The Urgent Call for Inclusivity in the Pakistani Healthcare System for People Who Are Blind or Have Low Vision

According to the International Agency for the Prevention of Blindness (IABP), in 2020, there were nearly 12 million people in South Asia who were reported to be completely blind, with 1.8 million residing in Pakistan (IABP, n.d.). This demographic reality underscores the critical juncture of the healthcare system in Pakistan, a lower-middle income setting, necessitating immediate attention and enhanced inclusivity to address the myriad challenges faced by individuals who are severely visually impaired or totally blind. Despite commendable efforts, such as achieving a national cataract surgery rate of 5,307 per million individuals (given cataracts are a leading cause of blindness), there remain several critical areas within the healthcare sector that demand targeted interventions to alleviate the persistent difficulties experienced by people with visual impairments (i.e., those who are blind or have low vision) (Khan et al., 2022).

Individuals with visual impairments can experience anxiety, depression, and fear due to the challenges they encounter when seeking medical care (Carlson et al., 2020). The current healthcare infrastructure in Pakistan presents a notable gap in inclusivity for individuals with visual impairments. Although the European Commission mandates the use of braille on medicinal packaging for enhanced readability, many pharmaceutical companies in Pakistan have yet to incorporate this feature (European Blind Union, 2022). Public sector hospitals, integral components of the healthcare landscape, often lack vital services such as large-print signs for enhanced clarity and staff members who are trained to work with people with visual impairments.

In addition, while private-sector hospitals are spacious, many public-sector hospitals are overcrowded, and the height of poverty can be observed in these settings. Individuals camp inside or outside the hospital premises, which disrupts accessibility for people with visual impairments. For example, many patient companions occupy space on hospital floors, since they cannot afford to pay for accommodation elsewhere during the duration of the patient's treatment. This environment restricts the movement of individuals with visual impairments, who may be using canes or other assistive devices for navigation.

Tactile signage and braille instructions are not available in other facilities such as restrooms. The current hospital standards, as outlined in the Sindh Service Delivery Standards for Hospitals in Pakistan (Sindh Health Care Commission, 2017) and the Islamabad Healthcare Regulatory Authority Standards (Islamabad Healthcare Regulatory Authority, n.d.), lack provisions for these crucial accessibility measures.

A study by Tariq et al. (2022) reveals that a majority of primary healthcare workers possess a limited understanding of eye problems such as blindness, leading to inadequate practices in primary eye care.

Although many hospitals have transitioned to online appointment systems, informational websites are rarely compatible with screen readers or use text-to-speech tools. Moreover, household diagnostic equipment like blood pressure monitors and glucose meters lack audio outputs, increasing the reliance of individuals with visual impairments on their sighted caretakers.

Telehealth services allow individuals with visual impairments to avoid the obstacles of needing to travel to and maneuvering around a hospital, however, one in two Pakistanis do not own a personal mobile telephone or smartphone (Gallup Pakistan, 2023), putting this approach of healthcare delivery off the table for a large proportion of the population. Moreover, according to Adnan et al. (2020) doctor–patient communication is not effective in certain hospitals in Pakistan. Since individuals with visual impairments are increasingly reliant on verbal communications, incomplete communication before treatment or any sort of imaging procedure can overwhelm the individual and result in ineffective care.

According to a study by Hosseini (2021), there are not enough accommodations for people with visual impairments across multiple hospitals in the United States. However, these hospitals do offer basic accommodations such as signaling on the walls, contrasting colors, and magnifying glasses. A few offered textured floors, colored food dishes, magnifiers, and audio guides, as well. Hosseini further reported that one of the centers offered remote controls and telephones with braille labels (2021). Another study, by Carlson et al. (2020), reported an educational scheme by which staff members in a hospital were taught how to improve the care of people with visual impairments. Braille versions of the hospital menu were introduced, the hospital provided useful daily care items to patients with visual impairments, and bracelets were distributed to visually impaired patients to alert staff members to their needs (Carlson et al., 2020).

A study by O’Day et al. (2004) highlighted several ways to improve communication and healthcare delivery to people with visual impairments. These authors listed suggestions such as ensuring privacy when visually impaired individuals are assisted to complete forms (e.g., paperwork at the front desk), allowing patients to audiotape medical instructions, introducing all personnel who enter the room when the patient is present, verbalizing visual information during examinations and procedures, and understanding the need for patients to bring service dogs such as dog guides into the facility. Above all, the study highlighted the need for visually impaired patients to be treated with respect and have a say in their own treatment plans.

Considering what is being currently done in healthcare settings across the world, the Pakistani healthcare system can be improved in order to be more inclusive. Firstly, healthcare personnel in Pakistan need to be trained to treat patients who are visually impaired. Training measures can increase their awareness of the needs of people with visual impairments and facilitate efficient conversations. Such training measures could include simple strategies such as never leaving a conversation without saying so, using accurate and specific language when giving directions or explaining where things are, and providing information in an accessible format such as audio recording instead of in writing or in print.

Another way to provide inclusive health care to people with visual impairments would be to improve accessibility inside hospitals and medical centers by providing tactile signs and large-print, high-contrast labels; and constructing infrastructure that takes into consideration the needs of individuals with visual impairments. To further facilitate such accessibility, hospitals could offer special boxes with essential items for patients with visual impairments such as lighted magnifying glasses, braille menus, identification bracelets, and special contrasting colored plates. These measures are easily implementable and can significantly improve healthcare experiences for individuals with visual impairments. By providing tactile navigation aids to patients with visual impairments, these individuals can navigate the premises independently and would not need to constantly ask for help and rely on assistance.

Additionally, current Pakistani healthcare policy should be reformed to integrate inclusive practices such as ensuring braille labeling on medicinal packaging. To ensure sustainability, regulations necessitating these changes can be imposed. By developing a feedback system for patients and healthcare providers, these services can be improved further.

Importantly, these proposed measures are neither expensive nor do they necessitate drastic changes, offering a convenient and pragmatic path toward a more inclusive healthcare system across the country for people with visual disabilities.