Education of traditional medicine for people with visual impairments in Brazil: Challenges and strategies.

Nearly 15% of the population worldwide lives with some form of disability; in Brazil, 24% of the population self-declares with disability. People with disabilities (PWD) living alone or in small-sized households and those with severe disabilities have high costs of living. PWD are at higher risk of insufficient social protection, get fewer opportunities for professional development, and are more socially unprotected, which translates into an inequality in face of job disputes.

Visual impairment—blindness or low vision—account for most cases of disability in Brazil. The total cost of visual impairments in 2010 was estimated at $3 trillion worldwide, with an expected increase of 20% by 2020. The average annual expenses of people with visual impairments (PwVI) are almost twofold the costs for non-blind people. With such an economic burden is urgent to promote local efforts and public policies for technical and higher education to include PWD in market labor.

In Brazil, shiatsu is taught in private/public schools as a technical/higher education (specialization for health professionals) in massage therapy courses; there are 231 courses with a 1200-h duration located in 20 (74%) States nationwide in public schools.

Shiatsu therapy is TM/CAM that comprises the use of pressure from body parts on points along pathways (i.e. channel). The anatomic location of channels and channel points are described using written texts and visual schemes (e.g. body charts). Teaching both the channel and related points usually involves the location of anatomic landmarks; some landmarks are arguably easily located by visual inspection, but others are far less evident or not evident at all without the aid of visual inspection (e.g. the pathway connecting two channel’s points). This makes the teaching-learning process of shiatsu a major challenge for PwVI—mainly for the blind (Fig. 1).

Fig. 1

The burdens of disability and education of people with visual impairment in shiatsu.

The visual impairment must be considered when selecting the methodological strategies applied in technical or higher education. ‘Students with special educational needs’ not only demand specific skills from educators but also new assistive learning technologies that might help educators teaching the same shiatsu program available for non-blind people. Nonetheless, there is not sufficient high-quality research on assistive technology for PwVI.

In Japan, there are several educational organizations for PwVI. The examination for PwVI is conducted in Braille script to obtain a national statutory license. In Korea, massage therapy was taught to PwVI as a form of vocational education during the Japanese colonial era (1910–1945) and was exclusive to PwVI from 1945 to the 1980s. Interestingly, in Hawaii, class notes and reading material were converted to Braille and audio taped for each student, alongside enabling access to skeletons and cadavers, such that PwVI were integrated to sighted students.

Classroom-based interventions for PwVI includes assistive technologies such as Braille devices, computer-based voice input-output, optical devices, audio recordings, vision aids, videophones, screen readers, among others., These technologies allow PvWI to access the same information available for non-blind people thus promoting all students through the same education process.

PwVI have different ways of understanding and being in the world—often with the aid of other senses. TM/CAM approach is based on the use of the five senses to clinical assessment and therapeutic interventions. Tactile exploration is an essential resource for the development of traditional medicine; it made early Chinese physicians aware of aspects impossible to ascertain through a visual inspection.

In conclusion, to promote education in TM/CAM for PwVI and hence contributing to the 2030 Agenda for the Sustainable Development, PwVI must be exposed to as many educational experiences as possible and encouraged to join the development of assistive technologies. Educators need to acknowledge the potential barriers and search for methods and techniques, in partnership with students. Institutes must provide assistive technology for PwVI focusing in tactile exploration, preferably developed and/or manufactured locally to avoid extra cost and irrelevant hindrance.

Acknowledgements

Centro Universitário Augusto Motta hosted this research and provided supervision as part of postgraduate study.

Author contributions

Conceptualization: MFS and ASF. Methodology: MFS and ASF. Investigation: MFS and ASF. Resources: MFS and ASF. Writing – Original Draft: MFS and ASF. Writing – Review & Editing: ASF. Supervision: ASF. Project Administration: ASF.

Conflict of interests

The authors declare no conflict of interests.

Funding

None.

Ethical statement

Not applicable.

Data availability

Not applicable.