Mandir, Panchkula,
Chandigarh - 134 109
Success & ABILITY APRIL – JUNE 2012
SWASRAYA TRAINING AND REHABILITATION
CENTRE, Vettickal P.O., Mulanthuruty,
Ernakulam Dist.,Kerala - 682 314
58
Contact: 0172- 2867591/2867519
Tel. 91 484 2748192/ 4862 224442
Email:swasraya@hotmail.com
COVER FEATURE
STANDING OVATION
Epitome of inspiration
-
S.VAIDHYA NATHAN
S Ramakrishnan - a person with cervical level spinal cord injury who cannot move even a
finger - exemplifies service to community in its purest form.
Rare is an individual who has done so much for those around him despite facing the most
challenging situations of life.
An accident during naval officer selection altered Ramakrishnan's world in 1975, as he became
totally paralysed below the neck. He was an engineering student when this life-changing event took
place. This high-level cervical spinal cord injury meant that Ramakrishnan had to face the world,
depending just on his intelligence and communication skills. For all else, he needed help at every
turn.
Helping him overcome and transcend debilitating physical constraints are a razor sharp intellect,
unfailing memory, innate ability to connect, expertise in marshalling local resources in a remote
village setting, his embrace of emerging forms of communication and leadership skills honed over
the years, as well as the unstinted support of his wife, Chitra.
What started as a small operation in 1981 - in Ayikudy, a valley near Tenkasi, Tamil Nadu, is today, a
shining example for everybody. That he managed to develop such an institution when the scope for
communication and networking was minimumal, only adds to the magnitude of his achievement.
Amar Seva Sangam, named after Dr. Amar Singh Chahal who helped in the rehabilitation of
Ramakrishnan, completed 30 years of excellence in 2011. Its services now transcend the world of
children with disabilities, to making a difference in many-a-village within its vicinity and beyond.
From a humble origin, Amar Seva Sangam today sports a multi-faceted dimension.
A spinal rehabilitation centre, a home for those with physical disabilities, a caring facility for children
with special needs, general and special schools, vocational training centres imparting a variety of
skills from the ancient to the contemporary, a nodal centre for government programmes, village
adoption programs and an open university study program - are all integral parts of Amar Seva
Sangam.
"Live To Serve" is the motto of Amar Seva Sangam. Hospitality gets a new meaning in Ayikudy. To
meet Ramakrishnan in person, is an experience rarely matched. You cannot miss his meticulous eye
for detail and a deep respect for every form and degree of support. Spending most of his day lying
down, he is however, always at work with a clock, mobiles, computer and caregivers.
Greeting every person with Namaskarams, Ramakrishnan has also been active in developing
informal networks of people with disabilities in different parts of India. These linkages have helped
many to find a friend and a source of support - an important element in community based
rehabilitation.
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He will forever remain a source of inspiration, hope and possibility in the face of adversity.
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LARSEN & TOUBRO AD
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COVER FEATURE
LIFE’S LIKE THAT
ALL IN A DAY’S WORK
-NITIN GOYAL
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COVER FEATURE
LIFE’S LIKE THAT
NITIN GOYAL, Head of Regional Treasury, Asia Pacific and India, Nokia Siemens Networks, Gurgaon,
writes regularly for various publications. For us at Ability Foundation he is a friend and a travel guide.
And boy! does he travel! Given half a chance he'd be wheeling his chair on to the icy slopes of Alaska.
Or is it Antarctica? He tells us how he manages it.
Travelling is an integral part of our lives. We move out of our homes almost every day to live out our
lives. And to work towards achieving our goals. With a physical or intellectual impairment, this very
basic component of our life becomes a chore and makes us struggle at least for some time until we
fall into a pattern.
Take me, for instance. I am a paraplegic and I use a wheelchair. I have a VW Vento with automatic
transmission (gears) in which our friend, Mr. Ferdinand Rodricks, has installed a set of hand controls.
It is a simple lever system installed between the steering wheel and the dashboard which is
connected to the foot pedals. When I pull the hand control lever towards me, it pushes the
accelerator down and races the car, while when I push the lever down, it pushes the brake pedal to
slow down or stop the car. I have been driving such cars for over twelve years and find them very
comfortable and reliable. It is a simple innovation that has provided me with tremendous
independence. The day I drove a car alone for the first time, was the day I felt I had truly put
paraplegia behind me.
ROUTINE TRAVEL TO OFFICE
I live in Gurgaon and my office is at the other end of the city requiring about 30 minutes of drive
each way. I put the wheelchair next to my car while my wife/mom/dad hold it to prevent it from
slipping. I transfer myself into the car and drive to the office. I keep another wheelchair folded in the
back of my car. In the office, a comfortable parking space is reserved for me. A security guard takes
out my chair and sets it against the car. I transfer into it and move into the office. The start of
another good working day.
TRAVEL WITHIN THE CITY
Ah! The weekend's here! Time to relax and to shake off work blues! But of course, there's shopping
to be done and bills to be paid off first and an infinite amount of permutations and combinations
involved. Each market and shopping mall has its own characteristic architecture and over a period of
time we have learnt our ways around them. We have identified the ones where it is easy to move
around in a wheelchair.
Sometimes, we drive to the market and I sit in the car while my wife buys the stuff. She may bring
out things to show me and discuss some matters (usually the shopkeeper sends someone along). If I
wish to go into the shops to look around, she pulls out the wheelchair from the boot, opens it and
sets it beside the car. I transfer myself to the chair and off we go.
In Mega Mall, we can park in the surface parking and use the ramp to get in. In Plaza Mall, we need
to go to the basement to use the lift as there are stairs on the surface. In Sector 14 market, there are
few places where I can get onto the pavement. In Sector 15, I need to take help as the pavement
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COVER FEATURE
LIFE’S LIKE THAT
is more than a foot high… and so on and so forth.
When we go to the movies, I take help from the theatre attendants to lift me and help me into the
theatre chairs. We make sure to buy aisle tickets to ease this. Earlier, I used to sit in the wheelchair
itself and take it up or down stairs to the intended row of seats for which we had tickets. But, it's not
easy navigating the stairs and people keep bumping into me while passing. Then there was a court
judgment on a movie hall fire case and movie theatres refused to allow wheelchairs in the aisles. I
too found the seats more comfortable. How do I escape if there is a fire? Well I guess that's a
separate issue. No, none of the movie halls around have special places for wheelchairs.
Often, we encounter stairs and steps. I ask the people around to help and have always found them
eager. Once at a cinema hall, we had to go up to the third floor and the lift turned out to be under
repair. We asked for help from other moviegoers and two young men helped me up to the third
floor!
I usually do not worry about accessibility of a place until we reach there. Rarely have we decided not
to pursue our quest just because it would be too strenuous.
DRIVING OUT OF THE CITY
Some years ago, we (Anjana my wife and I) went on a vacation to the Sariska Wild Life Sanctuary,
about three and a half hours drive from our home in Gurgaon. We started driving down the excellent
Jaipur highway before we detoured onto the state highway. To our surprise, we found the single
road in quite good shape and made good speed. About 10 kms short of the sanctuary, the toll road
ended and we fully realised we were in Rajasthan. There were more potholes than flat roads.
The hotel, Rajasthan Tourism's Tiger's Heaven, is situated just on the edge of the sanctuary. The
hotel staff helped me up and we checked in. They gave us a nice room on the ground floor. The hotel
staff was very friendly and helpful.
We took a short trip inside the sanctuary. As we drove down the narrow single-lane broken road we
had our eyes peeled out for signs of any animals. After some time, we started seeing Chitals, BaraSingha, Nilgai, Langurs, peacocks and other animals, crossing the road casually.
We returned to the hotel around sunset. It was a Friday evening, and the hotel staff regaled us with
stories about the sanctuary. As is usually the case, the bathroom door was too narrow for the
wheelchair. So we did what we always do. We remove the cushions and I raise myself up with my
arms resting on the arm-rest. Anjana folds the chair narrower and then pushes it in (with me
“hanging up” for dear life). Inside thankfully the bathroom was large and spacious. We always feel
that bathrooms are the most difficult things to manage while travelling.
The next morning we drove down to the sanctuary gates. We spent in the day driving in the
sanctuary. We saw jackals and wild boars, and several times we saw peacocks dancing with their
feathers unfurled.
We climbed uphill to reach the famous Hanuman Temple. There were too many steps at the
entrance, so Anju went in. We went up further to reach Pandupol, a pond where the Pandavas are
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believed to have taken a bath. Ah! The road
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COVER FEATURE
LIFE’S LIKE THAT
had been washed away in a landslide some years back. So Anju walked up the last kilometer uphill
while I caught some forty winks. She came back an hour later, breathless, excited and tired. The way
up was rocky and difficult to climb. Coming down was much more difficult, but she saw the place
and the pool of water below the natural bridge. I had seen the place long ago during childhood but
remembered it still.
Our next trip? Well, we drove to Ludhiana (about 400kms away) later that year with my family for a
cousin's wedding. I took a week off and visited relatives around Punjab! I have driven to Shimla and
to Agra, to Jaipur and to Patiala. And many more over the years.
Air travel has its own fun. No Indian airline is fully equipped to assist wheelchair users. Their airport
wheelchairs have small wheels. Only Indian Airlines has ambu-lifts to raise us to aircraft levels.
Usually none of the aircrafts have aisle chairs, usually. The staff is not trained. But what works is that
they are helpful and well-meaning. We have to be patient (very) and instruct them properly and
then we can manage.
The real fun is when we travel abroad. Have taken about a dozen trips to countries in Europe and
South-East Asia. Each country and city and hotel has its own peculiarities. We get the fun of
adventure sports just getting ready in the morning. In Europe, most bathrooms don't have a drain in
the main floor area, and it's not exactly easy for a paraplegic wheelchair user to climb into the tub.
More worrying - how will I climb out, without risk of hurting myself? Once in Geneva, I created a
towel wall at the door, took a bath in the main floor area, and then rinsed the floor using more
towels, squeezing the wet towels into the tub repeatedly. The cleaner must have really wondered
what we did with all the towels.
Some cities have public transport which is accessible. Munich in Germany has accessible metro
(train) and bus systems. In Paris only buses are accessible. Geneva (Switzerland) has accessible buses
and trams. In Helsinki (Finland), only every third tram is accessible on a route, and you may have to
wait for up to an hour till the next accessible one comes. Catching a train may mean a walk of half an
hour from hotel to station and then across the underground metro station. Furthermore, you may
end up at a metro station where the lift is missing or under repairs. A bus station could be 20
minutes walk away across cobble-stoned streets in sub-zero weather. Time is precious on a leisure
trip abroad, and you may not want to spend an hour of walking and waiting for a 10-minute bus ride.
Taxis are prohibitively expensive in Europe. A 2km ride could cost a thousand rupees.
So we improvise. We try to find a balance between effort, cost and time. We use the mode of
transport which suits at that time, which we can afford and which the weather allows. It only adds to
the fun! I don't need to go bungee jumping to get an adrenaline rush! Just wheeling across a cobblestoned street in sub-zero weather without gloves is fun enough!
And when we travel outside the city, travel is just as challenging as in India. Inter-city buses and
trains are not accessible.
The bottom line is, access is a challenge everywhere. I consider it part of the fun of travelling.
Accessibility is not a concern that makes me think and plan. We reach and we improvise. We find
ways of getting in and getting around.
So... when are you taking your next trip?.
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COVER FEATURE
ON THE MOVE
A n exceptional passion for tinkering with cars led Mumbai based Ferdinand Rodricks to come up
with an invention that would change the lives of many people with physical disabilities, who have a
zeal for driving.
The motto of Rodricks was to give everyone an opportunity to be independent. Thinking deely on
this, he embarked on his mission 25 years ago when he modified a car for a friend who had lost both
limbs in an accident. He first devised a hoist to get his friend into the car without difficulty. Once in
the driver's seat, his friend could hand operate the brake, accelerator and clutch.
Two years later, after completing his degree Rodricks opened an automobile workshop in the
backyard of his home and began modifying cars for people with physical disabilities. Back then, it
was a strange concept even for the auto majors. Over time, word spread, and persons with
disabilities approached him. Now, Ferro Equip, the only Automotive Research Association of India
(ARAI) certified car modification workshop has come a long way – in fact, far ahead of the times.
“Configuring a car is not an easy job. As disabilities vary, so the needs. I customise each vehicle in
such a way that it gives the best comfort and independence to the driver with disability”, says
Rodricks. For people with disability in their right limb, Rodricks attaches both levers to the handle
bar, which when pushed forward towards the windshield, makes the car brake and when pulled,
makes it accelerate. For a right limb disability, Rodricks modifies the gear stick – with the press of a
button on the stick, the clutch is automatically pushed down.
With such innovative features in each car, Rodricks has so far modified over 1000 cars from over 49
types of all makes and models across the country.
All his modifications come with lifetime warranty, and Rodricks guides customers on how to handle
the cars after they have been retro-fitted with the modifications. Ferro Equip's modifications ensure
that a car's normal settings work alongside the new adaptation, so that it can be driven by a normal
person as well. Modifications cost between Rs 17,000 and Rs 37,000.
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OTHER ACCESSIBLE PRODUCTS AND SERVICES FROM FERRO EQUIP

Vehicle hand controls- Hand operated Brake, Accelerator & Clutch, to suit persons with right
limb, left limb or both limb disability. This can be fitted on any car, automatic or manual
transmission.

Swimming pool hoists - Motorised swimming pool hoist designed for lowering and lifting
people with physical difficulties in and out of the swimming pool. Used for Hydrotherapy

Portable step ramps- Portable step ramps made in aluminium with anti skid makes it easy to
encounter single steps

Telescopic and pull out ramps- Vehicles are fitted with a portable ramp to enable a person
on the wheelchair to enter.

Lidwin lifter- Enables to lift a person independently from ground level to the desired height.

Bathroom fittings- (a) Folding handle fitted near the toilet seat to assist a physically disabled
person to get up or sit. (b) Grab rails fitted to assist mobility in the bath room.

Rotary seat- The seat can be rotated so that the disabled person can be seated and rotated
into position

Accessible Buses / transport - Accessible bus fitted with a folding ramp and steps, can
accommodate people on wheelchairs with locking devices, as well as folding seats for others

Patient Hoist - Manually operated patient lift that can be used by a single person to transfer
a patient from sleeping position on the bed to a sitting position on a chair or wheel chair.

Customised wheelchairs - Wheelchair customised with a keyboard stand with a side folding
table and adjustable mirrors to enable the user to maneuver independently.
 Wheelchair hoist - Electrically operated wheel chair 'hoist' enables a person on a wheelchair
to load it independently on to the roof of a vehicle.
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COVER FEATURE
RELATIONSHIPS
LOVE TRANCENDS ALL
-
RUSSELL COLES
We all want to find someone to spend our lives with, no matter what our situation.
This is probably one of the things that almost everyone on the planet has in common, disabled
or not.
A spinal injury changes your life in so many ways... ways that can only be understood fully by those
who have incurred the injury. What we must remember however, is that these changes are mainly
physical and can therefore, with time, acceptance and understanding, be dealt with. More than this,
many people with spinal injuries think that relationships and sexual partners, especially with able
bodied ones, are somehow not open to them. This is a misconception, particularly when we consider
the real nature of meaningful relationships.
Yes, in relationships where a partner is spinally injured things are different, with different obstacles...
but is there anything wrong in that? It is the people who need to match, not their physical abilities.
There is a great pressure to have relationships that are supposedly normal or even like those that we
see on TV, and apart from the fact that there is a wheelchair involved and some physical difficulties
to overcome – both personally and as a couple – there are not really any other differences.
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COVER FEATURE
RELATIONSHIPS
I know many couples here in England where either the man or the woman is on a wheelchair, as well
as where both partners are wheelchair users... and... all of them enjoy similar amounts of stress,
arguing, love and happiness as any other couple.
When two people's eyes find each other in a crowded place, it is much more than an impartial
recognition of a face. Rather, the two pairs of eyes find familiarity in each other and their gaze is
fixed for a moment. The two people are compelled to move toward each other through the crowd.
At this point, one notices a wheelchair and the other, the flight of stairs that hinders their meeting.
For the disabled person, the problems are much more immediate and debilitating, though for the
other, in a funny way, they are harder to get come to grips with. For the non-disabled person, there
is a great deal more to understand.
The point here is that the more we can get out, engage and socialise in the towns or cities we
inhabit, the less the differences become.
Upon going through the experiences of a spinal injury, for many, that flight of stairs is not what’s in
the way... it's not having the self assurance of knowing one's inner self and considering oneself as
attractive to others.
From my experience in England, knowing many spinal injured people, there is quite a positive
attitude and encouraging spirit that people on wheelchairs share amongst themselves. This, it
seems, is contagious and attracts a lot of non-disabled people who want to get involved with
wheelchair users. The illusion that there is a huge gap between spinally injured people and others
changes when time is spent together. Having been on activity courses and sports events myself, I've
experienced close friendships and how these have evolved beautifully between people with and
without disabilities.
An open and frank way can do wonders, so too talking to fellow injured people. The trauma that one
has to go through when a spinal cord is injured, throws several insights and several aspects of life
that were missed out earlier – spiritually and physically – thus presenting other refreshing views and
a meaningful intake on life. This, coupled with the tendency amidst those who have gone through
the ordeal, to have extra understanding and empathy towards others, inevitably can be attractive
qualities to the partner, more so in a world that has become increasingly obsessed with the
superficial.
The thing is to keep in mind that we all share difficulties in one form or the other which we have
overcome and we still have more that need to overcome – whether these be hidden, visible or
physical. We must also remember that we each have our role to play in life and we must always look
for new experiences and new people to enjoy these with. This is how we accept ourselves, learn,
teach and grow as individuals and it is surely no lie to say that it is a good indicator of someone's
character. The thing to do is to look beyond the obvious and not let these come in the way of
meaningful relationships. Sure, there are bound to be challenges but what's life anyway, without
challenges?
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COVER FEATURE
LIFE & TIMES
THE SILVER JUBILEE ON THE WHEELCHAIR
-
DR.SRUTHI MOHAPATRA
Twenty five years have passed. They were beautiful years, challenging years, years of changes, of
successes, of failures but always years of growth and development. Years before that were golden.
From my childhood I had always excelled in life, be it academics, debates, music or sports. I was my
parent's adored eldest child and my sibling's idol. My teachers, relatives, neighbors and friends
doted on me. The pinnacle was having got into Indian Civil Services in my very first attempt. Then
one day, my life took a somersault. My trials started with a road accident in April 1987 fracturing the
spinal cord. In minutes I lost sensation of the lower body, within hours I noticed that the strength in
my arms was going and within 12 hours of the accident, I was completely immobile but for the part
above the shoulders. And… suddenly, even a society disappeared. It mainly made its appearance in
the guise of sympathy, pity and condescension.
I spent two years in and out of hospital set ups. I still had not realised the full impact of the accident
– I was in a state of denial. But the fact was that, I had a spinal cord injury and this, I had to deal
with. This is the year 2012 and my paralysis is still complete. Life in a wheelchair is not much fun but
I have made it enjoyable, not just for me, but for all people around me by my 'smiling at life'
attitude.
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COVER FEATURE
LIFE & TIMES
I have lived a successful life. The challenges a spinal cord injured person faces are very hard to
understand for people who enjoy the normal use of their legs. So by ‘successful’, I mean being able
to efficiently manage the activities of daily living (with minimum assistance), have a smiling persona,
and essentially living a happy life.
This 14th of April, I completed 25 successful years on the wheelchair. Though I use the wheelchair
for as long as 12 hours or more some days, I advise others not to. It pushes one into a whole cycle of
spasms and fatigue that can make you dull, aching and drowsy for days. A good education, bladder
and bowel management, control of UTI and a good meal have helped me be on the wheelchair with
ease. Blessings of the divine, our elders and good wishes of all around facilitate this journey.
Education and earning a good living are major keys to living happy when you are disabled. With
money, comes freedom of opinion and courage which nothing else can substitute. Society accepts
you as a peer and respects your opinion. This I inherited from my parents. From our childhood it was
ingrained in us that education is the key to a life of dignity and riches. Our holidays were spent in the
lavish lap of grandparents. But when we returned home, discipline was quick to arrive, and,
punishments harsh. My anthropologist father and doctor mother taught us both the art and practice
of good living.
Bagayam is the place where I re-learnt to live. Bagayam Rehabilitation Centre in Vellore taught me
life skills. As I had, and had, severe spasms which do not allow me to separate my legs often, my
mother was taught to combine different techniques for bowel discharge like the use of laxatives,
oral medication, suppositories and digital stimulation. I'd never had constipation prior to my
accident. So I was baffled by this. My doctor, Suranjan Bhatacharjee told me that around 40% of
people with spinal cord injury experience constipation because the SCI changes how the intestines
work.
In the early years, I suffered several bowel accidents. I discovered, early in my rehabilitation that
bowel accidents occurred the day after I took dulcolax tablets. So I stopped taking them. My mother
ensured a fibre rich diet and till today green vegetables and saag and other fibrous food are part of
my diet. She also gave me isabgol husk with water or warm milk, as required, before bedtime. This
has helped me in leading a normal life. Bowel incontinence ( the inability to control bowel
movements) occurs but is limited to one or two episodes a year. I have also learnt to understand my
body language. When I feel a constant urge to pass urine and my urobag is unclamped, I know that it
is an unplanned bowel movement. So I retire to my room and evacuate.
Many SCI persons with whom I have interacted do not have a regular bowel habit. They just wait for
the bowel to discharge itself in 2-3 days and get cleaned. This leads to complications. Mother's
insistence on maintaining bowel regularity has helped me remain healthy, with no or little
intestinal/digestive problems, healthy appetite and a healthy skin. My advice to all SCI persons is to
maintain a regular bowel habit.
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I experienced bleeding from my anal region after about five years after my SCI. Mother said it was
nothing to worry about as it was from fissures (cuts or cracks in and around the anal opening ). With
a decrease in digital stimulation the bleeding in my case disappeared. However, it is always advisable
to remain alert and consult a doctor in case of rectal bleeding.
Bladder care is equally important for healthy and active living. After spinal cord injury, the bladder,
along with the rest of the body, undergoes dramatic changes. Messages between the bladder and
the brain cannot travel up and down the spinal cord, so SCI persons are taught various techniques of
voiding.
I underwent a bladder management program that allowed me to plan for bladder emptying in an
acceptable manner when it was convenient for me. This helped avoid accidents and prevent
infections. The level and type of injury affect the choice one can make for the bladder program.
Because each person's injury is different, doctor's conduct some tests to see how the bladder
functions. You also need to consider your hand function. How easy is it for you to do your own
bladder program? Can you manage alone or will you need help? During your rehabilitation you learn
different ways to empty your bladder.
Intermittent catheterisation is a safe and effective method of completely emptying the bladder. The
purpose of the process is to improve or eliminate urinary incontinence as well as to control bladder
and kidney infections. Most people are able to catheterise themselves. But because of the severity
of spasms in my case, my legs often became stiff and there was difficulty in separating them so I was
assisted in the process.
Mother and all the nurses who attended me performed CIC with great care. This minimised
infections. The golden rule she used was to wash hands thoroughly with soap and water and clean
the vulva and urethral opening with betadine lotion. She never pushed in the catheter in one go.
Similarly, she withdrew the catheter in small steps to make sure the entire bladder emptied. She was
very watchful when my care givers did it, ensuring the cleaning of the catheter with soap and water
after use and putting it in a jar of antiseptic solution.
UTI is a pertinent problem. Again my mother worked out a lovely plan. I take lemon juice or citric
drinks for a week. Then change over to alkaline drinks or simply alkasol. I suffered 10-12 UTI every
year, now it is hardly once a year.
After a long day, my care giver always turns me face down and gives a good dry massage, in summer
a shower of body talc, after checking for sores and redness. Prolonged pressure on the skin can lead
to the skin becoming damaged, and if left untreated to the further complication of skin pressure
sores. These can be life-threatening if they get too bad… as was in my case in the very early years. It
took three years to heal!
My mother, Dr. Annapurna Devi, and my care givers have taken very good care of my body. I have
had a series of personal attendants in these 25 years, but the one who stood by me for over 14
years, and is still going strong, is Seema. Exercises and pranayama are necessities. I ignored this and I
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suffered very badly.
The new change is that biologically, the body is growing old. In fact, a lot of us are getting older. I
look around, and I notice that a lot of us are getting gray. As I observe the elderly, I realise that
disability is just a part of life. I am increasingly losing the use of my hands and the little fingers. I am
also starting to feel the effects of spasticity in my arms which is at times quite marked. On days I
now have problems sitting for more than five hours at a stretch (I continue sitting but would strongly
advise not to). The back muscles tire very quickly and once fatigue sets in it takes me hours to
recover my normal strength.
My condition has slowly but inexorably declined. I only really realise this when I try and do things
that I haven't done for a while to find that I can't-like holding on to a paint brush. The spasms seem
to be getting worse again and are of a slightly different nature. Instead of one extension it feels like
several extensions with jerks in between. They don't really bother me yet - it's just that I try to hold
my head still, and breath deeply, so it will heal.
The aging individual experiences a natural decline in cardiorespiratory endurance, muscle strength,
flexibility, and body composition. For individuals with SCI, however, these changes can have an
immense impact on their ability to achieve activities of daily living. My doctors said upper extremity
pain is common in long-term SCI and most frequently affects the shoulder and wrist. So my
management techniques are hot and cold fomentation, as per the requirement.
I know from experience that upper extremity pain is because of transfers, wheelchair propulsion
(not in my case as my attendant takes care of that) and push-ups for pressure relief. And when your
injury is at a higher level, like mine, the hands take a lot of pressure due to poor trunk balance. As a
mid-cervical tetraplegic, I have a muscle imbalance that has resulted in relatively increased pressure
and sudden jerks, causing pain. I am also suffering increased spine pain, weakness, new onset
autonomic dysreflexia and loss of sitting balance because of long-standing SCI.
A few things which I have done and may help you are, throw away the splints and accessories for
upper hand, try and eat with your own hand (I struggled for a year), bathe with alternate hot and
cold shower, drink water, do not hanker for food, keep away from alcohol, smoking, drugs; and if
you are to get addicted get intoxicated with love. Life is not a competition, no one is your
competitor, we are each unique and a loving creation of the divine. My competitor is the 'not so
good' me in me – one who fusses, frets, cribs, gets an inferiority complex, inflates an ego or judges
others. My strength and my success is improving my 'not so good' me. Life is beautiful only if we can
open our eyes to the beauty around and ignore that which is not so beautiful.
Over the last two years, I am observing slowing down of activities and a recurring bout of fatigue.
Neither the newspaper, nor my TV channels attract me; neither my terrace nor the blue sky entices
me; neither music nor books draw me to them. But I am not sick. What I love most is sleeping. Sleep
and work. Closing my ears to the ticking clock, I leave time behind. In short, not doing a lot of things I
never could dream of not doing. Is life coming to a standstill? Or is this the beginning of the
inevitable biological process called 'Ageing?' I do not know. And I do not seek answers. I am happy to
be like this presently. When nothing is permanent in life, this is also a phase. And it too will pass
away. So till then I'm happy working…. And happier sleeping!!
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FOLLOWING A DREAM
NO TURNING BACK
-
SANAM RABADI KARUNAKAR
My life changed the day I lost my parents and woke up in a hospital. When the whirlwind of
operations, doctors and physiotherapy ended, I was faced with having to re-evaluate my entire way
of life. Living with a disability is an endless struggle to perform even the simplest of tasks. For most
people, dropping a pen is an inconsequential event. When you are seated in a wheelchair, with
limited mobility, the pen is often out of reach. Being forced to constantly ask for assistance from
others is depressing, especially when I used to be so active before.
This is my story. It tells you how I combated this depression and focused on the passion I have had
since a younger girl.
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FOLLOWING A DREAM
Being around animals always fascinated me. Whenever I was asked what I wanted to do when I grew
up, I would instantly say, “I want to be a vet'. I was not very good at academics and my parents
thought I would change my mind after my Class X exam and maybe decide on something I would be
able to do. However that did not happen. I told my mother that even if it took me 10 years to be a
vet, that was what I was going to be. They both gave in, but God seemed to have something better
in store for me.
At this point in my life I must say that I believe that we are all where we were meant to be. After my
accident on 17th April 1995, I thought my world had ended. I lost my parents, my independence and
my life. I would never be the same again. I thought I would be stuck at home, on the surgical bed and
would never see the world again. I was so wrong!
The turning point in my life was a trip to the Indian Spinal Injuries Centre (ISIC). That is where I learnt
that being in a wheelchair wasn't the end of the world. My life changed drastically after my threemonth rehabilitation program at ISIC. When I saw other people who were in situations much worse
than I was in, I realised that there were some things that I could still do. That is when I made up my
mind: I would continue to live my life - one day at a time - and see where I landed up.
When I got back from ISIC, some friends helped me to get into a college and continue my education.
I knew my parents would have wanted me to do it. I enrolled into the 11th standard at the BJPC
College, Mumbai where I was allowed to skip lectures and just go to college for the mandatory
attendance to appear for my examinations. I completed my graduation in Commerce in 2004.
Throughout my time in college, I was supported by my younger sister Ayesha and my close friends.
Once I completed college, I started doing some data entry work from home for a pharmaceutical
company. India not being wheelchair accessible, always posed a hindrance to my mobility. But I did
not let that stop me. I got a lot of motivation from my friends who always stood by my side. We
would find new ways to tackle obstacles and, slowly but surely, I started going out more often.
That's also when I met my husband Suraj through a common friend. Suraj walked into my life and
has changed it like no one else could ever have. We both fell in love with each other and although
we knew we would have to make a lot of compromises and adjustments, we knew we were meant
to be together. Suraj
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made me happy and continues to do so every single day. His love, encouragement and
understanding have helped me become the person I am today.
I was featured on the cover of the Bombay Times and that was another major turning point in my
life. In fact, I feel that it is that article that helped me pursue the career of my dreams.
Shirin Merchant, an animal behaviorist and dog trainer who runs the organisation 'Canines Can Care'
called me after reading the article in Bombay Times. She explained to me that ‘Canines Can Care’
was the only organisation of its kind in India that would train an assistance dog to help me with my
daily tasks. Shirin explained that they would place a dog with me and he would be taught various
tasks such as fetching dropped objects, opening and closing doors, switching on and off light
switches and much more. At that point of time I wasn't aware of assistance dogs in India and had
only seen them at work on television. I was overjoyed and needless to say I immediately agreed.
The day Magic, my assistance dog, entered my life the world became a sunnier place to live in. He
has become my companion when I am alone, my laughter when I am sad and most importantly, my
best friend. I always refer to him as my “Magic'al Angel” because that's what he is for me. The first
time I saw him, I fell in love. He has brought immense happiness and love into my life. He does not
judge me for what I can or can't do, Magic just loves me unconditionally. Sometimes when the two
of us are home alone, he just sits by my side and keeps me company and I feel safe. When I am sad
he licks away wounds no one can see and his gentle spirit calms and comforts me. He has brought
back confidence and hope once lost, and since the day I got him, I knew nothing was going to be the
same again.
Shirin also encouraged me to help in training Magic. Suraj and I both attended a month-long dog
behaviour and training course conducted by Shirin and learnt what it takes to train a dog. After the
course, Suraj and I started training Magic along with help and guidance from Shirin. Training Magic
was a lot of fun and required a lot of patience too.
Being around dogs made me happy. Shirin then suggested that I take up pet sitting as a career. A pet
sitter is a home-based kennel where people leave their dogs when they are on vacation or a business
trip. Something like a boarding and lodging facility for dogs with the comforts of a home and unlike
the usual kennels where they are caged up all day. I was skeptical at first but thought I should give it
a shot. So that is how Perfect Pooch was launched. By then we had another addition to out family,
our Bichon Frise named 'Laika'.
With the increasing number of dogs as pets over the years since I started ‘Perfect Pooch,’ there has
been increased demand for a service like mine where the dogs are pampered like they would be at
home. The owners drop their dogs in and from then on it is my responsibility to care for them. They
are fed as per their diet requirements and taken down for walks at regular intervals. My dogs Magic
and Laika are always around when our boarders need some doggie pals to play with.
This is how I have made my passion for animals into my dream job. Through all of this I have also
learnt that being disabled is not the end of the world. It does take some time to learn how to adjust
to your disability but once you have done that you can do what you set your mind to. If I had let my
disability stop me from being around dogs, I really can't imagine where I would have been. A lot of
people supported me, but there were also those who did not. That's fine. I plan to keep on doing the
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work
I
am
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THE SILSILAH OF WHEELCHAIR TRAVELS
-
SALIL CHATURVEDI
I sometimes look at my wheelchair and wonder: Is it a chair with wheels, or wheels with a chair? It
seems to be the latter. Travel is its very soul.
Most people will look at a wheelchair and think very limiting thoughts. Kids are an exception,
though; their eyes light up at the prospect of riding one. A wheelchair, then, like everything else, lies
in the eyes of the beholder.
I sometimes look at my wheelchair and wonder: Is it a chair with wheels, or wheels with a chair? It
seems to be the latter. Travel is its very soul.
My wheelchair prefers the outdoors. Over the years, it has travelled down mountains, explored
jungles, gone up a river by boat, watched sunsets on beaches, crisscrossed the Western Ghats,
ferried across the Brahmaputra. It has also hopped onto airplanes, trains and jeeps, and once rolled
itself all the way into the Ganga, my protests notwithstanding.
One of the things my chair loves, almost craves, is some sort of a challenge. I am reminded of the
time a few years ago when we went to Mandu, in the Malwa region of western Madhya Pradesh. It
was during the monsoon. The place was incredibly green – a perfect time for a chlorophyll addict like
me. The terrain, for the most part, was gently sloping and that excited my wheelchair.
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On the last day of the three-day trip we visited the pavilion built for the famed 16th-century singer
Rani Roopmati. A powerful wind was blowing and the sky was overcast. There were very few people
around.
Monika (that's my wife, not the chair) and I decided to go to the terrace of the pavilion. We looked
around for some help and spotted a balding travel guide at some distance. We approached him and
asked him whether there was a way we could get to the terrace. He looked at the chair and seemed
affronted, as if we were abusing his intelligence .”My baap can't walk. I haven't got my baap here
ever, and you think you can get up there on this?” he said. Monika began a harangue about
politeness, but I told her to let it be.
A little later, we came across a group of college students. They were boisterous, but they were also
well-built. Before you could say 'upsy-daisy', they had me, and my wheelchair, on the terrace. The
view was stunning. The wind was strong enough to propel the wheelchair, and I did some lengths of
the pavilion to satisfy the chair. Suddenly, I noticed the same guide on the terrace, and before I knew
it my wheelchair had sidled up to him. We shared the uplifting view for a while: the guide, the
wheelchair and me, and then I sighed and said, “You know, you should get your baap here
sometime. No point depriving him of such a fantastic experience.”
The man folded his hands, touched the wheelchair, and said,”Galti ho gai … Maaf kar dena.” (I erred.
Please forgive me.) ”Jokes aside”, I said, “I seriously think you could get your father here.”
Crowded places scare my wheelchair. It is almost phobic of temple destinations, though it loves Sufi
monuments. The one exception I can remember was when it went to Shirdi, in Maharashtra, the
home of the 19th-century Sai Baba. It was a hot
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afternoon when we got there. The crowds were enormous, owing to some holiday. We tried to use
the wheelchair as an ice-cutter, to part the masses, but soon gave up.
No sooner had we surrendered to the crowd, when a hand emerged from somewhere to our right,
grabbed the foot pedal of the wheelchair and pulled at it. I found myself suddenly going up a ramp.
Monika could not figure out what was going on, but she had the sense to push as hard as she could.
In a jiffy, three sets of helpful hands had emerged on my armrests, though they did not seem to be
pushing as much as being pulled by the chair. I looked at the owner of the hands on the left armrest
of the chair. ”Please, please,” he said. “Please, let me push, please, please…” he continued with a
pleading look.
The priest who had pulled me up the ramp, unlocked a metal sliding gate, and I along with my
'helpers' was suddenly inside a hall. Another quick right turn and I found myself heading straight
towards Sai Baba. He was sitting in the exact same position that I was sitting on my wheelchair, with
one leg folded over the other. I just seemed to be floating towards him, a bit shocked at the abrupt
transformation of spaces – from a heaving, sweating multitude, to a serene, scented passageway in a
matter of seconds. The moment had a satori-like feeling. The baba just sat there smiling, as if
amused by it all, or perhaps smiling knowingly.
A quick darshan and we were ushered out. One of my 'helpers' came again and shook my hands.
“I”ve never had a darshan like this, ever! Thank you, thank you!” he said.
“Thank the chair,” I said. Maybe it was the overpowering emotion of the place, but the man reached
down to touch the chair and then touched his hands to his heart.
Bachpan se hai?
While pine or sal forests are the first things that my wheelchair thinks of when you mention a
holiday, it has done its share of cultural tourism. The evening light-and-sound show at the Gwalior
Fort was a memorable evening, though our real reason for being in Gwalior was the Tansen Music
Festival. I was strolling (or, rather, rolling) around the mazaar of the Sufi saint Mohammad Ghouse
Gwaliori, enjoying the intricate jali (lattice) work, immersed in the mood of the raga being
performed. It was
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about ten in the morning. A man in white kurta-pyjama, his hair slicked back with oil, approached
me and popped the famous question: “Bachpan se hai?” (Since you were a child?)
I usually have some stories ready. As poet Robert Bly says, “If we have no stories, we cannot take
hold of our wounds.” One of my stories involves a failed parachute, another a treacherous mountain
crossing, one a Bollywood-type gang-fight over a girl. But just this once it panned out quite
differently. I found myself hollering at the man: “What lack of imagination is this! You're obviously a
rasik (connoisseur), and all you can do is ask me this dumb question. I'm not answering you. Go
away.”
The man was taken aback, so I continued, somewhat calmer. “Let's sit over there and talk a bit,” I
said, pointing to the chabutara of Tansen's grave. We sat and chatted for a half-hour, during which
he told me his family history, interspersed with 'Wah, wah!' when the singer displayed some
virtuosity. We discussed music and theatre, since his father had been a theatre artist. He told me
many fascinating stories. Then I told him my story, and when I arrived at the cause of the wheelchair,
we both smiled. “So there is your answer,” I said. “Now it's been done the right way.” We parted
ways – or perhaps, because we were sitting in a Sufiana place, we finally joined ways.
I am reminded of another question that a kid once asked me. “Do you take the wheelchair to bed,
too?” The image of a wheelchair stuck to me as I turn sides in the bed is a delicious one!
Anyway, getting back to the silsilah (matter) of wheelchair travels, it is curious how my wheelchair
manages to wrangle favours from forest officials. I remember a trip to Ranthambore National Park
that had turned out to be a bit of a bore. The motel owner came up to me out of the blue and
offered to drive me right up the Aravalis in a four-by-four Gypsy. The next day, we set out early in
the morning. On our way, we picked up a forest ranger who regaled us with incidents about
encounters with all sorts of wild animals. The funniest one was about an encounter between a Sikh
forest guard and a sloth bear. The bear had attacked the Sikh guard but in the skirmish, the guard's
pagri (turban) came off. As the guard's long hair spilled out, the bear watched the transformation in
a daze and then ran for his life.
For me, the high point of that trip was meeting Gopi, a three-month-old Indian antelope calf that
was being brought up by the Forest Department. A tiger had apparently killed its mother. When I
tried to pet him, Gopi latched onto my fingers and gave them the treatment. It was evidently his
mealtime, and the rangers eventually got out some milk bottles so we could feed him. Another time,
on a trip to Goa, the wheelchair had persuaded a cheerful bunch of men who called themselves the
Bombay Boys (but were actually beer-guzzling married men holidaying away from their wives) to
carry it up a steep flight of stairs onto the deck of a boat. In fact, my wheelchair's penchant for
finding drunkards for company will make for another long story.
When it comes to traveling in a wheelchair, I've learnt that you just have to surrender to the chair. It
has wheels, for chrissake. It knows more about travel than you do, and it finds its ways.
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FLIPSIDE
E-Shopaholism
-
Sneha Prabhu
They say that whoever said money can't buy happiness simply didn't know where to go
shopping.
Not so long ago, we took great pride in the large, glitzy malls that dotted our towns. Every
brand worth its salt had begun to establish a firm foothold in developing Indian cities, and
used every marketing gimmick in the book to attract shoppers by the horde. The centrefold
of newspapers and magazines drew our attention to all the sales - with discounts that were
'flat' or otherwise. A trip to a mall was an outing - an event you could brag about, even if all
you did was some basic window shopping. More often than not, you'd go from shop to
shop, try on a few things, sneak a peek at the price tag and hurry out of the store and
content yourself with some cup corn from the food court. Teenage girls could spend hours
at the trial rooms, preening and posing in fine feathers.
But that is all passé.
Like everything else that matters, the science of shopping evolves. Humanity has come a
long way from the time goods were bought in exchange for other goods in various forms of
barter. Communal marketplaces arose, where people socialised, showed off one another's
wares and learned to bargain. Little shops sprung up that stocked a limited supply of goods.
Then man became brand-conscious and shiny malls emerged.
And now, when the Internet has invaded every aspect of our lives, can shopping not have
possibly undergone a massive change? Nay. New-age retail therapy has arrived. Online
shopping is the rage, and here to stay. Apprehensions and security fears are being thrown
out of the window, as modern youth make all of their purchases at the click of a mouse.
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FLIPSIDE
New Internet portals arise every day, each offering better, more reliable services than the last. I'm a
big fan of certain e-commerce sites. It all started with books. It's always easy to start with books. You
can almost never go wrong. There are always plenty of reviews to help you make a good choice.
They're not breakable, and everyone gets the same size. Worried about paying online? You never
have to reveal credit card information or punch in your Internet banking password. Just choose to
pay when your order is delivered! That's one apprehension you can safely discard. No retailing
website will ever move away from the Cash on Delivery option- it's caught on so well.
Then it didn't seem like such a bad idea to buy appliances or gadgets online. The retailers
guaranteed no damages. They'd deliver the products beautifully packed - it's all handled with more
care than we would if we brought them home from the mall. The best thing about buying online is,
of course, the fabulous discounts! With fewer middle men and no showroom and salesmen costs,
these portals have the ability to offer absolutely irresistible bargains on the best of products. Not
convinced? A trick I had picked up when it came to gadgets was to go check them out at the closest
showroom to make sure they're what I wanted. Once I was convinced I'd made a good choice, I'd
rush home and order them online! It's a little unfair to the guys who own shops, but the wonderful
deals I got online made it hard for me to feel too sorry!
Every girl's dream came true next... clothes, jewellery and shoes came to be available online! Dozens
of brands unleashed their range of clothing on these sites. Pictures of models in each item of
clothing were splashed across the pages, that seemed to beckon buyers and keep them hooked. Not
sure if something you like online will fit you? Detailed size charts are provided against every item. It's
not too hard to take a call if something will fit you. Jewellery - gold, silver and junk - soon made it
online, with life-sized pictures and equally fabulous discounts. Shoes arrived, in every colour, size
and style, making girls giddy with excitement.
Still not convinced you can choose well online? Online retailers have taken another giant step - they
allow returns. They tie up with courier companies to not only deliver your order, but also come and
pick it up if you're not satisfied with it. Some ask you to post your returns, and in addition to your
refund, they reimburse your postal expenses quite generously!
As if the awesome service isn't good enough to keep you addicted, they send you discount coupons
every now and then.
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Carefully strategized schemes and bargains are sent your way, that are so tantalizing, you nearly
always end up making another purchase. It takes all of my will power to ignore reward points or
value coupons that I could redeem. My favourite clothes e-shopping site sends me a feedback form
every now and then, and reward me with an irresistible discount coupon for filling it up. That only
provokes the shopaholic in me to buy much more than I need. I've become so used to making online
purchases that I've learnt to understand trends in the prices - when they go down, when to look out
for better discounts, how to club purchases to avoid shipping charges, if any, and so on. I'm quite the
e-retail expert!
My friends who are setting up houses love shopping for trinkets and home decor online. I know of
people who have gone so far as to buy furniture on the Internet! E-shopping opens up to you a wider
choice of things to choose from. A brand of t-shirts I particularly like was available only in Mumbai.
That doesn't matter anymore. If you belong to a town that has decent postal services, you can buy
from any other corner of the country! More brands, more styles and a large price range makes eshopping a delight. Why go out in the hot sun, trudge through hordes of traffic, stand in long lines at
trial rooms and cash counters, and lug heavy shopping bags anymore? Retail paradise is a tap-tap of
a smart phone away!
What's next, you ask? Augmented reality promises to bring virtual trial rooms to our phone and
laptop screens. Upload a picture of yourself, and the virtual you can try on various outfits and judge
what would suit you best. Gone are the days when you'd beg your friend to stand outside trial rooms
and hand you clothes, while you'd preen and frown at yourself in the mirrors. Here are the days
when you shop from the convenience of your house, and when you shop not only because you need
something, but because it's just so quick and easy! Welcome, online shopping!
Success & ABILITY APRIL – JUNE 2012
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Success & ABILITY APRIL – JUNE 2012
87
ABILITY
FOUNDATION
Looking Beyond Disabilities & Breaking Barriers Together
INFORMATION. MEDIA.
EMPLOYMENT. EMPOWERMENT.
New no. 4, Old no. 23, 3rd Cross Street, Radhakrishnan Nagar,
Thiruvanmiyur, Chennai 600041. Tel/Fax : 91 44 2452 0016 / 2440 1303
e-mail : ability@abilityfoundation.org website : www.abilityfoundation.org
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