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LOW VISION SERVICES PROVIDED BY THE LOW VISION PROJECT - KENYA

 

Situation
Children identified as having visual impairment in East Africa are educated in residential schools for the blind or integrated programmes. Christoffel Blindenmission (CBM) supports 9 residential schools (6 in Kenya, 2 in Tanzania and 1 in Uganda) and 2 integrated programmes. Sight Savers International supports most of the integrated programmes in East Africa.
The Kenya Government initiated 40 assessment centers in collaboration with DANIDA which are responsible for assessing all children with impairments in general and refer the individual student to the most appropriate educational institution, this also applies to those children with visual impairments.
In Kenya and Uganda institutes for special education were established under the sponsorship of DANIDA, where teachers can be trained in a 3 months or 2 year course in special education for visually impaired children. From 1995, Kenyatta University has been offering a 4 years course in special education .
In April 1994, Christoffel Blindenmission (CBM) established a Low Vision Project based at Kikuyu Eye Unit, which has the mandate to improve the overall standard of education of children with low vision. For the last 3 years the Low Vision Project has been offering services to children with low vision and special training for teachers in the field.
In a survey conducted by the Low Vision Project in 1994, 1083 children attending special schools and programmes were assessed. It was found that 68% benefit from low vision services. Almost 80% of the children with low vision have useful remaining sight to learn print, 35% by the use of OLVDs and 45% through special reading and writing training

Categories
Children with visual impairments can be categorized in 4 different categories according to their special education needs.
The categories were developed by the Low Vision Project in 1994 and are based on the working definition of the World Health Organization developed in 1992.
There was also a need to create a fifth category for children attending special schools and programmes who were not visually impaired (since they were mono eyed or wearing high power glasses).
The categories are as follows:
a. Category 1
Totally blind children with no perception of light, who need training in orientation and mobility and should be educated in braille.
b. Category 2
Children with low vision which is not enough to read print, who need visual stimulation, functional vision training or/and training in visual orientation, and who should be educated in braille.
c. Category 3
Children with low vision who can be trained to use their sight for reading and writing print with the aid of optical low vision devices, meaning that these children require magnification to cope with regular print.
d. Category 4
Children with low vision who can be educated in print using special techniques and methods without OLVD to read and write regular print efficiently and fluently.
e. Category 5
Children who are not low vision because their sight is above 6/18 and they do not have a severe visual field defect. These children can almost function like normal sighted students and they do not really need special education as long as their sight is constant.

NB Non optical LVDs can be supplied to children from Cat II to Cat. IV.

Children assessed by the Low Vision Project are always grouped in these 5 categories. In the first 3 years, 3182 low vision assessments have been done on 2589 patients who are children and adults.
These children were supplied with non optical low vision devices and special low vision training in different areas if needed. Children in Cat. III were also supplied with optical low vision devices and were trained on how to use these tools effectively.

Materials Supplied
Optical low vision devices supplied for Cat. III patients are mostly locally produced according to the CBM low vision assessment kit developed by Peter Spoerer in 1991.
Special print exercise books were developed by the Low Vision Project in 1996 and they are given out to the children with contrast problems who cannot see the lines in normal lined exercise books.
If needed we supply children with low vision also with special desks, CBM reading stands, felt pens, tape recorders and electric lights.
Each time we give out any kind of low vision device we advise the teacher to make sure that the child is properly trained on how to use the devices effectively.

Work Organization
The Low Vision Project has two co-ordinators. One, Dr. Michael Njoroge is a special educator and myself a low vision therapist/orthoptist. Both work closely with the Project Director Dr. Mark Wood, a consultant ophthalmologist based at Kikuyu Eye Unit. The Low Vision Team spends half of their working time at the base in Kikuyu Eye Unit and the other half in special schools and integrated programmes in East Africa.
For example in 1996 212 patients with low vision were assessed in the clinic. 66 of these were supplied with optical low vision devices and 40 were referred to special schools and programmes for the visually impaired.
A further 365 children were assessed in special schools and programmes. 80 of them got optical low vision devices.
Optical low vision devices are produced in the Kikuyu Eye Unit optical workshop.

Training Programme
To guarantee appropriate follow up for low vision students and programmes we offered special training through seminars for teachers in the field. Up to now we have identified a group of 25 teachers who come from different parts of Kenya, who get regular follow up training in low vision therapy. These special teachers are low vision assistants for the Low Vision Project.
Further we offered a one year training for two low vision trainees who became low vision therapists.
They completed their training in May this year and are now integrated staff of the Low Vision Project. One was originally a teacher in an integrated programme for visually impaired and the other one an eye nurse. We have chosen these two professions to find out which is more appropriate for low vision therapy. Both have completed their course successfully and we think that both professions can be accepted for training in low vision therapy.

Low Vision Assessment Kits
The Low Vision Project is in the process of developing 2 different types of low vision kits.
One to be used by low vision assistants and the other by regular or special teachers with basic low vision knowledge.
The first mentioned kit is an assessment kit which includes all different assessment materials to identify individual needs of the child and training material to teach the child to use the vision effectively which can be used by special trained low vision personnel. The second kit is a screening kit which includes materials to help find out the category of the child.

Plan For The Future
Through the co-operation of the Ministry of Education and the Ministry of Health we hope that the low vision work will be acknowledged in Kenya and that the role of the low vision assistants and therapists will be officially established and recognized by the relevant Ministry within the Kenyan Government.

Further training is planned for special teachers working in schools/programmes for the blind. The Low Vision Team is also planning to hold a seminar for medical eye workers who are based at hospitals and clinics.

Low vision rehabilitation should become an essential part in the system of special education for the visually impaired in East Africa so that children with low vision are prepared to cope in the sighted world as independent as possible.

Goal of Low Vision Work
The final goal of the Low Vision Project will be achieved when at least one teacher in every school or programme of visually impaired is trained in low vision and when low vision work gets fully acceptable and children with low vision get appropriate service on low vision and educational services.

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