Documentary Film - Allah Loves Equality

I think that I had first met Wajahat Abbas Kazmi, then a young film-maker from Pakistan, about a decade ago, at the River to River film festival in Florence. I had even done an interview with him about his film "The Dusk" in 2011. Thus, when he invited me to see his new documentary film "Allah Loves Equality", I was curious.

Theme of Allah Loves Equality

The film looks at what it means to be a person of alternate sexuality or a LGBTQ person in Pakistan today. It starts with some examples of more accepting views towards alternate sexualities, especially towards cross-dressing, gay men and transgender women, in early Islamic society and in the Indian subcontinent, even during the Mughal period.

The film moves between 3 main strands - 

(1) The traditional communities of transgender women (Khawaja Sira or Hijra communities) and their accepted roles in the mainstream society;

(2) The struggles of gay persons (and a few lesbian persons) to live their sexual identities and their difficulties of coming out of clandestinity;

(3) The efforts of a few NGOs fighting for the rights of LGBTQ persons.

Moving between these 3 strands, the film explores their challenges, alliances and solidarities, as well as, what it means to live the porous and dynamic boundaries of different queer identities in contemporary Pakistan.

The violent reactions of a conservative patriarchal society are shown through a few social media and news clips. There is the vivid story of Alisha, a transgender woman, shot 6 times, forced to wait in the hospital because they could not decide if she should be treated as a man or as a woman and in the end, treated in the corridor of the male ward, in front of the lavatory, till her death.

The fear of violence is omnipresent in the film, expressed in the furtive gestures and anxious glances of film's testimonies. Bubbly, the guru/matriarch of a traditional Khawaja sira community, explains the importance of her traditional role in a soft and gentle voice - there is no other safe space, no space where you can find friendship and support outside their confines. She is reassuring and yet frightening because she underlines the perils of being an individual on your own in a society which does not accept you and can easily kill you.

Bubbly Malik has created a NGO called Wajood (Identity) for safeguarding the rights of transgender persons in Pakistan. She says "To live in a Daire Dari, the traditional home of Khwaja, you have to accept its rules. You get the love and support of a family but you must obey its rules."

Anaya Sheikh a young transgender stand-up comedian or Hannan Siddique, a well-known gay make-up artist, talk about the difficulties of living their sexual identities. Anaya can only be safe as a part of the Khwaja Sira and Hannan must wait for his companion, who is under family pressure to get married.

The crowd of young men dancing with joy in a private gay party or the transgender woman dancing at a home accompanied by a traditional musician are both facets of the same reality.

The lesbian women are a hidden world, briefly mentioned in the documentary for the violence they must face. "They can't even accept that lesbians exist here. To accept that would mean that women have a sexuality. So many women in rural areas are circumcised, they can't be allowed to have a sexuality."

In the film one person says, "It is better to have the traditional identity of Hijra or Khwaja Sira, it has a role in the society and it keeps us safe. Calling ourselves gay or transgender exposes us to violence." However, as Khwaja Sira, the opportunities for living are limited - you can beg or dance during marriages and births or sell your body for sex. There are no other options.

The NGOs, even if they are talking about HIV screening and prevention, need to be careful in what they say and how they are perceived. The film explains the efforts of Qasim Iqbal, who is considered the father of the movement for the LGBTQ rights in Pakistan.

If you wish to contact Wajahat Kazmi and to organise screening of this film, you can contact him through his website.

Conclusions

The parts of the film about Khwaja sira community reminded me of my (limited) interactions with the Hijra and Kinnar communities in India. Though many of the prejudices faced by persons with alternate sexualities are similar in India and Pakistan, I think that in India the LGBTQ world is much more ahead in raising their concerns and sharing their ideas.

The film does not talk of transgender men and other queer groups, showing that probably these groups are without voices in Pakistan and were not available to share insights about their lives in the film.

Some years ago, I had written about Parvez Sharma's film "Jihad for love" in which he had talked about the difficulty of reconciling the alternate sexualities with being a good Muslim. Wajahat's film briefly touches on this theme but does not go deeper. I guess that it is a difficult area to present in a sensitive way.

A few years ago, Wajahat did his coming out as a gay person and has been very active on social media in promoting the rights of young persons, especially Muslims, to live their sexuality without fear or repression. There was a period when I was worried that some radical Islamist group will kill him.

I can imagine that making "Allah loves equality" and shooting in Pakistan for this film could not have been easy. It is a hard-hitting film and shows aspects of alternate sexualities in Pakistan that are usually hidden from public gaze. Allah may love equality but some of his people do not love it. Wajahat has a long fight ahead of him, his film is a courageous step in that direction.

Film credits: 

Made by Il Grande Colibri, 2019, duration 55 min., produced by Elena de Piccoli, Michele Benini and Pier Cesare Notaro, directed by Wajahat Abbas Kazmi

*****

#lgbt #documentaryfilm #alternatesexualities #pakistan #lgbtpakistan

Long-Necked Women in Sculpture and Art

After months of travelling from one continent to another, I am finally back home in Schio, just in time for different art and culture initiatives. Last night I went to an art exhibition of local artists at Toaldi Capra palace. There were some nice works by artists like Alida Bertoldi, Galileo Gonzo and Livio Comparin, but what caught my attention (and inspired this post) were some sculptures by the sculptor Antonio Capovilla.

Capovilla's sculptures are all about tall slim women with long necks. This post is about my fascination with long-necked women in art and sculpture.

B. Prabha's Women

As a child during the 1960s in India, I loved painting. It was in those days that I had discovered the art of B. Prabha, which frequently appeared in the Hindi magazine "Dharamyug". She painted mostly women, often fisher-women holding or sitting around baskets of fish or rural women with birds. Dark and big eyed, often draped in half-saris which were made fashionable by the actress Saira Banu in the 1967 film Shagird, they were all tall slim women with long arms and long necks. For many years, I drew and painted women inspired by her art. Those women influenced my adolescence fantasies. Perhaps, that is the reason, why even today, I love tall, slim, long-necked women in art and sculpture.

Amedeo Modigliani's Women

Some decades later, in Italy, I saw the paintings of Amedeo Modigliani. His women, with their elongated faces and long necks, immediately reminded me of B. Prabha's women. I think that B. Prabha was inspired by his works, though she made it her own by locating it in the Indian rural milieu, while Modigliani's women were mostly half-body portraits of European urban women.

Long-necked Slim Women in Sculptures

The early artists of renaissance, including Leonardo da Vinci and Michaelangelo brought realism and perspective to art. In 16-17th centuries, first Italian and later, European artists went beyond realism and naturalism and adopted elongated bodies and this was known as Manierism style of painting, which was adapted and perhaps exagerated by Modigliani.

Over the past decades, many sculptors have been consciously or unconsciously inspired by Manierism and Modigliani's style and make sculptures of long-necked slim women. Here are 3 examples of such sculptures - the first 2 of these are by Mirella Guasti and the third one is by some unknown artists.

To conclude this post, here is another sculpture of two women by Antonio Capovilla, which had provoked this nostalgia trip about my memories of B. Prabha.

*****

#longneckedwomen #sculptures #paintings #art #bprabha #antoniocapovilla #mirellaguasti #modigliani #amadeomodigliani

The Metaphorical Ganesh

Among all the Hindu deities, my favourite is Ganesh, with his pot-belly and the face of an elephant. In this post I want to talk about my fascination with Ganesh ji and how I understand his metaphorical meanings, as well as, about a book called “Ginger and Ganesh” which I read recently.

The above image of Ganesh is from Guwahati in the north-east of India, where I lived for a couple of years. I love the 3 baby monkeys playing on the statue of Ganesh ji. It expresses perfectly how I see Ganesh as a deity. However, let me start this post with the book.

The Book: Ginger and Ganesh

Nani Power’s quirky book “Ginger and Ganesh – An Adventure in Indian Cooking, Culture and Love” (2019, Counterpoint, Berkeley) is a personal memoir of her love story with an Indian student and an exploration of Indian homes in North Virginia (USA) in search of traditional Indian recipes.

The book is dedicated to the Ganesh, “O elephant-faced God, Ganesha, you are served by the attendants of Shiva and you eat forest apples and blackberries. You are Uma’s son, the destroyer of sorrows. I bow to the lotus feet of the remover of obstacles”.

In the book, she explains her fascination with the figure of Ganesh: “On this path I met Sri Ganesh. You may be familiar with him: he is the ever-popular elephant-headed deity, accompanied by a tiny mouse. He has a large jovial belly, and holds a conch shell. I’m not sure why he in particular ignited my passion for this culture and beyond, but perhaps it was the fact that his statue was present the first time I tasted the incendiary potions of India I came to love. Or maybe, the wisdom and calm that he emanates soothed my world-weary soul, and he seemed to be a constant reminder—at the doorway of most houses, or in their altars—that I was on a spiritual path as well as physical.”

In the book, stories of encounters with Indian families alternate with vegetarian recipes and brief reflections about Ganesh ji, after she had placed a simple advertisement in the Craiglist about wishing to learn traditional Indian recipes. The book chronicles her experiences over a period of one year, summarised in the following words:

Almost imperceptibly, the culture of this rich and varied country slithered into my life like a sinuous cobra, combining the modern ways of the United States with the Technicolor of India, while I ate some damn good food. I wanted to understand the Indian culture and people; and what seemed so enchanting was that I was constantly being surprised and challenged by how complex—and contradictory—it can be. While at one time thousands of years old, in another time it seems jauntily modern, yet where this occurs bewilders me. I have learned to keep an open mind. Now, after this year of cooking real Indian food, I realize that the only real way to learn to cook is through the senses and heart. It turns out that it is the only real way to live and to love, as well …This simple year long cooking lesson—innocently started as a little two-line ad on Craigslist because I was frustrated with my lame attempts at Palak Paneer—taught me a lot more than how to make a killer spinach and cheese curry. It smashed open my heart, in so many ways. The kindness of the women, the beauty of the culture, the explosion of flavors, and, curiously, the very physical act of cooking led me to examine what is beyond all this: the spiritual realm.

Ganesh, the People’s God

The word Ganesh is made of Gan (people) and Ish (God) and he is one of the most popular deities in Hinduism.

Hinduism has different and sometimes contradictory ways of defining and understanding God. There are Hindu hymns which talk of God as a formless, beginning-less, ending-less, eternal consciousness which pervades all atoms and molecules. God is also present in each of us, humans, animals and plants, as part of our consciousness, as part of our soul. Then there are Hindu hymns which identify God through human and animal avatars – the pantheon of 33 million major and minor Gods.

Each Hindu deity is known by different names in different parts of India and Ganesh ji is no exception. Some of his other names are – Ganapati (people’s leader), Adidev (ancient God), Gajanan (elephant face), Gaurinandan (son of Gauri), Lambodara (big belly), Prathameesh (first God) and Vidyadhar (one who holds knowledge).

Mythology About Ganesh

The Hindu Gods can be seen as statues of deities, some of them in strange shapes and forms linked with mythologies. They can also be seen as symbols of different aspects of the human reality with deeper meanings.

The mythological stories about Ganesh ji, present him as the creation of Parvati (the daughter of the Himalaya mountain), the consort of Shiva. While Shiva is away on a long journey, Parvati creates Ganesh out of her own body. When Shiva comes back, Ganesha is a child, who does not recognise him. Since his mother is taking a bath, he blocks Shiva’s path, refusing to let him enter their home. An angry Shiva cuts his head. When Parvati finds this out, she is grief-stricken so, Shiva sends his men to look for a substitute head, and those men bring the head of an elephant. Thus, Ganesh ends up with an elephant's head.

Metaphorical Understandings of Ganesh

I am sure that Freud would have a theory about meanings and significance of Ganesh linking him with sex or sexuality. However, I think that Ganesha is a metaphorical representation of human brain and the different functions of mind in Hinduism.

The story of the replacement of Ganesh’s head with that of an elephant can be seen as a metaphor for human evolution, the arrival of Homo sapiens, those with the memory and intelligence. Elephants are known for their memory and their intelligence, and thus Ganesh can be seen as a representation of the human brain and therefore, of the emotions and instincts, as well as of the rational mind.

Different names of Ganesh point towards the different functions of the brain. As Vighnakarta and Vinayak, he is the one who creates obstacles; and as Avighna, Siddhivinayak and Vighnaharan, he is also the one who overcomes obstacles. As Vidyadhar, he holds all the knowledge. As Yogadeep, he is the one who does yoga and meditation. As Uddanda, he is the wild one, the one difficult to control. As Sarvasiddhanta he controls different skills. As Harsha and Pramod, he signifies happiness. As Kaveesha, he inspires our poetry and creativity. As Ekadrishta, he controls our mind’s focus and attention.

Thus, for me Ganesh is the guide to the path of meditation and reflection for controlling the mind and the senses, for focusing our attention and building our strengths. He reminds us that we create our own obstacles and teaches us to empower ourselves for overcoming those obstacles.

Conclusions

I like the figure of Ganesh ji because I think that the combination of his human and animal forms, is an important reminder to humanity to respect the earth, the environment and the nature. His vehicle, the tiny mouse, is another reminder that every life on our planet, even that of the smallest creature, is important for our biodiversity and for the future of humanity.

Hinduism has different human-animal mixed figures including those of Hanuman and Narsimha. It also has some animal and bird forms as deities, such as those of Varaha and Garuda. All the different Gods and Goddesses of Hinduism are linked to an animal and to a plant. Thus, every life form and every component of nature is seen as sacred. As we move recklessly towards destruction of nature and of biodiversity, it reminds us to be responsible for the way we use technology and safeguard the nature for the future of humanity.

Finally I also like that our Gods can have deeper metaphorical meanings, like the significance of Ganesh as a representation of Brain and mind. This way of understanding religion is more complex and non-linear, it does not have the God as a saviour or as someone who punishes you for your sins or tells you what to do or not do, instead, it is guide to the reality and complexity of life.

*****

#ganeshji #hinduism #religion #philisophy #nanipower #bookreview #recipes #indiancooking

From Niemeyer to Ai Wei Wei - Brazil Diary

I had visited a lot of countries for work. When ever anyone asked me about my favourite country, I used to answer Brazil. I loved the country for its wonderful people and for the large number of friends I had there. Now I try to avoid travel as much as possible, the only travel I want to do it for meeting family (below, WWII memorial in Rio de Janeiro).

Over the past 35 years, I must have visited Brazil at least ten times, however it was a long time since I had been to Rio. This journey took me back to Rio de Janeiro after almost 20 years. It was also an opportunity to visit two other little known cities - Niteroi and Campo Grande. I could also see the works of two important personalities - the Brazilian architect Oscar Niemeyer and the Chinese artist Ai Wei Wei. Here are some notes from my Brazil diary.

Campo Grande

Campo Grande is a relatively new capital town of the state of Mato Grosso do Sul, which was carved out of the southern part of Mato Grosso in 1977. The city has grown mostly over the last 20 years, though it is a relatively small capital with less than a million inhabitants. I was there for a few days to conduct a couple of seminars on community-based rehabilitation (CBR) and emancipatory disability research (EDR) in the schools of nursing and physiotherapy. It seemed a kind of unexiciting town, spread over a vast area with low anonymous kind of buildings.

I was staying with a friend near the medical college and one evening, went for a walk to the Lago do Amor (Lake of Love), which had a large number of white herons and a funny looking sculpture of two kissing fish (in the image below).

One morning I went to visit the city landmark, the Park of Indigenous Nations, named because of a museum about local indigenous cultures inside the park. The park has a nice lake, though when I visited, it had been dried and desilting was going on. It also has a futuristic looking acquarium, whose construction is going on for many years. The most beautiful part of this visit was to see free-moving animals including a Capybara and a whole group of Quati (in the image below).

The park also has a big Indios monument (in the image below).

Finally it has the Don Bosco Museum on Indegenous Cultures, which presents the different indio-cultures from this part of Brazil, especially from Pantanal area including Guatò, Kadiweu, Kaiowà-Guarani and different groups living along Uaupés river.

On my way back from Park, I got a woman Uber driver, Mari Gisele, who was overjoyed when she discovered that I was Indian. She said that she was an Ayovasca tribal shaman and that their indio-culture has many beliefs similar to Hinduism. While driving the car, she sang for me some Shiva prayers, concluding them with a loud "Jai Shambhu Shanker" and "Har Har Mahadev". It was completely unexpected and exciting.

Niteroi

This is an old historical town, situated across the Bay of Guanabara opposite Rio de Janeiro. Till 1970s, when Rio was the capital of Brazil, Nietroi was the capital of Rio de Janeiro state. Now, its claim to fame is the wonderful views of the Rio skyline across the bay. Another reason of its fame are a group of buildings designed by Oscar Niemeyer.

Alcohol Drinking Cultures in India and Brazil

I was staying close to the city centre and the boat terminal, from where a 20 minutes boat ride takes you to Rio. One evening I went for a walk along Avenida Milton Tavares. Along the sea, the road had small shacks, where people sat drinking beer and enjoying the view. It brought to my mind a similar walk along the sea in Fort Kochi in India and was wondering how the two cultures, Indian and Brazilian, have such distinct alcohol cultures. In Fort Kochi, you can't have a glass of cold beer except in some high class hotel or in dark and dingy bars, where people carry beer bottles wrapped in newspapers or drink fugitively to get drunk. Here, you just have a glass of cold beer just like you would have a soft drink. Most people just want a little buzz and they are not trying to get drunk.

Island of Boa Viagem

The walk brought me to the beautiful island of Boa Viagem (Good journey), which is connected to mainland by a bridge (in the image below). Unfortunately, the island can't be visited since it is occupied by military. It is surprising how much power military has in Brazil, they occupy prime lands and are very much in your face. Since Brazil has no wars with any of its neighbours, the military is controlling the Brazilian people only. Probably the history of this military power goes back to the time when it was a military dictatorship.

Further up from the island of Boa Viagem, is an iconic Niemeyer building - the saucer shaped Contemporary Art Museum, known as MAC. It looks like a space ship waiting to take off (in the image below). The permanent exhibition at MAC has the works of 4 Brazilian artists - Antonio Dias, Antonio Manuel, Ivan Serpa and Rubens Gerchman.

At the MAC, one evening I saw an amazing sunset with the red sky and beautiful skyline of Rio. 

Another nice walk was towards the boat station. Beyond the boat station, I walked towards the bus terminal. Through the covered market I reached the Niemeyer park which has 3 buildings designed by Oscar Niemeyer. This reminded me of huge squares and futuristic buildings designed by him in Brazilia.

Rio de Janeiro

I could visit Rio a few times. The first time, I had a seminar in the school of nursing which is located just next to the famous landmark, the Pao de Acucar (Sugarloaf hill). Twenty years ago, I had taken the cable car to visit its top. During lunch time, with some of the professors, we went to eat in the military canteen located in front of it (even here Military occupies some of the best prime land of the city). The image below has me with the teachers of the School of Nursing and some Brazilian friends.

One day in Rio, I went to see the Museum de Amanha (Tomorrow's museum). It has a beautiful building, like a giant white alligator (in the image below). However, inside I was expecting to see more use of innovative technology, while it only has a lot of computer screens where you are expected to read about the future and the climate change.

I also went to see city art museum, contemporary art museum and the second world war memorial.

However, the highlight of my visit to Rio was to accidentally find an exhibition of the Chinese artist Ai Wei Wei, which was absolutely amazing. WeiWei is like Niemeyer, some of his installations are massive. I hope to write one full post about this exhibition. Here let me tell you about one of his installations, which had hundreds of ceramic flowers woven into a white carpet. This installation referred to the period when he was under house arrest in China. To protest, he had put a bicycle in front of his house and everyday in the bicycle basket he used to put flowers. These ceramic flowers are a representation of his flower-protest (a close-up in the image below).

Another wonderful experience was at the Rio Museum of Contemporary Art. It was a Saturday and outside the museum, different groups of young people were practicing dances. It was there that from inside the museum glass walls, I saw an amazing dance performance. Most persons of this group were young trans-sexual young men and their dance was just amazing. I was so fascinated by them that I forgot that I could have made a video. By the time I had thought of the video, they had almost finished.

Conclusions

I missed not seeing so many of my old Brazilian friends during this visit. The highlights of this visit were the Oscar Niemeyer buildings and the Wei Wei exhibition. I felt that the two of them, each in his own distinct way, shared a love of big spaces and elaborate designs - both have their fantasy worlds which are placed in a world of giants where the human beings are like the liliputians.

I was afraid of carrying my DSLR camera on this trip since Rio has a bad reputation. So all the pictures were taken with my mobile phone and they are not bad. Since the DSLR camera weighs so much, I think that in future, I am going to take more pictures with my mobile.

Let me close this post with another beautiful moment in Rio. It was evening and the sun was going down. With some friends we went for a beer near the tiny Urca port behind the Sugarloaf hill. The view of Corcovado with the giant statue of Jesus at the top and the sun going down behind it was absolutely amazing, as you can see from the image above.

*****

#riodejaneiro #niteroi #campogrande #oscarniemeyer #aiweiwei #brazildiary

Lessons of Life from Adam Smith

Adam Smith is considered to be the father of liberal capitalism and free markets. His book "The Wealth of Nations" is considered as one of the most influential books on economics. Smith had written another book, "The Theory of Moral Sentiments", which is hardly remembered today, which was about human nature and how to live a fulfilling life. Russ Roberts' book "How Adam Smith can change your life" is a reflection and analysis of this lesser known book of Smith.

This post is about the book "How Adam Smith can change your life - An Unexpected Guide to Human Nature and Happiness". The book is full of interesting insights about human nature and why we behave the way we do. In this post I am going to focus on only 2 ideas of this book.

Self-Deception & Confirmation Bias

According to Smith, human beings are self-centred. For us our own life problems are much more important compared to big tragedies befalling humanity in some far away place.Human beings also have a big capacity for self-deception, sometimes unconsciously, so that we find an excuse to do things without listening to the voice of our self-conscience. Russ writes about this self-deception:

Rather than see ourselves as we truly are, we see ourselves as we would like to be. Self-deception can be more comforting than self-knowledge. We like to fool ourselves. 

When we behave in selfish and self-serving ways, sometimes we even justify it by saying that we did it for altruistic reasons, to help others. We describe our selfish actions in selfless language. According to Smith, we do this not only to convince others but also to convince ourselves, so that we can continue to hold a positive image of ourselves in our minds. According to Smith, our behaviour sometimes falls short of our ideals not because we’re bad people and not because our self-interest outweighs our benevolence, but because of what is called the "confirmation bias" - we don’t realize that we’re not living up to our ideals.

A modern name for Smith’s insights about self-deception is confirmation bias. Confirmation bias happens when we filter reality through our biases, ignoring evidence that challenges or refutes what we believe and eagerly accepting evidence that confirms what we believe. ... Another modern name for the challenge of understanding our complex world with any precision comes from Nassim Taleb—the narrative fallacy. We like narratives that follow a nice, clean pattern. Evidence that fits the narrative is noted after the fact. Other evidence that doesn’t fit the narrative is discarded.  
Among the persons offering advice motivated by self-interest and camouflaged as altruism, there are some examples of doctors, which brought to my mind many instances of distorted private medical services. For example, private nursing homes have much higher rates of Caesarean section instead of normal deliveries. Heart specialists in private hospitals advise much higher numbers of coronary artery bypass operations. I believe that this is a mechanism of self-deception, so that we doctors convince ourselves that we are not doing it for money but these operations are for benefiting those persons. However, this is not just about doctors, it is true for all kinds of professionals and private businesses. They don't see themselves as dishonest, many of them may be convinced that they do it to help others.

Everyday Actions Creating Civilization

The second idea from Smith that I want to touch in this post, is about small or minor actions by each of us, which taken alone are insignificant, but combined with similar actions of millions of other persons, together create the norms of our societies. Russ calls it this process, the "Emergent Order".

The economist Milton Friedman captured this strange paradox of small effects amounting to something significant when he said about supply and demand that the sum of negligible forces need not be negligible. So while my demand for apples has no impact on the price of apples, our demands all together, along with the decisions of suppliers, are what determine the price of apples. Not the greed of the grocer down the street, not my desire to get a good deal, but all our interactions together. And even though any one apple eater has no measurable or noticeable effect on the price, because she contributes an insignificant portion of the total demand for apples, apple eaters as a group have a very significant effect.Thus, Smith says that with our individual choices can lead to important social outcomes and this is how we create our society including our norms about morality, mutual trust and civilized behaviour.

This part of the book stimulated me to think about the kind of societies we are creating today. I think that when we choose our leaders and celebrities who behave in a certain way, they amplify the actions of their followers and thus determine the civilizational norms of our society. Through social media, such as Facebook and Twitter, these followers amplify their messages and gain strength from each other. The confirmation bias helps them to not see or listen to anything which does not fit in with their ideas. Thus, people with different ideas on the left and right of political spectrum, remain in their own circles and increasingly express themselves in ruthless and brutal terms, unable to see that they are mirror images of what they wish to fight.

At the same time, there is increasing acceptance of more extreme ideas. For example, when the news came about the sinking of a boat full of emigrants, some persons who are against emigrants, wrote on Twitter that it was good for feeding the fish. I think that this kind of thinking goes beyond being against emigrants - such ideas denote psychopath personalities. Thus, we creating societies where such expressions are acceptable, and persons can openly express such opinions without feeling ashamed about them. Across the world we have many political leaders, who encourage such ideas, sometimes using religions to justify them.

Conclusions

Adam Smith had written his book "The Theory of Moral Sentiments" in the mid-18th century and the original book is not so easy to read. Russ Roberts' book "How Adam Smith can change your life - An Unexpected Guide to Human Nature and Happiness" explains its ideas in an easier to understand manner. As you can see from my reflections above, these ideas from 18th century are still valid and have much to teach us. I think that Russ Robert's book is one of the more interesting books I have read recently.

*****

#adamsmith #russroberts #bookreview

From Disability Action Plan to Rehab 2030

In July 2019, the "Global Disability Action Plan (GDAP) 2014-2021" of the World Health Organisation (WHO) was replaced by the "Rehab 2030" plan. This post is about the key differences between GDAP and Rehab 2030 and also about my opinions regarding the new plan.

WHO is the health body of the United Nations (UN) and advises national governments on their health policies and programmes. Thus, Rehab 2030 is important because it will influence rehabilitation programmes and services in countries over the next decade.

Global Disability Action Plan (GDAP) 2014-21

The overall goal of the GDAP 2014-21 was "Better health for all persons with disabilities" and it had three objectives:

(1) To remove barriers and improve access to health services and programmes

(2) To strengthen and extend rehabilitation, habilitation, assistive technology, assistance and support services and community-based rehabilitation (CBR)

(3) To strengthen collection of relevant and internationally comparable data on disability and support research on disability and related services

The GDAP 2014-21 was supposed to reach these 3 objectives through human rights based approach, empowerment of persons with disabilities, life-course approach, culturally appropriate person-centred approach, multi-sectoral Community-Based Rehabilitation (CBR) and universal design.

Rehab 2030 Plan

The new plan has a wider view of the rehabilitation services by focusing on functionings which can be limited due to health conditions, environment and by the interaction between these two. It proposes to develop Packages of Rehabilitation Interventions (PRIs) for the following groups of functionings within the next 10 years:

(1) Musculo-skeletal:Low-back pain, neck-pain, fractures
Other injuries
Osteoarthritis, amputation, rheumatoid arthritis

(2) Neurological:Cerebral palsy, brain injury, Alzheimer-dementia, spinal cord injury, Parkinson's disease
Multiple sclerosis, motor neurone disease, Guillain-Barré

(3) Cardio-Vascular Diseases including myocardial infarction and heart failure

(4) Chronic respiratory diseases

(5) Neoplasms

(6) Mental disorders:Schizophrenia
Developmental and intellectual disabilities
Autism spectrum disorders

(7) Sensory Impairments:Hearing loss
Vision loss

Rehab 2030 aims to make these PRIs to be available as part of the Universal Health Coverage at different levels of the health services, as shown in the graphic below.

The lowest level of intervention is that occurring at home and in the community - informal and self-directed rehabilitation. Moving up from below, the other levels of rehabilitation interventions are primary health care, secondary & tertiary health care, community-delivered rehabilitation and specialized high intensity rehabilitation.

Changes from GDAP to Rehab 2030

From Impairments to health conditions: In many ways, the vision of Rehab 2030 is very different from that of GDAP. Till GDAP, the focus was on the effect of impairments. The focus of Rehab 2030 is on the impact of health conditions. This subtle shift, focusing on "health conditions" instead of "impairments caused by the health conditions" opens rehabilitation programmes to the needs of other groups of persons, such as elderly persons, and persons with cardiac and respiratory conditions.

Rehabilitation Interventions: The other significant change from the past is the focus on "rehabilitation interventions". During the late 1980s and early 1990s, the Disability & Rehabilitation team at WHO had decided to focus on the delivery of rehabilitation services at community and primary health care level, leaving aside the issues related to rehabilitation interventions at intermediate and higher levels. However, over the past 20 years, new technologies have introduced a better understanding of health conditions and raised opportunities for their treatment which were not available in the past. WHO needs to provide guidance about these interventions. For example, today some children born with deafness can have cochlear implants and grow up hearing. This change goes in that direction.

Outreach Services: Another significant change is the acknowledgement of a level of rehabilitation services, which was not mentioned in any WHO document over the past many years, the "community-delivered rehabilitation". During our visits to rehabilitation services in different countries, we often came across the rehabilitation staff visiting some peripheral or rural areas to provide rehabilitation in the communities. This was called "outreach rehabilitation services". I remember a few discussions in WHO about the undesirability of these outreach services - they were costly, and often did not have adequate staff. I think that by acknowledging the Outreach services, it accepts an existing reality instead of closing our eyes to it due to ideological beliefs.

Downplaying CBR: The 4th significant change is that it downplays "community-based rehabilitation" (CBR). Instead of CBR, it calls it "informal and self-driven rehabilitation".

CBR did start as informal and self/family driven rehabilitation interventions in 1980s. However, in 1990s, other interventions related to education, livelihood, etc. were added to the CBR mix, which were not rehabilitation interventions. More recently, many organisations involved in CBR programmes have opted for the term "Community-based Inclusive Development" (CBID), which means that perhaps we can go back to using the term CBR only for the rehabilitation intervention activities at community level. Anyway, the new rehab plan rightly limits itself to the health services component of rehabilitation instead of mixing it with CBID and non-health sector interventions. 

Needs for defining community rehab interventions: I also hope that through the PRIs, Rehab 2030 will also look at defining of rehabilitation interventions for "informal and self-driven rehabilitation". During 1990s, WHO had played a crucial role in development of simple manuals on basic rehabilitation interventions, for example, for children with cerebral palsy and persons with spinal cord injury. Today, many countries have CBR as part of their national rehabilitation strategies. It will be useful for them to have updated information on evidence-based basic rehabilitation interventions for use at self-care and community level (though in part, internet is bringing better information, skills and technological support to the communities and families, who can also share their personal experiences with other communities).

Social Model and Rehab 2030

Rehab 2030 hardly ever uses the word "persons with disabilities", because it focuses on "functioning related to health conditions" instead of "impairments". However, persons with disabilities will be one of the biggest group of the users of the rehabilitation interventions and it will be difficult for WHO to not engage with them. The UN Convention on the Rights of Persons with Disabilities (CRPD) and the focus of Sustainable Development Goals on persons with disabilities, make it obligatory for WHO to engage with the DPOs/OPDs. For example, the UN Flagship report on disability which came out earlier this year (2019), also links with rehabilitation and assistive technology services.

During 1980s-90s, the Disabled Peoples' Organisations (DPOs or Organisations of Persons with Disabilities OPDs) came up with the "social model of disability", which was seen in contra-position to the "medical model of disability", implying that medical rehabilitation services were somehow bad or not useful. I personally believe that the two models are complementary - medical model focuses on individuals with impairments and social model, helps us to fight against the barriers created by the society. Both are needed. Rehabilitation interventions in the health services can not be organised through the social model - they are medical interventions and are carried out in line with the way medical/health services are organised.

Persons with stable impairments such as persons who are blind or deaf or those who had a disability in the childhood and are now grown-up, such as persons with cerebral palsy, often complain about "labelling" of their identities with their clinical diagnosis, which creates specific expectations and prejudices among people. However, rehabilitation services cannot provide treatment without a diagnosis. Such issues will continue to be a cause of friction between persons battling for superiority of social model over the medical model of disability. However, persons with disabling progressive health conditions understand the complementarity of the two models of disability in their lives much better.

Final Comments

The famous Alma Ata conference on primary health care (PHC) held in 1977 had proposed "preventive, promotive, curative and rehabilitative care" at the community level. However, in practice, citing lack of resources, PHC was limited to certain key interventions, which had excluded rehabilitation services.

During the 1990s, repeated attempts to promote inclusion of rehabilitation services in PHC had yielded little or no results. Only during the past 10-15 years, some countries have adopted the CBR approach and a few of them have linked it with their PHC services.

Today, in most countries we have persons with disabilities and DPOs/OPDs who are strong advocates for their rights while countries have signed and ratified CRPD. New national disability policies and programmes related to SDGs may also be offering opportunities for promoting rehab services in countries, which were not there in the past.

The increase in ageing populations and chronic life-style conditions, have made it imperative for people to play a greater role in their self-care, while using hospitals and specialized services for acute care and complications. New technologies including internet and mobile phones are playing a role in people's access to information. Rehab 2030 will need to facilitate this transition.

By focusing on funtionings, hopefully the new rehabilitation plan will help us to think of rehabilitation needs in a holistic way.

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#rehab2030 #rehabilitationneeds #who_rehab #cbr #personswithdisabilities

Accessible Children's Park in Schio

I had heard about the construction of an accessible children's park in our city Schio. I like going around on my bicycle and I had tried looking for that park a few times, but had not managed to locate it. Finally, yesterday during an evening walk with my wife, we found it.

This post is about this new park of Schio (VI, Italy), which is accessible to both adults and children with disabilities. It is a park for all, no one is excluded.

Right to Play

Article 31 of the U.N. Convention on the Rights of the Child (1989), states that all children have a right to leisure, play, and participation in cultural and artistic activities. Irrespective of country, culture, religion, and social status, all children have always played from prehistoric times. You just need to look at baby animals to understand the importance of play in their growth and well-being. Yet, few persons think about children with disabilities and their right to play. Accessible playing grounds and parks are needed so that they can be children like all the others.

Lack of play opportunities and social interaction with other children hampers the proper development of children with disabilities.

Even adults with disabilities need accessible playgrounds for their children, so that they can accompany their children and play with them like all other parents.

An Accessible Park and Playground

An accessible park and playground does not have stairs or narrow gates at the entrance. If it has stairs, it also has a ramp for the wheel chairs. Inside the park, there are suitable paths for wheel-chairs and crutches and persons with mobility problems. For the blind and low vision persons, the paths are well-marked and easy to see. At the path crossings, to help the blind persons, there are suitable surface marking which they can feel with their walking canes. Where necessary, even inside the park the stairs may be accompanied with ramps. They should have clear sign boards with both icons and texts to explain each play-structure. For blind persons recorded audio messages can also provide information.

Accessible park does not mean that every play-structure will be accessible to all the children with disabilities. There can be specific play-structures for specific groups of children with disabilities, such as the swings for children on wheel-chairs. For the use of some or most play structures, help may be needed from adults or other children, as it happens for children without disabilities. Different age groups of children may also need adult supervision.

Accessible Park in Schio

The park is located in Magre part of Schio, on Via Pio X, next to Banca Alto Vicentino. The park has been partially completed with rides and play structures, while they still need to build the Baskin court (for playing modified basketball, which can be played together by all children including those on wheel chairs or with other disabilities - it was invented in the Italian city of Cremona in 2003). It is supposed to be the biggest accessible parks in the Veneto region.

The park has a ramp for reaching the top of a slide, and each ride/play structure is marked in vivid colours. Each area is made of some soft material which acts like a cushion if you fall down. Some of the rides look strange, not usually seen in play grounds. Many of them have a futuristic look. The next time my grand daughter will come to visit me, I am planning to go back to this park and explore all these rides with her.

The park is not very well known, probably because it is not complete yet and there are no public sign boards to guide people to this place. It would be great if this park can be connected by a bicycle track or a passage to the larger park and cycle track on the other side of Alto Vicentino bank (along Via Campo Sportivo), because then more children can reach here without needing some adult to bring them here on a car.

Conclusions

I think that the idea of making an accessible park is great. City municiple government and Alto Vicentino Bank along with other partners deserve our congratulations for thinking of it.

This visit brought back a memory from Guyana (S. America) of many years ago. I had met two boys, 8-12 years old, both had a genetic muscular dystrophy, which was gradually becoming worse. The older boy was already on a wheel-chair, though he could still manage to climb stairs with difficulty. While I was talking to their grandmother, both the boys had found a slide and immediately climbed up to slide down and play (in the image below). There was no treatment for their condition and both boys were destined to get progressively worse. I remember the desperation of their grandmother and their joy in playing.

When we were visiting the accessible park of Schio, there was a man on a wheel chair with his family while a child on a wheel chair was playing on one of the rides. To see them in the park was the proof that all cities need such places, because we all have persons and children who can't enter playgrounds - they are waiting to come out of their homes and play with others.

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#accessibleparks #accessibleplayareas #accessiblesports #schio #italy