Saving Sasha: Helping Children in Institutionalized Care in Serbia
By Tamar Hahn
Sasha is a 14-month old baby boy living in Kolevka, a children’s home in the Serbian town of Subotica. There are 179 other children aged 0 to 8 in Kolevka. They live in overcrowded conditions, 15 to 16 to a room. Two nurses are assigned to each room, which means that the children receive very limited attention. Cuddling, speaking, singing, even diaper changing is in short supply. The children have few toys and rarely go outside.
Little Sasha is in the habit of banging his head against the floor and, according to the staff, is aggressive to others. However, when picked up by a visitor he becomes calm and cuddly even though he still looks sad. When offered a teddy bear which usually sits high up on a shelf, beyond his reach, he cuddles it with a firm grip, afraid it might be taken away from him at any time.
According to child psychologists, Sasha’s aggressive behaviour is nothing but a desperate call for attention. At his tender age, he has come to understand that whenever he behaves aggressively he receives attention from the staff and that if he just lies in his crib complacently he is ignored for hours. Sasha’s behaviour is proof that he has not given up on his social environment while most of the other children in the room just lay motionless and stare into space without showing any emotion or emitting a sound.
Sasha’s resilience is rarely seen in institutionalised young children. For most, inadequate social stimulation and emotional deprivation has a drastic effect on their impressionable and dynamic mind. As a result, they become inactive, quiet and compliant infants within as little as three months of institutionalization.
About 1.5 million children in the CEE/CIS live in public care. In Serbia, an estimated 5 out of every 1000 children below the age of 3 spend some time in residential care. Many of these children are placed unnecessarily and for too long in institutions. Few of these children are orphans. In Kolevka, for instance, 145 of the 180 children in residence have parents or other relatives. The high number of institutionalized children seems to be the result of poverty (over 10 per cent of the population lives below the poverty line) and a lack of other support systems for parents dealing with a child with disabilities or facing difficulties at home due to substance abuse, domestic violence and mental health problems.
An internal, unpublished report from the World Health Organization Collaboration Centre on Child Care and Protection at the University of Birmingham draws a bleak picture of the situation of most of the children living in institutions.
In “Stacionar za majku i dete”, a Belgrade institution which houses 300 young children under the age of 3 all children up to 18 months of age receive only medical care and nursing with no psychological or educational programs. Rarely do they go outside. A third of the children are considered to have disabilities.
Starting at 18 months the children are placed in social groups but the staff to child ratio is 1:10, which limits the degree of psycho-social stimulation that the children receive causing harm to both their physical and emotional development. The young children are physically well cared for in a clinic-like environment but show a failure to thrive with height, weight and head circumference below the norm expected for children from Serbian families. This growth failure, known as psycho-social dwarfism, is the result of social and emotional deprivation and overcrowding commonly seen in institutionalised young children.
At Kolevka, a home for young children (0 to 8 years), restricting movement in a young child to prevent self harm (scratching).
In this environment any disability problems are exacerbated and even non-disabled children show developmental delay and do not begin to walk or talk until later in comparison to children who grow up in a family setting. The missed milestones in development have a knock on effect and the children never reach their optimal potential for physical and psycho-social growth and development.
Some parents do visit their children but they are restricted to the use of a small room with minimal furniture and no toys while they spend time with their children. There seems to be little attempt to engage the parents in the physical and emotional care of their child and to help around the busy clinic environment to support nursing staff.
One of 285 young children (0 to 3 years) in Stacionar za majku i dete, Belgrade: Growth failure and developmental delay is a consequence of over crowded conditions with little social stimulation and no variety of experience.
The government of Serbia is eager to improve the situation of children like Sasha. In 2004, it introduced a National Plan of Action for Children which lists as one of its objectives protecting the rights of children deprived of parental care by gradually dismantling the institutional forms of protection currently in place and encouraging family based care.
To do so will imply a shift away from state residential care and towards a more integrated approach designed to help parents meet the needs of the child and to create support in the communities in which these children and their families live.
Clinical Centre of Serbia, Institute for Obstetrics and Gynaecology, in Belgrade: Children separated from their mothers after birth. They are all placed on a trolley together and wheeled from room to room to be delivered to their mother for breast feeding every four hours. This is convenient for hospital management but disastrous for the development of the mother-child relationship.
Following a pilot project in 2002, the Serbian government has been engaged in a programme designed to transform residential institutions for children and youth with the support of UNICEF and the Norwegian government. A major goal of the programme is to carry out an assessment of each of the children in five different institutions spread throughout Serbia and to develop an individualized plan for their future care.
By the end of April 2006, 1700 children had been assessed, plans for the transformation of 19 institutions were developed, a list of services required at the local level was established and proposed measures for change had been delivered to each institution. The next steps include transfering certain number of children from institutions into a less restrictive environment in the nearest future, developing services contingent upon actual needs in municipalities where residential institutions are located and creating efficient gate-keeping mechanism to prevent future placement of children in institutions
A lot is at stake. Studies claim that the neglect and damage caused by deprivation in early childhood are akin to violent abuse. For Sasha and the thousands of other children like him in Serbia a change will mean a better childhood and the chance to develop to their full potential as adults.