Community Participation for Rehabilitation of Blind on the Orientation & Mobility from the Unsettled
Takbai Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
According to the United Nations in the Universal Declaration of Human Rights, the term disability means that a person who has the limitation of opportunities to take part in the individual life and the life of the community because the competence of mind and body are not perfect if they have happened since they were born or not. An inspection of population’s health of the National Statistical Office in 2007 found that there are 1,871,860 disabled people in Thailand, 746,549 blind people, 39.88% in total. In 2024, a number of blind people will increase to approximately 49%, and there are 2,179 blind people who live in Narathiwat Narathiwat is the southernmost province in Thailand and has been having an unsettled situation since 2004 such as explosions, snipers, the killing of hostages, the robbing guns from military camps, and the shooting of police in Tak Bai police station. Hence, people think that the government agencies and authorities are at a very high risk of danger. According to this mentioned situation above, the local people form Narathiwat are very scared and don’t rely on government agencies, so the situation obstructs the local people from getting treatment from hospitals and affects the mind and soul of blind people who cannot attend rituals The goals for blind people practicing orientation and mobility skills are to be able to live by themselves in daily life, to go to anywhere with a cane by themselves, to have a career depending on their own ability, and to attend the rituals and community activities. The orientation and mobility instruction in the three-border-province of the southern region of Thailand, Yala, Pattanee, and Narathiwat, does not work. Only 8.9% of blind people are taught in Narathiwat because of affectation of the current situation, the attitude of care takers who think that the skills cannot rehabilitate the blind people, the distance which is very far and tough to get a learning place, not enough income and little collaboration between people and whom it may concern. Moreover, these reasons affect the blind people who need help from their relatives and care takers. Tak Bai hospital found that many are sad, do not want to be alive, and blame themselves. For example, an old woman says “I really hate myself because I am a blind person. I cannot help my children and they have to take care of me. I do not want to be alive anymore. I am not able to do or help anything for my family. When there is an explosion or shooting, I do not know who is injured and died. I hear only the loud noise. If I can go to the Mosque to pray for peace, it may be better than sitting in the house. Sometimes, I think that I have a lot of sin.” The Buddhist and Islamic blind people’s mental health has problems such as anxiety and depression. And there is an increasing expense to hire someone to look after the blind people in the family. In some families, a care taker cannot go out to work and has few jobs. Furthermore, the main problem in the community does not help to facilitate for blind people because it is seen to be society’s problem. These problems affect the body and mind of blind people, so the cooperation between people in the community and organizations will help blind people to rehabilitate their orientation and mobility skills. These skills will support blind people to have a competence to take care of themselves, to have a more healthy body and mind, to do what they want to do in daily life, to have a career and to have a good attitude towards themselves and others. Consequently, they do not want a care taker to help them anymore, so that they have the better quality of their life.

B. Strategic Approach

 2. What was the solution?
In 2012, Dr.Somchai Srisombundit, a director of Tak Bai hospital, had the concept of orientation and mobility rehabilitation for blind people, and he set policies for promoting networks, participation and education so that they can live by themselves or within their families, communities and societies in daily life. They will use the rest of their senses to learn anything instead of using their vision, and they can do some of their routines independently, happily and safely. Moreover, they can adapt themselves to the new environment safely and correctly by moving anywhere with a cane. They also have a career and income and do not trouble anyone, especially their families, societies, and nation. Resources and cooperation with whoever it concerns help to develop the quality life of blind people in Narathiwat and neighboring provinces amidst southern Thailand’s insurgency, but it cannot definitely process the project. Tak Bai hospital, responsible for processing the project, has selected 5 nursing volunteers. Four of them from Ratchasuda College have been taught under a topic of orientation and mobility skills for a month and returned to be instructors. In addition, the final volunteer is responsible for coordinating the project in the 13 districts of Narathiwat for setting vehicles to support and separates volunteers to work offsite following government rules. The National Health Security office, Songkhla province provides an amount of funds for the rehabilitation of people with disabilities, tries to support the community to be a learning center. It also tries to make the care takers understand them, and has cooperation between public and private sectors such as community hospitals, Tambon health Promoting hospitals, District Health offices, Organization of Local Administration, head of communities and religious leaders. All of them take part to specify and search for blind people in the area. An advertisement of the project and giving the information to blind people and care takers about the orientation and mobility project help blind people understand each other, and blind people can rely on government authorities, and they will provide the orientation and mobility instruction in the community. The instructors will teach how to use ears to listen to the car sound in order to cross a road, social manners, how to move to anywhere with a cane in blind people’s area such as mountains, rubber tree plantations, orchards, riversides, roads, going in and out of buildings, going up and down stairs, attending religious activities in a temple or a mosque, so all of the skills make blind people have a better quality of life and appreciate themselves more.

 3. How did the initiative solve the problem and improve people’s lives?
The rehabilitation of blind people on the orientation and mobility has occurred for a long time. The blind people who were trained before taught other blind people in blind clubs or institutions for needy people. Right now, the orientation and mobility instruction is not enough for blind people. Then the National Health Security office sets the public health service units, province hospitals and so on, to be a learning place, and a period of a course is twenty days. The process still does not cover all the target blind groups for the five provinces of unsettled in southern of Thailand involving Satun, Phatthalung, Songkhla, Pathanee, Yala and Narathiwat. These are problems in rehabilitation of life quality of blind when compared to other regions of Thailand. Thus, the process of development of blind people’s quality life on orientation and mobility is combined with the sufficiency economy concept of King Rama IX which is approach, comprehension, and participated development. The first one is the approach: right now, the blind people are taught in hospital. They are not convenient to go there every day, so instruction in the hospitals should be changed. It should be happened in the community where a number of blind people are living. The second one is the comprehension: to tell blind people, care takers, their relatives and people in the community that the blind people can help themselves or do everything without help from other persons after they learn to rehabilitate on orientation and mobility. The last one is development: learning and teaching should be changed from twenty days to be ten days or one hundred sixty-six hours to be eighty hours; moreover, a period of travel is decrease from more than one hour to be less than 20 minutes. Consequently, other expenses are also decreased. There is cooperation between government sections and people in that area, Community hospitals, District Health offices, Tambon Health Promoting hospitals, Organizations of Local Administration, Village Health volunteers, head of communities, and a religious leaders, and all of them should make the target groups understand correctly the orientation and mobility project. They all have to find the target groups in the community and take the target groups to get the orientation and mobility course. Then they follow and assess the process. For example, are the instructors kind? Are the instructors brave enough to teach outside in dangerous situations? Does Tak Bai hospital support this project? Do the instructors continuously have a vehicle to take them to other districts in Narathiwat every day?

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
Orientation and mobility strategies for blind people are divided into 3 steps 1. Preparation: Tak Bai hospital arranges 4 lecturers and a volunteer who is responsible for coordinating the project, and all of them from Ratchasuda collage got the training how to teach blind people on orientation and mobility. The hospital will prepare equipment for workshop, advertising CD, and vinyl banners. Moreover the hospital also makes a curriculum which is applied from community context. A period of the curriculum is 10 days. In the first five days, the content is about theory, and for the rest of the five days, the content is about practical parts. The total period is 10 days or 80 hours. The hospital prepares a performance calendar and then let authorities, who work in Organization of Local Administration, Community hospital, Tombon health Promoting hospital and work as a village headman, religious leaders, and village health volunteers in the 13 districts of Narathiwat province know about the performance calendar at the Community hospitals or District Public Health office. The authorities or volunteers try to find blind people and tell them about the orientation and mobility project. 2. Performance: all participants will follow the strategy or plans in each area, and the 5 instructors will teach outside and take a Tak Bai hospital vehicle with a local driver to a learning area for ten days. Public health officers and instructors will teach blind people together. In addition, Organization of Local Administration authorities will take blind people and their relatives to a learning place for a period of 10 days, and a religion leader and a village headman will help local people understand the orientation and mobility project correctly. Consequently, the local people have a more positive attitude and can rely on the government. In the same way, the performance of Tak Bai hospital is more efficient, authorities will feel safe while they are working in the area of unsettled. 3. Following and Assessment: public health volunteers and authorities follow and assess the result of orientation and mobility skills when blind people go home and spend their daily life with their families and communities. The volunteers and authorities will assess them by using the line program technology after blind people finish learning after 2 weeks, a month, 3 months, and 6 months. If there are blind people who do not pass the criterion of assessment, the authorities will train them again.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
There are 5 stakeholders involved in rehabilitation of blind people on orientation and mobility project in the unsettled situation, Narathiwat 1. Organization of Social Development and Human Security provides information about blind rosters of all districts in Narathiwat province and address details in order to facilitate to find blind people in the community. 2. Organization of Local Administration provides vehicles to transfer blind people and their relatives to the learning places. It also sets the learning places and a canteen for blind people and their relatives. 3. Community hospital authorities, Tombon Health Promoting hospital authorities, District Health Officers, Public Health volunteers, and instructors register blind people in the blind roster and assessment. 4. In Narathiwat, there are two religions, Buddhism and Islam, and blind people and local people misunderstand and have negative attitudes to the orientation and mobility project, so religion leaders and village headmen can help blind people correctly understand the project. 5. Five lectures will provide instruction on orientation and mobility skills for blind people, and public health authorities will provide the media to facilitate them at the learning place for a period of 10 days and in daily life with their families and communities.
 6. How was the strategy implemented and what resources were mobilized?
Due to the unsettled situation in southernmost Thailand, the rehabilitation of the blind on the orientation and mobility should be designed for smoothly working. For the unity of work, the resources for the initiative were as following. 1) Human resources consisted of 4 trainers, 1 project responsible man for training the blind on orientation and mobility, health officers from Community hospitals, Primary care hospitals, Public Health office, Sub-district Administrative Office, Community Leaders, Religious Leaders who are responsible for target searching and managing the O&M service for the blind, educating and guiding the good attitude about the training to the blind and their relatives. 2) Materials consisted of a white staff, devices in everyday life such as glasses, toothpaste, drinking water bottles, wallets, bills, and other necessary things in their community, vehicles for trainers and the blind. 3) Equipment/Methods consisted of a curriculum for the rehabilitation of the blind on the orientation and mobility in which the training period is 10 days. The curriculum is composed of orientation skills, journeys following leaders, self-protection skills, walking by a white staff, up and down stairs, getting on a public bus, cross the road, barrier crossing, bill checking, sense perception, smelling, listening, daily life skills, manners, evaluation and work planning. 4) Budget The National Health Security Office 12 Songkhla supported budget for officers training on the orientation skill and mobility training 10%, the staff and equipment in ADL skill training 30%, allowance for trainers, meals and drinks 30%, Evaluation cost 10% and others 20%.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
From 2555 to 2557 B.E., the target was 198 blind men from 13 districts were trained in the rehabilitation of the blind on the orientation and mobility according to the blind needs in the unsettled situation in Narathiwat province. The most successful output was that the journey time was reduced from 1 hour to 20 minutes, the journey cost was reduced and the training time was reduced from 20 days to 10 days. If 100% of the blind are 158 blind people from 4 districts who were trained in past 3 years, 90% of blind people could attend the community activities, religious activities, do the daily activities by themselves, 57% of blind people could do their own work such as do the garden, do the hand-made broom, cooking, do housework. 100% of blind people were satisfied with this training. The expected output of this training is the blind can walk outside of the house by the white staff to other places such as markets, attend the community activities such as wedding ceremony. The important thing is the blind can go to pray at the mosques or temples by themselves more than 3 times per week. The unexpected result after this training is the blind self-care network and the rehabilitation officer for the blind in Narathiwat province was conducted. Both networks supported the service for the survival skill training for the blind in the community and remote areas. The number of the blind who was attended the training was increased respectively. This training service and the mentioned networks distributed the services gain opportunities for the blind. This is a free of charge service. All above, the officers had provided very good services for the blind to release their suffering in the unsettled situation.

 8. What were the most successful outputs and why was the initiative effective?
The community participation for rehabilitation of the blind on the orientation and mobility in the unsettled situation in Narathiwat province was started from 2555 to 2557. The team monitored the activities step by step in order to resolve the problem for the smooth working of the next steps. The activities which were monitored by the related team were the training design and work plan, during training, result summarization, evaluation, the community network meeting, problems and obstacles. There are 2 systems for activities evaluation: 1) An evaluation form for the orientation and mobility (O&M) skill efficiency after training which is composed of 4 parts of questions, the score is variation from 0-4 points, the total score is 100 points. If the score is lower than 50 points, the blind have to re-attend the training. 2) Line program follow up (group O&M). The officers of the districts will summarize the evaluation score and submit it to the trainers of the Takbai hospital via the Line program. The trainers of the Takbai hospital will visit the blind that got a low score at their home after training in every 1 month, 3 months and 6 months in order to re-evaluate and solve the different problem of each case. The evaluation score will be used in the curriculum improvement for other places.

 9. What were the main obstacles encountered and how were they overcome?
The rehabilitation of the blind on the orientation and mobility in the unsettled situation in Narathiwat province was very difficult to conduct. 5 trainers of the Takbai hospital had to set up the training outside of the hospital according to the plan in all districts in Narathiwat province. There are many obstacles in this project. The main obstacle was the unsettled situation such as the main road was bombed that the trainers could not use that road and had to find a new road which was far than the main road. That situation made the trainers feel unsafe and wasted time. Second, more than 90% of the blind are Muslim that they think that touching between men and women who are not relatives is not allowed. Therefore, the religious leaders of the community were invited to explain to the blind that they are allowed to attend this kind of activities. Third, the villagers in the unsettled situation were quite afraid of attending the activities which were conducted by the government agency for many days since the local terrorists will think that the blind might give their address and other information to the military. That made the blind and their families stay in an unsafe situation, and might be injured by the terrorists. In this case, the community leaders and the religious leaders of the community had to explain the objectives of the training to villagers that this was a medical service for the blind. After the villagers understand the objectives of this training, they all gave good cooperation. The last obstacle was the language barrier because most of the blind speak the Jawi language, the local language, but only 2 of trainers can speak the Jawi language. The ratio of trainers and the blind is 1:5. So, the training time was more than usual. The solution of this case was to find more volunteers and health officers who can communicate in the Jawi language with the blind.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The key benefits from the rehabilitation of the blind on the orientation and mobility under the network integration and the community participation were that the medical services were distributed for the blind in 4 districts in 3 years. 198 blind men gained these services. It means 100% of the blind accessed the service. This services distributed opportunities for the blind in the village and remote areas free of charge. The suffering of the blind was decreased. They could stand by themselves and had a much better quality of life. Below are the words from the blind who attended the training. “The white staff is like the eye light. I really appreciate this staff. I can walk anywhere I love that I am not bumping into anything. I can walk to visit my nephew by myself” (Mrs. Sitibidoh Ar-wae) “After the training, I can go to anywhere conveniently. I can avoid the barriers better than before” (Mr. Ar-wae Hama) “Before, my wife had to take care of me in everything. It is really lucky for me that the doctor came to teach me how to use the white staff. Now, I can take care of my wife instead. I can work in the night time without turning on the light.” (Mr. Ing Maneerut)

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
The rehabilitation of the blind on the orientation and mobility was moved on with proactive initiative and network integration that affects the project sustainable in 3 years. This project can be used in nearby provinces such as Pattani, Yala, Songkhla and Satun province. The National Health Security Office 12 Songkhla reports that the problem of the training of the rehabilitation of the blind on the orientation and mobility in other provinces which are near Narathiwat province is that the trainers could not conduct the training in all districts in the provinces, and the number of the blind who were attended the training was lower than 50% of the target. As per the sustainable of the trainers of the Takbai hospital, they were invited to conduct the training in Satun province in 2555-2556. The main project sustainability is the Vision and Mission of the agency, “To distribute medical services to disadvantaged groups under the multiculturalism of Buddhism, Muslim communities in the unsettled situation in the southernmost provinces”. Health officers who have a service mind and a good attitude in this type of training are needed. The target of the blind are many types of the blind such as 2 sides blind since birth, dimmed vision caused by other diseases or by an accident. The training place should be set up near the blind house since the far training place was not convenient for the blind, and their families wondered if they can take care of themselves during the way to the training place or not. The training period was reduced from 20 days to 10 days (80 hrs.). The blind were trained around their house with their family at their living places. The facilities for the blind during the training were the bus, meals, snacks, and a white staff. All trainers who are responsible for taking care of the blind were certified by the Ratchasuda College. The ratio of trainers and the blind is 1:5. The training was composed of the environmental awareness skill, position, direction, sensory perception via smell, physical touching, listening, the rest of visual ability skills, protection skills, walking alone without staff/leader skills, how to use the white staff, how to walk in the dark, how to follow instructions. All skills of the training aims for the blind can stand by themselves with a better quality of life, more conveniece and improved safety. The result of the evaluation by the 198 blind men in 2555 and 2556 found that 95% were satisfied with the training.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The developing concept of His Majesty King Bhumipol Adulyadej is the lessons from the rehabilitation of the blind on the orientation and mobility in the unsettled situation in Narathiwat province. His concept is the understanding and accessing to the lifestyle, attitude, and beliefs of the people who have different religions, understanding the family members of the blind. One more thing that the staff has to realize is the different levels of satisfaction of the villagers about government services. Now, the villagers accept and realize that the Takbaihospital services people with sincerely. The Takbai hospital intend to develop the survival skills for the blind, and plan for the target blind searching together with the health officers, community leaders, religious leaders, the local administrative offices and volunteers. The networks cooperate with the Takbai hospital under the community participation in every district. The important thing that made the trainers and team feel safe is the guarantee of safety by villagers and religious leaders in the local area, even though there were bombings and assassinations daily. The villagers helped the trainers of the Takbai hospital to solve the unexpected problems from 2555 until now. Finally, because of the cooperation between the Takbai hospital and community, the quality of life of the blind is improved, and they all feel proud of themselves and have a much happier life than before.

Contact Information

Institution Name:   Takbai Hospital
Institution Type:   Government Agency  
Contact Person:   Dr.Somchai Srisombandit
Title:   Director,Takbai Hospital  
Telephone/ Fax:   +(66) 7 358 1200/+ (66) 7 352 4227
Institution's / Project's Website:  
E-mail:   was.na@hotmail.com  
Address:   114/63 Takbai Hospital
Postal Code:   96110
City:   Takbai
State/Province:   Narathiwat
Country:  

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