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Dickens,
Boys Town or Purgatory:
Are Institutions a Place to Call Home?
By Victor Groza, Daniela F. Ileana, and Ivor Irwin
The impacts of instutionalism on adopted children of Romania,
along with a discussion of the history that lead to this sad state of
affairs. Part Two of Chapter 3, "Institutions for Children in Romania"
from the book "A Peacock or a Crow : Stories,
Interviews and Commentaries on Romanian Adoptions."
Return to Part One
Part Two Contents
Introduction
A Description of Romanian Institutions
Studies of Romanian Institutions
Summary: An Institution Is No Place
to Call Home!
Introduction
As mentioned in Chapter 1, the Ceauscescu government developed a solution
for families who were unable or unwilling to keep their children at home.
The solution to the problem was institutionalization. The exact figures
are as yet unavailable and may never be known, but, by the end of the
Ceauscescu dictatorship in December of 1989, it is estimated that there
were 600-700 institutions in Romania that provided residence for an estimated
100,000 children.1
Just as problematic as the number of children residing in institutions
under Ceauscescu is the number of children placed in institutions after
the dictatorship. According to UNICEF, following decreases in the number
of children in institutions in 1991 and 1992, by 1994 the numbers had
increased and become greater than the number of children in 1990. UNICEF
reports that in 1990, about 86,000 children were in institutions. In 1992,
only about 73,000 children were in institutions, largely due to international
adoption. By 1994, however, the numbers had increased to over 98,000 children.
2 In these institutions, about 24% of the children are
under the age of 8, 20% are 9 to 11, 31% are 12 to 15, 19% are 15 to 18,
and about 6% are over the age of 18. 3
Children continue to be abandoned, mostly in the maternity hospitals.
Mothers will deliver at the hospital and, simply, walk away. The hospital
staff can tell who is most likely to abandon their child. There is a typical
profile. It is a women who shows up at the maternity hospital, ready to
deliver, without her official papers. She will be from out of town. She
will be a single mother or a mother who already has several children.
Once she delivers her baby, she may give the child a name but often does
not. Without a name and the official paperwork, the child is instantaneously
placed in legal limbo. You can't track the mother because there are few
social workers to do outreach and you don't know if you have the correct
information. The child cannot be adopted because, under Romanian law,
the child is not legal -- he or she is nobody's child.
(From Victor's diary and notes): Ancuta was 19 years old, from
a village near Brashov, in Transylvania. Her water had broke by the
time she arrived at the maternity hospital. She had traveled in the
morning by train, arriving at Gara de Nord (the north train station
and main station in Bucharest) around noon. She told the doctor that
she was in a rush after the contractions started and forgot her papers.
However, she promised that her family would be bringing them when they
came for a visit after the baby was born. Ancuta was unmarried and the
father of the child refused to marry her or claim the child. In fact,
they had broken up over the pregnancy. She had a previous pregnancy
a year ago that she terminated with an abortion -- it was so painful
she decided not to have a second abortion. She worked on her parents'
farm. The interview was interrupted when her contractions increased
and she was taken for delivery. A day after she delivered, the mother
was gone and the little girl, whom she named Ana, was left in the maternity
ward -- with a name but with no registration and no way to track the
mother. She would stay at the hospital for about a month and then be
assigned to one of the state orphanages.
The hospitals will keep children up to three months, but then they must
be moved. It is chilling to walk into the nursery at a maternity hospital.
Instead of hearing children crying and seeing them move around, they are
quiet -- too quiet. It's not natural. The children, if their eyes are
open, stare blankly into space. While the wards are generally clean and
the necessary medical supplies are available, they are eerie -- silent
and abnormal without child activity.
There have been many official and some unofficial reports about the structure
of the child institutions in Romania. The following has been pieced together
from official documents, unofficial reports, and personal experiences.
4
Under the old regime, up until the age of three, children were placed
in institutions called orphanages or leagane. These residential
facilities were under the direction of the Ministry of Health. It appears
that, at around the age of 3, the children in these orphanages were divided
into two or three groups. The first group were 'normal children.' Children
were classified as normal if they could pass an assessment conducted by
a physician or, in some institutions, a team of professionals. There was
little training in child development for the persons conducting the assessments
and a lack of uniformity in assessment techniques; children were generally
considered normal if they could talk, were toilet trained, and suffered
no apparent physical difficulty. These children were sent to training
schools where they were fed, clothed, sheltered, and received an education.
Interestingly, few gypsy children were judged normal. The "normal"
children were under the guidance of the Ministry for Education until the
age of 18.
The second group was made up of those children who had minor handicaps.
There was one school for the deaf, one school for the blind, and other
schools classified as "special schools" or "special hospitals."
"Special school" may have been the words used to describe the
place, but there was nothing "special" about the program. They
were not as well supplied as the normal schools, but these children were
still at least seen as salvageable and educable. These children were also
under the Ministry of Education.
The children who belonged to the last group were diagnosed with physical,
medical, or psychological problems that were considered too severe for
either of the placements mentioned above; therefore, they were sent to
an institution for the 'Irrecoverable.' These were children who were considered
unsalvageable. The children in this group included those with major mental
and physical defects, as well as children with medically correctable handicaps
such as crossed-eyes or club feet. 5 The main purpose
for sending these children to institutions of this sort was to hide them
away, helping only to maintain the belief that Romania did not have any
social problems or handicapped children. These children were under the
direction of the Ministry for the Handicapped.
I remember that first year so vividly as we drove from Bucharest to
the Institution for the Irrecoverables in Videle. After two hours of
driving, through black, oil-drenched fields where cows walked around
the oil slicks, we arrived at the village. We stood at a large compound
of white buildings that, from the outside, looked like they needed a
lot of work. The paint was chipped with big splotches of unpainted cement.
Electric wires were dangling and blowing back and forth. Many of the
windows were missing. Between bricks, mortar was gone. It was hard to
believe that anyone could live here! The front gate was probably about
8 feet tall; next to the gate was a guard station and a large fence
circled the entire complex.
We were escorted from the front gate to the back of the complex by
the guard and an official from the Ministry for the Handicapped. At
the very back of the complex, surrounded by raven-colored fields on
three sides sat another of those white, three-storied buildings with
a large white stockade fence that fortified the alcazar. You could see
the faces of children peering through heart-shaped grates, black and
rusting, which covered the windows and the doors -- vacant eyes, older
then they should have been, looking at us through black, rusted hearts.
More dismal then the building was the screams and cries that echoed
out and through the gates while we waited to enter. Here were the Irrecoverables
-- hidden from most of the populace and obscured in the back of a large
compound, children screamed from the pain and purgatory of institutional
life.
The three-tiered-system of institutions had very different physical conditions
as well as child care standards. The most horrendous conditions were found
in the institutions for the Irrecoverables and the images seen in the
media such as those presented in the "20/20" special "Shame
of a Nation" were from these settings. Romania was not unique in
this system of institutions. It appears that there are similar institutions
and tiered systems in Russia 6 and the Baltic States,
7 with a range of quality in their atmosphere, staff,
and programs.
A
Description of Romanian Institutions
A more formal description of these institutions is necessary to gain
an understanding of the devastating impact these orphanages and institutions
had on some of the children adopted from Romania, as well as the continued
risk that they pose for children still surviving in them. In must be mentioned
that there were differences among the various institutions -- some had
bigger budgets and better qualified personnel. Still, in layman's terms
-- it was a case of bad to worse, the rock in competition with the hard
place, the devil doing a doggie paddle to prevent drowning in the deep
blue sea.
We pushed the buzzer and waited to be escorted into the building. We
were immediately swarmed by children, some half-dressed, many with obvious
physical handicaps, coming to see the straine (strangers). They
were shooed away by the guards and we were ushered into the Director's
office. Since this was our first meeting, after introductions we were
all served tzuica with selzer water. Of course, it was 10 AM
but this is the hospitality of Romanians. Besides, the staff were more
interested in Americans than the children under their care. We were
then left alone and our escorts left the premises. We were told to make
our report to the Ministry for the Handicapped when we completed our
work. The Director left his office and said he would return. With nothing
else left to do, we waited. This is what you do a lot in Romania, you
wait. Often, you wait for nothing. Several hours later we were shown
to our rooms -- two rooms on the ground floor that were big enough to
be a classroom for 20 children -- joined by a smaller room with a sink,
toilet and shower. The walls were painted mustard-brown. The water,
when it ran, was brown. On one side was a pig farm; on the other side
the sewer drained on to the playground, and in the back were large garbage
dumpsters. Surrounded by sewage, garbage and pigs -- a clear metaphor,
if this was the "wrapping," you can only begin to imagine
what was inside.
The orphanages were colorless, shockingly quiet and devoid of any of
the usual visual or auditory stimulation that children usually receive
from bright colors, pictures, and displays. Walls were painted in dark
browns, to hide the dirt. The paint absorbed any light -- when there were
working light switches and light bulbs -- making halls and bedrooms darker.
It seemed as if the entire building was sucking the souls of the children,
and perhaps the staff that worked there. There were no toys. There was
no exercise or exposure to the outside. 20 Most of the
time, the children did not have enough to eat or drink. Consequently,
most children were below the twentieth percentile for height and weight
compared to normally developing children. 21 One consequence
of low height and weight is greater susceptibility to diseases. While
official data were not available, some staff said that mortality rates
in the winter could reach 40%. Recent information suggests that 50% died
within the first 24 months. 22
In the back behind the dumpster was a small field with a fence all
around it. In a farm village, all land is used. But this small area
was speckled with little mounds that were grown over with grasses, weeds
and wildflowers. We asked the staff about the little field. They said
it was nothing, just unused land. Then, one of the children, an "irrecoverable"
with spina bifida who had learned to speak English, said that it was
the field of the dead children. After speaking to some of the volunteers
and the local school teacher who taught English, we learned that when
children died, they were buried in this field in unmarked graves. These
children had no families, so there was no sponsor to have them baptized.
If they had no families and were not baptised, they could not be buried
in holy ground. Besides, even if the families knew the children were
here, they couldn't afford a burial. So, the little mounds were graves.
It was as the bitter Romanian saying: lucky for the dead, their ordeals
are over.
In addition, children in orphanages were exposed to stunningly inadequate
child-to-staff ratios ranging from 8:1 to 35:1. This allowed for an absolute
minimum of personal interaction. 23 Crying was ignored,
both as policy and as a natural reaction to so few staff caring for so
many children. The staff provided minimum touching and handling of the
children; the children who were left lying in cribs were not changed in
position or stimulated for most of the day. 24
The first day that we were to conduct assessments, the Director had
set us up in a room at the end of the hallway on the first floor of
the institution. The first floor housed all the children ages 3 to 6,
our target group for assessment. We were on time for our program and
waited for the translators to arrive. They were an hour late. We went
with the translators to the first room, which had 8 beds and 12 children.
The nurse was directed to bring the first child, a little boy of 5 named
Florin, with her for the assessment. She picked up the child; he pushed
her away. As she got to the door to go down the hall, he started crying.
By the time we had walked about 100 feet to the office, he was inconsolable
-- screaming, crying and trying to get out of her arms. We were shocked
-- we asked the translator to explain to us. First, the nurse said it
was because we were strangers. However, we pointed out that we had been
in the bedroom with him and he had been curious about our presence,
not upset. After going in circles for almost an hour, what we discovered
was that this child had never before been out of the room. Can you imagine?
Five-years-old and only to have known the same four walls! Children
only distinguish between what is familiar and unfamiliar to them. This
child was frightened and distressed by the unfamiliar surroundings.
Since most of the children had never left their rooms, we changed our
protocol and conducted the other assessments in the rooms where the
children had lived most of their lives.
However, on a bizarrely positive note, jobs are hard to find in Romania,
thus staffing was and remains very stable. The same people were involved
with children over time, and, one can surmise, that, even if the quality
of care was extremely poor, the children were familiar with the staff
who "took care of them."
It was never clear if there were expectations for the staff to do something
with the children. We would see them standing together at the end of
the hall, smoking cigarettes and drinking coffee, once the Director
left the premises. The children were put in bed after dinner and just
lay there. If the television was on, it was usually for the staff, although
sometimes the older girls were allowed in the staff's room to watch
TV. At night, while we sat in the room, we could hear children crying,
followed by a slap, and silence. It wasn't unusual the next morning
for us to see a bruised child, reportedly caused by one child hitting
another child.
The only time the children were allowed out of bed or outside was when
the foreign volunteers came. But the volunteers (from Ireland) did everything
while the Romanian staff just stood by and watched. Did they just watch
because they didn't care? Did they watch because it didn't matter what
they did, they would have the same job at the same wage for life? Or,
did they just watch because they felt no ownership in what was going
on? A disempowerment from strangers who did not know the Romanian reality,
strangers who would leave and go back to the comfort of their rich countries
while nothing really changed here? With so many children, who belonged
to no family, and a guaranteed job regardless of what you did -- as
long as you showed up -- why do anything?
With so many children and so few staff, the children received minimal
routine care. Educational and recreational programming was virtually nonexistent
-- no activities for children to stimulate them or for fun, no school
or specialized programs designed to help them grow and develop. Children
were left to their own devices for stimulation. Many would become autistic-like
-- having a blank stare, rocking back and forth, and looking constantly
at their hands. Those children who were too active in exploring their
environments were restrained -- either physically with straps or chemically
through tranquilizers. 25 Proper hygiene often could
not be practiced due to a lack of hot water, soap, washing machines, clean
bed linen, and an inadequate number of cots and beds. It was not uncommon
for children to lay in their feces or urine. Having two children in the
same bed was typical. In addition to a lack of running water, sewer systems
were often inoperative.
What I remember is the smell. Having had nasal surgery a decade before
I went to Romania, I suffered some damage. If I could smell it, I couldn't
imagine how others were experiencing the smell. The staff would start
to wash clothes, then the water would cut off. So, they would take the
half washed clothes -- most of which were covered with feces or soaked
with urine -- and leave them in the tubs until the water came back on.
Sometimes, they stayed in their watery trough for days and a fetid film
would develop. At times, when they ran out of bed clothes, they would
put them in the dryer regardless of where they were in the wash cycle.
The heat from the dyer would spread the smell throughout the whole building
and the sheets would return with huge stains as well as the dried-in
smell. So, our experience was open sewer on one side, pig farm on the
other, pools of fetid water in the basement, and the hot air of human
excrement. Some days we would have to walk to town. We could escape.
The children could not.
The physical structure of these institutions was also a problem. Most
windows had neither screens nor glass. In the summer, flies would swarm
the rooms and rainstorms would flood the floors. In the winter, children
suffered frostbite due to a lack of heat and an inability to keep cold
out of the wards and rooms.
Problems with administrative records added to the horrifying physical
conditions. Birth records, medical histories, and information about biological
parents would obviously have been invaluable to such children and their
care; but, because so many children had been abandoned at the hospital,
this was an impossibility. Most charts in Romanian institutions were found
to only have two lines, created by the institution itself. 26
When children were moved from institution to institution, which was a
common practice, their charts rarely followed them. In many cases, if
parents wanted to find their children again, it became an impossibility;
they were lost to the system. Even more diabolical was the fact that,
after Iliescu took power and the adoption chaos began in 1990, the law
insisted that no adoption could take place without parental consent. So,
you had children with no records and parents who didn't know where to
find their children, often having no contact with them for several years.
We spent one day just reviewing children's records with our translators.
You have to keep in mind that these children were between the ages of
three and five. Typically, there was a one-page record. We did get some
information, however, from these records: about 60% of the children
were there because of poverty -- the parents couldn't afford to keep
them. But, then there were all these diagnosis that we had never heard
of -- nor had the translators, both who were college educated in Romania.
It seemed that under communism an entire nomenclature of diagnosis had
been established that had no relevance to western treatment and made
little sense to the Romanians. Even if the Romanians understood the
"diagnosis," there was no treatment or plan for treating the
diagnosis given. The saddest thing is that we found almost nothing in
most of the files about the families of these children.
Staff hired to work in the orphanages and institutions were not required
to possess any special qualifications that might improve their interactions
with these children. Job descriptions, rewards for excelling, and organizational
charts were not available. Penalties for failing to perform tasks were
not enforced, which only served to enable incompetent staff members.
It was obvious that the only person in charge was the director. So,
when he was in his office for a break or left the building, the children
were ignored. The staff, who were mostly unskilled peasant women, would
congregate around the television to drink coffee, smoke and laugh with
each other. Usually, one of the older children was left to oversee the
other children, or else the door to the room was shut and the children
would not dare open the door. One day, when we came back from doing
our daily shopping at the piata (market place) in town, we found
all the children on one floor huddled under the steps of one of the
landings with one of the boys standing over them. They cowered silently
while he glared at them. If they moved, he would grunt and lunge at
them -- forcing them to cower back under the stairs. One of the children
obviously had challenged his authority and was left bruised and bleeding.
It seemed that the Director had left the grounds for the day, so the
one child was rewarded with cigarettes and candy to "watch"
over the other children.
Since the closing of social work programs in the 1960's, there were no
social workers to conduct permanency planning, crisis intervention, extended
family foster care services, domestic adoption, or home-based care. When
abandoned children became ill, despite socialist propaganda claims, hospitals
would oftentimes refuse them based upon insufficient means of official
family identities. These children had no advocates, so it was common for
them to remain in institutions and receive little or no medical care for
their illnesses. It was no wonder they had to have a burial field for
the children whose only escape was through death.
Studies
of Romanian Institutions
"A whole people, not yet born
Is condemned to be born."
Gabreiela Adamsteanu, 1990
The veracity of Ms. Adamasteanu's verse cannot be doubted. There are
more children institutionalized in Romania than ever before. The Romanian
government, despite the elections that set "democracy" in motion,
still plays shell games when it comes to information access for visiting
foreign social workers and the media. Nevertheless, the anecdotal evidence
gleaned from scores of interviews and off-the-record conversations with
English, Irish, French, German, Canadian and American social workers,
nurses, physicians, lawyers and adoption consultants -- many of whom have
been regularly in and out of Romania for the past seven years -- and accounts
such as the United Nations Report on Children in Eastern and Central Europe,
27 shows that, although conditions are slightly better
in some institutions, the number of incarcerated children has risen. The
much publicized Orphanage Number One -- patronized and filled with toys
by the pop music icon Michael Jackson -- may look great in the thousands
of sound-byte broadcasts put out around the world, but it's all cosmetic.
Help is still desperately needed.
Several studies were conducted in various institutions and orphanages
in Romania. Studies were conducted prior to and in the immediate aftermath
of the "revolution," and over the past seven years since. The
findings of these researchers are remarkably similar to those first published
by Henry Dwight Chapin at the turn of the century.
Olimpia Macovei, 28 a Romanian scientist, assessed
the developmental delays of institutionalized children in the district
of Iasi from 1976 to 1986. The delays she noted included less physical
growth, decreased social and motor skills, and lags in psychological and
intellectual functioning. These findings were corroborated by Dr. Dana
Johnson and colleagues 29 when a group of 65 adopted
children from Romania were examined at a clinic in Minnesota. Dr. Johnson
and colleagues reported that only 15% appeared to be developmentally normal
and in good health; head circumference, weight and height had all been
negatively affected by institutionalization.
Two other problems of institutionalized Romanian children, reported as
early as 1990 by the Center for Disease Control, were the predominance
of the human immune deficiency virus (HIV) and hepatitis (HBV) infections.
As of 1990, the incidence of pediatric AIDS ran second only to the number
of cases reported in the U.S.
Consequently, because of the lack of knowledge about infection control
and a denial of the existence of the virus by the Romanian government,
universal precautions were not practiced. It appears that the infections
children acquired, along with those passed on by blood transfusions, came
from syringes that weren't properly sterilized and were used repeatedly
on as many patients as possible. As early as February 1990, two months
after the revolution, families adopting children from Romania were encouraged
to have their children tested for HIV/AIDS 30.
As the world's attention focused on the orphaned and abandoned children
in Romania, many organizations and individual volunteers entered the institutions.
From these efforts, several reports were generated about the children
from these institutions. Some researchers suggested that the children
in the orphanage displayed clear deficits in social and cognitive functioning
compared to same age children attending kindergarten. 31
On the basis of these differences, researchers predicted that these children
would have learning difficulties in the future. Yet, the way in which
these children utilized one another during testing -- constantly adapting
to each other as "friends" even though they were deliberately
rotated from room to room and, sometimes, from facility to facility --
showed major coping skills and strengths. Also, once international groups
arrived, the vast majority of children made tremendous positive changes
in their growth and development. Some promising results have been reported
that offset many of the harsh effects. Programs that involved changing
the institution and training community volunteers to stimulate children
can improve children's functioning, even if they continue to reside in
institutions. 32
Summary:
An Institution Is No Place to Call Home!
"Please, sir. I want some more."
Oliver Twist, by Charles Dickens
Institutions, regardless of the quality of care, have profound negative
effects on children that may well last a lifetime. At a minimum, the regimentation
of institutional life does not provide children with the type or quality
of experiences they need to be healthy, happy, fully functioning adults.
In group care, the needs of any individual child are secondary to the
requirements of group routine. Relationships between adults and children
are superficial and brief, with little or no warmth or affection. Institutional
staff do not connect emotionally or physically in nearly the same way
families connect with children. In developing countries like Romania,
early institutional care will likely lead to institutional care for the
rest of a child's life. Prevention of institutionalization should be emphasized
because some children may not ever be able to completely overcome the
negative effects of institutionalization.
Hope is there, however. Some children are just plain ol' resilient, regardless
of the sticky experiences and circumstances of their early lives. Children
leaving institutions can be positively affected by the quality of the
family life they enter. The effects of institutionalization are very much
influenced by the age of the child when they enter and the length of time
spent incarcerated. While this evidence has been accumulating for many
years, the children of Romania offer us a unique opportunity to review
what we know and further examine until we know for a certainty which trauma
is reversible and which is at least manageable.
Return to Part One
References
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Adoption of Children with Special
Needs
