György Könczei[1]

 

THE STORY OF THE POOR SOLDIER

(Or: people with disabilities in Hungarian society)

 

 

1 An introduction: the past

 

”Once upon a time, there lived a soldier; he had been serv­ing in the king's army for long years, but when the war came to an end, there he was, unfit for service, due to his many inju­ries.

The king summoned him and said:

– You may go, wherever you like, I do not need you any­more.

– But how am I to earn my living from now on? – asked the sol­dier.

– That is up to you to manage – answered the king. – I do not need you and soldiers are entitled to a pay earned by service only.

As there was nothing else for him to do, the poor soldier started boldly for the World.”

(Grimm 1989, page 213)

 

The story has a great deal in common with the situation of people who have become disabled. There are several differ­ences, however. Firstly, there is the fact that the soldier has the honor that the king himself deals with him: it is him, who drives the soldier away. Second, though the miraculous power of his blue gleaming lamp, the soldier not only takes revenge on the king for his derogation, but even marries his daughter eventually! That is in the tale. Nowadays how­ever, people living in our country have no miracles to rely upon.

Institutions doing various deeds of philanthropy for people in dire straits – the poor, the orphans, the injured – began to proliferate in Hungary at the time when Christianity was adopted. (King István imposed mercifulness and good deeds on his son, Count Imre as royal virtues.) In the middle ages this line of work was practised mostly in churches, chapels, and their affiliated hospitals. The nation-wide organi­sation of the in­stitutions for charity took place at a consider­ably later time – in the eighteenth century, under the reign of Marie-Theresa. Im­me­di­ately before this time and several years be­fore the institu­tion of the first orphanage, a privateer, Éva Bello, had endowed a foundation for the establishment of a home for the aged.

 

In the decades to follow, this foundation was supported by others (Mór Pausch, Zsuzsanna Szalay, Mihály Wieser) as well, with very substantial financial contributions.

 

The first institute intended explicitly for disabled people was founded by the lawyer András Cházár, after he had spent three years in Vienna, where he got the opportunity to visit the local institute for deaf-mutes. This shocking experience urged him to request an audience with King Ferenc, who sup­ported his idea. At home, after a feverish campaign  of fund-rais­ing and or­ganisation (a fund of 40 000 forints had been col­lected) the institution was inaugurated in 1902, in Vác. It provided home and training for its fostered and a bit later it could run its own bindery.

 

The period when the institutions for charity of this type became widespread in Hungary thus the nineteenth century. Let us quote the programme of the ”Society of Women for Charity in Pest” as an example:

 

”The Society, having under­stood at the time of its foundation that only the salva­tion, proper in its extent and administration, can offer true and therefore most charitable help; the mere alms giving however, being an un­cer­tain, expensive and mostly harmful method, not being compli­ant with the principles of Christianity, as it would supply for fraudu­lence, invoke idleness and eradicate diligence. As the following five articles: Catering, Clothing, Lodging, Medical Help in Illness and Meticulous Care provide for the inevitable needs of human life; those who are in need of one or other of the above are the poor and deprived and are the only beings deserv­ing the atten­tion of the institution for the poor. As far as the above principles are concerned the poor, deserving true salvation, may be classi­fied into six, main categories:

a) Those who need only momentary help.

b) Those who... would be able and willing to earn their living if they could get a job suiting their circumstances [condi­tions], that they can not obtain, as – being old, disabled, or handicapped in other ways – nobody wants to employ them.

c) People who would be able to earn a part of their living, but not at the level necessary to satisfy their needs, due to their helplessness though senility or other circumstances.

d) Those who are old and ill to an extent that precludes earning their own living.

                          e) The poor and ill in need.

       f) The abandoned, unsupported orphans”

(Béry, 1929, pages 17-34)

 

Soon after its foundation the Society established a nurs­ing home in a rented building, but as the capacity of the facili­ties was far from sufficient, the accommodation of orphans, dis­abled or aged individuals was arranged for with reliable families, for an appropriate fee.

 

The committee, providing institutional care for the inva­lids of war, war-widows and orphans, was organised after the First World War, under the chairmanship of the prime minister, Ist­ván Tisza. The activity of the H. R. Office on Disability is worth mentioning as well. Its primary function was to co-ordi­nate the functioning of the nation-wide network of schools for invalids (e.g. in Vác, Kolozsvár, Debrecen, Kassa, and in Buda­pest — on the left bank of the Danube in Pozsonyi utca, and on the right bank of the river in Szegényház utca) and nursing homes for invalids (e.g. in Besztercebánya, Alsótátrafüred, Po­zsony, Kas­sa, Kolozsvár and in Budapest, at the Császár-fürd_, Bajza ut­ca, and Fehérvári út). The H. R. Home for Inva­lids of War was  in the Timót utca, running a brush– and a basket-making manu­facture. One time soldiers not able to find re­em­ployment could take part in professional rehabilitation at the department of disability of the ”H. R. Vass József Insti­tute for War-Orphans” in Székesfehérvár. The clients of this institute could train as a carpenter, shoe-maker, house-painter or tailor, and could obtain a single grant in equipment at the end of the curriculum. Courses in apiary and hive-mak­ing were or­ganised as well, with the help of the Society of Apia­rists at Kolozsvár.

 

Considering the circumstances, the H. R. Artificial Limb Works was an important link in the rehabilitation of war-inva­lids. Apart from prostheses, it produced all sorts of wheelchairs, spectacles, spine-supports and crutches as well.

 

Amongst the many societies of war-invalids, relevant po­liti­cal and economic movements, the state granted official ac­creditation and regular, monthly allowance only to the HADRÖA (National Alliance of War-Invalids, Widows and Or­phans).

 

Exactly one hundred years after the foundation of the in­sti­­tu­tion of András Cházár, the National Home of Disabled Chil­d­ren and its affiliated society was established in Budapest on Mexikói út. The Home, founded to alleviate the hard­ships of poor children and orphans, ran a school for profes­sional train­ing, providing six years' education in the pro­duction of fancy-leather goods, in book-binding, tailorship, shoe-making and in textile weaving.

 

The modalities of insurance, including the loss of working capability, began to develop in the 1870s. The General Sick-Relief Fund for Workers and for the Disabled (Ál­talános Munkásbetegsegélyző és Rokkantpénztár) had been founded in this period. An Act of Parliament on this subject was passed in 1891 for the first time, and decentralised the vari­ous cash-desks – regional, corporate, professional, building-contractor and private. All these – 97 workers' in­surance associations and 80 corporate sick-relief funds – were incorporated into the National Workers' Insurance Fund (Or­szá­­gos Munkásbiztosító Pénztár [OMP]) in 1907. The OMP was later succeeded by the National Institute for Workers' Insur­ance (Országos Munkásbiztosító Intézet). The activity of the As­socia­tion of Workers for Disability and Pension (Munkások Rokkant– és Nyugdíjegyesülete) – founded in 1897 – was essen­tially differ­ent: despite its name, it had recruited its members from middle class as well.

 

”The institute provides support for the aged, and for those with premature disability – on the grounds of insur­ance policy, but without the objective of obtaining business yields – who can afford to lay up savings in the form of a certain, weekly due insurance fee at most...; Foreign experience shows... that this type of independent institution for insurance  does not become obsolete with the introduction of social security but – as a form of supplementary insurance – it is further utilised. The for­mal objective of the Association is to provide pension and allow­ances for disabled members and for their orphans and wid­ows”

 

– writes Sándor Szerdahelyi on the subject (Béri 1929, pp. 350-351). From its foundation, at the beginning of Decem­ber 1928, the Association paid over 20 million pengő (pound) – a con­sider­able sum in real terms as well – in allowances for dis­abled individu­als. Its first two branches were established in 1893, with almost 700 paying members. After a period rapid florid devel­op­ment, the number of paying members approached 200 thou­sand by 1917, with 550 branches all over the country.

 

At the beginning, an allowance for disability (if the acci­dent that caused disability had happened unintentionally) was available to members who were duly paying their fees for a year and to all members who had deposited the fee for a full ten years. There were three classes. The premium was 10 krajcár (“penny”) a week in the first, 12 in the second and 15 in the third class. The weekly allowances in these classes were 4.20, 4.90 and 8.50 Hungarian forints respectively. The pensions of the members, the sup­port of their widows and orphans, the subsidies for the case of death and the payment of severance were managed in a slightly different way. The development of the money market after the First World War however, undermined the financial stability of the association. The modifications of the statutes in 1927, in­creasing the number of insurance classes to eight and raising the fees, were of no avail; there were no new members anymore, the old ones dropped out gradually. At this time, the allowances for disabil­ity were calculated according to the entrant's age and the du­ration of membership. The fees in the eight classes ranged from 30 fillér (penny) to 3 pengő a week. A mem­bership of 40 years' duration entitled its owner to a pension of 30 pengő a month in the first class, and to 300 pengő a month in the eighth. The amount of the allowances allotted in the re­maining classes was calculated between these extremes.

 

The institution of obligatory insurance against disability, old age, widowhood and orphanhood appeared in the Hungarian legislation in 1928. It was declared at this time that the obliga­tory insurance should not be based on charity and the insur­ance of workers should be  extended to develop a social se­curity system. The so called limit of allowance was set by Article XL of 1928 at 500 pengő a month, that is, at 6000 pengő a year. This sum was later increased to 800 pengő a month and 9600 pengő a year in 1942. Policy holders were stratified into two categories. In the first category, insurance was obliga­tory only if the total sum of monthly (annual) allowances stayed un­der the limit of the allowance, as in the case of clerks, shop as­sis­tants and foremen. In the other category, however, insurance was compulsory, regardless of the magnitude of the allowances.

 

The expenses of the insurance policy were covered by con­tributions from each insured individual, the amount of which was calculated by advanced methods of insurance mathe­matics. It may seem strange nowadays, but the preva­lent key for these calculations was determined by a decree of the De­part­ment of Interior. The employer had the right to charge the employees with half of the expenses by deducting it from their salary, but was obliged to pay the rest himself. Un­der the limit of allowance, the amount of the contribution was not to ex­ceed 4.3%; over the limit of allowance it was 3.5% of the daily rate of the salary. Ac­cording to the Act on Disability, disabled employees over the limit of allowance were considered as inva­lids, if they had be­come unable to earn one-third of the income of healthy employ­ees with similar qualification and experience. Under the limit of allowance this rule concerned individuals who could not earn half the average income of healthy employ­ees (See in detail: Országos, 1943).

 

In addition to the medical rehabilitation of soldiers with se­vere war injuries, victims of Heine-Medin paraly­sis and pa­tients with neoplastic disease, the rehabilitation of patients with pul­monary and psychiatric disease is also im­portant. Promi­nent Hungarian pioneers in this field were Alajos Orth­mayer and Imre Vas (who has the credit – along with numer­ous other deeds – for the foundation of a social establishment in Új­pest).

 

Additional data. As long as the activity of Churches and denomina­tions was not restricted (they enjoyed signifi­cantly greater freedom before the late 1990s), they could engage in the rehabilitation of convicts and individuals released from prison. The missionary activity pur­sued in the prisons could become a part of the rehabilitation  by interpretation, as well as being in accordance with tra­dition and usual practice. Along with the monks, clergymen and theo­logians, a great variety of associations were engaged in this field for the patronage and sup­port of prisoners. As they had visited the prisoners regularly, managed their affairs, taught  penman­ship to illiterates and strove to support their families, they often suc­ceeded in developing a fruitful relationship with individuals convicted or released from prison, in spite of the occasionally delivered moral sermons. Released individuals got assistance with their lodging, and gifts of food and clothing. And primarily by ef­forts to find an employment for them, their  adaptation to the free, civil life was supported as well.

 

 

2 Who are they and how are they living?

 

The political and economical metamorphosis of the coun­try, hardly effecting the lower layers of the society yet, has produced radically new conditions in the labour mar­ket. The perspectives of people living with disability have been ­clouded significantly and this trend is far from being concluded. Neither conclusions, nor exact analyses can be drawn for the time being, but the prognosis for a vast proportion of the society, highly significant in numbers, seems definitive. Consid­ering people with disabilities and handicapped together, the already diffi­cult, un­stable and financially desperate situ­ation of about 1-1.5 million people will inexorably deterio­rate further.

 

A significant portion of disability and permanent health damage in Hungary is attributable to the ex­plosive changes in the society and in the economy, that have recreated the whole world of the people along with their and mentality. They were driven to accept not only new technologies (industrialisation), a new envi­ronment for their homes, jobs (urbanisation), but to com­ply with new values, knowledge and standards; a very unpleasant and rough process indeed. The old network of self-organ­ised communities was not replaced by a new, strong and orderly communal system. These fundamental changes took the people unprepared, both in the physical and in the mental sense. The effects of this process caused extensive damage to the health and the tolerance of people, especially amongst the handi­capped. Disabled people themselves attach great importance to the staggering blows of misfortune in hu­man life. A study, based on inter­views has shown (Novák 1983, p. 22), that most of people with disabilities (50.8%) attributed their invalidity to health loss resulting from their jobs, one-fifth of them to par­tially congenital diseases and a lesser portion of them to shock­ing events in their lives (6.2%), to conflicts in the family (5.2%), or to other factors such as existential problems, blunders in health care, etc. (16.2%). Most of these people had worked overtime and spent their weekends working, before they became dis­abled. One-third of them have taken up some kind of job again since they were declared invalid.

 

The changes in criteria for disability along with the above prob­lems, have resulted in an approximately 1500% increase in the issue of disability pensions! (See detailed statistics in Könczei, 1987). In recent years, and in the years to come, the population of disabled people in Hungary is expected to grow by at least 60 000 a year. The trend is on the rise all over the  world but surveying several statistics, I could not find one country with an increase of this magnitude.

 

Many of people with disabilities are living on the margins of so­ci­ety already. A preponderant portion of them is insufficiently edu­cated, poor (deprived) and often handicapped not only due to disability but to other causes as well. Two-thirds of people with disabilities do not own real estate and their household lacks items of the more expensive category. Only about one-fourth of the house­holds is able to deposit money (usually a small amount) for fu­ture needs! (These data are almost ten years old but, con­sid­er­ing the prevailing tendencies in Hungary, the situ­ation is more likely to have changed for the worse than for the better: compare Novák 1983, p. 67.) The hopelessness of their life is enhanced by their exclu­sion and the prejudice against them occurring at every mo­ment in our country as well. As their in­come is constantly losing its value, people on dis­ability pen­sion are driven out to the la­bour mar­ket, but most of them return home having experienced just another failure. On the one hand, declaring their invalidity and doling out their pensions, the society ac­knowl­edges that most of their working ability was lost working for the community. On the other hand it is precisely the arti­ficially low value of disability pen­sion, that the society uses to exert a permanent and signifi­cant pressure to drive them back to the labour-mar­ket. The way out of this situation (be it diverse, and intricate, or the ”only redeeming solution”) is hidden by an impene­trable dusk of uncertainty. The old ques­tions are there­fore to be asked again.

 

3 The responsibility of the profession in the narrow sense

 

The staff, working in the field of rehabilitation numbers sev­eral hundred altogether. Taking all the doctors, civil ser­vants, stray researchers, teachers for handicapped children, gymnast-therapists and the predominantly vol­untary experts together, the group thus gathered will be rather small. (In English-speaking countries it is called the rehabilitation family. This expression is very apt in Hungary as well.) Most of its members are socially sensitive, of developed conscience, facing the ever mounting multitude of problems in steadily dwindling num­bers. Their prime motivation being individual vocation, money is somewhat less important to them. The saying, ”Glory uncertain, payment – nil!” holds good for rehabilitation. The profession was also un­prepared for the Great Transformation. There is still no com­pre­hensive conception either for putting the situation of the field in proper order, or for the development of social security. We were, and still are, far from the optimism of a central figure in Ervin Sinkó's novel the Opti­mists who, having just marched into his office under the Com­mune in 1919, produced the ready sentences from his at­taché-case. Some are new to the field, some  have changed sides or kept themselves busy describing and analysing the problems, some are bound to managing troublesome personal business of individuals from the ministerial office, others have taken up minor ventures in rehabilitation and wasted five or ten of their creative years holding their ground against change, because of distrust of the new, fear of losing power and on everyday skir­mishes. Even today, only few believe in the possibility of large-scale en­terprises.

 

3.1 The situation

 

As has been adequately shown in many analyses, re­ha­bilitation as a whole – together with its regulation – has evolved in Hungary in a random fashion. It does not constitute a sys­tem and does not function like clockwork as would be desirable as far as the principles of the normative the­ory are concerned. The measures taken in vari­ous speci­alities (medical, social, professional, etc.) to improve the welfare of a given individual are not tailored to his needs but are inci­den­tal, and several important phases are often omitted. Amongst the multiple causes of these phenomena are the eco­nomic and so­cial scales of values that have been pushed hard from ”above” for decades: the only true values are those that are provided by the state, that are central; the so called personal, private, inde­pendent, or civil values, how­ever, are worthless. Many individual initiatives were wasted due to this judgement, as it prevented the development of inde­pendent and self-gov­erned humanitar­ian programs in the field of rehabilitation. The central offices of the state, governing the economy, had rigor­ously tapped the lo­cal resources accumu­lated in the commu­nity or in private hands and by applying rigorous re­strictions and fi­nancial regulations on the modes for accumu­lation, made the development of such re­sources virtually im­practicable. That is why the present initiatives, overdue now for dec­ades, have been ap­pear­ing only recently. The multiplicity of its missions makes the ”Motivation” Founda­tion for the Support of people with disabilities a good example. The aim of this foundation is to help disabled people with their adaptation to society, to enable them to become citi­zens with even chances again. Following the principles of the movement for ”independent life”, the founda­tion wants to teach its fostered to take responsibility for their own lives. Its serv­ices consist of coun­selling on ways of life, on self-support for example, they provide courses in de­cubitus-prevention and the control of bladder func­tion, coun­sel­ling in matters of sexuality, law, building, edu­cation, sup­port and employment, and also psy­chological training. The foundation maintains extensive rela­tions with the institutions concerned: with hospi­tals, nursing homes, local authorities, as­sociations of people with disabilities, churches, companies manufacturing and repairing therapeutic devices, ministries, terminal compa­nies, and others. As for its staffing, there is a social worker, a lawyer, a psychologist, a computer expert and a gym­nast-therapist amongst its employ­ees.

 

As from time immemorial, the education and training of professionals are completely tacking from the field of rehabilita­tion: almost the whole staff of rehabilitation is made up by self-educated activists. Not a penny has been invested from the cen­tral budget on training or research into meth­ods. The lack of the radical reform of the system – now long overdue – has resulted in several serious consequences. Reha­bilitation has become one of the fields in health care, or man­power-management, that produces the big­gest deficit; most of the foreign examples show however that rehabili­tation can prove itself at least cost-effective. (In her 1981 analysis of profitabil­ity, Maria Major showed the true extent of the financial damage to the economy caused by the lack of re­habili­tation of a single worker.)

 

The first step and logical starting point in the mechanism of rehabilitation in Hungary is the ”leszázalékolás” “down rating” on percentages. Though this term expresses the process by a linguistic twist, it is apt, all the same. This inhumane mecha­nism, which recalls the world of Kaffka's novels, has evolved due to the blissful functioning of the Great Bureau, commis­sioned to asses the extent of the damage to the individ­ual's working abil­ity. Examples of its operation  could be enumerated by the score. ”They exam­ined [me] and said: – Trash! Literally so! -” recites a skilled workman from the provinces (Novák 1984, p. 242). The whole process is defective in its premises already: the in­tention is to down-rate the work­ing ability of the individual, to show the ac­tivities he can not perform, instead of finding the ones he could pursue! This is the reverse of the problem al­though, the real task would be to up-rate disabled indi­viduals, to strengthen their damaged self-esteem by giving real hope. (Not to mention the fact that the whole process – as far as its essence is con­cerned – remains concealed from the indi­viduals on their pilgrimage to the Országos Orvosszakértői Intézet. They are often poured into the ”produc­tion line” denuded,  they are oc­casionally willing to pay their footings – as it is usual in the health care system in our country – just to obtain a top secret phone-number for in­quiries about the result.)

 

The second step is the system of motivation, or interest. The inexcusable inadequacy of the whole mechanism strikes as eyes again here: the individual must be incited artifi­cially for something good, moreover, he is to be made interested against his own, well-comprehended interest! No individual can be blamed for this scandal: this system has been functioning for dec­ades in Hungary. It is just about time for it to undergo a thor­ough overhaul Just as in previous de­cades, the key factor today is the institution of disability pen­sion. Its original function would have been to induce the com­panies, or­ganisa­tions and individuals needy to effect rehabilita­tion themselves. On the contrary, the disability pen­sion is traditionally faiting in this function. Under the influ­ence of the regulations, the companies are actually eager to get rid of their disabled employees and to replace them with able ones. On the other hand, the employees are inter­ested in back­ing out of the process by obtaining a disability pension for them­selves. The provisions of law, created in the last two and a half decades, imposed the rehabilitative employment of workers with impaired working ability but did not supervise the execu­tion of the regu­la­tions or even keep a check on it, and did not encourage the process at all. Rehabili­tation thus hard­ly meant training for a new job with perspectives, or adaptation of the job for the in­dividual, recom­mended in the lit­erature as the best advanced methods. Most of the time it meant that the under­paid, hard-to-man vacancies with a low prestige, but necessary for the company (lift-boy, pa­per-bag sticker, night-watchman, overseer of miner's trucks or pro­duc­tion lines, doorman, swim­ming-bath attendant etc.), were filled with inexpensive per­sonnel. These people would have been disadvantaged by the discrimination amongst their em­ploy­ers and colleagues anyway, even without their dis­ability.

 

However, it is not the employ­ment in a normal job as described above but rather the jobs cre­ated explicitly for rehabilitated workers that are the most impor­tant in Hungary. There were only four com­­panies and co-operatives organized for this purpose in 1980, and more than the half of their employ­ees were rehabilitated people. The number has been mul­tiplied by eight in the last ten years, along with the number of their disabled em­ployees. If Vance Packard, the great expert on American society had known about the financing of these com­panies, he would have surely mentioned it in The  Waste Makers. The direct, pecuniary assis­tance for these institu­tions was allot­ted and looted at individual discretion at the Ministry of Fi­nances; the essen­tial factor in the decision was simply the amount needed by the given organisation for its survival. The humanism of this proce­dure can hardly be doubted, but it was this type of bad, so­cialist humanism that resulted in subsidies that varied by as much as 650% between eligible enterprises. This victory of medi­ocrity had a more than unfavourable effect on the support of good ideas, true develop­ment and innovation. The practice had not changed at all by 1991, however.

 

There is only one kind of so-called protected sphere for the purposes of rehabilitation, namely the telephone operators' job for blind people. In theory this means that if an individual with impaired vision applies for employment as an operator, that job has to be given to him. This institution resembles the tobac­co­nist shops of the period after the First World War, when the li­cence for the tobacco shop was issued only to war invalids. There are other kinds of protected jobs as well, such as the so­cial work­shops and specialised social homes but as with the whole system of professional re­habilita­tion, their relentless and thorough reformation is more than overdue. To understand this necessity, it is suffi­cient to recite the interna­tionally accepted definition of pro­tected jobs: A rehabilitative service purposely designed for work-activity, where the envi­ronment of the em­ployee is con­stantly controlled, individual re­habilitative objec­tives are set and fulfilled, with the aim of helping individual with disabilities to lead a normal life and obtain productive employ­ment. Reha­bilitative jobs of this sort – either normal or pro­tected – are non-existent in Hun­gary.

 

As far as the number of the individuals of adequate age and  impaired working capacity is concerned, we are left to rely upon rough estimations. The number of invalids exceeds half a million and more than 200 000 of them are in their able years. These are only the invalids, however. Besides them, there are those people who had been assessed by the Committee, but were not down-rated as invalids (their loss of working ability is 66% or less) and those, who did not even try to take advantage of this procedure that is, 600 to 700 thousand people altogether. Only an insignificant minority of them are white-collar (8.8%, 15% and 13% in three separate stud­ies) and a minute fraction of them has finished gradu­ate train­ing (1.8, 3.1 and 4%). The Hungar­ian studies thus confirm the results of those conducted abroad: the quali­fied workers in stable circumstances, the employees with good salaries in prestig­ious jobs are rare guests in the in­stitutions of rehabili­tation. Disability is a problem predominantly among people, living on the margins of the society battling their difficulties in a multiply handicapped position. If the work­ing class exists at all, then this population is cer­tainly a significant contribution to its numbers. The situation was the same even in the  era when the notion of the leadership of the work­ing class was a central element of the ideology. The study con­ducted by Maria Novák gave a picture of the situation: ”their lives are characteristic to the particular ecology of the existence of people with disabilities. Due to their very brief range of mobility, secluded world and poor health, they are living in ”so­cial isolation”. Their range of activity is predetermined... dimin­ished... most of them are short on adequate and acceptable jobs or even lacking those”. (Novák 1983, p.79)

 

The liquidation of companies and jobs made the difficul­ties  in employment general. Job standard are now set to comply with the quest for performance. The inflation is undermining salaries to an ever-increasing extent. As the ap­propriate forms of employment have not been devel­oped, the primary victims of this – essentially positive – process are people with disabilities. For them and for rehabilitation as a whole, the seven lean years have already begun. However, will it be only seven years or sig­nificantly more? This question can not be answered with certainty at the moment. The future develop­ments of the econ­omy and the economic and welfare policy – both contained by social policy – will naturally exert an essen­tial influence on the problem.

 

Considering the state of the affairs prevailing in Hungary, we are facing not only urgent tasks, but a certain amount of hopelessness as well. In one of the closing stages of my research I could not see any sign of a net­work in the community to support individuals in need. Or at least, that was my conviction in 1987. Studying the subject further, I had to modify my opinion to some extent.

 

3.2 Urgent work to be done

 

But what can be done? The problem is undoubtedly beyond the scope of traditional social science; it is unavoidable though. To reel up the endless, almost inextricably entangled thread of problems in rehabili­tation seems nearly impossible at present. Suggestions can be put forward only if the thread is cut here and there, without regard for its connections beyond the sphere of rehabilitation. That is the only way to form a viewpoint at all. This method is of course fraught with the danger of joining the sug­gestions in a random, accidental fashion, resulting in an agenda with no logical order. Only the lessons drawn from past results can serve as a starting-point for further investigation. New legislation is due, as the system of rehabilitation is badly in need of rehabilitation itself.

 

1. Physical obstacles to the people with disabilities must be brought down: ramps are necessary at every relevant site, as are suitable lavatories. Services should be made available for disabled people as well. Perhaps Hungary could be turned into a ”Mecca of people with disabilities” as well? (The first signs of transi­tion are visible already: on the prompting of deputy member, Mr. Gábor Zalabai, the general assembly of the municipal author­ity of Budapest has mode a unanimous decision to use the reserve budget for 1991 for the reconstruction of both of its townhalls, to make them accessible for individuals with wheel­chairs or crutches. On completion of this reconstruction, at least the exercise of climbing the stairs will not impede people with disabilities from going about their administrative business. A fund for expenditures of this kind will be separated in 1992; from that time, the construction of buildings will have to com­ply with the regulations ordaining accessibility. Rec­ommen­dations in this context will be soon mailed to the district com­munity authorities as well.)

 

2. To bring down the walls separating the worlds of normal and disabled citizens, all the respectable interactions and com­munication between these worlds, that are suitable to reduce stigmatisation signifi­cantly, must be encouraged. (If I had a friend ”of this kind” for instance, I could make efforts not to treat him and his fellow sufferers in a denouncing fashion.)

 

       3. The means to make the best of their essential hu­man and citizens' rights must be guaranteed for people with disabilities. We do not even have to consult the Court of the Constitution to realise that polling-stations, medi­cal consulting rooms, churches, schools, workplaces and build­ings are inaccessible to wheel­chairs. In Hun­gary, people bound to lead this way of life – to­gether with the patients of closed institutions – are thus de­prived of their most essential rights, en­coded in the Constitu­tion as well, not to mention the right to se­curity of existence!

 

       4. The society has to make all reasonable efforts to integra­te disabled people into the field of education, economy and all oth­ers, understanding at the same time, that full remedy is im­pos­sible: the associations for self-assistance of the similarly stig­matised individuals are good examples of the limitations.

 

       5. The media (television, radio, press) must be used to form a more realistic image of disability and people living with dis­abil­ity. It would be a great mistake to show them as sadly de­pend­ent, dull, emotionally incontinent victims – as is usual in fund-raising campaigns in the USA – just to appeal to the pity of the population.

 

       6. The ingenuity of advertising can be put to good use as well. The advertisement of BENETTON, the famous manufacturer of sports goods is a good example, taken from a rather different field: in the nicely composed picture the tiny, black hand of a black child rests peacefully in the vast hand of a white man.

 

       7. The programme of rehabilitation must draw on the strength of the family unit, to the greatest extent practicable.

 

       8. The replacement of the huge institutes by small homes for groups of 40-60 should be encouraged. (Small is really beautiful.) The antiquated doss-houses and large nursing-homes-massive, isolated, ghetto-like structures-should be gradu­ally closed up and forgotten forever.

 

       9. It is unavoidable and sev­eral decades overdue that the experts give a thorough consideration to the sexual problems of people with disability.

 

       10. A curriculum in rehabilitative medicine needs to be established. The intellectual knowledge necessary is essentially present, or could be gathered at the cost of a relatively insignificant pro­fe­ssional and financial investment (the publication  of a textbook, compilation of the subject-matter for instruction, creation of an institute). There is a parallel condition, however: the profes­sional and financial acknowledgement of the physicians work­ing in the field of re­habilitation – a problem, that is unlikely to be solved in a short time. (Let us take a man from Veszprém, Attila Sisak for a positive example.: Having spared no expense he an­nounced a competition jointly with the Foundation against Cancer, for Mankind and for Tomorrow, for the post­graduate training of haematologists and oncologists. Both the essential idea and a portion of the funding were his private con­tribu­tion; the provisions were drawn up and the applications were in­vited by the Foundation. Many young doctors have ap­plied for the scholar­ship of the Sisak Foundation in the last two years; the scholar­ships are awarded annually, by a jury. Why could not there be a similar private foundation created jointly with the Hun­garian Society for Rehabilitation? The pre­condition for this would be the theoretical possibility of achieving specialist degree in rehabili­tative medicine.)

 

       11. The training of the various professionals in rehabilitation (for counselling, assessment and development of ability) has to be started at secondary school. All these professions can be inte­grated into one, general qualification in the framework of coun­selling in professional rehabilitation.

 

       12. Explicit training in rehabilitation has to be incorpo­rated into the curriculum of gymnast-therapists, clergymen, psychologists, social workers and teachers of handi­capped chil­dren, where the students would have to study the fundamen­tals of rehabilitation as one sepa­rate subject at least.

 

       13.  An essentially new economic regulation and legislation (or perhaps an Act) are also needed, that concentrate on individual with disabilities. The exact content of these measures can only be outlined at present but, the essential principles are as follows:

    –   The interest in obtaining a disability pension has to be elimi­nated.

    – It is essential that people in need of rehabilitation get as­sistance from society through the application of these regulations, to help their own rehabilitation. This assistance would cover the cost of living, ad­justed to the prevailing inflation. The individual, however, would be interested in finding re-employment at the end of a high-quality programme of professional rehabilitation.

    – The regulations must provide for a selective control, ad­justed to the diffi­culty of re­ha­bilitation: there are individu­als with severe, or multiple dis­ability, but there are prob­lems that are easily solved as well. Differing situations obviously need different economic and legal solutions; the appropriate combination of the market-motivated and altruistic (providing services or as­sis­tance) regulations is necessary to accomplish this ob­jec­tive. The appropriate starting-point of this process can be the market as all the performers on the scene must be in­terested to par­ticipate in the process. Research in this field suggests that other sources of motivation are not important. As the state can obtain its share from the income tax of its citizens only if the income of these citi­zens is significant and thus taxable; as the con­tractor can make profits only, if his enterprise in rehabilita­tion is flourishing; so the future employer will employ rehabili­tated individuals only, if they will be able to fulfil the eco­nomic requirements of their employment; and so also if rehabilitated individuals themselves need to be sat­isfied with their income.

    – If employment on commercial terms is imprac­ticable due to the severity of the disability, the altruistic components of the regulation must compensate for the de­ficiency.

    – Despite its drawbacks, the maintenance of the system of quotas seems worthwhile, but the quota should be in­creased signifi­cantly, i. e. doubled at least (at present it is still 3%!), together with the amount of the accompanying com­pensation, which should be trebled.

       – A well founded, nation-wide programme is necessary for re­habilitation. Our era is often spoken of as the age of great humanitarian programmes. The devel­oped countries are sparing no efforts to solve a myriad of human problems by specialised, humanitarian pro­grammes. Once developed, the national programme should be divided into local modules, with key phases exactly de­fined as far as the financial resources are concerned and a careful assign­ment of private, community based and state spheres of ac­tivity.

    – New, up-to-date social security systems are needed, with the option of having an insurance against disability built in them as well. People must be made interested in health, not in illness.

 

14. A key element for transformation in the economy is the entrepreneur in rehabilitation. If the enterprises in the field of re­habilitation will have become profitable indeed – as they already have in many developed countries – the number of agencies on rehabilitation can be expected to increase. Strictly speaking, there are no organisations of this kind in Hungary at present. These structures, together with their training centres, the mainstream of blood-flow, these are the sites would be where the es­sential ac­tivities (assessment, training for a new profes­sion, re-employment) of principal importance to the individual take place. These institutes, using high-quality methods and equip­ment and quaffed personnel for the assessment of ability and for training and development of abilities, would function as professional centres. Assess­ment and development of ability, professional counselling and training, services in psychology and re-employment, pro­tected employment and follow-up after re-employment would all be included in their activity. They would provide training for new jobs, and creative solutions of job-adaptation, as well as courses in housekeeping for disabled mistresses; moreover, in the case of severe injuries, they could instruct individual with disabilities on the basic skills needed in domestic life. Naturally, special training of appropriate professionals for the fulfilment of these tasks is naturally required. The list of social workers, specialist nurses, counsellors on professional matters and problems of rehabilita­tion, gymnast-therapists, psychologists and profes­sionals as­sessing and developing abilities is still far from complete. The ra­tionalisation of rehabilitation will demand extra ex­penditures as well.

 

       15. Conflicts between the profit-oriented, pure interests of the employers-economists and ethically ”higher” princi­ples seem inevitable. Considering the unbelievable pollution of the environment, the destruction of forests, the al­ternative move­ments, and the rising incidence of disability this problem is not at all unexpected. American researchers in the so­cial sciences have de­veloped a reasonably proven method to resolve conflicts be­tween the antagonistic initiatives. Let us suppose that the unit of economic activity is  adequately small, consisting of so-called profit-centres, that perform everyday eco­nomic activity by egoistic mo­tives. These are coun­terbalanced by human-centres, con­sisting of at least partially independent scientists, dilet­tantes, experts on the protection of the environment and professionals of rehabilitation, to guard the ”higher”, i.e. substantive, altruis­tic and value-ori­ented interests. There is an incessant dis­pute, reconciliation and dialogue between these human and profit centres. If conflicts arise, the achievement of a summerising reconciliation, or the develop­ment of a compromise is the responsibility of the management of the company. In our concrete example, the mechanism is works as follows: indi­vidual profit-centres decide to dispose of the slop water into the river, or to fire the surplus of disabled or able employees. The human-centres on the other hand take into account and pro­tect the interests of all parties concerned. They try to develop organisational solutions to settle the conflicts. If their negotiations with the profit-centres are un­successful, the problems are disclosed to the management of the company for reconsideration and the neglect of the interests of either party becomes impossible at this level. The ”higher princi­ples” such as the protection of disabled employees, the prevention of environmental pollution and the re­sponsibility for the community that are considered totally external in the present system of economic organisation, can be assimilated into the problems of the company. The condition for this solution to work, however, is the thorough recon­struction of the traditional power-structure of the companies pursuing eco­nomic activity (Zsolnai 1986).

 

       16. Though it is six years since the idea of a Bank of Rehabilitation was been submitted for the first time (Józsa – Kovács 1985), a detailed analysis of the subject has not been carried out yet. A banking institution, specialising in the spon­sor­ship of enterprises in the field of rehabilitation, would be a significant development, as it would be unprejudiced, and at the same time deeply inter­ested in the profitable operation of the sphere. Entrepreneurs in this field will need to borrow on more advantageous terms, than other banks could provide for. The precondition for this bank­ing strategy to function is the continuous, external infusion of capi­tal into the bank concerned. How else could it lend out credits at advantageous terms – with the inter­est rate prevailing on the market – without risking bankruptcy? As Pál Ju­hász pointed out years ago, it would be important to invest the shares, representing the original capital of the bank into enterprises outside the sphere of reha­bilita­tion, as in the case of a substantial crisis of the sphere the risk of bank­ruptcy would be enormous.

LITERATURE

 

BÉRY László 1929 (szerk.): A magyar filantrópia könyve. (The book of Hungarian Philantrophy). Légrády Testvérek, Bp.

GRIMM, Jacob és Wilhelm: Gyermek- és családi mesék. (Tales for Children and Families). Magvető, Bp. 1989

JÓZSA Miklós – Kovács Zoltán 1985: A foglalkozási rehabilitáció szervezeti megoldásai. Egyetemi doktori disszertáció. (Organizational Solutions of Locational Rehabilitation, University Doctoral Dissertation). MKKE, Bp.

KÖNCZEI György 1987: A nem orvosi rehabilitáció elméletéhez. A rehabilitáció néhány sarkkérdése Magyarorszá­gon 1968 - 1986. (To the Theory of Non-medical Rehabilitation). Szövetkezeti Kutató Intézet Közlemények 200, SZKI, Bp.

NOVÁK Mária 1983: A tartós egészségkárosodáshoz, rokkantsághoz vezető okok. (Causes of disability). Szakszervezetek Elméleti Kutató Intézete, Bp.

NOVÁK Mária 1984 (szerk.): “Így lettem rokkant.” Szerkesztett interjúk. („The way of my becoming disabled” – edited interviews) Szakszervezetek Elméleti Kutató Intézete, Bp.

ORSZÁGOS Társadalombiztosító Intézet 1943: A magyar társadalombiz­tosítás ötven éve 1892 - 1942. OTI, Bp. é. n.

ZSOLNAI László 1986: “A gazdaság társadalomökológiai megközelíté­se.” (“The Social Economic Approach of the Economy”). Közgazdasági Szemle, 4. sz.

 

 


[1] The author – the head of the Secretariat for the European Social Charter: Ministry of  Social and Family Affairs, and a Professor at Budapest University of Economics – is indebted to Mr. James Farral for his stylistic recommendations.