Bep van Sloten

Core Message

In the support provided to orphans and vulnerable children it is important to take as the starting point the healing power of families and community to overcome the losses of beloved family members and move on. Responses from government, NGO’s and FBO’s should be directed to build on the strengths and coping mechanism of the family and community system and assist them with coordinated material and emotional support in order to overcome traumas, be able to provide financially for the children in the family and build on their future.

Full Paper

(shortened version will be presented and made after the preparation session with the three presenters beginning of August )

I meet her at a meeting with foster parents. Among the group of old ladies who take care of their grandchildren she is young. She masters English very well and the three year old toddler on her lap sucks his bottle. She is the head of the household and responsible for 10 children aged 3 – 19: her siblings, the children of her sister and the sun of her youngest brother. In 2006 her parents both passed away and they were already taking care of these 10 children. Her brother and sister died before them.

She is only 28 and has this huge responsibility.

She was in the third year of University, only one more year to go, but as there was no other family member available, she came home and took care over this group. Her sisters do well in school, the oldest two are in the school hostel and look nice and clean in their uniforms. They are well cared for as is the little one. The only financial support she gets is 1100 Namibian dollars, around 100 euros a month.

How she copes?: better not ask; she goes to all NGO’s in the region and receives an extra food parcel here, a free uniform there, fee exemption in school: it takes much time, but it is worth it.

What is difficult is that she would like to start a family of her own; really her own, with her boy friend who does not know that she is responsible for 10 children. “He would run!”

28 years old, my daughter is of the same age: married, completed University and working as child psychologist.

What a difference!

The effect of HIV and AIDS on children.

In many countries HIV and AIDS has caused havoc on society. A study of ANPPCAN in one of the slums of Nairobi shows that 58% of the families is caring for one or more children that are not their own. A common saying is: “You go to a funeral and come home with one or two children; but what if you have a funeral every weekend?”

Children live with illness and death around them. And more losses does not make this easier, it makes the problems and the grieving only worse.

The report: “Home Truths” of 2009 by the Joint Learning Initiative on Children and HIV and AIDS reads “that the well-intended but misdirected efforts have drained resources that could have been invested more effectively for children and young people. Responses to date have not been sufficiently grounded in either evidence about children’s circumstance, or a clear understanding of the root causes of children’s vulnerability.”[1]

The report identifies failures in existing approaches to children and families affected by HIV and AIDS and calls for fundamental shifts in policies, programme, and funding to squarely refocus the response along four critical lines of action:

I was very happy to read this. Children are best supported in families. When HIV and AIDS enter the community all people are affected; when relatives get ill even when it can be treated with ARV, this has an effect on the whole family. Death is suddenly around the corner and things that seemed impossible become possible. For children parents are eternal, especially when children have loving parents and feel safe and secure.

But there is more. As the report states, families and communities currently bear approximately 90% of the financial cost of caring for infected and affected children. Many of these families already live in extreme poverty and as you have seen in the case study described of the young woman I met, the support they receive is scattered and often not coordinated. Projects are delivered on a small-scale and only few receive too little support. People I met described it as “shopping around” and “nobody has time, you never know when the social workers are in. You have to wait for hours to discover they will not come today. When you have told your story, you discover that you do not qualify for the support they give or your children cannot get a free uniform as you already receive a grant. But that grant is just enough to buy food and pay the school fees.”

Foster parents in our societies would speak up and lobby the government but when you are already poor, when you are ill or old or a child: what can you do?”

Most reports speak about prevention of infection; of promotion of safe sex and awareness and education of teenagers. Or they focus on financial problems related to HIV and AIDS. About the lack of material support, food supplements, ARV and medical care, and access to education. This is important and should be resolved.

But we must not forget to also look at other needs of the children affected by HIV and AIDS.

The importance for this is based on focus group discussions held with separate groups of children, caregivers and professionals from the Ministry in Namibia and an NGO in India.  They all worked for and with children that were no longer living with their own parents but instead with grandparents, aunties and siblings.

Children and young people were asked what their needs were and to rank them in order of importance. The same was done with the professionals.  Questions they answered were: “What assistance would caregivers ask for?” and “What are their needs?”

The four groups of social workers all were of the opinion that caregivers solely come for the grants, for school uniforms and other material support. When that is fulfilled they may come and speak about difficult behaviour of the children or you never see them again.

The caregivers however ranked highest the parental skills training.  “We need to come together”, they explained: “we see that the children have needs”. “They are easier angry, there is very little needed to frustrate them. They are sad, but they react irritated and with anger”. “We really need skills to handle that aggression, to handle their depression and to help them.”

The children started as they should: with education. But when they discussed their initial ranking they discovered that care was most important and agreed: “the most important is love”. “If your caregiver loves you, she or he will care for you and will provide you with all you need”

And that is important. With love, they will provide.

But because the caregivers love the children and want to provide quality care for them, they also see what they cannot provide. And that is not only the case in so called developing countries.

Two teenagers in Amsterdam told their social worker that they were concerned about their mother. Not because she has AIDS, but because they saw that she was concerned that she could not be the good mother she wanted to be. As a therapeutic activity these two teenagers made a video. In this video they tell their mother what a good mother she is for them. How “cosy” she makes it at home, even when she is not feeling well and they have to care for her instead of she caring for them[2]. 

The Third Stocktaking Report of Unite for Children, Unite against AIDS recommends: “Assistance to orphans and vulnerable children continues to be carried out primarily by families, faith-based groups and other small organisations, and successful programming reinforces the capacity of these support systems.[3]”

The capacity of this mother is that she can create the cosy and safe environment for her children. And support of organisations should be directed to reinforce that.

That is what the video makers did.

This paper directs the focus on the emotional support these groups can provide and on the reasons behind the fact that “the children are easier angry, depressed or aggressive.”

Grief in phases.

Imagine what happens to us when relatives die. We are going through a series of phases which need to be understood and allowed expression. Only then children can feel safe and secure and start to attach to new people.

These phases[4] are:

Denial: unbelief; this cannot have happened and not to this person. Children can also panic and start searching for the person in complete anxiety. But they may also do as if nothing happened. “If I do like normal, life will be normal and my mother will walk in the door again.”

Anger and Guilt: why did this happen, why to us, why to her? Why did God do this to us?

What did I do to make this happen? Children sometimes feel guilty because they were naughty, “did she die because of that?” Their parent was ill and they did not behave always well; some have even wished their parent dead and feel guilty.

Depression; if this happened to us, what is life worth, why should I continue to live?

Children are tired, sometimes exhausted and have no energy.

Reconciliation; starting to have moments of happiness again, energy is returning.

Re-attachment. New people to bond with, open again for new relations with new caregivers. Children can take on tasks and responsibilities and start to be themselves again.

When in our society a beloved person passes away we receive counseling and are carried through these phases by our relatives, by friends, the church or by professionals. The world around us understands that we have difficulties with concentration. That we cannot perform and that we are sometimes angry and other moments feel depressed. We are being cared for and get time to go through the process.

Children have a special skill to survive difficult moments in their life. They can extent the grieving until the moment they are ready for it and until they see that the people around them are ready to help them. You may recognize that some children are playing happily after the death of a beloved person. It looks like they are not having strong emotions.

School results are good; some children do even better in school than before. It looks as if these children put all their energy in being kind, in pleasing and in working hard for school. “As long as I do not have to think, it is good”.[5]

There is denial: “as long as I do as if it did not happen, it might not have happened. Daddy will return.”

When their brain can handle grieving and when they see that their remaining parent or their caregiver has started to reconcile and reattach to the world again, they allow themselves to start the process. Often that is not understood. “Why difficult behaviour and all this angriness and aggression at this moment, his father passed away two years ago, not recently?”

Failure to express true feelings can mean that the possibility of re-attachment is never reached. Imagine what that will mean for the generation that is faced with death after death. Grieving is not easier when you do it more often. They will not even start with the bereavement process and may stick to the first three faces and never attach to people again.

“Why should I, they will all die” and often this is the terrible truth.

When I met with groups of children and young people that were living with others than their parents I saw high levels of stress. You saw the unresolved bereavement reflected in them. Some were aggressive, some were very depressed. Schools report a higher level of suicide among OVC and school drop outs that see no reason to work hard when there is no future.

But when we discussed what is important and what their dreams for the future are, children expressed high expectations. They wanted to become doctors, nurses, teachers, engineers and one even said: “I want to become the Minister of Child Welfare; I want to make life better for the children without parents.”

Another group expressed that they were studying very hard, but were concerned that after they completed secondary education, there would be no funds to further their studies. Unemployment is high among school dropouts. The only option to provide an income for the family is entering into criminal activities and/ or selling your body. They all knew young people that ended up like that.

The Jlica report again: “poverty does not cause AIDS, but AIDS does cause and compound poverty and impedes efforts to reduce its impact”. A family living in countries, like The Netherlands, where social security systems will compensate loss of income due to illness and death is able to cope. What if there is no social security system and when poverty is all around you without being addressed appropriately?

Education can drag young people out of poverty. It is often the access point to support from outside. Education and material support is extremely important and we have to address it.

But the children and their caregivers also need emotional support, in particular in the often forgotten grieving process.

Caregivers, in particular grandparents, tend not to speak about the death of their beloved ones. “When I speak about their parents, I start to cry myself”. That crying together would help the children, is something one has to learn.

“They tell me not to think about my parents, as then I cannot study” a boy told us with tears in his eyes.

Caregivers ask for help to manage behaviour but they need support groups to help their children to grief and re-attach.

Children were asked to make a drawing of their family and introduce them to the rest of the group. After the first presentations one girl changed the titles on her drawing.

While one boy explained that his mother was here in the picture and she passed away, his father the same etc. the girl suddenly saw that she could allow herself showing the real relations in her family. The word mother in her drawing was crossed and became aunt, father became uncle.

Assistance to orphans and vulnerable children continues to be carried out primarily by families, faith-based groups and other small organisations, and successful programming reinforces the capacity of these support systems.[6]

It is essential to ensure that support is provided where the children are, in their families and communities. Love is central and can only unconditionally be provided in a family environment. It is extremely important to prevent that we add an extra separation to the ones children are already going through. Let them after the death of their parents not be separated from their relatives and friends. Many young teenagers want to stay in their own home. Child headed households can cope, when they are supported. Communities must be mobilized and I have seen that it can be done. A contract made by the community in a village in rural Orissa in India helps two parentless children staying together in their own home with an organised safety net of appointed members of the community.

The best support we can provide is to reinforce the support system the families and the communities have created themselves.

To return to the young lady we started with. Hearing such story one may think that the best solution would be that all younger children were placed in children’s homes and she could complete her University and start a job and family with her boyfriend.

But if we look deeper we see that that would not really help her and her siblings. The healing power can be found in the family as a whole and in their going through this loss of relatives as a family. They do have and need each other and have the potential to cope. Programming should reinforce the capacity of this support system targeting both the needs of the children ánd their young carer. The community, the traditional leaders and important women in the community should be supported to assist this family. NGO’s and FBO’s can set up a day care centre to take in the young ones and give a scholarship to complete University to the young “mother” while providing for household supporters from the community. They can provide free uniforms and money to pay for the school fees. All this should be based on a care plan made together with the whole family and based on the needs of all children. Why should they go around asking for help? Instead of this organisations can sit with the family, mapping out the needs and provide.

I saw this happen in the Indian village and the contract made together was signed by the group of supporters around such family. The social worker came once in two months to check progress, to provide some money and to arrange a support group meeting to renew the agreement.

That will give these and many other children the time and the peace to go through the grieving process. To reach the stage of reconciliation and start loving and trusting people and the world again. And most importantly that they, like we, believe that they indeed do have a future!

Endnotes:

[1] Joint Learning Initiative on Children and HIV/AIDS (JLICA) Report February 2009

[2] Lifeboat Films; A women’s guide to HIV positive motherhood; www.lifeboatfilms.org

[3] Children and AIDS, Third Stocktaking Report, December 2008, Unite for Children, Unite against AIDS, UNICEF

[4] Phases of grief Elisabeth Kubler-Ross, Separation and Loss; handout British Association for Adoption and Fostering;

[5] Are you listening to me?, Listening to children, Martine Delfos, PICOWO, The Netherlands

[6] Children and AIDS, Third Stocktaking Report, December 2008, Unite for Children, Unite against AIDS, UNICEF

References:

• African Network for the Prevention and Protection of Children against Child Abuse and Neglect (ANPPCAN), Research on Foster Care in Korogocho in Embakasi Division, Nairobi Kenya 2005.

• Joint Learning Initiative on Children and HIV/AIDS (JLICA), Home Truths, Facing the Facts on Children, AIDS, and Poverty, 2009, JLICA

• UNITE FOR CHILDREN; UNITE AGAINST AIDS, Children and AIDS: Third Stocktaking Report, 2008, UNICEF

• Kubler-Ross, E, Death: The final Stages of Growth, Prentence-Hall, Inc. 1975, USA

• Draft UN Guidelines for the appropriate Use and Conditions of Children in Alternative Care, 2009.