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International Child Health Section: Articles
Francistown, Botswana, May-June 2007
Submitted by Gillian Morantz
I am very grateful for the recent research experience I had in Botswana, under the supervision of Dr. Jody Heymann, the director of the McGill Institute for Health and Social Policy. Over the course of six weeks in May to June 2007, I collected qualitative and quantitative data at the SOS Children's Village in Francistown, Botswana's second largest city. This international child welfare organization is a residential care facility for orphans and other vulnerable children who have been either neglected, abused or abandoned. For many of these children, the HIV/AIDS pandemic has played a significant role in determining their need for placement. In addition, 38 of the 232 children in residence at SOS Francistown are known to be HIV infected. I chose to undertake a study at this particular organization because it provides comprehensive care services. The ultimate goal of this research project is to further the understanding of the biopsychosocial needs and experiences of orphans and other vulnerable children in residential care in sub-Saharan Africa, in the hope of improving their care.
Although Botswana is currently one of Africa 's most stable countries, like many other countries in Southern Africa, it has been ravaged by HIV/AIDS. With more than one in three adults infected with HIV, Botswana presently has the second highest prevalence of HIV infection in the world. Due to this disease, the life expectancy in Botswana, which was 64 years in 1990, is now 35 years, the lowest in the world. This scourge is resulting in an epidemic of orphans as well as the "apple-coring" of society with the very old left to care for the very young. In Botswana, 1 in every 5 children is an orphan. Several studies have shown that AIDS orphans are less likely to go to school and have food security than their peers. They suffer higher rates of depression and anxiety and are more likely to be exposed to HIV. Moreover, we have yet to fully comprehend the psychological impact that growing up without one or both of their parents will have on a large part of an entire generation, not to mention having to witness and often care for their parents during their illness and death.
Previously in sub-Saharan Africa, orphaned children were absorbed by extended family networks. Although the majority still are, these networks are being overwhelmed by the sheer numbers of orphans, and weakened by the death of prime-age caregivers, urbanization and poverty. Residential care facilities offer an alternative. Such facilities have come under scrutiny for a number of reasons. They characteristically have high staff turnover rates and child-to-staff ratios, result in difficult transitions to community life in early adulthood, cost more to run and face greater challenges to scaling up. A number of studies on residential care facilities have revealed worse physical and mental health outcomes. Nevertheless, when extended family networks fail or are unable to provide safe and caring environments, residential facilities may become necessary.
SOS Francistown is one such residential facility that strives to provide comprehensive care in a family environment. It is part of the well-established SOS-Kinderdorf International and receives funding from this parent organization, as well as from private local and international donors. SOS Francistown was established in 1999 and currently houses 232 children who live in groups of 12-15 within 17 family homes. Each family home has 2 "SOS Mothers" who are paid caregivers that supervise the children's day to day life. The organization has 14 teenagers living in the boys and girls youth facilities, where they are given more independence with the aim of easing the transition to independent living. SOS Francistown also operates a kindergarten on its premises attended jointly by preschool-aged children from SOS and from the surrounding community. As aforementioned, 38 of its children are known to be HIV-infected. These children are all on highly active antiretroviral therapy provided free of charge by the government of Botswana.
During my 6 weeks at the organization, I completed 160 semi-structured interviews with the aid of a translator. I spoke with nearly 80 children, youth, programme graduates, and over forty SOS staff. I interviewed twenty of the children’s teachers at the SOS kindergarten, as well as in the community schools they attend. I also questioned several of the parents who send their children to the SOS kindergarten. My interviews were geared to obtain a better understanding of the facility’s selection process and the comprehensive services it offers. I tried to uncover the children’s perspectives of their lives before coming to live at SOS and after. I also collected quantitative demographic information on all the children in the form of a database.
I am in the process of analyzing the data that I gathered and hope to publish a case study of SOS Francistown, as well as several articles on various aspects of the project. Currently, I am working on an article that will be written entirely from the point of view of the children and their recounting of their life experiences.
My personal interest in this project stems from previous work with HIV infected and affected children in Zimbabwe and Burkina Faso. Although I had been fortunate enough to have worked in several countries in Africa, my previous undertakings there had been either in development work or clinical medicine. This experience was my first opportunity to pursue a research project in a developing country. I have learned a great deal about interviewing children and adults in a different culture and about the qualitative research process in general. Moreover, it confirmed my interest in making international health research and advocacy a significant part of my eventual career in paediatrics. I am extremely thankful to the Don and Elizabeth Hillman International Child Health Grant for supporting this endeavour.
Posted: October 2007
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