Trinidad and Tobago is now in the third Phase of Child Health. The first Phase lasted approximately from around Independence (1960) when the first local paediatricians arrived home, until around 1980 and was characterized by improved and expanded immunization programmes and the decline of infectious diseases including gastroenteritis and pneumonia.
The second Phase lasted until the start of the 21st century. During this period cardiac problems, haematological illnesses, paediatric cancers, various neurological entities and improvements in the care of newborns and “preemies” came under some sort of control.
The third Phase started at the turn of the century and is defined by Psycho-Social-Paediatrics. The problems now are those of childhood obesity and its adult effects (diabetes, heart attacks, high blood pressure & strokes); violence - both outside and inside the home; educational and above all, children with disabilities.
According to the UN Enable definition, disability is defined as “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.”
A disability can refer to any of the following:
a) Physical: visual, auditory and mobility
b) Medical diseases: diabetes, epilepsy or cancers
c) Psychological: intellectual disability, emotional disturbances, dyslexia and other learning disabilities and phobias
d) Developmental: autism, Down Syndrome, Attention Deficit Hyperactive Disorder
e) ‘Hidden’ disabilities: mild forms of the above
[UN Programme on Disability - available at: http://www.un.org/esa/socdev/enable/faqs.htm.]
It has been estimated that around 16% of children in Trinidad and Tobago have special educational needs. (Marge Report 1984 ; Miske Witt 2008). That is almost 64,000 children.
- Hearing 4.6%
- Speech & Language 4.1%
- Learning Disability 2.0%
- Emotionally Disturbed 2.0%
- Physical 1.7%
- Mental 1.0%
- Visual (severe) 0.7%
When these disabilities are apparent, it is relativity easy to identify them. When they are mild, they are unlikely to be diagnosed unless specific testing is done. They can be termed as “hidden” disabilities.
Children with visible disabilities continue to need earlier recognition and more services but they represent the tip of the iceberg. Many children who appear to function normally are failing school because their disabilities are not being recognized and diagnosed. These are the children who do not hear well in a classroom of thirty boisterous children. In the school year 2005 to 2006, 3% of 30,552 primary school children failed their first year hearing screen. These are the children who cannot see the blackboard from the back of the classroom where they have been placed because they are not doing well, who have challenges reading and writing because of unidentified learning disabilities, who have some form of ADHD or who lie somewhere on the autistic spectrum; or have high IQs but are turned off by the local educational system with its emphasis on learning by rote.
In the same year, 2006, a Ministry of Education survey revealed that 23% of approximately 16,000 primary school children had been referred to their Student Support Services Division for learning and behavioural problems. A Families in Action survey of one primary school in St. Ann’s, Port of Spain in Trinidad found that an astonishing 70% of the children were academically impaired, due to hidden disabilities, both learning and social.
Many of these children, often coming from low socio-economic backgrounds, are unfairly labelled as “social misfits” and treated as such with rejection by school authorities, leading to school failure. This is not to say that the problem is one exclusive to poverty but certainly access to paediatric and psychological help is easier in the private sector.
The options of those in poverty are limited, especially where there is insufficient assistance in the public sector. There is a well-documented link between delinquency and lack of literacy. The further link between education or lack of education and crime is established. These children drop out of school and may have no option but to join a gang and end up in prison or dead at an early age.
The late Professor of Economics, Dennis Pantin, was able to assess that in 2001 each prisoner annually cost Trinidad and Tobago an estimated $34,000 and that in 2002 the overall recurrent cost of crime to the economy was estimated at TT$4.6 billion or 9.1 percent of GDP.
The Paediatric Society of Trinidad and Tobago, the Association of Psychologists of Trinidad and Tobago and Student Support Services have formally declared that “Children with Disabilities” is cause for national concern.
Various studies, (Masse & Barnett, 2002; Schweinhart et al., 2005) have concluded that Early Childhood Programmes dealing with children with disability save money by decreasing crime-related costs, by decreasing the need for special education/remediation costs and welfare payments and also by increasing income tax revenues and by increased earnings to participants.
Such programmes are urgently needed as early as possible (pre-school or even before). In Trinidad and Tobago however, common problems of the Public and Private Sector concerning Disabilities abound.
There is a lack of early diagnosis of children with developmental challenges or special needs. There are limited numbers of professional staff. There are huge gaps in the service requirements for children with disabilities and long waiting lists sometimes ranging into years. Finally, there are negative societal attitudes which in some instances reach far into the medical and teaching profession as well as into families.
Given the scarcity of professional help, the need for a National Multi-Disciplinary Team of Specialized paediatricians, psychologists, social workers, special education teachers, Physical therapists etc. who are able to offer holistic medical expertise to children with disabilities, give seamless, prompt evaluation and treatment to children, support and counselling for parents and able to produce public awareness campaigns and push for legislation for children with disabilities is necessary.
Marge, M. (1984). Report of the National Survey of Handicapped Children and Youth in Trinidad and Tobago. OAS/National Project in Special Education and Rehabilitation of the Handicapped. Trinidad and Tobago: Ministry of Education.
Masse, L. N., & Barnett, W. S. (2002). A Benefit Cost Analysis of the Abecedarian Early Childhood Intervention. New Jersey: National Institute for Early Education Research.
Miske Witt & Associates. (2008). Achieving Inclusion: Transforming the Education System of Education Trinidad and Tobago: Prepared for Trinidad and Tobago Ministry of Education. Minnesota, USA: Miske Witt & Associates.
Schweinhart, L. J., Montie, J., Xiang, Z., Barnett, W. S., Belfiled, C. R., & Nores, M. (2005). Lifetime effects: The HighScope Perry Preschool study through age 40 (Monographs of the HighScope Educational Research Foundation. Ypsilanti, MI: HighScope Press.
About the Author
Dr. David E. Bratt (CMT, MD, MPH) is a Trinidadian-based Paediatrician with over thirty-seven years of public and private practice of Paediatric care at the hospital and University level. He is a graduate of the American Board of Pediatrics (1978) and a former Consultant for the Pan American Health Organization/World Health Organization (PAHO/WHO). Dr. Bratt also worked as a Senior Lecturer in Child Health at the University of the West Indies Faculty of Medical Sciences for eighteen years.