Community for Rehabilitation of Blind on the Orientation & Mobility in the Unsettled Situation in Na
Takbai Hospital

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
According to the statistical data on disabled people from the National Office for Empowerment of Persons with Disabilities in 2014, the approximate figure of disabled in Thailand was 1.5 million (3.1%). Among that, about 10% were blind. In Narathiwat Province, there are around 2,000 blind people. Narathiwat is the southernmost province in Thailand and has been suffering from unsettled situations since 2004. Explosions; snipers; robbing guns from military and shooting have occurred for more than 10 years with a huge number of deaths and disabled. The distrust among local people and governmental officers are obvious and discourages public services in local areas. This also affects the health care services at the health facilities. Patients are reluctant to get treatment at the hospital and health centres. Disabled seem to get worse due to the obstacles of their limited independence. It is acceptably proven that blind people could live on their own if they could learn and practice in an appropriate way. Orientation and Mobility (O&M) is a kind of practical workshop to accommodate blind people to be able to be independent on their daily lives. Prior to this project, only 8.9% of blind people in Narathiwat got trained. Moreover, the training place and facility was not situated in the province. This even became serious obstacles for blind people to be away from their home town for more than a month. Many of them were not allowed from their families and relatives. Eventually, only few could have a chance to participate the O&M course.

B. Strategic Approach

 2. What was the solution?
The training centre was established at TakBai Hospital as a provincial hub in 2012 and has performed the course on a regular basis. The network of disabled groups in all districts together with local authorities searched and convinced those blind to participate the O&M course. Assessment after the certain period of time was done at their home by local authority staff and public health volunteers.

 3. How did the initiative solve the problem and improve people’s lives?
Prior to the project implementation, most blind people in local areas are kept in their homes as they are not able to live on their own outside without care givers. In particular, many of poor families with blind member(s) have to leave them at home during working. Without skills to live on their won, the limitation to mobilize independently is very common. Blind people generally feel frustrated and depressed accordingly. Moreover, under the unsettled conditions, security has been primarily high concern. A lot of families have to have a care giver to stay with their blind family member. This either increases the family expense or decreases the family income in case a care giver is one of the family members. After learning and practicing, most of them are happy to live independently, particularly outside homes. Many of them could go to pray at mosques and have more societal activities within community. Some of them dare travel outside their home villages. They are more confident to have activities without care giver. Cheerfulness is very common during the assessment. In the family perspective, saving family expenses is obvious. Family members who once have to take care of blind person could have been working and earning more money. On the other hand, full-time or part-time paid caregivers have not been necessary. As a result of multi-disciplinary teamwork, trust between local residents and government personnel has been improving. This is one of the critical strategies for peace in this area.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
The National Health Security Office set aside an O&M fundin 2012 according to the urgent need of increasing training centres of O&M for blind people nationwide. The main purpose was to train a large scale of blind people for independent living annually. The Ratchasuda College, Mahidol University, was an institution to perform training for trainers. The director of TakBai Hospital, Narathiwat Province, was interested in thisprogramme and forming a team to take part in this course. The standard duration for training blind people is 20 days. Five skilled trainers prepared the course at the hospital as a training centre. The first year of this new provincial centre, 4 batches of learners (50) were trained. All blind scholars had to travel on their own to the hospital daily. At the end of the courses, most learners complained the difficulty of traveling and many topics could not meet their actual needs. The recommendations were partially served as an important input for the following year. The curriculum of the following year was reviewed to meet scholar needs. The training place was moved into the community on the decision-making of multi-stakeholders. Scholars could participate in deciding which situations they wanted to practice. Eventually, as the training centre was moved into the community, the total duration was shortened to only 10 days with the similar achievement as the standard course.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
The director of TakBai Hospital expressed his concern upon the quality of life of disabled in the unsettled areas. The accessibility to health care of these people seemed not to be conveniently reachable. Due to insecure circumstances, many of them are left at home unless they got seriously sick. It is quite obvious that the quality of life of disabled group is rather poorer than ordinary people. When an announcement of O&M centre establishment project was addressed in early 2012, the director did not hesitate to apply for. He was convinced that blind people could have a great opportunity to practice in the workshop that has been as good as those at the centre. An O&M team was then set up. Four nurses and a village health volunteer got trained atthe Ratchasuda College, Mahidol University, ancentre of excellence for disabled rehabilitation. The advanced course took place for one month. The National Health Security Office, Region 12 Songkhla, additionally supported an amount of budget at 9,000 baht per one blind person for providing a training course at the hospital. The duration of the course was 20 days. Due to the inconvenience of daily traveling during the course and the place for practicing was not met their actual needs. Since 2013, the outreached training course has been undertaken at the community level. The duration was shortened to 10 days, nevertheless the overall objectives are still accomplished. It is highly expected that the rotation of courses would take place to all districts of the province. Each batch, the local authorities; district health officers; head of communities together with the instructors will make decision on the appropriate place as a centre for training. Moreover, the people-centred approach is still applied for other places in the community that they would like to practice. Apart from the centre of training in the community, they could have a chance to practice at the rubber tree plantation; orchards; riversides; local roads; going up and down stairs; and attending religious activities either at temple or mosque. This community approach is very favour able to all participants. From 2012 to 2016, the total number of participants is 351 covering 10 districts of Narathiwat Province. In the present year, the last two districts will be covered.
 6. How was the strategy implemented and what resources were mobilized?
The multi-disciplinary cooperation among stakeholders in the community is a key strategy of this project. The people-centred approach is another issue to be raised in order to meet their real needs. Outreached training programme has, thus, be implemented. Human resources play a pivot role of this project. Without the cooperation of local authorities and health workers, it would be rather difficult to search for blind people in villages. Community leaders and religious leaders also play as a key role to convince and ensure blind people and their relatives and families about the advantages of the training course. Financial support mainly came from the National Health Security Office. It covers all the expenses throughout the course i.e. training materials; white cane; travel expenses of participants and their care givers; and all other operational costs.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
Narathiwat Provincial Social Development and Human Security Office takes charge of the official disabled registration. The list of blind people with addresses has been supported. Health care staff of TakBai Hospital play a key role in this project. The National Health Security Office, Region 12 Songkhla, is the coordinator function of financing support. Teamwork from all district health offices and health centresare key players at local levels in line with community leaders to search for blind people. Last but not least, religious leaders facilitate the acceptance of the training course in the community.

 8. What were the most successful outputs and why was the initiative effective?
The quality of life of blind people is the primary goal of this project. Even if the coverage of this project within 5 years is not high (351 out of 2,179 (16%)), the distribution of service provision to other districts is apparently accomplished. The whole province is expected to be covered within this year. Upon the following-up after 2 weeks; one month; 3 months; and 6 months, respectively, many of them stated that they could live independently and have a much better quality of life. All of them were satisfied with this training course. Using white cane effectively, they are confident to walk outside and have less accident. Almost 90% of respondents replied that they are able to participate community and religious activities; andto perform daily life activities. More than half of respondents could be able to work again such as gardening, cooking, and household work. Cheerfulness becomes apparent. Members of families got several positive effects. First, they have more time to go to work. Second, in some families that hire care giver to look after a blind person, they save a lot of money. From the political point of view, this project plays a fundamental role of mutual understanding between local residents and government officers. Trust could be developed and very obvious. Eventually, peace is the prime benefit of this project as well

 9. What were the main obstacles encountered and how were they overcome?
During the first batch of the course, the learning centre was at the hospital. All details of the curriculum conformed what the Ratchasuda College designed. Along 20 days of the entire course, all participants had to travel from home to the hospital. Generally, they were not familiar with traveling as mostly they were kept inside their home. It was not very convenient to get on public transport especially in remote area. In addition, the sessions all were designed by experts in Bangkok. This standard curriculum was absolutely not appropriate for people in countryside. As a result, several participants could not attend everyday. In addition, most of the topics and practical sessions were developed upon the urban situation. No recreation activity during the day was intervened. Many of participants complained that the course was not interesting. After the first evaluation, restructuring the details of sessions was immediately conducted. The outreached approach was applied. The community centre was replaced. The duration was shortened down from 20 days to only 10 days. However, all objectives were still in place. All participants of each batch must be in the same district for travel convenience. Need assessment was done in advance. Recreation activities were intervened in order to keep participants’attentionand to gain student participation in the class. Places for white cane training in local community could be listed according to their needs. It is interesting to note that Muslim language was preparedin particular for the ones who cannot understand Thai language.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
Independent living of blind people is the key benefit. Improvement of quality of life is highly expected. Trust between local residents and governmental officers could be developed. Peace is expected to be enlightened from this small but powerful task.

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
Equity in accessibility of services for quality of life in this vulnerable group is clearly feasible. Integrity derives from the clarity of life when blind people are not necessary to depend on their care giver all the time. It is evident that TakBai Hospital really accounts for the leadership in health and quality of life in the district area. Moreover, it is highly proud that the hospital could serve as a centre of the whole Narathiwat Province. This hospital becomes very famous on rehabilitation in all aspects in the region. The holistic approach towards disabled people is applicable. Eventually, this leads to successful outputs and outcomes within a few years.

 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)
Narathiwat is one of the three provinces in the southernmost that has faced armed struggle for more than 12 years. Sabotage and violence occur spontaneously in different places. Militants have been settled in every village to control situations. Distrust happens between local citizens and militants mostly from outside. The difference in religion even widens the gap in communities. Disunity and disturbance become more aggressive. Guerrilla warfare and holding and operating forces deteriorate economic situation.Local citizens become one of the most vulnerable groups in the country. Within this unfavourable period of time, health-related activities seem to be the least risk of operations in general. Only few health care professionals suffer from this unsettled situation. Hospitals and other health facilities are generally not the prime target of sabotage. It can be stated that health-related activities are a key tool for reconciliation and societal conformity. The rotation of this project to all districts of the province enhances the collaboration between government organizations and involved local authorities throughout the province. As blind people tend to be withdrawn from society, O&M participation could raise their lives up again. Not only blind people are cheerful, but their relatives and families are also happy. Many of them could go back to work or at least live on their own with much less support from family. Obviously, economic constraint has been released.

Contact Information

Institution Name:   Takbai Hospital
Institution Type:   Academia  
Contact Person:   Somchai Srisombundit
Title:   Director of Takbai Hospital  
Telephone/ Fax:   +(66) 7 358 1459/+(66) 7 352 4227
Institution's / Project's Website:  
Address:   114/63 m.4
Postal Code:   96110
City:   Takbai
State/Province:   Narathiwat

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