Inadequate medical facilities with lack of specialised drugs and other essential medical items, scientific isolation of medical staff, unavailability of orthoses and wheelchairs: such were a few of the problems identified in Bucharest in July 1991. The aim of the federation at the start of the project was to launch an action in many directions using two basic principles: using local means including human resources, and improving the existing facilities instead of erecting new buildings. Training of the staff goes side by side with the practice of total initial care. The family is taught to position and turn patients, practice chest physiotherapy and has become a major psychological and emotional support. An orthopaedic workshop has been set up to provide orthoses and to supervise the construction of wheelchairs in a local factory. The social situation of patients is assessed to initiate social integration in the community. Home visits are organised to offer advice for adaptations. The implementation of these actions is difficult in a country which has to solve many economic problems.