Trauma amongst Children

Trauma amongst Children

Many children are exposed to traumatic life events. But what separates their experience is that unlike adults, over time, most children return to their prior levels of functioning. Veena works with Aangan as a Program Associate and has provided a basic sense of what Trauma and counseling entails through her daily experiences with children going through the same.
Infographic by Ananya Khaitan.

India’s Forgotten Children

The author, Deepika Khatri is the Strategy and Advocacy Coordinator at Aangan. 

The metal entrance gate to a Children’s Home for Girls is barred and locked and a young girl sits banging her head against it.  No one pays her much attention. Behind her, four girls are lying in the corridor silently staring at the ceiling as a staff member cleans up after a girl who has just urinated on herself. A fifth sits in a corner, rocking back and forth. Inside, we’re immediately surrounded by a group of children. Three come up to shake hands, asking if we will play with them. The institution smells of unwashed clothes, urine and sweat. The girl at the entrance continues banging her head against the gate.

The cook-cum-cleaning staff member who lets us in says that it is what she does to get attention; it’s nothing to worry about. ‘Pagal hai, bas roz hungama karti hai’, she says. With other children needing her immediate attention to be cleaned, bathed and fed, and having to manage all the girls single-handedly, she is forced to prioritise who to care for first. Caring for children with incontinence implies having to repeat the cycle of washing and cleaning multiple times a day. Upstairs, another metal gate separates the ground floor from the first floor, where the ‘normal’ girls live. The staff member also has to ensure that these girls are readied for school and given their four meals a day. It is a full time job for four people, she says, not one.

The institution has a recommended staff capacity of 13. The actual number stands at 6, of which only 2 staff members directly engage with the children. They have a visiting doctor, but no paramedic. And at no point have these staff members been given any sort of support on caring for children with disabilities. The result? Intense pressure on the staff to simply get from day to day in circumstances that would rob anyone of the energy and ability for empathy. And the consequent impact on children: neglect, heightened vulnerability and a denial of even the fundamental right to dignity.  

In a lot of the work done with children by different stakeholders working in child protection, the words ‘marginalised’, ‘vulnerable’ and ‘disempowered’ feature. Looking at institutionalised children with disabilities, one comes to understand what that really means—what it means to be invisible. For a person’s existence not to matter to anybody. The implications of not having a voice, of being able to exercise any sort of choice, and of continuously being perceived as a burden, lacking in potential and capacity.  

Many of these assumptions stem from social perceptions of people with disabilities—that people with disabilities are in some way less human. The stigma attached to disability is such that at every level, advocating for the rights of children with disabilities is to battle deep-seated biases about the role children could play in the community as participating members. Existing conditions being what they are, only serve to dehumanise and deny children the opportunity and possibility of fulfilling their potential.  

In this context, we are advocating for an inclusive approach, for staff to be supported in caring for children through basic training on health and hygiene and for lateral linkages between government departments to enable children with disabilities to access their fundamental rights. It means having to challenge the rhetoric that children will be better off in an institution created for others like themselves—that purportedly homogenous group of children with disabilities, where one is indistinguishable from the other.

The impact we hope for is an acknowledgement of the magnitude of the problem in terms of the sheer numbers of invisible children with disabilities, and to engage with other stakeholders in the disabilities sector to promote the rights of the children. The trickle-down effect this could have is for children to be able to go to school with their peers, to access the toilet, or to have someone help and train them to put on a pair of trousers on their own.

The silver lining is that for the most part, caring for children with disabilities is not rocket science. It involves support from a specialist to understand the needs of a child, but thereon, to ensure that the child receives that care—whether it is through simple changes in an institution along the lines of universal design such as the construction of ramps to key access areas, training a child in going to the toilet on their own, and in the more severe cases, to ensure that the child is fed, cleaned and cared for. No one-size-fits-all separate institutions but simple ways of standing for the child’s right to dignity and inclusion.

Where is My Home?

The author, Suparna Gupta is Founder Director Aangan and Ford Foundation Mason Fellow from Harvard Kennedy School.

UNICEF reports more than ten million homeless children in India. Where are they, who should care for them and what can we do to keep them safe?

Fifteen year-old Vicky was homeless, bringing himself up after both parents died. Various odd jobs, a couple of thefts, nights spent on the streets and three years in a shelter – it was only when he was arrested for a petty theft that he was placed by state authorities in a reputed shelter. Here, shelter authorities made it their mission to re-unite him with family. (Child rights advocates the world over agree that placing children in institutions or shelters/rescue homes/orphanages must be the last resort and as far as possible children must be at home with family).

Within months they found Vicky’s estranged brother who lived in Mumbai and while this was heartening, Vicky was diagnosed with tuberculosis. He was placed into the care of his older brother. Also struggling to survive his brother lived in a makeshift house at his employers’ storage facility. Vicky stayed with his sibling, but his illness went untreated and in the harsh physical conditions his health deteriorated quickly. In December 2012 he was admitted to hospital, but soon after, Vicky died in a government hospital– untreated, alone and afraid.

As India joins the rest of the world in trying to keep children out of government-run institutions and in family or community care, we are faced with a critical question: Are we ready to empty out institutions/shelters/orphanages and place children back in neighborhoods and districts which drove them out in the first place? Vicky’s not uncommon story warns that it would be dangerous, even fatal for India to rush into what the United Nations Office of the High Commissioner for Human Rights[1] terms as “chaotic de-institutionalization,” emphasizing that while community care would result in far better enjoyment of human rights – it could also go very wrong if systems were not strong enough.

The need of the hour then is that we strengthen communities to be safe for children. In this context there are interesting lessons be learned from psychiatrist Franco Basaglia’s pioneering work in the 1970s – when Italy’s famous Law 180 did away with prison-like state mental hospitals. Basaglia’s inclusive model kept mental health patients at home with family, within the community, pulling them out of the role of “problem population” into a collective responsibility of the community.

But Basagliawas not naive about the challenges of preparing society for such a change. He was astute in understanding then that closing down state run institutions is in fact about opening up communities. He started this work gradually and creatively – beginning by opening up mental hospitals through community events so there was interaction, later in the community – linking mental health patients to one another, then to other marginalized groups, children in the community and finally to district authorities for employment. There were discussions and exchanges so that diverse populations began to understand each other better. However the process failed to engage broader political and economic institutions. And without enough funding and political will, communities cannot sustain such challenging work.

The foundation work of integrating children into their communities must begin early. First by “opening up” otherwise isolated institutions/shelters/rescue homes/orphanages so that people are clear that“remand homes” (as they are colloquially known) are not full of dangerous criminals, but rather are crowded with children who have who have been abandoned, orphaned, trafficked and exploited over long periods of time. The other huge task ahead, is to build  protective systems in communities- so people and government services are alert, grown ups are ready to listen to children and feel motivated to keep them safe.

Now for one optimistic moment let’s imagine that Vicky had moved with his brother into a community, which was ready to receive him. Would alert grown ups have identified him as a child who needs more support?  Would his brother been supported to care for him? Would education officers have spotted him as being out of school and investigated the reason? Would Vicky have felt more confident about going to the government hospital and accessing free health services? It’s hard to say. One can’t be certain that Vicky would have survived or lived longer. But at least he would have been treated, supported and cared for in his last few days, rather than been forgotten and failed by a system that never considered his existence.