in charge of one of our local programs of rehabilitation, has made the face of Mexico over in this field and he has done it by encouraging research and especially training. This young man is one of the great ambassadors for peace and understanding in the republics to the south of us.

So, in closing, Mr. Chairman, I would like to express again our deep appreciation for the opportunity to be heard. I would like to express, on behalf of all of those working in the field of rehabilitation in our country, their commitment to the objectives of this bill, their desire to share what they have with their colleagues throughout the world, and their belief that the rehabilitation philosophy is perhaps, more than any other, the epitome of the motto of our department, a motto which we cherish and try to make real, not only for our own people, but for all the people throughout the world, when we have an opportunity to do so "Hope, the Anchor of Life."

The CHAIRMAN. Thank you very much, Miss Switzer. We will have your prepared statement appear in full in the record. (The statement referred to follows:)

STATEMENT OF MISS MARY E. SWITZER, DIRECTOR, OFFICE OF VOCATIONAL REHABILITATION, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Mr. Chairman, I appreciate this opportunity to appear before your committee to offer testimony on Senate Joint Resolution 41, a measure to provide for a cooperative international effort in developing and conducting research, research training, and research planning in health and rehabilitation.

It is my firm belief that a well-planned and well-defined international program in these fields would offer an unparalleled opportunity to advance understanding and peace among mankind.

There are vast areas of misunderstanding and mistrust among nations today, born primarily of differences in social, economic and health standards, national mores, and the problems of education and communication. But in this sea of differences, there are islands of quick understanding, honest affection and mutual trusts. One of these is the internationally shared dream of all peoples that the specter of disease and the humiliation of the dependent cripple shall not forever be an inescapable part of their lives.

I speak of this subject with the enthusiasm and conviction that comes of many years of close association with international activities in the health and rehabilitation fields. I had the privilege and responsibility of being a representative of the United States at the first International Health Conference, which developed the constitution of the World Health Organization. In 1948 I was a member of the American Preparatory Commission for the first World Congress on Mental Health, and a member of the United States delegation to that Congress in London. Subsequently I served on United States delegations to world health assemblies and as a representative of our Office of Vocational Rehabilitation at other important world congresses, including those of the International Society for the Welfare of Cripples and the international congresses on poliomyelitis.

I have the privilege of serving at present on the board of directors of the International Society for the Welfare of Cripples and as chairman of the Committee on International Rehabilitation of the National Rehabilitation Association. From these and other experiences, I have become convinced that a high degree of statesmanship can be achieved through properly conceived and conducted international programs which are aimed at the worldwide problems of disease, injury, and disability. This kind of practicing statesmanship gets through to both governments and people, for it reduces to clear terms the human problems of mankind and how they are resolved in the kind of democratic system we support.

SENATE JOINT RESOLUTION 41

The Department of Health, Education, and Welfare, and the constituent agencies primarily concerned with this bill, have given intensive study to the measure. The Department's report on the bill, along with the supplementary remarks of

the Secretary and other departmental officials, have been furnished to the committee. Therefore I should like to present to the committee some of the background of international rehabilitation activities as they pertain to plans for such a bill, and to indicate how this measure would advance research, research training, and research planning in the rehabilitation of the disabled.

I should like to present a fairly broad look at international research in rehabilitation, which takes into account not only the major interests of the Office of Vocational Rehabilitation but also recognizes other related activities within the Department, such as the crippled children's work of the Children's Bureau and certain activities of the Public Health Service.

RELATIONSHIPS TO PRESENT ACTIVITIES OF THE OFFICE OF VOCATIONAL REHABILITATION

The basic program of vocational rehabilitation is, and has been for many years, responsible under the law for the provision of diagnostic and other evaluative services for handicapped persons; with corrective surgery or treatment necessary in correcting or modifying a disabling condition; in securing hospitalization, procuring prosthetic devices, and providing various other services required in the rehabilitation process; and in providing financial assistance and other aid for the development of rehabilitation facilities.

This basic experience in rehabilitation, gained in our years of cooperation with the 91 State rehabilitation agencies, has formed the background against which both our international activities (described later in this statement) and our rehabilitation research program, have developed. At present, under our research and demonstration grant program, about 200 projects are in operation and another 25 have been approved and will be initiated soon. This national research program in rehabilitation, for which the Congress appropriated $4,600,000 for the current year, is seeking better answers to rehabilitation problems in practically every type of disability and among a wide variety of rehabilitation methods. The National Advisory Council on Vocational Rehabilitation, now entering its fifth year as an integral part of the administration of this program, reviews all applications for research and demonstration grants, and makes recommendations for action.

Our interest, therefore, arises from experience, both in the administration of research and in conducting international activities.

THE DEARTH OF INTERNATIONAL RESEARCH IN REHABILITATION

In the last few years, there has been a remarkable increase in world interest and activities in rehabilitaiton. In a long list of countries, the desire of the people expressed both through their governments and through voluntary associations-to do something constructive about their disabled men and women has produced new programs of rehabilitation, new rehabilitation centers and related facilities, and an increasing number of students and visitors who come to us for professional training.

For the most part, however, research in rehabilitation has been conspicuous by its absence on the international scene. There are, of course, isolated exceptions to this general fact, but compared with the need of the millions of disabled people involved, the research effort in rehabilitation is infinitesimal.

Of equal importance is the lack of adequate mechanisms and adequate financing for disseminating any research results that might be obtained.

It is wasteful, in my opinion, for those of us who aim toward expansion of international rehabilitation service programs-and there are many of us in both governmental and private roles who have considered this a major goal for some time to devote large sums of public and private funds to service programs, without the protection of a comprehensive research program. I use the word "protection" specifically because I am convinced that research produces not alone new knowledge to extend our service capabilities, but that it also saves money and scarce professional staff by eliminating outmoded, expensive, and nonproductive methods.

REHABILITATION RESEARCH NEEDS AND OPPORTUNITIES

This proposed legislation would make possible the beginning of a comprehensive research effort on a variety of problems related to disability. The nature of the investigations would, of course, vary from country to country, just as it does from city to city or State by State in this Nation, dependent upon the nature

of local need and investigative talent. I might add that there are countries today which are so completely underdeveloped in their health services, their social services and general level of living that the introduction of research in rehabilitation would be neither profitable nor feasible.

The following are a few examples of research fields in rehabilitation where the needs are obvious, and the opportunities for advancing the world's knowledge are very great.

Deafness

At present we are in the midst of negotiations with an outstanding institute for the deaf in Holland-the Holy Angels School for the Deaf at St. Michielsgestel where Dr. Bernard Tervoort is trying to develop research into a new approach to language for the deaf. I have met Dr. Tervoort and discussed his proposals at length, as have specialists in work for the deaf in this country. His ideas are intriguing, for they involve highly technical features as well as some theory which appears new. One certainly cannot predict what might come of his proposed research, for it presents some rather radical concepts in the construction of communication patterns by deaf children in their early and formative years.

But I do know that the lack of clear authority for our Office to enter into support of foreign research in rehabilitation has been a formidable barrier so far in our efforts to aid and advance this intensely interesting proposal. We still have not resolved the problem.

Epilepsy

The limitations upon our research efforts, and how they sometimes limit the broadening of our own rehabilitation efforts, was pointedly brought to our attention during the past year in connection with one of the projects now underway in the rehabilitation of epileptics. For more than 2 years, our Office has provided grant support for an intensely interesting project conducted by EPI-HAB, Inc., of Los Angeles. This nonprofit organization set out to determine whether persons with epilepsy, whose seizures were so severe that they could not be satisfactorily controlled with medication-and who therefore are routinely rejected by nearly every major employer in this country-might be able to work successfully in a special environment. The project studied also the effect which employment might have on the frequency and severity of attacks, as well as production and safety records.

The experience of the special EPI-HAB workshop has shown conclusively that such epileptics can work successfully; that with a few precautions, the workers are not a danger to themselves or their coworkers: that both the severity and the frequency of attacks decrease under regular and suitable employment; that production records are excellent, enabling the company to meet competition from other industrial subcontractors; and that accidents were so little a problem that the insurance carrier voluntarily reduced their insurance coverage rate. The success of this project has led to the establishment of two others, in Phoenix and Long Island.

We turn now to another development, far removed, to a community in Germany, where equally interesting work is being done with epileptics. At Bethel, Germany, special work has been carried out in the care and rehabilitation of epileptics, with a large epileptic population available in the institution for study. The American sponsors of EPI-HAB have asked our aid in a joint project with the Bethel staff to investigate common problems, share their findings, and try to advance our total knowledge in rehabilitating the epileptic. So far, this has not been possible.

Hansen's disease (leprosy)

This age-old scourge of mankind continues to be one of the principal cripplers in the list of world diseases. While it appears in many parts of the world (including the United States) the Pacific and Asian countries regularly see large numbers of their people stricken and disfigured by the disease.

There is a tremendous need for research into rehabilitation methods by which Hansen's disease victims may be restored and taught the essentials of living useful lives. This has become possible since the development of sulphonamides and surgical techniques which it possible for large numbers of these patients to regain the use of their hands and frequently to eliminate much of the disfigurement, so that a total rehabilitation process becomes possible.

Research in this direction might well be undertaken at Vellore, in south India, where Dr. Paul R. Brand has done an outstanding job in medical, surgical and rehabilitation care at the Mission to Lepers.

There are further research potentials in the Philippines, where a pilot rehabilitation center for Hansen's disease was established in 1958 at Tala. This program, headed by Dr. Julio Pasina, a former Hansen's disease patient who was successfully rehabilitated in India under Dr. Brand, could well serve as an international pilot research center in the rehabilitation of those with Hansen's disease.

The Vocational Rehabilitation Division in Hawaii has acquired over the years extensive and valuable experience in providing services to Hansen's disease cases. We would hope that it would be possible that the vocational rehabilitation staff in Hawaii, the staffs in the Philippines and in India might pool thier experience and produce research projects in rehabilitation of an exceptionally high order.

Mental illness

While substantial progress in the rehabilitation of those who are recovering from mental illness is being achieved in the United States at present, we actually know very little about the success which might be had with similar techniques in other countries. Our experience so far with halfway houses, for example, indicates that this type of transitional experience between the hospital environment, and the demands of home living and a job, can enable large numbers of patients to leave our mental hospitals, most of them permanently. Job placement, techniques, sheltered workshop experience, graduated employment-these phases of American rehabilitation services for the mentally ill remain unknown quantities so far as their applicability to the mentally ill of other nations, other cultures, and other economic systems are concerned.

In connection with the plans for the forthcoming World Mental Health Year, the National Advisory Council on Vocational Rehabilitation considered, at its last meeting in January 1959, an application from the U.S. Committee for a grant ot help support the rehabilitation phases of that event. We look forward to the WMHY as the forerunner of a great upsurge in activity for the mentally ill.

To translate need and intention into action, however, there is a very great demand for adequate research into rehabilitation methods which will be effective in other countries.

Brain damage

In Finland there is a unique institute for the treatment and rehabilitation of persons with traumatic brain damage. This institute has served some 4,000 disabled veterans plus many disabled civilians during the last 10 years. It is doubtful if such a wealth of accumulated experience in this specific problem exists anywhere else in the world.

In June of last year, an experts' meeting on the medical, vocational, and social rehabilitation of those with traumatic brain injury was held at this institute and was attended by several specialists from this country in neurology, rehabilitation, and other specialized fields.

The research opportunities in rehabilitation at this institute in Finland are tremendous.

Prosthetic appliances

Here in the United States our researchers presently are concerned with refining a number of new prosthetic devices, such as the pneumatic arm and electronically powered limbs-both of them products of present-day science.

The pneumatic arm, popularly known as the Heidelberg arm, has come to us as a product of German engineering. The pneumatic actuating device and the first rather crude arms were developed in Germany. After prolonged delays and difficulties, and with the cooperation of several governmental agencies, it was possible to bring pilot models to this country and to undertake the developmental work which would refine the arm to the point where it would meet the two basic requirements-that it be sufficiently light and manageable to be usable by the amputee, and that most of its components could be mass produced. The Office of Vocational Rehabilitation currently is providing grant support for part of this developmental work. Had there been a program for international research in rehabilitation at the time this new breakthrough in prosthetic

limbs happened, I feel certain we could have advanced this extremely important piece of work much, much faster.

Now let us look at the other extreme, those other parts of the world involving millions of people where no artificial limbs of any type are available. The need for research here, research which is tailored to the specific problems and needs of the individual country, is one of the great needs in world rehabilitation today. First we must bear in mind that, in many places in the world today, the highly developed artificial limbs which we use in the United States would be of little or no value. On a country-by-country basis, we need to study the question of what type of artificial limb is best suited, to the rice paddy of the Orient, the deserts and hills of the Middle East, and the extreme cold of nations in northern climates.

For example, it has been estimated that there are 5,000 amputees each year in Burma, many of them resulting from tropical or infectious diseases. Well planned and conducted studies need ot be made to determine on a practical basis the type of prostheses needed by amputees in Burma, where heat, humidity, and rural conditions combine to make many of our modern prostheses impractical for their local use.

I should mention that Burma has had one of the most heartening expansions of rehabilitation of any country in the Far East. A number of experts from this country and elsewhere have been invited to Burma to help them plan, staff and initially operate their new facilities and services. Mr. Kurt Jansson, Chief of the Rehabilitation Unit, United Nations; Mr. William Tosberg, Technical Director of the Prosthetics Service, Institute of Physical Medicine and Rehabilitation, New York University-Bellevue Medical Center; and other professional and technical experts have gone to Burma to help. Dr. Howard A. Rusk has visited Burma several times, the most recent visit being in November 1958.

As a result, Burma now has two excellent rehabilitation centers, the Thamaing Center and the Mingaladon Center. The facilities and services now are largely staffed by Burmese who have had excellent rehabilitation training in the United States, and the Office of Vocational Rehabilitation had the privilege of aiding in planning the programs for several of them.

Here is another illustration of a situation in which both the need and the opportunity for rehabilitation research and research training are present in full measure.

Blindness and other visual disabilities

Although blindness is one of the most prevalent of the severe disabilities of the world, no more than token efforts are being made at present to develop rehabilitation research in those countries most seriously affected. Here is a field in which all the armamentarium of present-day science-in prevention, in treatment, in rehabilitation, and in broad research-should be at work to control one of the oldest afflictions of mankind.

Although blindness is a disability common to all countries, certain nations in the Orient and Middle East have historically been the principal victims. The prevalence of trachoma, glaucoma, and other diseases of the eye still produce thousands of blind persons for countries such as India. In Ceylon, there are an estimated 6,000 blind persons in a population of less than 9 million.

Many effective procedures in the rehabilitation of blind persons have been developed in this country. Unfortunately, we do not know whether, or to what extent, these might be sucessfully applied in other countries, where differences in environment, employment, education, etc., raise important problems peculiar to the individual country.

Experiments should be conducted in establishing optical aids clinics, on the pattern now used in a number of communities in this country. Through the use of modern optical lenses, many persons with such extremely low vision that they are blind for all practical purposes now are able to read newspapers and perform other activities, including success in holding jobs. A sizable inroad on the problem of blindness in the world could be made if we were able to establish experimental pilot projects in adapting our optical aids clinics, along with related rehabilitation services, to the specific eye conditions and associated problems of those in other countries of the world.

Disability, employment, and social insurance systems

The progress made in the United States in bringing the handicapped into productive employment, much of it due to the fine work of the President's Committee on Employment of the Physically Handicapped, has been matched by