How I see it … getting around in the UK and Hamburg

For those of you who are new to my blog, I am a nurse and academic who happens to have a vision impairment. In the last year or so my night vision has decreased and susceptibility to glare has increased. To learn more about my vision, please see my previous blog entries. I have recently started using a white cane to get around mainly when it is dark, or the glare is excessive.

This blog post primarily focuses on moving around London using public transport to get to the conferences that I have been attending along with visiting friends and family. There is a lot to cover, so I have concentrated on spatial awareness, travelling on the London tube, the pedestrian environment and crossing signals.

So far I have participated in an education conference in Bloomsbury, London for three days, visited friends in Hamburg and Oldenburg in Germany and am currently staying with family in the south of England until returning to London for a Digital Health conference next week.

Spatial awareness …

One thing that has stood out while moving around in the UK and Germany is that people appear to be more spatially aware than those in Auckland. What I mean by this statement is that so far fewer people seen to walk around staring at their cellphone or feet and more people seem to notice what is happening around them. While this is a generalisation, and there are always exceptions to the rule, I feel safer moving around in crowded areas because more people notice what is around them.

One of the challenges I have is in crowded areas where people moving around me affect my ability to judge distance, and any movement distorts my vision; this means that I tend to limit moving around and feel nauseous when others move.

The other surprise was the number of push bikes in Oldenburg; however, these travel on the road or bike lane on the footpath and both pedestrians and riders show far more respect for others sharing the space than I have encountered in Auckland. The part of navigating around Germany that was the most challenging was re-learning traffic patterns and remembering traffic approaches from the opposite side of the road. A tip for vision impaired travellers is that there are no buttons on to press at the crossing, but you need to cover the whole front of the box with your hand, and it detects this. Hidden on the bottom is a plastic indentation which moves when the light is green.

On reflection moving around as a pedestrian in both London and Germany has been less stressful than I expected. I suspect this was directly related to the spatial awareness displayed by others and the distinct lack of electric scooters on footpaths. While I have been known to ride an electric, I did not realise how much stress sharing a path with unpredictable and fast electric scooter riders in Auckland had caused me until I was in a place where they did not exist.

Travelling on the London Tube …

Navigating the tube has been an “interesting experience” the most significant difference from Auckland is the sheer volume of people who try to fit onto the one train is somewhat overwhelming. Often I have found that I am standing holding on to a rail with people crushed against me on all sides. As someone from a country where there is less crowding on public transport, I found this quite confronting. In comparison, the trains in Hamburg were very well scheduled and timed, and this meant that I always got out of one train carriage, walked about ten paces across the platform and got straight on to the other train which meant that both platforms and trains seemed less crowded.

However, in saying this, in the UK, even though the transport system is crowded, many staff members are there to assist in navigating the system and are very quick to offer assistance. For example, at Victoria station, I stood for around 30 seconds looking at a sign before I was approached by station staff asking if they could assist, he then offered to walk me to the platform I needed.

Similarly, each time that I have entered a tube station with my white cane, a staff member has approached and asked if they can help – which is fantastic. So far the assistance I have accepted has been in the form of asking the way to a particular platform and I have been given very clear directions and if I have declined further assistance staff have accepted this without question. What has stood out is that the workers in London and on the Southern UK train network never seem to make assumptions about the assistance that I need but asked if and how that they can help.

In contrast, interacting with members of the public travelling has been variable. I have had some very positive interactions and some very poor interactions. For example, in a packed tube train where I was standing surrounded by people and unable to move in any direction, the tube stopped at a station, and several people got off of the train. A woman grabbed both of my arms and pushed me into a seat saying “sit down”. A seat is excellent, but, I was somewhat overwhelmed by someone deciding that they could by physically moving me without asking is not pleasant and is also making assumptions about my needs. This treatment put me in a vulnerable position, where I felt very uncomfortable.

The Pedestrian Environment …

After travelling in New Zealand, Sydney, Brisbane and Melbourne, I was surprised that the distance between the platform and train was so variable in both height and length. Similarly, the curbs and stairs are also variable. While many people could argue that this is a part of history and charm of London, this has meant is that I have had to rely on my white cane to determine distance far more than I would at home. An advantage of this is ensuring safe travel, but as a part-time cane user, it has been an emotional step for me to increase the cane use.

wlo-bl-nbplat

Photo from: https://www.squarewheels.org.uk/rly/LUgenPhots/WLO-BL-NBplat.jpg

Some tips that may assist vision impaired travellers:

UK General:

  • Accessibility is well legislated, conferences etc. offer large print and accessible materials as a standard.
  • Audio described performances at the theatre are common and often no extra charge.
  • Attractions will often offer different and more extensive tours to those with a disability.

UK Transport and Travel:

  • Obvious one traffic drives on the left.
  • Expect more crowds.
  • Traffic signals have tactical markers under the box in the form of a cone that spins when it is safe to cross.
  • Train platforms aver variable in distance and height to and from the train.
  • Stairs in the underground are variable in markings (can be absent), shape, size and surface.  They can also be odd shaped such as curved with unexpected pedestrian tunnels crossing in older parts of the network.  London Transport offer guidance on how to avoid stairs they also offer accessible journey planning advice including planning trips without stairs.
  • Some platforms are curved and not straight.
  • Cobblestones are problematic, consider a rollerball tip for your long cane.  If you did not bring one you can order one online or buy one onsite at the RNIB in London.
  • Tube Maps are tiny to read.  You can download a PDF or order Large Print and other formats.  An audio guide to the london underground is also available.
  • You can order a badge saying “please offer me a seat” although I did not do this and can not comment on the usefulness.
  • Concessions may be available.

Germany (Hamburg and Oldenburg):

  • Obvious one is that traffic drives is on the right.
  • No buttons on the crossing boxes, apparently you cover your the front of the box with your hand to activate the crossing if this is required (some crossings are automatic) and tactile feedback is an indentation on the underside of the box.  
  • Cobblestones are problematic, consider a rollerball tip for your long cane.  If you did not bring one you can order one online or buy one onsite at the RNIB in London.
  • People seem less likely to offer assistance with less staff at stations in Hamburg.

How I see it …. getting around in the dark

Getting around in the dark is something that I have been unconsciously avoiding for quite some time now, but it was not until last week that I realised just how much. I will explain a little about my vision and then relate this to getting around in the dark.

For those who have read about my vision, you will know that I have some vision loss. Here is a quick overview, I have good central vision in my left eye and can see a small slither of light at the bottom of my right eye. My vision changes depending on the light, time of day, how tired I am, what I have been doing (e.g. reading) and I am very susceptible to glare with decreased visual acuity in the dark.

Several things impact getting around; the first is that I have no depth perception which is caused by having monocular vision (or only having vision in one eye) and decreased peripheral vision in my left eye. Essentially this means that I see the world as flat with less in the central nasal area where I have a blind macaroni shaped patch. Monocular vision is similar to looking at a photograph or two dimensional image.

As an aside here, ironically my PhD topic has a component around computer vision, and part of this is transferring two-dimensional points to three-dimensional representations and back again, anyway – back on topic.

No depth perception means that I need to interpret what I see using techniques that are different from those who have binocular vision, what I have found is that at times I consciously need to stop and think about the environment when it is unfamiliar or where there is sudden or unexpected movement. One place that I particularly have difficulties is in crowds. I love shopping but find shopping malls are particularly tricky as they are crowded. In society today other people are often walking in a group, looking down at their phone and – dare I say it – are often self-absorbed. I do my best to move out of the way, but at times I find myself, bumping into people, their reaction is often that I am being rude and not looking where I am going.

If I am in a crowd for more than five minutes the movement of others around me causes me dizziness and nausea, and this has led to me avoiding shopping malls and supermarkets unless necessary and doing most of my shopping online. One of my strategies, is to walk directly behind another person and to walk where they walk. This generally works well, however, when out with friends this doesn’t make for the best social situation.

Another challenge is at events such as graduations. I love to see my students graduate, but find the crowds and glare very difficult. For this reason, I have been asking other staff members attending if I can hold on to their arm in the crowd. Asking for help was a big step for me at first, mainly because I needed to admit that I needed assistance and stop trying to hide it. What I learned was that my colleagues did not seem to mind this and my thoughts of it causing problems were unfounded.

The second thing that influences getting around is glare. Last time I discussed it with my retina specialist, he said, “that’s because you have a blonde retina”. However, I believe the majority of susceptibility to glare is multifactorial, for example, a little from each medical condition retinopathy, glaucoma and post cataract surgery. The sensitivity to glare is not solely related to the eye conditions but also influenced by side effects of treatment to retain my sight along the way, for example, an iridotomy, retina laser, a lens implant and more.

Last week I needed to be across town for a workshop at 0830, on public transport this meant leaving before 0600 when it was dark to catch two busses and a train. While walking to the bus stop I came to the realisation that I unconsciously avoid going anywhere in the dark, or if I do it is usually with friends or in very well lit places.

While walking to the front gate, I tripped on the footpath on a crack in the pavement that I knew was there and usually manage to avoid (good start). The next issue became the glare and starbursts around streetlights. I was always told that the halo and glare effect around streetlights would get better after having a cataract removed; in fact, I have found the opposite, it is much worse. The photo below shows glare, halo and starburst light and I find at different times I have a mixture of all of these with the glare and starburst being the most prominant.

Photo from http://glaucomaassociates.com/wp-content/uploads/2017/10/Types-of-light-glare.jpg

The below photo is of presbyopia which is usually only possible in people who have binocular vision, but this is the closest representation I can find of how the glare splays out from lights and sometimes across my whole visual field when I look straight or up changing the tension on my retina.

Back to the story from last Wednesday morning. Oncoming traffic, coupled with streetlights made it impossible for me to make out anything around me which caused me to walk off the side of the footpath. Until this point, I had not realised just how much I adapt my life so as not to be outside of my house or work in the dark. Interestingly, the glare has probably been this bad for the last year or so but I had not been in a situation where I had needed to manage this alone or where it had been that dark.

I have been doing some orientation and mobility work with an instructor from the Blind Foundation and she had introduced the idea of a white cane for use when I needed it (e.g. at night). I had been learning how to use a long cane and felt safe in learning to use this for “future use” and had got to the point where I knew some of the basics but had not fully accepted that there were, in fact, times I would need to use it. Accepting a cane (even if it is only for use in the dark) is a big emotional step. There were so many fears, for example, that I would be labelled, that others would be confused as I don’t use it in the day and do at night or in crowds, that it was a sign of defeat or dependence. What I really should have been doing was flipping this dialogue, for example, it warns others I might not see them and is a sign of independance but at that time, I did not feel ready to do this until reflecting later.

I did pull out my cane and use it to get to the bus stop and I found it easier getting onto the bus. The most important part was that the tactile feedback I got from the cane was keeping me safe. The majority of my training had been in situations where I could see large objects such as the road, bins etc., so the cane was giving me secondary tactile information. In this situation I couldn’t determine objects, so needed to rely on the cane to give me primary information which was a new experience for me.

On reflection, until this time, I had always been with other people when out in the dark and when on my own there has been enough light for me to see enough to avoid things like walking off the footpath into the road. In other words, I was unconsciously managing my safety. What I have now learned is that I need to make a conscious decision to risk assess before leaving the house and anticipate any environmental needs such as glare and the dark instead of doing what I have always done, just walking out the door and problem solving along the way.

I am trying to come up with a witty catch phrase around being a part time / night time cane user but am having difficulty formulating one. Something along the lines of “Full time …, part time cane user.” If anyone thinks of a witty catch phrase let me know.

I hope that this story helps others to learn from my experiences.