or 23-year old Pang Har, a chance for exploration is sheer bliss. Touching the various fruits and vegetables during his visit to the supermarket brings 'oomphs' and 'aahhs' and huge smiles, as he listens attentively to his teacher's repetitive sayings of the fruits' names. After the supermarket visit, one spontaneous communication Pang Har does is to ask his teacher when she is taking them 'jalan jalan' (a Malay word for 'shopping') again.

This field trip is one of the many key features of the Multiply Handicapped Training Programme by the Singapore Association of the Visually Handicapped (SAVH) for its trainees with additional disabilities. Hands-on training in natural contexts enables Pang Har and his classmates to develop understanding and meaningful relationships at home, in school and within the community.

Pang Har has been visually and intellectually disabled since birth. His grandmother cared for him while his father worked. He had no other playmates and did not engage in play even on his own. Pang Har is a shy, undemanding child with very limited opportunities for social interactions.

A big dilemma hung over Pang Har's father on how he is going to foster the young man and earn a living at the same time, when his grandmother passed away. Pang Har was like an untrained child. With mixed feelings and limited family/societal support, his father left him alone at home for work with a heavy heart.

Some concerned neighbours brought Pang Har's plight to the media's attention, and the government intervened to place him in a welfare home. Sadly, the staff at the welfare home was untrained to deal with a client with both visual and mental disabilities. Pang Har soon shifted to parental foster care, to the Singapore School of the Visually Handicapped, where he was placed in the special class before moving to Tampines Home. That's a home which provides institutional and respite care for patients with disabilities.

In school, Pang Har is not alone and has the company of five more students with multiple disabilities. Pang Har's "buddy" in the MHTP is Lay Eng, who is deaf-blind. Like a gentleman, Pang Har will attend to the needs of Lay Eng, occasionally being a big brother to her. As a result of the "buddy system", Pang Har has to learn sign language to communicate with Lay Eng.

Like him, Lay Eng was taught the Activities of Daily Living, and is able to assist her mother in simple household chores at her own pace. She was able to see better when she was young, but her sight has since deteriorated and now she can only communicate through signs, hand-over-hand gestures.

Nevertheless, with increasing age, Pang Har and Lay Eng must have age appropriate skills through prolong intensive, consistent training. Under these circumstances, the best training and place can only take place in a programme that best suits their needs. This evolved in the Multiply Handicapped Training Programme (MHTP) in 2000 by the Vocational Training Department at SAVH.

This programme is structured for the clients to progress through special learning environments, which meet the individuals' developmental and functional needs. The training follows fundamental best practice, where instructions are given in natural contexts and with frequent practice. The curriculum comprises of four training areas: Language & Communication, Personal & Social Development, Concept Development, and Physical & Perceptual Development.

Thrice a week, two-teacher assistants work intensively in creating a variety of learning environments in domestic, community, leisure and vocational settings. One of the key elements is to have Mr Tay and Mdm Chong Tai, parents of Pang Har and Lay Eng respectively, participate in developing individualized programme planning. Since then, the programme has witnessed remarkable progress.

So where do Pang Har and Lay Eng go from here? The next focus, based on individuals' progress is to place some trainees in pre-vocational skills sessions. Maybe someday they may re-integrate into the sheltered workshop as they become independent in their personal care, vocational, social, communication and functional academic skills to lead more meaningful interactive and satisfying lives.

There are many more multiple handicapped persons with visual disabilities, who may eventually need to be a part of the MHTP. Positive feedback from parents gives SAVH the confidence that the programme must be supported and further strengthened, so that it may eventually progress into a full-time Day Activity Centre. Visit www.savh.org.sg for more information.