1 Students, learning disorders and inclusive education in Haiti: A review of the literature

Introduction

This review of literature is the outgrowth of a project undertaken in 2018 by the Groupe d’Initiative pour l’Étude de la Cognition du Langage, de l’Apprentissage et des Troubles (GIECLAT) and Langues, Société, Éducation (LangSÉ) entitled “Students with disabilities and pedagogical practices of teachers in three regions of Haiti” funded by the United States Agency of International Development (USAID).

This literature review focuses on scholarship concerning students with disabilities and inclusive education produced from 2010 to 2020. Before we get there, however, let me familiarize the reader with the geographic location of Haiti. Haiti, officially the Republic of Haiti, is located on the island of Hispaniola, which it shares with the Dominican Republic. Hispaniola is situated in the Greater Archipelago of the Caribbean Sea. The country is located to the east of Cuba and Jamaica and south of the Bahamas and the Turks and Caicos Islands. To the southwest lies the Island of Navassa. The population of Haiti is estimated at 11.1 million people living on 27,750 square kilometers.

The years 2010 and 2016 will forever mark the memory of Haitians after an earthquake and a violent hurricane left visible and invisible scars on buildings, road infrastructures and people. The 7.0 magnitude earthquake left 300,000 people injured, 1.3 million people displaced, 97,2294 houses destroyed, and 188,383 houses damaged in the capital and in the southern region of the country. It is estimated that the earthquake affected over 1.5 million people and that the children and youth represented more than half of those impacted by the disaster (Dube, Moffat, Davidson, & Bartels, 2017).

In 2010 the population of Haiti was estimated at 8 million people. The proportion with disabilities was around 10%, approximately 800,000 people, according to national statistics. However, this number does not necessarily include people with invisible disabilities, such as patients with mental problems, schizophrenia or bipolar disorder, for example (Handicap International, 2010; Oriol, (n.d.).

Services for people with disabilities remain scarce. The mobility of individuals with disabilities is very constrained. Buildings, churches, schools and public transportation are not equipped to facilitate accessibility. Only about five percent of children with disabilities attended school before Matthew. Among the few services offered were braille reading, the use of a white cane and physical therapy (Phillips, 2011).

In the aftermath of Matthew there were close to 4000 estimated amputees (Dube, Moffat, Davidson, & Bartels, 2017). It is unknown how many people experienced psychological shock or post-traumatic disorders as a result of the hurricane. These people are still part of the population and yet cannot be identified because the services are not readily available or simply because they remain invisible to those who provide those services. There are also the prevalent myths about disability that erect strong barriers to assistance for persons with disabilities who are called “cocobé” in Creole, implying they are worthless. This cultural response is an added liability preventing effective assistance to individuals with disabilities (Phillips, 2011).

The hurricane tragedy has focused scrutiny on government efforts to provide needed services to people, especially those with disabilities. The government response has been insufficient despite the 10 billion dollars received by the Haitian government over the past ten years. This study is an effort to understand the plight of children with disabilities in an effort to formulate recommendations that can guide the government in providing the necessary services to persons with disabilities, starting with education. It is the notion that education is a human right that has motivated the GIECLAT study.

In the following section I describe the method used for this review and the findings followed by a discussion.

Method

I used a variety of databases to search for literature on children with physical and mental disabilities and on inclusive education. The databases included LILACS (Latin American and Caribbean Center on Health Sciences Information) ProQuest Central, Google Scholar, Education Resources Information Center (ERIC) and the Research Dissertation database, as well as an NGO pre-selected database and UN and government agency websites. The keywords used included learning disability, students, Haiti, inclusive education, special education and cocobai. I also included phrases such as student with learning disabilities, physically handicapped student.

Education-related research in Haiti has examined an array of topics including early childhood education (Blazek, 2003), teachers (Dupoux, Wolman & Estrada, 2005), youth and schooling (Lunde, 2006, Institut Haitien de Formation en Science de l’Education [IHFOSED], 2007); the educational system (Wolff, 2008), inclusion and the quality of education (Février, 2013; Etienne, 2008), the family and education (Nicholas, Stepick, & Stepick, 2008), teacher training and evaluation (Cherenfant, 2009), access to education (Demonbynes, Holland, & Leon, 2010), post-secondary and higher education (Interuniversity Institute for Research and Development (INURED), 2010), community participation and local capacity (Desir, 2011; DiAquoi, 2011), sociology of education (Allerdyce, 2011; Nelson 2015), professional development (Coupet, 2015), and reading (Degraff, 2017).

I was able to identify 126 articles using my keywords. I read the abstracts or summaries of these documents in attempt to identify those that were relevant to children with disabilities and inclusive education. I have classified these articles using the above-mentioned criteria. Some articles focus on more than one topic. A great deal of medical literature deals with the traumatic aspects of the earthquake. However, a major literature gap exists concerning inclusive education and children with disabilities. I found two dissertations and three articles with content on inclusive education and teachers’ attitudes toward children with disabilities.

Findings

The literature review yielded a large number of articles describing the traumas resulting from Hurricane Matthew. My focus, however, was on students with learning and physical disabilities and inclusive education. I adopted the World Health Organization’s definition of disability, which is “a contextual variable, dynamic over time and in relation to circumstances based on the individual and his or her environment” (Phillips, 2011). Learning disabilities are disorders that affect the brain’s capacity to collect, process, accumulate, react to, and convey information.

Understanding disability

According to national statistics that need to be taken with a grain of salt, the population of individuals with disabilities was about 800,000 individuals of which roughly 200,000 were children (Phillips, 2011). A report by Haiti’s Ministry of Social Affairs and Work confirms that only 3.5 percent of an estimated 120,000 children with disabilities in Port-au-Prince were accessing education. Since the lack of identification affects prevalence figures, it can be assumed that the percentage of school-aged children with disabilities is even greater, either because they are not currently attending school or are struggling in regular classrooms without the appropriate services (Dupoux, Hammond, Ingalls, & Wolman, 2006). Only two schools in Port-au-Prince addressed their needs. It is also important to take into account that there are disabilities that were never counted prior to Matthew, including mental health issues, Down syndrome, visual or hearing impairment, muscular dystrophy, epilepsy, autism and cognitive disabilities.

It is difficult to be certain whether the inaccuracies in the statistics are the result of government neglect or lack of resources. However, it has to be mentioned that there is a cultural dimension that must be considered when addressing the needs of individuals with disabilities: “cocobai.” This belief about disability presents a serious barrier to assistance to people with disabilities. It is a belief that leads to discrimination. In Haiti, disability is viewed as supernatural in origin. Phillips (2011) writes: “For example, children experiencing epileptic seizures can be presumed possessed, and crop failure can be blamed on children with disabilities. Many parents of children with disabilities either abandon them or hide them from public view for fear of reprisal and because they lack the rudimentary skills, education, community support and financial means to cope.” (p. 3). This way of understanding disability challenges advocacy efforts on behalf of individuals with disability.

The hurricane caused massive destruction: an estimated 316,000 deaths, 300,000 people injured, 1.3 million people displaced, 97,294 houses destroyed, and 188,383 houses damaged in Port-au Prince and the southern part of Haiti. Estimates suggest that the earthquake affected over 1.5 million people, and children made up more than half of those impacted (Dube, Moffat, Davidson, & Bartels, 2017). These numbers likely rose due to poor sanitation conditions and a shortage of clean water which resulted in wound infections causing amputations. Not counted are also the people who experienced post-traumatic stress disorder, mental health challenges, depression, anxiety, blindness, and mental disabilities due to the psychological shock of the hurricane

In 2010 the government of Haiti completed the Action Plan for Reconstruction and National Development, a ten-year plan based on the post-disaster needs assessment which evaluate losses and damage. The focus of the plan was environmental sustainability and the rebuilding of infrastructure. Sections of the plan dealt with health, safety, education, employment and reconstruction. In the Consolidated Recommendations of the Haitian of the Diaspora Forum, the authors made clear the inclusion of persons with disabilities in the school system. Phillips (2011) writes: “Thus, new approaches to developing and teaching the curriculum in Creole need to incorporate the learning needs of the disabled, utilizing large print text books, Braille, visuals and, when possible, technological aids. Access to education is directly related to social inclusion and employment to ensure that persons with disabilities can gain freedom from extreme poverty.” (p. 4).

The school system

The government of Haiti earlier recognized the importance of education as promulgated in its 1805 constitution explicitly noting “…education shall be free. Primary education shall be compulsory. State education shall be free at every level.” (Salomé, 1984). Despite this recognition, political instability, chronic poverty, social inequality and dire socioeconomic conditions have created a pyramidal educational system, with a small group of elite private schools at the top followed by the public schools and at the bottom the vast majority of private schools (Salmi, 2000). The educational system is geared toward the best and the wealthier students, ignoring the needs of most students with special needs (Ministère de L’Éducation Nationale de la Jeunesse et des Sports, 1998).

Haiti is in a unique situation in that the private sector is the major supplier of education services. The country has the second highest proportion of private school enrollment in the world. Today private education represents about 75% of primary school enrollment and 82% at the secondary level (Salmi, 2000). Two thirds of the private schools are religious schools. There are Catholic schools with long-standing reputations. Then come the mission schools. These include Baptist, Protestant and Pentecostal schools. A third group are the Presbyterian schools that are generally poorer and variable in quality. There is also a category of non-denominational schools composed of community schools and commercial schools. The community schools tend to be established and supported by Non-Governmental Organizations. This is a recent phenomenon. In practice, the commercial schools do not follow any form of governmental control. They are also known as école borlettes, named after the local lottery because the children attending these schools have the same chance of graduating as of winning the lottery (Salmi, 2000). In 1980, under the leadership of the United States Agency for International Development in collaboration with Catholic and Protestant schools, the Haitian Private School Foundation (Fondation Haitienne d’Enseignement Privé FONHEP) was created.

Haiti does have a special education system in a very few expensive private schools under the administration of teachers with master’s degrees in special education obtained mostly from universities in the United States. Public schools do not offer special education. It is fair to say that public education response to the needs of children with disabilities is in a state of transition. There is a recognition in the executive branch of government that low-performing students need extra help through identification and possibly special services. The Office of Special Education was set up in the two most populated provinces outside Port-au-Prince to pilot test an integration program in a few public schools. This initiative received startup funding from UNESCO, UNICEF, USAID and the World Bank. The challenges for this kind of endeavor is that those receiving the funds have to implement values imported from a different cultural context.

Dupoux et al. (2006) pointed out that

One of the structural problems is that low performing students are not routinely tested; thus, many students who would be classified in the high incidence categories (i.e., speech and language, intellectual disabilities, learning disabilities, emotional disorders) in a developed country are sent to regular classrooms in Haiti. However, while this may look as if regular classrooms are integrated it is not so by design but rather by default. Many teachers indicated that they would welcome a formalized process of testing to help them target those students who need specialized instruction. (p. 2)

It is also important to recognize that policymakers in developing countries in general tend to favor the mainstream model, arguing that the inclusive model designed to meet the needs of children with learning disabilities tends to be cost-prohibitive as opposed to additional services provided to low achievers (Baine, 1993; Mushoriwa, 2001) in a regular class. Addressing the needs of children with learning disabilities is essential since most countries recognize that education is a right. Mainstream education is not in good shape either. It is harmful to consider special education or inclusive education a luxury or a benefit that only industrialized nations can afford. Dupoux et al. (2006) write “To paraphrase the former Secretary of Education for Haiti, an advocate for special education: When the main house is on fire, who cares about what becomes of the guest house? (Personal communication with E. Buteau, Haiti’s former Secretary of Education, September 26, 2003).”

Teachers

The quality of education in Haiti is below international standards, notably in the working conditions of teachers. There is a lack of resources and professional development. Teachers have to deal with uncoordinated development of curriculum and instructional materials. They are paid poorly with devastating consequences for students’ achievement. Salmi (2000) reports the results of a French language test administered to a representative sample of 1200 public and private school teachers. The French language test was designed by the Ministry of Education in collaboration with a small group of French specialists. One third of the primary school teachers did not know how to rank words alphabetically; eighty percent of the teachers could not use the passive form in French. Only 41 of the 1200 were able to perform basic arithmetic operations from the Grade 4 program.

Private school teachers tend to be less qualified than public school teachers. One third of public school teachers are graduates of teacher training colleges whereas only 19% of private school teachers have equivalent qualifications. In 1991 FONHEP administered a diagnostic test to a sample of 2000 teachers from poor private schools. The test revealed that the large majority did not have the academic level of a Grade 5 student (Ministère de L’Éducation National et de la Jeunesse et des Sports, 1995, p. 36)

Teacher attitudes toward students with learning disabilities

It is important to know that in Haiti there is no policy at the national or the provincial level concerning the inclusion or integration of students with special needs in mainstream classrooms. There is no requirement for teachers either to hold an advanced academic degree nor to take courses dealing with special education. In this context, teachers’ attitudes toward children with learning disabilities is key (Vramidis, Bayliss, & Burden, 2000). As discussed by Cook & Gerber (1999), Larrivee and Cook (1979) the cooperation and the commitment of those directly involved in implementing mainstreaming policies are essential. I found two research papers published by Dupoux et al. (2006) examining teachers’ attitudes toward students with disabilities in Haiti. One paper was published in 2005 comparing teachers’ attitudes toward integration of students with disabilities in Haiti and in the United States and the other published in 2006 exploring urban and rural teachers’ attitudes toward students with disabilities in Haiti.

Teachers’ backgrounds, the nature of the disabilities they encounter, the school environment, the resources and administrative support all influence the attitudes of teachers toward students with disabilities.

Teacher backgrounds

Generally speaking, teachers tend to resist including in their classes children who have intellectual, behavioral and emotional problems, due to lack of training and prior experience with this population (Leyser & Tappendorf 2001). Teachers feel that they are not equipped to deal with these children. However, some researchers have indicated that levels of teacher education may have an impact on their acceptance of or resistance to children with disabilities. They found that the higher the level of education, the greater likelihood they would accept children with disabilities. Other researchers have contradicted this finding, suggesting the reverse. Prior experience or practical training with population of students with disabilities tends to correlate with acceptance. A teacher with prior experience with this population of children was more likely to have a positive attitude toward integration. The gender of the teacher  tends to be a factor. Research indicates that male teachers tend to hold more negative attitudes toward student integration/inclusion than female teachers (Dupoux et al., 2006).

Nature of the disability

The nature of the disability is another factor that conditions teachers’ attitudes toward the integration of children with disabilities. There are milder and more severe disabilities. As a rule, teachers tend to refuse working with children who have severe disabilities, especially those with behavioral, emotional and intellectual problems. A couple of NGOs in Haiti provide services to children with disabilities but focus on those with physical disabilities.

School environment

Each school has a culture. School culture sets the tone of the environment and is likely to affect teachers’ attitude vis-à-vis the children and especially those with disabilities. A teacher is likely to be less resistant to a child who has a disability if he or she sees colleagues working with the child. There are schools where leaders have made a commitment toward integration and encourage their teachers to follow suit. Such a commitment and positive attitudes can break down resistance that is fueled by the cocobai mentality (Dupoux et al., 2005).

Students with disabilities

Most children with disabilities do not receive specialized education or social rehabilitation services and some, with more severe levels of disability, may reside in institutions (Jacobson, 2008). One major structural problem pertaining to low performing students is the fact that they are not tested. I am not a big believer in testing but if it can yield information to help a struggling student why not? Testing struggling students can determine the reasons for the struggle. Testing students in the US is almost routine and helps school identify students who need special help or have learning disabilities.

Recently, the Office of Special Education piloted the inclusion model in two classrooms in Port-au-Prince. Besides the Office of Special Education, the Special Education Center provides education, training and services to a limited number of students. Some NGOs have created schools for children with disabilities. However, their focus is physical disabilities. The Ministry of Social Affairs has a very limited budget allocated to services for individuals with disabilities. The result of this is that the majority of children with disabilities do not receive specialized education or social rehabilitation services (Jacobson, 2000)

In Haiti, the quality of education that children receive is directly related to where they live and the level of tuition their families can afford (Salmi, 2000).

There are no scholarship programs to alleviate the burden on poor families. There is the Fond de Parrainage, a private foundation that offers scholarships to needy children enrolled in eligible private schools. There are around 13,000 children receiving these scholarships per year, representing a mere 1.3% of students enrolled in private schools. There are also many religious schools that offer subsidized education to low-income children for whom it means the difference between no schooling at and some kind of education.

Discussion

Haiti is at the beginning stage of developing an inclusive education system addressing the needs of students with learning disabilities. However, there is a serious cultural impediment that needs to be addressed so that more substantial progress can be achieved in developing an inclusionary education system. A disability in Haiti is something mysterious and dangerous. It is interpreted as a curse from supernatural spirits (lwa) who tend to have a great influence on the world of human beings. God in this theology punishes those who do not obey his will. A child born with a disability reflects God’s punishment of a family member, the parents most likely, who did not obey him. This thinking is at the origin of the way people with disabilities are treated in Haiti. Most Haitians are afraid of people with disabilities and treat them as if afflicted with contagious diseases. Touching a person with disability is felt to be dangerous if the disability is caused by a spell, as the spell is likely to be transferred. A person with disability who jumps into a pool can instantly clear the pool. Parents make sure that an individual with a disability does not hang out with their children, and parents who have a child with a disability make efforts not to expose their disabled child to public ridicule (Jacobson, 2008).

It is my contention that this interpretation of disability lies at the core of the neglect experienced by people with disabilities. Some researchers have talked about the myth of disability perpetuated in Haitian society while others e.g., Arbeiter and Harley (2002), have concluded that Haitian people do not understand what disability is. This argument needs to be refuted because Haitians have a sophisticated understanding of disability. Indeed, the drawback for this form of understanding is that it marginalizes people with disabilities and further acts as a barrier to advocacy efforts to include and accommodate people with disabilities. All around the world people with disabilities are treated differently, which is why laws prohibiting discrimination against people with disabilities exist. There is a need for an interpretation of disability that is more inclusive. This is one reason efforts to include this population remain stagnant in Haiti.

The Haitian constitution supports the idea that individuals with disabilities shall have the means to ensure their autonomy, education and independence. This is good on paper but there are no policies to provide adequate education to all children, let alone those with disabilities, or any law requiring specific services to be provided. Although there exist a number of ministries and departments addressing the needs of individuals with disabilities, there is no comprehensive strategy for support and inclusion for people with disabilities (Jacobson, 2008).

Limitations

I set out to study the educational conditions of children with disabilities by looking at studies of inclusive education in Haiti. I found a great deal of research literature focused on health outcomes and health-related issues especially in the aftermath of Hurricane Matthew. I discovered that inclusive education is truly nonexistent in Haiti except in few elite schools where it has been tried and where teachers had special education degrees that they received from abroad. However, what emerged in the few articles that I read was that teachers’ attitudes toward children with learning disabilities and policymakers’ recognition of the importance to address the needs of children with disabilities are that that special education is a luxury and should not take precedence over mainstream education. Suffice to say that inclusive education – special education – is in transition in Haiti.

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