Table of Contents  
LETTER TO THE EDITOR
Year : 2021  |  Volume : 29  |  Issue : 2  |  Page : 147-149

Encouraging Inclusive Education for the Blind in Developing Countries


Department of Ophthalmology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria

Date of Submission14-Sep-2020
Date of Decision04-Aug-2021
Date of Acceptance25-Aug-2021
Date of Web Publication18-Jan-2022

Correspondence Address:
Adedayo Omobolanle Adio
Department of Ophthalmology, University of Port Harcourt, Port Harcourt, Rivers State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njo.njo_37_20

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  Abstract 


Blindness rates especially avoidable ones still remain high despite various interventions in developing countries. Vision 2020 was therefore unattainable. Once a person goes irreversibly blind, the costs of rehabilitation and educating such a person dramatically rises. The response of government has been to send them to blind schools which has the distinct disadvantage of isolating them from their peers and causes them to lag behind educationally due to teaching methods not commensurate with modern standards. Recently, visually impaired people are encouraged to be schooled alongside their peers in an inclusive manner. For this to be successful, they need to be (re)habilitated first, then empowered with appropriate assistive devices. This communication highlights how this can be done so it can improve the current deplorable statistics of successful blind young people in developing countries such as Nigeria.

Keywords: Blind, inclusive education, Nigeria, visual impairment


How to cite this article:
Adio AO. Encouraging Inclusive Education for the Blind in Developing Countries. Niger J Ophthalmol 2021;29:147-9

How to cite this URL:
Adio AO. Encouraging Inclusive Education for the Blind in Developing Countries. Niger J Ophthalmol [serial online] 2021 [cited 2022 May 22];29:147-9. Available from: http://www.nigerianjournalofophthalmology.com/text.asp?2021/29/2/147/335917



Dear Editor,

I write to you about a very important (but often inadequately prepared for or overlooked) aspect in the education of the disabled especially the visually impaired mainly found in developing countries. This is because avoidable blindness rates have remained high despite various interventions.[1],[2],[3] Cost of funding to control it has not been sustainable (even though government should spend at least 5% of its GDP on health-related matters[4]); therefore, many who go blind, unfortunately remain blind.[5] Vision 2020: Sight for all was unattainable as up to 1,648,926 million Nigerians remain blind in 2021.[5],[6],[7] To compound the issue, blindness is an important cause of stigmatization,[8],[9] especially if the individual is uneducated. This gap will be mitigated with quality education.

Once irreversible blindness happens, the cost of rehabilitation and education is much higher,[2] leading to educational delays,[10] especially among girls.[11] Missing out or not completing education affects quality of life for individuals and their families, and has negative economic impact for countries which may lead to cycles of blindness in successive generations.[12],[13] Throughout Africa, less than 10% of children with a disability are in primary education. In some countries, only 13% receive any form of education.[12],[13] Even in countries where education is valued, many children with disabilities do not go to school.[12] In addition, they have more difficulty due to unsuitable buildings, inaccessible transport, inadequate special teacher support, and lack of access to assistive devices.[12]

Inclusive education for this vulnerable group reduces cost of education and improves integration. Government and all stakeholders should therefore make effort to start it. The Nigerian survey for blindness showed that blindness rates increase significantly with level of illiteracy (5.8%)[14] and the female gender (4.4%) and depend on the zone of Nigeria in question, with the north-east of Nigeria having a higher prevalence (6.1%) and on whether it is a rural (4.3%) or an urban area (3.8%).[15] Among children of the age group 10 to 15 years examined (by convenience sampling), the blindness prevalence was shown to be 0.6% with more blind kids in the south-south zone of Nigeria where I work[15] and a higher prevalence in the female gender (0.89% vs. 0.33%) as well as among illiterate children (1.53% vs. 0%). This shows the significance of literacy level. Education budgets in developing countries are however often limited, leaving insufficient resources for children with disabilities and especially toward the education of the blind.

Some authors have estimated that the cost of training blind people is five times greater than the cost of training a sighted person. [16,17] From unpublished personal experience with sponsoring blind people, the minimum yearly training costs to fully rehabilitate a blind person range from about N950,000 to N1,200,000 which is equivalent to approximately 2300 to 2800 US dollars (at N400 to 1 USD). Most of this amount goes into the assistive devices they require to be able to go through life successfully. This makes it very difficult for the blind to access quality education.[18],[19] Most schools exclusively for the blind which are government owned often do not have enough facilities to train appropriately and often only offer primitive methods limited in scope such as the Braille slates/Marburg and stylus. Since January 2019, when the disability bill was signed into law[20] parents still have to purchase their wards’ assistive devices at very high cost.[17] For example, less than 5% of published books in libraries are available in formats appropriate for people with visual impairment. [13,17] There is no plan which is visible except the same age old poorly maintained blind school facilities that have been in existence for decades. Plans should be made to accommodate modern assistive devices and Braille books and paper for visually impaired students in the education budget. No nation can live above its educational system.[21] Ours is currently overstretched, because annual education budget is atrociously low. In 2018, only a little above 7% was allocated to education, far below UNESCO’s recommended 15% to 20%.[22] Therefore, inclusive education may be better[23] and may bring social equality[24] instead of separating students based on disability and requiring far more funding. On an average, it has been observed anecdotally that blind students are at best 5 to 10 years behind (some more) in education compared with sighted people when you educate them separately. However, engaging them in inclusive education narrows this gap and makes them have higher quality of education.[25]

This plan however assumes that the visually impaired child has access to a school. Sadly, United Nations Children’s Fund made an observation that one in every five of the world’s out of school children is in northern Nigeria.[22] Education should be made to be equally accessible and inclusive in line with the policy of universal basic education. All that a visually impaired child requires is to be taught nonvisual modes for education in an inclusive manner with sighted peers.[23],[25],[26]

In case we have readers who are not familiar with preparing a child for inclusion. A period of adjustment or (re)habilitation depending on if they were born blind or became blind sometime after birth is required. If they were born blind, then there is no baseline from which to readjust from, they have to be taught from scratch how to experience and “visualize” what others who are sighted have taken for granted (this is called habilitation). For example, colors and objects are difficult to explain to someone who has never had vision but these concepts can still be taught in other specialized ways. However, if they had vision till sometime after birth, then it is referred to as rehabilitation. This intentional adjustment ideally should start as soon as it is decided that the condition is irreversible or untreatable and not a moment later. The eyecare worker (ophthalmologist) should decide this, not just a parent or guardian to avoid leaving those who have treatable conditions blind.[27] There are well-documented cases, where vision of kids sent to blind school was improved simply with good refraction and low vision aids.[27],[28]

A short period not more than 2 years depending on the age of the child should be used to train the child intensively, specifically employing modern nonvisual methods using the expanded core curriculum[29] before he/she can start inclusive education. These include compensatory academics − speaking and listening, organizational and communication (Braille) skills, orientation and mobility, activities of independent daily living, personal grooming, time management, cooking, cleaning, clothing care, money management, social interaction skills − how to express emotion and affection appropriately, active participation in physical and social recreational activities, for example, trying new leisure activities, following rules in games and activities at an appropriate level, maintaining safety during leisure activities, sensory efficiency − skills that help students use the senses, including any functional vision, hearing, touch, smell (olfactory), and taste (gustatory). Using optical aids, using augmentative and alternative communication devices, using touch and smell to identify personal items and location in addition to use of technology, for example, the laptop with text to speech software such as Job Access with Speech or Nonvisual desktop Access, etc., so that they can communicate with non-Braille literate teachers and colleagues in more productive and independent ways in addition to the use of the manual typewriter (especially if a printer and/or internet services is not widely available), use of the internet and information devices, for example, SMART phones, recording devices to keep any information acquired are also required.

To avoid lag in education, if a child is born blind, he/she should be enrolled by the age of 4 years for habilitation.

After 2 years of concentrated teaching and habilitation or rehabilitation, the help of a teacher of the severely visually impaired for follow-up is required to ensure methods taught are adhered to till the child is stable and proficient. Thereafter, the child is enrolled in a normal school and taught alongside other sighted kids, interacting in the same school, same class, writing the same examinations, and same assignments with future members of the same community with whom they can both contribute to the growth of that community. However, this will be so much easier if a child can have access to an electronic or smart device such as an iPad or similar.[30]

All schools where sighted children are taught are encouraged to be open to accommodating or inclusion of visually impaired children so that no child is left behind. Slight modifications will make this possible in most schools especially if they have the will. Government is encouraged to take their place to enforce this for the healthy progress of all its citizens and provide an enabling environment through provision of appropriate assistive devices that they will require to study effectively in addition to proper payment of teachers to ensure they concentrate on their work. Engaging in inclusive education will help to improve the statistics of successful blind young people in the country, which are currently less than 10 in number.[31]

In concluding my letter, I strongly advocate that blind children should not be educated separately in a blind school. It will not enable them reach their full potential, or allow for good societal integration. It usually ensures the visually disabled child is already disadvantaged from the start due to lower standards of instruction. They can actually reach for the stars like any other person. Let us leave no child behind.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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