Introduction
As eye health workers, we give much attention to learning and teaching the importance of health education and the prevention and treatment of eye disease. Despite our gained knowledge, sadly, our efforts are not always successful and we are presented with the responsibility and challenge of caring for people who have to cope with visual impairment, perhaps for the rest of their lives. We have to understand their difficulties, recognise their abilities and learn how to cooperate and communicate with them in a social as well as hospital environment. It is often within the eye hospital itself that the lack in education of health workers and their understanding of the assistance needs of blind and visually impaired patients is all too evident.
Visually impaired and blind people come from all kinds of backgrounds. Many are elderly, some are young. They may be sportsmen and women, gardeners, farmers, chess players, teachers, typists, musicians, lawyers, housewives, computer programmers, physiotherapists, social workers, telephonists, parents……
Such people have many abilities and can achieve many things despite visual impairment or blindness, but there are times when they will appreciate and welcome practical assistance.
Meeting and Greeting (Fig. 1)
Fig. 1.
There are some general points to remember, which are really common sense and a matter of courtesy:
Always ask first before offering any help and do not be offended if it is refused. Some people have had very bad experiences of what a sighted person thinks is being helpful!
Be precise if giving instructions – giving directions by pointing and saying, ‘it is down there on the right’, is not much help and very thoughtless
The use of a white cane does not necessarily mean that a person is totally blind
In some countries a person is accompanied by a guide dog but the animal must never be distracted. Often it is the animal who receives attention and the owner ignored! Together they usually make a good working team and rarely need extra help
Once into a conversation, never leave without saying you are doing so. Do not allow the blind person the embarrassment of talking into the air!
Approach and Attitude
Always treat a blind person normally; speak first and introduce yourself
Shake hands but only if a hand is offered
It is also politeness to look at him/her during conversation and adopt the same level of position, e.g., sit or stand
Do not be afraid of using normal language and include words like ‘look’, ‘see’, ‘read’, remembering that blind and visually impaired people have exactly the same vocabulary as sighted people
Explain noises and silences and do not shout
Do not expect or invite others to speak for blind people. Do not be afraid to ‘touch’ but be sensitive to cultural differences.
Guiding (Fig. 2)
Fig. 2.
Always consider a person's age and any other disabilities
- Never presume where the person wants to go. Ask for details of where and how he/she would like to be guided. It is not uncommon to see a person being propelled or steered, and at great speed! Go at their pace and, if there is space, walk side by side and always ‘hand to arm’
Trying to be helpful – but the patient would have felt more supported if the helper had walked alongside himPhoto: Sue Stevens If there is a guide dog, but extra help is needed, approach and walk on the other side. The animal has been trained to understand that he is still in charge and responsible!
Give adequate room around obstacles and hazards and plenty of time for response if you need to say, “bend your head low to avoid this tree branch!”
Describe any sudden changes in the environment. It is also very important to explain changes in ground surfaces and especially when moving into wide open spaces, e.g., fields.
Walking in Single File or in Narrow Spaces (e.g., in shops, offices and busy crowded areas) (Fig. 3)
Fig. 3.
Tell your partner of the change in surroundings and then move your own guiding arm towards the middle of your own back
Your partner should automatically step in behind you, still holding your arm, and together you will be able to negotiate a narrow space.
Doorways (Fig. 4)
Fig. 4.
It is important to take this manoeuvre (movement) very slowly; it is not an easy one to master
Tell your partner if the door opens towards you or away from you
Go through the door with your partner on the hinge side
Open the door with your guiding arm; your partner should place his/her hand against the door to feel the handle
He/she should then follow you through and close the door behind both of you.
Steps, Stairs and Slopes (Fig. 5)
Fig. 5.
Tell your partner whether the steps, stairs or slope go up or down. Going down is more difficult.
Allow your partner plenty of time to hold the handrail securely and judge the first step carefully
Go one step ahead and take a slightly longer stride on the last step to allow your partner space.
Kerbs and Roads (Fig. 6)
Fig. 6.
Never take risks!
Tell your partner if you are approaching a ‘kerb up’ or ‘kerb down’ (the step onto or off a pavement/sidewalk) and pause slightly before taking the step
Make sure you approach the kerb together – both facing, and at an equal distance from the kerb – taking extra care with rounded kerbs
Cross the road using the shortest distance and go straight across
Tell your partner if you are parting company after crossing the road and ensure they know which way they are facing.
Seating (Fig. 7)
Fig. 7.
Never propel or steer a blind or visually impaired person backwards into a seat!
Guide your partner to the seat and explain what type it is – e.g., upright chair, low sofa, armchair, stool
Ask them to let go of your arm and place their hand on the back or the seat of the chair
This is sufficient help as your partner will now be able to judge the height of the seat and will be able to sit safely and at his/her own pace.
Travelling (Fig. 8)
Fig. 8.
Tell your partner if he/she is getting into the back or the front seat of a car and whether it is facing left or right
Place your guiding hand on the door handle and allow him/her to slide his/her grip hand down your arm to the door handle
With his/her other hand, the car roof can be noted and your partner will lower his/her head appropriately
At the end of the journey, get out of the car before your partner and help them out
Tell them if there are wider than average gaps to cross – this is particularly important when travelling by train!
Always lead your partner on and off public transport.
In rural areas, extra help may be needed when you and your partner have to negotiate getting on and off unstable modes of transport, e.g., carts, boats, etc.
In the Eye Hospital
The patient will expect eye health workers to know how to help them
Always apply all the principles mentioned above; be extra gentle and take time
Remember your patient is at the hospital because they cannot see well – sadly, an often seemingly forgotten point, even by the more senior or so-called experienced staff members!
Never be afraid to ask the patient's opinion about a situation specific to them and how they would like to be assisted
In the treatment room, always explain what you are going to do – and to which eye!
When providing written information, make sure it is in a readable size and font and pass it to an attending sighted carer for future reference
An unaccompanied patient who may be unable to hear, as well as having sight problems, may benefit from taped information to take away and share with family at home.
Eye health workers have a responsibility, and an important position, for teaching others about assistance to the visually impaired. But we must be seen to be practising what we teach. A community-based rehabilitation project in Uganda, some years ago, used a very appropriate and challenging means of raising awareness. They provided T shirts for the project team members with illustrations and slogans which read, ‘Don't pull me’ (front – see Fig. 9) and ‘Walk with me’ (back – see Fig. 10). Can you think of similar activities, perhaps?
Fig. 9.
‘Don't pull me!’
Fig. 10.
‘Walk with me!’