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Providing vocational rehabilitation services in Pacific Island communities: myth and reality.

Tropical Pacific islands, beautiful scenery, palm trees waving in a gentle ocean breeze, people dressed in lava-lavas while lying on a remote beach and sipping exotic drinks from coconuts - Paradise! The stuff of dreams! Dream of a free and easy life with no stress and no worries. These are the popular images of the Pacific: the images promoted in tourist advertisements, travel adventure stories, and even cartoons. Do these images of the Pacific reflect reality?

For the tourist or adventure away from the many trapping and convenience of modern life, the remoteness of the islands, the climate, and the unique cultures are an important part of the islands' appeal. But the reality is much more complicated (Connell, 1991). And for vocational rehabilitation (VR) counselors working in island communities these same things are challenges, sometimes barriers, to providing effective services. The challenges are complicated by the fact that many VR policies and procedures are developed with urban (and generally Mainland U.S.) populations in mind and, thus, there are few guidelines to assist counselors in meeting the needs of clients in island and other rural communities.

One way to identify critical service delivery issue and begin to develop guidelines and models for improving service delivery is to draw on the experiences of people knowledgeable about these communities. This was the purpose of the meeting described in this article.

The PBRRTC Meeting

In June 1991, a group of people associated with island and rural VR programs came together on the island of Molokai in the State of Hawaii. Island representatives came prepared to make case presentation that would provide a focus for discussions of effective service delivery. The presentations and discussions were electronically recorded with the permission of the participants.

The meeting was organized and sponsored by the Pacific Basin Rehabilitation Research and Training Center (PBRRTC) with the assistance of the State of Hawaii, Division of Vocational Rehabilitation and the Molokai Vocational Rehabilitation Field Office. Participants represented a number of communities in the American associated regions of the Pacific Basin - American Samoa, the Republic of Belau, the Commonwealth of the Northern Mariana Islands (Saipan), Guam, and four Hawaiian islands (Hawaii, Kauai, Molokai, and Oahu). Two PBRRTC representatives, three representatives from the American Indian Rehabilitation Research and Training Center (AIRRTC) in Flagstaff, Arizona, and one representative from the University of Hawaii Vocational Rehabilitation Counselor Education Program participated in the discussions.

Molokai is one of the most rural communities in the island state of Hawaii; it was, therefore, an especially appropriate setting for this meeting. Convening there encouraged discussions focused on rural communities. The travel required to get to the island (and the delays and difficulties experienced) helped emphasize the remoteness, isolation, and transportation issues common to island communities. Molokai also exemplifies other issues, problems, and challenges encountered by counselors in other islands as well as in many rural mainland communities.

This article begins by sharing two individual cases and one composite of cases that highlight some of the most pervasive challenges and some unique solutions to effective services delivery. We then outline some of the service delivery issue raised by these presentations and the discussions that accompanied them. Finally, we look at some elements identified as necessary for developing successful service programs for VR clients living in rural, remote communities.

Case I

"Paul" is a military retiree, is married, and has three teenage children. The family lives on land owned by Paul;s wife and located on the outskirts of the island's small population center. Paul has a 30-year history of a chronic, progressively debilitating back problem resulting from an injury incurred while in the military. Immediately after his injury, his job was changed from diesel mechanic to clerical worker. Paul performed clerical work until his retirement, when he move to the island with his family and got a job as a clerical worker. He was laid off from that job 7 years later and then spent the next 5 years in a variety of part-time, temporary jobs, few of which accommodated his functional limitations. He came to the attention of the Department of Vocational Rehabilitation in 1987.

Paul was motivated to work. His retirement pension and his wife's wages from part-time employment were not sufficient to support his family. Although Paul lived near the population center, the employment centers are located on the other side of his home island as well as on a nearby island. He owned an old car, but it was constantly breaking down. Because the island does not have public transportation, travel to the employment centers was difficult and frequently impossible.

Attempts at direct job placement were unsuccessful for a variety of reasons: not enough funds were available for sponsored employment; local small business owners were unwilling to take on an extra employee, especially a nonrelative; transportation was unreliable; and, because of a high island unemployment rate, he was competing with about 200 able-bodied people for roughly 20 island jobs. The counselor finally decided to help Paul established his own yard cleaning business, in which his work would be light, with no heavy lifting. He could then identify his own customers and arrange a mutually agreeable work schedule, one that would allow him to work around and with his functional limitations. Although his back problems are still disabling, 2 years after his case was close Paul continues with his yard work business and seems to be quite successful and satisfied.

Case 2

After "John" received multiple injuries in an automobile accident, he was referred to VR by a former VR client. John is single and lives with a sister, who provides most of his support. He helps his sister around the house, with her coconut producing business and, in caring for her children. Before the accident, he occasionally worked in low skill jobs but was unemployed most of the time.

During the counseling sessions his counselor learned that what John really wanted was a low stress, undemanding, flexible job which would provide him with financial independence from his sister, specifically in terms of his spending money. Neither John nor his sister are uncomfortable with the current living/financial arrangement.

John liked helping his sister with her coconut business, so he, his sister and the counselor worked together to develop a plan where John would acquire half of his sister's retail business with the idea that he would also develop his own set of customers. John, with the counselor's help, obtained the necessary licenses to set up a booth at the open market where he could sell coconuts to local people and tourists. He now makes enough money to meet all of his personal expenses, he receives no public assistance, and he and his sister are quite happy with the arrangement.

Cases Involving Transportation

Transportation is one of the most pervasive challenges confronting clients living in rural communities. A composite of cases revolving around transportation issues is presented below.

Few island communities have public transportation. When such transportation is available, it does not meet the needs of people outside the population centers or those with disabilities. People usually have to rely on family for their transportation needs, and most families have ready access to only a single functioning vehicle.

In one case, the counselor helped a client purchase a bicycle to ride to work. In another, the counselor approached all the client's hotel coworkers until he found someone with the same schedule and who was willing to provide transportation for the client.

At times, solutions can be designed to address the needs of the communities as well as the clients. For example, two clients were provided assistance to buy automobiles, not just to meet their transportation needs, but to start taxi businesses. One of these men now owns five taxis and works as the manager and dispatcher rather than as a driver. On another island, a cost sharing arrangement was made to purchase an automobile and business license so a client could develop a taxi service. However, in some communities there are restrictions on the purchase of motor vehicles.

In a couple of cases, adapted motorcycles and sidecars were purchased or adaptations to other vehicles were made to meet client transportation needs. Unfortunately, in rural island communities repairs, especially of adaptive equipment, present a serious problem. Repairs are expensive, parts are difficult to obtain and few people are available who can do the repairs, In one case, a former client who lives in a very remote area has asked that his case be re-opened, because even though he is currently employed, it has been impossible for him to get his adapted motorcycle repaired. If he cannot get it repaired, he will lose his job because his volunteer driver cannot continue driving him "forever."

Several participants at the PBRRTC meeting have found it necessary to become community transportation advocates and to get involved in planning island transportation systems which would help meet the needs of their clients and others with disabilities.

Discussion

These and other cases stimulated much discussion, which can only be briefly summarized here. The dialogue focused on issues common to all the communities - issues which are also relevant to other rural communities.

Because island rehabilitation personnel are often professionally isolated, some used the meeting as an opportunity to exchange information. For example, during discussions of transportation issues, participants asked one another for practical information on how to justify and administratively handle requests for vehicles and costly adaptive equipment. Another case, involving a woman with progressive blindness, was presented specifically to elicit information about how she could best be served on her island and what off-island resources are available to help meet her rehabilitation needs.

Service Delivery Issues

Isolation and poor or limited transportation. As indicated above, much of the meeting focused on transportation problems - problems most rural communities share. Rural clients often live considerable distances from wage-labor employment opportunities; thus, the lack of reliable, accessible transportation precludes placing many rural clients in such positions.

Participants noted that the isolation of rural communities and the distances between residential areas present problems for the counselor, such as excessive travel time and poor communications. These are the kinds of obstacles that can be particularly challenging to effective service delivery.

Limited employment opportunities. Rural communities generally provide limited wage-labor employment opportunities. In several cases (i.e., Paul and the taxi drivers) the solution was to help the client become self-employed. Developing self-employment opportunities in rural island communities suggests policies and procedures rather different from those applied in urban, mainland settings. On the other hand, as participants pointed out, there is a need for only so many yard cleaning businesses in a small community.

By urban, especially Mainland U.S. urban, standards, expenditures for weedeaters, machetes, boats, and fishing gear may seem outrageous to some administrators, and support for jobs like John's retail coconut business may seem frivolous; but such expenditures allow realistic and appropriate solutions for the employment of people with disabilities in these communities, solutions that are consistent with island needs and lifestyle. Although the counselor who helps a client acquire a machete or fishing gear may not expect that such tools will help the client generate income, these tools will help feed the family island style by allowing the client to harvest from the family's land or from the sea.

Information offered in this meeting suggested the importance of more than one kind of acceptable closure, especially for rural clients: the client earns money or the client is able to make some other contribution to the family and to the community (i.e., is able to fulfill a standard culturally identified role).

Unemployment rates vary widely among the communities represented at this meeting. In general, island communities have a limited economic base, with tourism often being the only major growth industry. In John's case tourism played a coincidental role. Tourists who buy coconuts at the open market to taste fresh coconuts for the first time and tourists hotels represent a significant portion of his market. In many other island cases, the tourist industry, especially hotels, is the primary employer of VR clients. This is especially true in communities like Guam, where tourism is undergoing major expansion. But hotels are generally clustered only on certain parts of the island, often far from where the local people live. Lack of diversity and the virtual absence of an industrial sector limit the range and number of employment opportunities for all people, including those with disability.

Cultural Resources and Barriers

Islander clients and their counselors c ome from a wide variety of cultural backgrounds. Some communities are fairly homogeneous, others are multi-ethnic. In spite of the cultural variety, participants were able to identify common cultural issues that affect service delivery. It was clear that VR counselors must include cultural considerations - the beliefs, values, ideals, and customary behaviors and expectations of their clients, the client's family, and the community - when they assess client needs and develop and implement service plans.

Concept of Family and its Role

In the islands, the ideal is: families "take care of their own." This is seen as the family's right and obligation and has important implications for the provision of rehabilitation services. In some cases, the family can become a barrier to the provision of needed services, but in others, like John's, the family support system is one of the client's greatest resources. Other issues include the following:

* Some families are uncomfortable allowing counselors entree into family affairs.

* Some families see no need for VR services, or see the need for such services as shameful and indicative of family failure; they expect to deal with the individual's needs within the family, and some are quite successful.

* Because many businesses in these communities are family owned, the owners are reluctant to hire people outside of the family. On the other hand, island families, like island communities, are undergoing many changes. For example, as more members of the family enter the wage labor market or migrate, there are fewer family members available to care for, or supervise, those at home.

Culture Contact and Culture Change

Modernization and increased opportunities for exposure to other cultures has resulted in rapid change in the islands - changes that affect all aspects of island life. Such changes present a unique set of challenges for VR counselors. When new or adopted values emerge, they are often in conflict with traditional values. Problems can occur when clients, counselors, and employers come from different backgrounds and have different values concerning such things as lifestyle, work, seeking help outside of the extended family, and the goals of rehabilitation.

Such potential conflicts are exemplified in statements like this one offered by one participant:

"Why should I change somebody's lifestyle if that's the way this person is so used to living? Who am I to change his lifestyle" That may be what he wants for the rest of his life, but that's something we have to wrestle with because of the changing times. For one thing, expectations have changed and some people are not changing with the times."

Another mentioned how "touchy" a situations can be "when you're dealing with the cultural ties and federal mandates ... Sometimes you don't know which way you turn; you're talking about a person's values and your values as a public servant."

A related issue, and one which could just as easily be placed under the family heading above, is whether the individual or the family should be the focus of services and who should make substantive decisions. Among other things, the "Middle-American cultural paradigm" (Howard, 1974, p. 212) values personal achievement, development of one's abilities to maximum potential and the development of self-reliance. Counselors are usually socialized into American culture and trained to deliver services with American models, such as "Individualized Written Rehabilitation Programs." They often believe that it is right, proper, and to the client's advantage to have the client, as an individual, play a major role in making all significant decisions affecting the client's life, including vocational rehabilitation decisions. But some of the participants pointed out that Pacific cultures often deemphasize the individual and value the affiliative response. Important decisions are generally oriented towards the needs of the family as a whole rather than of any one individual. There is a greater emphasis on interdependence rather than independence. There is also a strong respect for elders and, traditionally, young people defer to them. Young people seldom make major decisions alone, especially if the decision will affect the family; and almost all major decisions affect the family in these sociocentric societies.

Elements of Effective Service

Programs

Based on information from this meeting, we can suggest that effective service delivery strategies involve creativity, flexibility, sensitivity, knowledge of the client and the client's community, development of community support services and a supportive infrastructure, and the willingness to use a broad range of resources. Service programs must be family as well as client oriented, individualized for each case and uniquely motivating, culturally sensitive, and responsive to the lifestyle and conditions of the community. Counselors and VR agency administrators must be willing to adapt or modify standard guidelines and to extend their advocacy for clients to include justifying expenditures and policies which may seem unusual by urban, U.S. Mainland standards.

Conclusion

While few people who live in Pacific island communities would be willing to give up the benefits of living in "paradise," life is not always idyllic, especially for people with disabilities. The same elements which evoke the image of paradise are the challenges people with disabilities and their VR counselors must overcome. The needs of VR clients in all communities, but especially island communities, must be met with creative, innovative solutions, solutions which address the limitations provided by the sociocultural, economic and physical environment and at the same time draw on special, sometimes unique, resources found within clients, families, and counselors.

We hope the material presented here will be useful for others working in rural communities. Meetings like this, and information from them, can contribute to the development of policies, procedures and service delivery models which more appropriately meet the needs of clients in rural communities. We also hope it will inspire those trying to develop creative solutions for their clients - no matter where they live.
COPYRIGHT 1992 U.S. Rehabilitation Services Administration
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

Article Details
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Title Annotation:Rural Rehabilitation
Author:Anderson, Daniel D.
Publication:American Rehabilitation
Date:Mar 22, 1992
Words:3039
Previous Article:The role of independent living centers in delivering rehabilitation services to rural communities.
Next Article:Innovations in rural independent living.
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