Personal views: “Forward!” The experience of a new guide dog owner
Authors: Rhiannon Tudor Edwards
Journal: BMJ (2002)

Diagnosed at Moorfields Eye Hospital at the age of 4 with retinitis pigmentosa and told that I would not see beyond the age of 15, I have been fortunate to reach the age of 35 with some residual peripheral vision. Not many people appreciate that only 18% of people registered blind can see nothing at all. I have never liked the word “blind,” with its negative connotations in everyday terms such as “blind drunk” and “blind ignorance.” In my line of research, even the term “randomised double blind trial” has left me feeling awkward. However, since I have started walking into walls, opening tins of peaches for our rather surprised cat, and putting my two and a half year old daughter in the bath still wearing her socks, I decided it was time to reassess matters.

Although I have carried a white cane for many years, this has not proved effective in signalling my limited vision to people. So when offered the opportunity to apply for a guide dog, I realised that it might, in fact, be a relief to “come out” as a blind person. 

After a six month wait I was matched with a lively black labrador retriever named Vikki and off to Leamington Spa for two weeks of intensive training with the Guide Dogs for the Blind Association. The long awaited moment when I finally met Vikki, was, alas, not the positive, emotional moment I had imagined. Missing her trainer, with whom she had bonded, she lay and whined by the door. It took some time until she came to “talk” to me. She did not understand who I was or why she should do as I asked. Five hours a day of one to one training was both physically and mentally exhausting. With a new person in tow, the dog pulled on her harness until I felt as if I had one arm three feet longer than the other. Mentally, I imagine it was comparable to five hours of driving lessons a day.

My visit to Leamington Spa was an unexpectedly traumatic acceptance for me of what it is to be blind. Living for two weeks with a group of totally blind people, some of whom were on their third or fourth guide dog, taught me immense respect for those who do indeed have no sight. It left me feeling fortunate, though a little embarrassed, for having some peripheral vision.

The training offered by the Guide Dogs for the Blind Association was excellent. It was fascinating to learn how the dog had been trained to respond to the command “forward,” working from curb to curb, to turn left and right, to find doors, indicate steps up and down, and, most amazingly of all, to refuse to obey the command “forward” into the path of traffic. Crossing busy roads is a challenge for a blind person, even with a guide dog. Contrary to myth, the guide dog does not know when to cross. It is up to the owner, reliant on his or her hearing, to indicate to the dog when to leave the curb. So the offer of sighted assistance is always welcome.

Now, after just two months, Vikki (whom I later found out was one of the worst behaved trainee guide dogs they had ever had at Leamington Spa) has turned out to be an excellent guide dog. We have established a routine mile and a half walk to work, and have travelled alone to meetings and conferences in Cardiff, Edinburgh, and St Andrews by car, train, and plane. I feel more relaxed, confident, and safe. People offer to help even before I have started to feel lost. Although, of course, no one talks to me any more—they talk to the dog!

It costs a staggering £35 000 to breed, train, and maintain a guide dog over its 9 year working life, all raised through charitable donations. As a health economist, I have conducted a “back of a dog-biscuit packet” cost per QALY calculation of becoming a guide dog owner. Based on an n of 1 (me), even without any impact on life expectancy through accident avoidance, I stand to gain an annual improvement in quality of life in the region of 0.61 on the EQ-5D instrument. This translates into a gain of 5.49 QALYs over Vikki's 9 year working life, or an undiscounted cost per QALY of £6375, relatively good value for money. Within our largely medical model of health, it is of note that for many blind people, potentially the greatest health related improvement in quality of life has four legs and a wagging tail.