The image of a primary school child leaving their wheelchair outside a pit latrine and crawling across an unclean floor to perform basic bodily functions is stark.
These and similar stories emerged from a study we conducted in a Malawian town. And they suggest that while the southern African nation is being hailed for its efforts to get more children in the classroom, more work is needed to ensure their experiences on school grounds - and especially in bathroom facilities - are positive and safe.
In our study we assessed the water and sanitation facilities at primary schools in a rural town in Malawi to see how disability friendly they were. We were keen to understand how well schools had translated Malawi's policies on access to water, sanitation and hygiene into practice.
Our data showed that no school had facilities that fully met the needs of students with disabilities - not even private schools which is often thought to provide better services.
Instead we found that children with disabilities had several challenges. Some had no access to facilities while others had to walk long distances to access them. Others struggled to walk on the uneven walkways; and others struggled to operate the hand pumps to access water.
Our study highlights some cost effective measures that schools can invest in to make these facilities more disability friendly. But it also underscores the need for increased government support, budgeting and enforcement to ensure national policies are met.
But our findings are also important to show education policymakers that the existing policies are not effective in rural areas. It's a scenario that is likely to play out in many of the low-resource districts in Malawi and in other low and middle-income countries.
Barriers of access
We conducted our study in Rumphi - a small but growing agricultural trading town known to grow tobacco as a cash crop. People get water from municipal water taps or hand pumps and most households have an unimproved traditional pit latrine, consisting of a basic pit covered by an earthen floor and either brick or grass walls.
Malawi has several policies that ensure that people with disabilities have access to water and sanitation. The national sanitation policy, introduced in 2008, stipulates that public places must have facilities which cater for people with special needs. Schools, according to the policy, must have at least one latrine or toilet for boys and girls that cater for pupils with disabilities.
But in practise, this is not the case. In our study we evaluated the infrastructure at 10 schools in the Rumphi: seven public and three private schools.
During interviews with pupils who had disabilities and teachers we were given first-hand accounts of the difficulties the pupils encountered.
There were two sets of problems. The first related to the children's inability to access and operate drinking water facilities; the second related to cleanliness and privacy of the pit latrines.
Most students asked friends rather than teachers to help them. Others just tolerated the situation.
Drinking water facilities
Most children were put in harm's way when they tried to access facilities with drinking water. Children who were, for example visually impaired, struggled to see the path to the pump if there was too much sunlight or cloud cover, placing them in danger of falling. Others who had physical disabilities struggled to operate the hand pump handle. They risked the danger of hurting themselves.
Some of the water sources were as far as 350 metres away from the classrooms. None of the schools had access ramps to the pumps or supporting rails leading to the source. Some had steps leading to the water source which would be difficult for a child with physical impairments to access.
At most of the schools the paths to the hand pump was uneven and at all the facilities there was no shade to help children with albinism.
Unclean pit latrines
The children also struggled to use sanitation facilities because they were unclean and sometimes the floor was covered in urine and faeces. Wet and dirty floors were the most common challenge. This was particularly problematic for children who had physical impairments and needed to place their hands on the ground in order to access the pit latrine.
In addition, we found that some of the pit latrines were up to 114 metres away from the classrooms. The World Health Organisation has recommended that facilities shouldn't be further than 30 metres from classrooms.
Only one school had a toilet with a door and a raised seat but none of the schools had drop-hole covers or supporting rails leading to the pit latrines.
The latrine doors were less than 1 metre wide so wheelchairs could not access them. This mean that children in wheelchairs had to leave them outside and crawl into the facility to use it.
In our interviews with the pupils they raised cost effective solutions that could make the existing school infrastructure friendlier. This included keeping facilities clean, adding doors for privacy, reducing the height of steps or replacing them with a ramp. These could cost as little as 54 000 Malawian kwacha (USD$78) per school.
This shows that authorities should include the input of students with disabilities whose voices are often overlooked when solutions are considered. It also shows that special education teachers need to be trained on ways to make infrastructure at schools more disability friendly.
Malawi could look to countries like South Africa where a national guideline was developed in 2008 to allow people with disabilities to access toilets easier. These guidelines could be practically adapted for schools in Malawi.
When the school bell rings to end the day in Malawi, both government and community-based action are needed to step up to help children with disabilities at school in smaller towns. The situation in Malawi is likely to be consistent across other neighbouring countries.