The aim of my blog is to stress the importance of making “continuum of care” a core goal in any child welfare system by re-visiting the topic of child abandonment and orphanhood.
According to UNICEF, at least 2.2. million children around the world live in orphanages. Despite global initiatives and government policies to deal with the problem, the number of children living in orphanages appears to be on the rise.
Research in Romania has shown that the chronic neglect associated with large orphanages can weaken and disrupt the development of brain structure and functioning, impede language learning, and lead to mental health issues. A global study on violence directed at children has found that those living in orphanages were among the most vulnerable to violence, abuse, and exploitation.
Lack of Individualized care at these institutions has long-term consequences. Infants are group-fed on a schedule rather than on demand, diapers are changed on schedule rather than as needed. Charles A. Nelson III, Professor of Pediatrics at HMS and Boston Children’s Hospital as well as a neuroscientist whose work includes research on the brain development of orphans, notes that “Cognitive ability and psychological well-being correlate directly with how much attention young children receive, how much they are read to and held.”
Upon reaching a certain age, children must leave the orphanages. Frequently unprepared for independent life, they face unemployment, homelessness, etc., and thus end up costing society more in the long term due to expenses related to health care, education, and legal services.
A study conducted in Europe found that poverty and homelessness were responsible for the abandonment of children (and their subsequent placement in orphanages) in over 90% of cases. Other driving forces included parents with HIV and AIDS. Such chronic diseases too are frequently correlated with poverty.
Russia has the highest rate of children living in institutional care. Since 2004, more than 23,000 Russian children have been adopted by parents in the United States, but in 2013 a ban on American adoption brought that practice to a halt. The pendulum has now swung too far in the other direction and has contributed to delays that keep the children at state-run facilities longer. The Russian Government is currently prioritizing the problem of child abandonment by reducing the use of institutionalized care with the aim of preserving and increasing the size of the country’s population through the so-called “Children of Russia” program) in response to an alarming decline in national fertility rates and simultaneous escalation in the infant mortality rate (National Center for Health Statistics).
The founder of the Civic Platform party, Mikhail Prokhorov, who has established a charity fund to help orphans and sick children, states that “all problems can be settled only by an efficient state. So, our political party, caring people decided to be responsible for the most difficult part. Firstly, we want to change the ideology of our society toward sick children who are left without parents. Secondly, we want to encourage adoption of sick children and will help people who adopt sick children. We will consider every case separately and offer help exclusively to such parents. Thirdly, we will provide social adaptation in orphan houses for establishing special rehabilitation centers for children of the fifth health group.”
Investment in programs that prevent children from going into orphanages has been shown to have long-lasting benefits not only for children and families, but also for communities and entire nations.
Protecting Newborns against HIV in Russia is a unique intervention program currently underway in Tomsk, Russia, and endorsed by an American NGO Partners in Health, stands out for its bold relief program for orphanages.
By mobilizing and leading local response to the growing HIV-epidemic among pregnant women, it has lit the path to “an alternative care option” that decreases reliance on orphanages. The project also provides effective lessons in health care reform at the implementation rather than policy level without labeling it as such. The invincible spirit of PIH is helping redefine the global agenda and bringing resilience and renewal to the world at large. This process of renewal goes beyond rebuilding infrastructure to inventing new concepts and reinterpreting legislature.
PIH has not shrugged off the region as “desperate and hopeless,” but has instead established collaboration with the Tomsk Anti-AIDS Center, through which they find and nurture HIV-infected and homeless pregnant women, and get them to adhere to treatment. Those treated deliver HIV-free babies! “A labor of love,” PIH’s groundbreaking work manages to win the hearts of women who have lost hope after failing to believe that “anyone cared” about them. Through the organization’s help, pregnant women become physically and emotionally stabilized and emerge stronger and better prepared to embrace motherhood. The real winners are the infants; they are healthy and will grow up at their mothers’ sides.
PIH is thus not only changing the lives of women and children, but also changing society. Without its intervention, infants would remain in deplorable conditions with poor medical and nutritional care and experience no strong maternal bonding and attachment during their critical, formative years.
Current global statistics and key facts suggests that orphanage care has detrimental effects on children’s social, emotional, and cognitive development that often lead to permanent disability.
As Dr. Boris Gindis, a leading expert in the field of international adoption has well observed, “It takes the global village to provide a child with an opportunity for a normal childhood.”
I have found most of the stories of my own patients who grew up in orphanages or were abandoned by mothers totally incoherent. The contrast between failed cases of international adoption and the appealing, hope- and promise-filled telegenic promotion of adoption by parents abroad is a deeply personal issue for me. I thus hope that “the global village” will grow into a hemispheric community that enables us to embrace our inner diversity by discovering our common humanity. In today’s turbulent times, these values are becoming increasingly important.
As a physician working primarily with children for more than two decades, I fully understand that children’s health is more than just a medical issue. I feel privileged to be a doctor and, at the same time, I feel a deep sense of responsibility to work towards making a better health care system for this vulnerable part of our population.
There is drastic shortage of child psychiatrists for our nation’s 75 million children and teens. Currently there are only 8,300 child psychiatrists nationwide, some 30,000 short of what is needed. In Massachusetts, waits of four to six weeks for a child psychiatry appointment are common, and several community mental health centers report three month waits.
The American Academy of Child and Adolescent Psychiatry (AACAP) has worked hard to make the government aware of the crisis of limited access to child psychiatrists. I was inspired by AACAP’s legislative program to get involved in persuading policymakers to address the shortage of child and adolescent psychiatrists.
In the spirit of doing my part to address the crisis in access, I have also signed up to volunteer with the National Association of Free and Charitable Clinics to provide free care to homeless women and chidren in greater Boston area and I have created my website as a place where stakeholders can interact and come together on behalf of our children.
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