Professor Madan Prasad Upadhyay, Founder Chairman at the BP Eye Foundation, discusses unlocking the door for pre-primary schooling of children with blindness and visual impairment.
Smriti Lama is a seven years old and the school ambassador for hygiene and cleanliness. She and five other children have just graduated from the Early Childhood Development Centre in Bhaktapur.
This sounds like a pretty normal story, but Smriti (pictured above) arrived on 15 January 2013 at the centre with a total lack of confidence and unable to perform basic daily chores. She had very low self-esteem and was defiant about receiving any kind of training that could help her. Smriti’s parents and siblings neglected her at home, she lacked any of the human dignity that you or I would expect. All because Smriti is blind.
The day when field trainers from the Enabling Centre at the Children’s Hospital for Eye, ENT and Rehabilitation Services (CHEERS) found Smriti and persuaded her to spend a few days at the centre changed everything.
After several sessions of counselling in the first three months Smriti agreed to stay and has thrived. She is a favourite at school and received her graduation certificate, along with five classmates, from the principal of Nepal’s first school for the blind, Dr. Rajendra Kumar Rongong. Twenty four other children with blindness, deafness and autism have been admitted to pre-schools and hopefully many more children with disability will begin to take the same journey.
The Ministry of Education in Nepal has set up 34,000 Early Childhood Development Centres (ECDC) like Smriti’s in the last ten years. The centres have brought rapid progress, from 80% of primary school age children being enrolled in 1990 to 94.5% in 2012.But there are no children with blindness or visual impairment in any of these centres. And children with disabilities make up for less than 1% of all school age children enrolled.
To meet the Millennium Development Goal (MDG) of primary education for all, Nepal needs to ensure enrolment of the missing 5% of the population. The challenge is being met by a coalition of partners who aim to scale up early enrolment through the project, ‘Making early childhood education inclusive for the CWBVI in Nepal’.
To address this urgent need the BP Eye Foundation and the Children’s Hospital for Eye, ENT and Rehabilitation Services (CHEERS) implemented a project that is administered by Sightsavers and funded by the UK Government.
To overcome the difficulty of identifying young children with a visual impairment for enrolment in pre-ECDC training, the project team have developed a partnership approach, harnessing multi-sector collaboration in a Search Army– an exercise that mobilises workers from the health, education, disability, civil society, and local development sectors.
Eye hospitals and medical colleges and schools were asked to refer CWBVI aged between three and six years. Referrals were also sought from Disability networks and children’s eye camps (which provide eye care services).
Children’s clubs and mother’s clubs, which are in many villages, promoted peer to peer communication on the subject of identifying CWBVI. Messages supporting the campaign were broadcast on radio, telecast and television.
All the CWBVI identified through these measures were assessed at CHEERS for their training needs and provided with training on daily activities, such as face washing, combing hair, brushing teeth, feeding themselves, walking independently and orienting them in time and space. An exercise called Dream Planning, designed by one of these trainers, was used to help motivate the children. They were asked what they would like to be when they grow up and then to tell a story about a little girl or boy who was blind, deaf or both and had overcome these barriers to achieve their dreams.
Key to this project was training for the children’s carers, the facilitators and the helpers of the ECDCs. Government officials were also trained in ways to improve enrolment levels of young CWBVI, in order to help the Department of Education meet the MDG target of universal primary school enrolment.
The Search Army exercise resulted in the identification of 39 CWBVI, exceeding the target of 30.
The attitude of parents, teachers, peers and the children was changed from a reluctance to engage into a desire to work. Self-confident children who are keen to learn are growing in esteem as a result of their experiences in education. In total 30 CWBVI have been enrolled in pre-schools, with only a few drop outs.
Most impressive was the change in mind-set of government officials. Their intention to reform and innovate in policy on the inclusion of children with disabilities in pre-primary schools is a lasting legacy of this project.
Among multiple challenges faced were: difficulty in finding CWBVI initially. When found, some CWBVI were not willing to undergo training. Some parents were unwilling to send their children to schools because of concerns for their safety while some other parents did not have the financial resources to support the child’s education. The ECDCs were unwilling to accept CWBVI because of mistaken belief that young CWBVI cannot cope at pre-primary schools. Following completion of training at CHEERS, the children themselves were not willing to go to school as they feared they would not get care and education similar to what CHEERS offered.
Although we thought that Female Community Health Volunteers would be enough to identify CWBVI because of their close proximity to the communities, additional strategies like the Search Army had to be used to identify CWBVI. There is no single solution to the complex problem of education, particularly for children with disabilities.
Need for modification of infrastructure
Although some children with multiple disabilities have been enrolled at CHEERS, the infrastructure developed to train CWBVI was in need of modification in order to meet the needs of children with multiple disabilities.
Many CWBVI were living far from the project area and it became clear that a hostel facility owned by the ECDC programme was essential. But, acquiring buildings suitable as a hostel for these children’s needs has proved very difficult.
Poverty an impediment to education
Although parents were convinced of the need for educating CWBVI, they were reluctant to support it because they simply didn’t have the money. Guidance was given to these parents on seeking support from local government and non-government bodies. This emphasises the need for cross-sector collaboration as a key driver of successful enrolment, retention and quality of education provision for these children.
In developing countries, it’s not easy to include CWBVI in mainstream education, because of the myths and misconceptions that abound. Parents find it difficult to accept their children with a disability as “children of God” just as other children are. That blindness is not “a curse of their past life”.
Teachers need training and enhancement of their capacity to support these children alongside other children in mainstream schools. Children with disabilities are often reluctant to attend school due to fears of harassment by teachers and students. The Search Army strategy is an effective way for identification and enrolment of CWBVI in schools which can address these fears. This hands-on approach of orientation and mobility, together with counselling, engages children with disabilities – opening the doors to early childhood development.
By Prof Madan Prasad Upadhyay, Founder Chairman at the BP Eye Foundation