Paola Biocca Rehabilitation Center

Project location: Jordan, Amman
Project start date: October 2014 - Project end date: October 2015
Project number: 2014-030
Beneficiary: You Able Onlus

 [2016-033]

Paola Biocca Rehabilitation Center is a project by two Italian organizations in partnership: You Able Onlus and Campagna Italiana Contro le Mine. Following achievements of both Organizations.

You Able Onlus was founded on 2012 by a group of experts, with disability and not, already working or volunteering in disability matters, searching an Organization that will offer all necessary expertise to adopt projects with a full approach on disability, until then not existing in Italy.
First achievement of You Able Onlus is to unify these people to work for the same projects, catch all skills to run projects with and for disabled people.

Main achievements of the Association:

• Give access to technology trough creating a network of organizations worldwide
• providing devices and technical assistance,believing strongly in the right of availability of appropriate devices regardless individual social or economic conditions, age, nationality or religion and in the right to have restored the functional capacity to walk, run, live and to be helped during rehabilitation
• checking the rehabilitation process of each person the Association took in charge. The aim is help people with the disability but it has to be reached sharing good technical practices, giving the opportunities to organizations to upgrade their skills.
• helping around 200 beneficiaries in Guatemala, Bolivia, Italia, Rwanda, Palestine, Perù, Sirya, Ethiopia, Tanzania, Haiti
• Promote sport in Italy
• supporting a Paratriathlon team organizing events to spread sport opportunities around Italy for people with amputation or affected by paraplegia,
• organizing team of people - with disability and not - running together relay marathon (3 editions), each year increasing the number of people taking part and the number of countries they come from. From the last 2 years the Association takes part to the Campaign to Ban Landmine, being the marathon in April and being on the 4th April International Day for Mine Awareness and Assistance in Mine Action. The aim is also promoting a concept of sport as a bridge between people with a disability and not, the Association is against any separation of sport disciplines that means discrimination.
• promoting a call per year recruiting new young people willing to practice sport
• now working with the University of Pavia to a study for a handbike accessible to people. This project is aimed also to begin a new activity in Italian schools to engage guys with a disability and not to practice the handbike
• Promote sports abroad
• Some beneficiaries were selected with local organizations partnering, to become testimonial in their country: Jacinta Odima in Kenya and Joseph Amo in Ghana, Tolosa Gonfa and Habtamu Assefa in Ethiopia, after You Able sponsored them to run and come in Italy to check the fitting work and to run with Italian guys, they started to run National Marathons, were on local TV and come back here each year to share with us their results
• Support the creation of independent orthopedic laboratory or agreements with available services locally.
• You Able has helped non-profit rehabilitation centers in different countries to offer a good assistance, upgrade their equipment, give good devices, promote sport opportunities. Until now the Association was really lucky to find the right local partner available to work together, in some cases, as in Perù, the situation of Japanese monopoly was partially solved trough an agreement between Health Foundations and the Institute National de Rehabilitation (agreement reached thanks to us), in other, as in Sirya, it was possible to help until June 2013 thanks to TDH Sirya mobile clinic, in other too, as in Bolivia, the problem regarding the political obstacles to International Cooperation, leaving people with a disability with no hope, is possible to face working with organizations having a heath network on the field.

Italian Campaign Against Landmines will be partnering You Able Onlus in the coordination and monitoring the project at the same level, engaging their expertise for impact evaluation and sustainability, advocacy, mine risk education, campaigning, victim assistance and coordination with International Organizations and national and international Institutions (Ministry of Foreign Affairs, - United Nation Mine Action Service UNMAS, Diplomatic delegation Representatives, Network of international ONG part of International Campaign to Ban Landmine and Cluster Munition Coalition). You Able Onlus as lead organization, here indicated, will manage the technical and medical aspect of the project and their implementation on the field. Each decision about the project will be taken together by the two organizations.
Founded more than 40 national realities in December 1993 is part of the International Campaign to Ban Landmines co-graduated Nobel Prize for Peace in 1997.

The Italian Campaign (CICM) mine was constituted as non profit organization in 2000 (as an association of persons, associations and local authorities). Among the organizations that have promoted the non-profit organization: Medicin San Frontiers, Mani Tese, InterSOS, Pax Christi, and the City of Castenedolo Institute for Cooperation in Alexandria.
The Italian Campaign Against Landmines is also part of the International network Coalition to Ban Cluster which promotes the ban of cluster munitions. CICM has the leadership of the "Stop Rape Campaign in Italy. Initiative launched by the Nobel Women's Initiative.

The Italian Campaign to Against Landmines (CICM) participates as a representative of civil society in the Committee of Humanitarian Actions Against Mine (CNAUMA) held at the Ministry of Foreign Affairs and chaired by the Secretary for Foreign Affairs in charge of disarmament policy.
In 2007, CICM has taken steps to participate in the organization of the Meeting of States Parties held in Jordan (18-22 November 2007) to providing as many as 10 volunteers for organizing the participation of civil society from all over the world under the coordination of International Campaign to Ban Landmines (ICBL). The volunteers were students of academic disciplines of political science of international course trained by CICM.
The Italian Campaign also has supported several projects in the field, such as: support for demining and humanitarian mine risk education in Afghanistan and Kosovo, to support child victims of war and explosive remnants of war through the Nepalese Campaign to ban landmines, humanitarian demining and mine risk education projects in Bosnia and Herzegovina and activities of Alberto Cairo in school support for children victims of landmines.

In line with the recommendations of the resulting "action plan" of the Conference review of Ottawa convention held in Cartagena des Indias, -Colombia (2009) CICM has focused its activity support to projects in the field with particular emphasis on activities dedicated to survivors and their socioeconomic reintegration, particular attention is paid to children and women.
CICM has promoted in 2001 by state law the establishment of the Fund 58/01 dedicated to the cooperation in "mine action and victim assistance" and ensuring the support of Italy to humanitarian priority determined by unexploded ordnance. The fund is still active and it is monitored in its annual financial appropriations and its use based on-guide line of the Conventions by the CICM

The country is a peaceful country in an area full of conflicts. Every day there is a rise in the number of people with conflict-related impairments, especially among the refugee community (Palestinian, Yemeni, Libyan, Kurdi, Iraqi, Syrian): 170,000 disabled people in Jordan, 799 injured by land mines (ICBL Cluster Munition Monitor), over 400 amputees are registered with the registry of the Syrian refugee health association based in Jordan. It's now expected a new immigrants wave from Iraq. 22% of refugees are assisted in refugee camps from many ONG, 78% of refugees are around Jordan, especially in the north region and coming to Amman for health care. Registered Syrian receive a daily allowance from UNHCR, including families with children, while children without parents receive health care assistance and after come back to the camp.
Jordan is contaminated by antipersonnel and antivehicle mines as well as explosive remnants of war (ERW), both unexploded ordnance (UXO) and abandoned explosive ordnance (AXO). These result primarily from the 1948 partition of Palestine, the 1967-1969 Arab-Israeli conflict, the 1970 civil war, and the 1975 confrontation with Syria. Military training ranges and cross-border smuggling have added to the ERW problem.
In Jordan, over 300,000 mines were removed from estimated 509 mine fields what is a huge but not insurmountable problem.
It lacks totally an equitable medical and rehabilitation treatment. Firstly there's a technical gap in rehabilitation, professionals go to work abroad meanwhile people working in private business need training and upgrading. In 2013 there was a program of training of the university of Amman with 3 Italian Universities, the program had no great results, probably cause it was not based in Jordan but in Italy, infect now the University of Amman is searching a way to offer a practice in place to his students.
There's no any non profit support to people with a disability providing rehabilitation services at the moment. Only available services are from military (granted to military but only to paying civilians), government (unable to offer a complete rehabilitation of the patient and unable to face the needing), private (totally not accessible to ordinary people). There are no organization controlled by disabled people except for Life Line Consultancy & Rehabilitation - our partner - actually offering a peer to peer support to amputees and managing a consultancy work for many International Organizations involved to help people with a disability from the recovering from trauma to a complete work and social inclusion through grants and loans.
About devices: at the moment prosthetic components are imported from Turkey and China (wood foot) with a really high range of speculation, it costs from 550 to 800 $ to a patient (for a value of 100-130 $ of materials), while 1400 $ is asked for above knee prosthesis. The cost of the below knee prosthesis is the medium monthly wage. No fiber carbon foot is provided unless in 1 private center.

Urgent needing
• to give the opportunity to disabled people to be able to run a normal daily life (study, work, walk, etc.), organize themselves, advocate for their rights
• to train people in the field of prosthetics and orthotics.
• to open a independent center that will provide good devices, in a health framework allowing to assist patients, in an Institutional framework which will guarantee collaboration (NCDR, University, etc.), managed locally by people with a disability. It will be the first really non profit Orthopedic center.

Goals:
• To set up an independent prosthetic/orthotic rehabilitation center able to provide good quality prosthetic and orthotic devices of all people in needing beyond any discrimination of religion, age, nationality, economical or social status.
The rehab center (open 9 to 15 pm) will provide the following services:
1- prosthetics and orthotics,
2- rehabilitation,
3- peer to peer support,
4- maintenance
• The rehabilitation center will also be used for O&P training for prosthetic/orthotic technicians, ongoing training workshops will be conducted by local and international experts to upgrade technical skills.
• The rehabilitation center will provide prosthetic/orthotic devices free of charge, based on their social and economic status. A mechanism of other service providers' support will be implemented after the set up is established. The services of the workshop will be available with the same principal as we operate with amputees in general, meaning those who can afford to cover expenses will do so, and those who can't will be covered by the center based on their social security income details. A list of patients will be available and service will be provided upon it.
• The Local Manager of the Center will be DR. Kamel Saadi, landmine survivor, amputee, founder of Life Line Consultancy and Rehabilitation, working with the International Campaign to Ban Landmine and consultant for rehabilitation programs in the country. Management of the center activities and daily work will be run by LLCR in coordination with the leading organizations.
The Rehabilitation Center is in line with Foundation' goals:
• Project aim: healthcare for the most disadvantaged people, refugees or low income people with a physical disability,starting from amputees unable to walk
• Target: the most part of victims of mines are young people under 30 years, the most part of refugees with impairments are children and women
• Project Approach: the creation of the Center of excellence will allow to give first-aid intervention in the emergency situation now, but working in a long run plan that will also provide a self-sustainability.
• Disabled approach: working with the Organizations on the field for not only medical rehabilitation but social and work inclusion, engaging directly people with a disability is the only guarantee of a peer-to-peer approach and of a real respect of disabled people rights, giving them the opportunity to advocate for their own rights
• Evidence as stated former projects the Foundation supported, the principle people with a disability has the same right worldwide, meaning also appropriate devices to run a normal life, also when this means to give accessibility of technology
• Partnering approach to optimize economic and human resources, working in coordination and collaboration with all Institutions and organizations on the field as UNHCR, UNMAS, Italian Development Cooperation Unit, King Hussein Cancer Foundation
• Offering a chance to empowerment

This project, which received a grant from the Nando Peretti Foundation, has the following goals:
Objective 1: Project planning
Actions:
1.1 - 1st Needing assessment closed. The work on this project began on December 2013, closing the need assessment with a mission on the field and testing also the collaboration sending first donation kits for children in needing, as the Association do for each project - to evaluate affordability and technical skills- . Obviously the situation is changing due to conflicts in the area, more refugees arriving, considering also we are taking charge of patients and needing of people can easily change. For this reason we will keep on monitoring needing with periodical missions and trough our local partner.
1.2 - Defining the Institutional and health framework. After the 1st need assessment it's clear the urgent need of an independent workshop free to work on upgrading skills to be able to help people with no assistance. Collaboration with Institutions and other organizations locally is important and already on working.
1.3 -Arrange logistics by the support of Italian Foreign Ministry Emergency Unit (Accomplished. In many countries importation of medical devices and expensive machinery has a lot of obstacles, this is not the case of Jordan where hospital are also free periodically to import custom exempt to upgrade their equipment. Furthermore our Institution are really available to help for any procedure.)
1.4 - Define locations and proceed to registration (almost accomplished, registration of the You Able Onlus will require some time but thanks to the local partner it's not necessary to start the project, an accounting firm will ratify agreements with LLRC to avoid any legal problems)
1.5 - Recruiting experts locally (Almost accomplished. The staff: male technician, female technician, manager, administrative staff, already asked them to join the project. We have just to sign the employment contracts)
1.6 - Defining main donors and co-funding (The project will be endorsed by up to 5 donors)
1.7 - Signing agreements (This step will close the 1st objective and will be accomplished only after the signature of the 1st donation)

Objective 2: Setup a prosthetic workshop lab.
Actions:
2.1 - Equip the workshop on 2 years developing plan,
1st year: equipment will follow the basic one (mainly 2 rooms of 35 square meters: patient area - fitting/measurement room - workshop room - machinery; storage room of 25 square meters, bathroom), the center will use the physio unit of all hospitals that will send patients; all instruments and machinery have been defined by the staff: 2 orthopedic technicians (one man, one woman), the manager and 1 or 2 assistants (2 syrian women amputees unemployed are on being recruited to help daily activities as registering patients, organizing appointments and follow up, registering clinic papers and all documentations will be sent to us)
2nd year: upgrade the workshop following to need assessment, example: assistance and devices for spinal injuries and arms amputees.
2.2 - Sign the employment contracts
2.3 - Managing the 1st mission: P&O expatriate - 1 month.

Objective 3: Defining a standard for quality prosthetic and orthotic fitting.
Actions:
3.1 - Trained technicians will operate under the supervision of international experts. Quality assurance will be granted by the monitoring missions visiting and checking into the center and patients periodically. 1st month an Italian doctor in rehab with a therapist and 1 P&O will tutor the local staff and will follow up during the year. ISPO will involved to offer their upgrading courses.
3.2 - Quality components and services: Fiber carbon components, acrylic resins, titanium bars and adapters will be provided to meet the up to date standards of prosthetic/orthotic quality components.
3.3 - Establish a procedure in the center for customer care and feedback from patients (software for the internal management is under current evaluation)
3.4 - Monitoring missions by professionals: after the 1st month tutoring the activities by the P&O, other 2 missions (6 days each one) will be held in 2015 at a mid stage and at the end of the 1st running year, managed by the 2 organizations and the P&O.
Objective 4: Defining the procedure to face the increasing number of recipients
4.1 - Defining recipients the center will be able to accept, in coordination with local organizations as following.
Service amputees recipients free of charge:
1- refugees, also through collaboration with the UNHCR,
2- unemployed people
3- children of unemployed,
4- persons with poor social security status,
5- collaboration with the Al Hussein Cancer Foundation,
6- collaboration with the National Committee for Demining and Rehabilitation,
Service recipients who will contribute:
1- health insured,
2- with income,
3- donor support,
4- private funding,
The center will only charge those who have the financial ability only a small portion of the service provided to support others who are not able to pay through a trust fund.
4.2- You Able Onlus will run a International campaign in coordination of the Italian Campaign to Ban Landmine, as the project start to find private sponsor joining to support the project and a distance adoption of children with disability in needing. Publications and events about the results of the project will be held from the beginning of 2015.
4.3 - Managing agreements with hospitals. The center will accept patients from all the hospital and organizations. A future collaboration with the Motion Center (new area of the Palestinian Hospital aiming to be the 1st place in Middle East for Rehabilitation) is already on place, it will be operative in 3 years.

The expected achievements will be improving the conditions of life of people with disability.
Results:
• Helped around 300 people in 1st year
• Involved all local actors in the project in a network
• Started and running the 1st independent to any political and religious view, able to take care of any person with a disability beyond his faith, nationality or status. Reached the sustainability of the Center thanks to the high quality of services and devices; the center will be an excellence in the field for technology and self- sustainable
• Engaged people with a disability in the daily activities of the Center
• Establish a strong network with all hospitals that agreed to take care of disadvantaged people.

In 2016, this project received a further grant covering year 2017.