Petra Verweyen and Lea Hyvärinen

P.C.E.A.Kikuyu Hospital, Eye Unit, P.O.Box 45, Kikuyu, Kenya

The Low Vision Project - Kenya was started in 1994 by Christoffel Blindenmission (CBM) to support the education of visually impaired children. The aim of the project is to assist children with low vision to access education through optimal use of sight. To achieve this, the project provides optical and non-optical devices to individual children and offers training to teachers on how to efficiently support children through application of various methods of low vision therapy. The Project works in close collaboration with the Ministry of Education, the Sight Savers International and the Kenya Society for the Blind. It is based at the PCEA Kikuyu Hospital Eye Unit near Nairobi.

Now five years later the functions of the service have been evaluated by an Evaluation Team consisting of one Local Evaluator, Mr. Yalo from the MasenoUniversity College, Department of Special Education, Representatives of the Ministry of Education, Mr. Samuel Ogwang, Inspector of Schools and Mrs. Jane Ganira, Assistant Director of Education and an External Evaluator, Dr. Lea Hyvärinen, Senior Lecturer from the University of Tampere, Finland. During its work the Team had several resource persons from the Low Vision Project and the CBM.

Six Primary Schools for the Blind and two Integrated Programs have been the main target of the Project but also 10 additional Integrated Programs and the only Secondary School for the Blind have been supported with following services:

  • comprehensive assessment of individual children's vision
  • optical and non-optical devices, fitting and training
  • training of teachers
  • follow-up of children once a year or more often
  • conducting awareness and information seminars.

Assessment and Educational Categories
With the individual assessments, which covered refraction, visual acuity at distance and near, oculomotor functions and fitting of optical and non-optical low vision devices, groups with the following educational needs were detected:

  1. Children who could use print as their educational medium and
  2. Those who needed to use Braille.

The groups were further divided into five Educational Categories:

  • Category I, totally blind children, Braille users
  • Category II, children with some useful vision but not enough to read print, thus Braille users
  • Category III, children reading print with optical devices
  • Category IV, children reading print with geometric magnification

At the beginning of the Project there were at the schools for the blind, also children whose vision was close to normal; some of them have not been able to transfer to regular schools. They are

  • Category V children with no need of special services.

These categories have been very useful when explaining the educational needs of children with low vision. The description starts from educational methods that are well known, i.e. the techniques of the blind, and then covers Category III children with obvious needs of magnification. With this order of presentation it is easier to accept and understand the more complicated problems of Category IV children than if the discussion had been started from the group with the best visual functions.

In Kenya these Categories have now become a standard in communication between medical and educational personnel when children's educational media and special educational needs are reported. The Evaluation Team recommended them for international use as the Educational Categories of Visually Impaired Children.

Devices, optical and non-optical
Children at the schools for the blind have received 151 spectacles for correction of refractive errors. The lenses and frames are often broken and some families take the glasses when the child comes home and don't give them back to the child when (s)he leaves for school. Sometimes when one of the lenses is broken, the glasses must be used like monovision lenses until somebody can bring them to the optician.

Many children have been operated on for secondary implantation of intraocular lenses and thus their glasses have become easier to manufacture locally. Some pseudophakic children have good vision in both eyes, some in only one eye.

134 optical and 101 non-optical devices have been given to schoolchildren. The optical devices are produced locally except for a few telescopes that have been supplied by CBM or donated by the School of Optometry in Berlin. The non-optical devices are made by a local carpenter, e.g. the reading stands with a box for reading materials, the so called "CBM-boxes", and the complete CBM-desks.

Training of Vision Support Teachers and Low Vision Therapists
The services for the visually impaired children required new personnel. Two groups of personnel have been trained: Vision Support Teachers (called Low Vision Assistants) who are teachers at the Schools for the Blind or in Integrated Programs and Low Vision Therapists who are trained to carry out the comprehensive low vision assessments. A curriculum for training was developed and is in process of official recognition in Kenya.

Vision Support Teachers have been trained as two separate groups, the first one started in 1996, the second in 1997. The first group has had 3 seminars, one each year, and the durations of the seminars were 15, 8 and 10 days. The second group started in August 1997 and has had two seminars. During the seminars the teachers have had lectures on anatomy, physiology, optics, special education, psychology, and assessment and training methods covering both the clinical, optical, educational and functional aspects. Tuition has also covered management of Low Vision Centres, networking and referral systems. The participants used one half of the time to practise assessment techniques, first testing each other, then assessing visually impaired children.

The seminars have been also used to develop assessment and training materials and recording and reporting forms. The Low Vision Centres are small, only one room in the schools where the Vision Support Teachers can carry out their assessments and training based on the assessment by the Low Vision Therapist. There they also have their Assessment Kits and their files, some in cabinets, some still on chairs. Despite the limited resources, the Vision Support Teachers have been able to train children to use their optical devices, to carry out preliminary assessments of visual function and to help the classroom teachers to understand individual children's visual functioning Of the 50 teachers who started the training, 32 work at present as Vision Support Teachers.

The Low Vision Therapists are trained for a year at the Low Vision and Squint Clinic at Kikuyu Eye Unit. The two first trainees worked together with the Co-ordinator of the Low Vision Project and the present two trainees with the two Low Vision Therapists who graduated in June 1997 and who now work as members of the Low Vision Team.

A Low Vision Therapist is required to be able to assess low vision in all other aspects but retinoscopy, which is a very demanding task, especially in the examination of the pseudophakic infants and toddlers. Results of the assessments of school children are sent to the Vision Support Teacher who continues training at the local school or at the School for the Visually Impaired.

Before the training started, a lot of consideration was given to the question 'who should be trained to become a Low Vision Therapist'. It was decided to choose a nurse and a teacher to be trained as a pair of trainees. Both backgrounds have been found to give a good starting point for low vision work.

Since, to begin with, the low vision services for children in Kenya were planned for the children at school age, a close collaboration with the Ministry of Education, the District Educational Officers, and the Head teachers of the schools has been an essential part of the work. They have participated in the planning of the Project, and a special seminar was conducted in 1996 for the Head teachers and in 1997 to sensitise the District Educational Officers so that the Vision Support Teachers would get exemption from part of their classroom work. In most districts they now can use two days a week to work in outreach or to train children at their own school.

During the Evaluation of the Low Vision Project in May 1999, representatives of all levels of administration expressed their gratitude because of the improvement in the education of children with low vision when they now can study using print as their learning media. Also most teachers have positive attitudes but there are still some sceptical voices and the Evaluation Team found even one child who has continued to read Braille visually.

More work is needed to introduce orientation and mobility, daily living skills and communication skills as parts of special education. Also further training is required in all areas of the services, especially in the administration and organisation of the low vision work at the schools.

In 1994 there were 1083 children in the Primary Schools for the Blind and in the Integrated Programs. Of these children 68% had low vision, 45% of whom could have used print although they were using Braille as their learning media. 15% of all the children had visual acuity better than 0.3 (6/18, 20/60). Now most of these normally or near normally sighted children study in regular schools.

At present, after the introduction of school fees and reinforcement of integrated education, there are 855 children in the Primary Schools for the Blind and the two Integrated Programs. Of them 539 (63%) have low vision and 42 still use Braille although they could use print as their learning media. These numbers also include the 31 Category V children who are still at the Schools for the Blind. These schools have thus become schools for the visually impaired and some of them have changed their name accordingly.

According to the Evaluation Team the Low Vision Project - Kenya has helped the schools to go through a major change in their education, hundreds of children have been and will be able to use their low vision effectively in learning during their formative years. The Low Vision Project - Kenya has demonstrated that it is possible to create a well functioning low vision service in a developing country using local materials and building the functions with due respect to local traditions.