Caring for Orphans After Ebola: My View and Experience

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The importance of Putting Ebola Effected Children in a Family Home

Amidst the horror and heartbreak in Liberia of the Deadly Ebola Virus, there is the added atrocity of children losing their parents to the disease. Like all children, these orphans not only need good physical care, but they also need the love, attention and an attachment figure from whom they can develop a secure foundation for future relationships.

To families struggling to cope with orphans in their care, an orphanage would seem to be appealing as it would appear that the child is sure to receive food, clothing and an education. However, programs to keep children within a community, or surrounded by leaders and peers that they know and love, are ultimately less costly, both in terms of finance and the emotional cost to the child. In fact, there is now an abundance of global evidence demonstrating serious developmental problems associated with placement of children in these facilities, as residential development specialists have recognized that they consistently fail to meet children’s developmental needs for attachment, acculturation and social integration. Already orphanages are not well supported, and a child who has lost one or both parents does not receive the affections that they were accustomed to, as caregivers and administrators as busy just looking for food for these children.

As is the case in Liberia, these residential institutions are not the best means of caring for these children as many of them are not well supported. A particular shortcoming of institutional care is that young children typically do not experience the continuity of care that they need to form a lasting attachment with an adult caregiver. Ongoing and meaningful contact between a child and an individual care provider is almost always impossible to maintain in a residential institution because of the high ratio of children to staff, the high frequency of staff turnover and the nature of shift work. Institutions have their own “culture,” which is often rigid and lacking in basic community and family socialization.
My experience of growing up in an orphanage gave me a sense of providing for some of my own basic needs, and this experience led me to many future life challenges. Today, children at various orphanages live at the mercies of the communities, and will face these same challenges. Having a meal is a luxury and even having a proper education is a matter of privilege – which of course should be a right. Most of the time, instructors are former students of the orphanage. In fact, in one case, an entire elementary school had to be run by a 76 year old great grandfather who had difficulty communicating directly with the young children.  Orphanages today receive little or no support, and notwithstanding their best intentions, without question these children systemically miss parental love and care. To have this new batch of orphans that have been created by this Ebola crisis placed in institutional care will prolong this problem.

During the civil war there was huge support to orphanages , as they were seen as a means to bring up the children who have lost their parents, however, it is just the opposite today. These children have difficulty forming and maintaining relationships throughout childhood and adolescence. Indeed, those who have visited an orphanage are likely to have been approached by young children wanting to touch them or hold their hand. Although such behavior may initially seem to be an expression of spontaneous affection, it is actually a symptom of a significant attachment problem. A young child with a secure sense of attachment is more likely to be cautious, even fearful, of strangers, rather than seeking to touch them. A rule of thumb is that for every three months that a young child resides in an orphanage, they lose one month of development. Children under three years should not be placed in a residential care institution without a parent/primary caregiver. Foster care as a means of giving a child a hope of a family will increase their chance of developing the affection they require. Government must shift from an institution support to foster care for these children.

Seeing their parents die before their eyes is something that these children must deal with all of their lives, and will require psychosocial counseling to allow for proper emotional development.  For those who do not receive such assistance, they must rely on the institutional system which is ill-equipped to provide such support. The effect is the crippling of that child’s potential and the predetermined limitations of a generation of Liberians, which in turn will restrict our national economic, political and social growth. In fact, our observations show that due to the lack of support to the orphanages one in three children who leave the various orphanages becomes homeless; two in five ends up with a criminal record; and up to three in five of the girls get pregnant before graduation from high school.

Further, even if one were to prefer the continuation of institutional care, the economic reality does not support that position. Orphanages area more expensive option, as the facilities require staffing, buildings must be maintained, salaries must be paid, not to mention the rising costs of food and supplies. The  World Bank calculated that professional foster care would cost USD$91 per month per child (based on 1998 official exchange rates) compared to between USD$201 and USD$280 per month/per child for the cost of institutional care. A cost comparison in east and central Africa by Save the Children UK found residential care to be ten times more expensive than community-based forms of care. The per-child costs cited above offer meaningful points of reference, but they do not tell the whole story. For example, they do not take into account social welfare infrastructure investments that may be needed (e.g., social work training
and social welfare services that enhance the effectiveness of foster care and reunification). Also, when there is a transition to family-based care, total costs are likely to increase for an interim period because institutional care must be maintained until new family-based alternatives are developed. However, it is clear that in the medium and longer term, the resources that would have been used to sustain institutional care could be redirected to provide improved care for a much larger number of children through family- and community-based efforts. Family based care not only tends to lead to better developmental outcomes, but it is also ultimately a way of using resources to benefit more children. Studies focusing on the reasons for institutional placements consistently reflect that poverty is the driving force behind their placement studies show “that resources committed to institutions can be more effectively used to combat poverty if provided to alternative, community-based support organizations for children and families.”

Further, institutional care has largely been judged to be developmentally inappropriate and phased out of developed countries that continue to support this care in poorer countries.

As these new orphans have been created from Ebola, we need to work out a plan of reintegration, reduce the rate of stigmatization against them, and develop a plan of creating supportive foster homes for the children.

Amos Sawboh is a child rights Advocate in Liberia. He grew up in a Liberian orphanage, and is currently the Founder and Executive Director of Orphans Concern Liberia.  ORCON is comprised of young people who grew up in various orphanages during and after the War in Liberia.

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