Running head: PERSPECTIVES OF GUYANESE CAREGIVERS

The Key to a "Good" Home: The Perspective of Guyanese Children's Home Caregivers

By

Shaneika C. Bailey BA, University of Waterloo, 2007

Master's Thesis

Submitted to the Faculty of Social Work in partial fulfillment of the requirements for Master of Social Work Wilfrid Laurier University 2011

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Abstract

This thesis examines the perceptions of long-term caregivers in a Guyanese children's home regarding

what makes a "good" residential children's institution. Using a hybrid of reflection on data and

autoethnography (or reflexive ethnography) as my methodology, I conducted individual, semi-structured

interviews with nine participants centred on the question, "How do you define or describe a good

orphanage?" What emerged from the study was a range of opinions regarding whether children's homes

were actually good for children as well as the elements of a good orphanage. Participants provided

responses that were organized into the following themes: a nurturing physical environment, well-trained

staff who are suited to the work and greater government involvement. Participants also identified

challenges to providing good care.

After reporting the thematic analysis of the interviews with caregivers, in keeping with reflexive

ethnography, I present my own personal and professional reflections on the interview process, the results

and the effects of the research experience on my perspective about what contributes to the making of a

"good" children's home. The discussion that follows examines how the aspects put forth by Guyanese caregivers compare to the protective mechanisms Emiliani and Bastianoni (1993, as cited by Palareti &

Berti, 2009) deem to be essential to operating a good residential institution for children. In closing, I make recommendations for creating and maintaining good orphanages in Guyana. ii PERSPECTIVES OF GUYANESE CAREGIVERS Acknowledgements

Firstly, I would like to acknowledge my family for their support and patience with me during this journey. It has not been easy: both my time and temper have been short and my priorities shifted. Your support means the world to me.

Secondly, I would like to acknowledge Dr. Anne Westhues, my advisor, as well as my committee members: Dr. Carol Stalker and Dr. Nancy Freymond. Thank you for believing in me and my abilities and giving me this opportunity.

I would also like to thank the staff and children of the Guyana Red Cross Children's

Convalescent Home for allowing me into their space and considering me as a part of them.

And finally, to my Guyanese loves, Bo & Koby, "Just now". PERSPECTIVES OF GUYANESE CAREGIVERS Table of Contents

Abstract i

Acknowledgements ii

List of Figures vi

List of Tables vii

Terminology 8

Chapter 1: Introduction 9

Chapter 2: Review of Literature 15

The Bad Orphanage 17

The Good Orphanage 38

Developmental Interrelatedness 50

Chapter 3: Theoretical Framework 53

Autoethnography 54

Ecological Systems 57

Chapter 4: Research Methodology 61

Research Questions 61

Research Design 62

Sampling 62

Data Collection 63

Data Analysis 65 iv PERSPECTIVES OF GUYANESE CAREGIVERS

Ethical Considerations 67

Limitations 68

Chapter 5: Results 70

Range of Opinions 71

What Makes a Good Orphanage/Children's Home? 72

A Nurturing Physical Environment 73

Staff Who are Well-trained and Suited to the Work 77

Greater Government Involvement 81

Challenges to Providing and Maintaining a Good Orphanage/Children's Home 84

Personal Reflections, Observations and Comments 88

Chapter 6: Discussion and Conclusion 93

Reduction of Exposure to a Stressor 94

Child Self-esteem 95

Negative Reaction Reduction 95

Positive Interpersonal Relationships 96

Social and Relational Activities 96

Physical Development 97

Emotional/Psychosocial Development 97

Cognitive Development 98

Attachment 99 V PERSPECTIVES OF GUYANESE CAREGIVERS Recommendations for Guyanese Orphanages 101

Conclusion 105

Appendix A 107

Appendix B 108

Appendix C 112

Appendix D 114

References 115 vi PERSPECTIVES OF GUYANESE CAREGP/ERS List of Figures

Figure 1. Baby 'A' has signs of severe wasting and appears to be developing marasmus. (Bailey,

S.C.,2004) 24

Figure 2. Baby 'B' shows signs of kwashiorkor, including loss of hair pigmentation and puffy cheeks. (Bailey, S. C, 2008) 25

Figure 3. The Transmission Model explains the relationship between parental internal working models and child attachment (from Berlin, 2005) 100 PERSPECTIVES OF GUYANESE CAREGIVERS List of Tables

Table 1 21 PERSPECTIVES OF GUYANESE CAREGIVERS VII

Terminology

"...most of the homes now, I don't know if you can call it an orphanage 'cause orphanage is for people who don't have parents and most of the children have parents. You might find one or two that don't have parents, but the majority is children with parents. " - Interview B

For the purposes of this thesis, I have decided to use the terms orphanage, home, and residential care institution interchangeably. The reason behind this melange is the mere fact that in Guyana, these terms are used synonymously because of the nature of their residential child care establishments. Children's homes in Guyana cater to vulnerable children, meaning that although some of these institutions do house children who have lost both mother and father, the majority of the children may have one or both living parents who either have chosen to no longer care for them (abandonment), who cannot care for them due to circumstances of poverty or who have been ordered by social services to place the children in the institute for any number of possible guardianship "infractions". PERSPECTIVES OF GUYANESE CAREGIVERS Chapter 1: Introduction

In 2004 I was fortunate enough to receive a co-op placement with the Guyana Red Cross

Society (GRCS). I was excited and nervous about the prospect of travel, but I had always thought that my dream job would be in international development and so I figured that my undergraduate years would be the best time to find out whether or not the career actually fit with my goals. I was to be the volunteer Administrative Assistant for the Children's Convalescent Home (CCH), a residential home located in Georgetown, Guyana, for orphaned, abandoned, neglected, abused and destitute children under the age of five. Of course I was excited. I love children and being an assistant would mean that I would have plenty of free time to play and interact with babies and young children and experience and delight in their developmental milestones (an area in which I had recently become obsessed). I had no inkling that this posting would change my life and my goals forever. Nor did I foresee that the Administrator would resign two weeks into my posting, leaving a 21-year-old me to administer a facility boasting 22 staff members and 30-odd infants and toddlers. Throughout my placement, I maintained an optimistic hope that my solo run would be temporary and that they would replace the Administrator in no time. Unbeknownst to me, they already had -with me!

During my first four months as CCH Administrator, I bumped into some resistance to my newly inherited position. I was younger than most of the staff, some of whom had children my age or older, and age plays a large part in receiving respect in Guyanese society. In anticipation of running errands and playing with young children, I had packed mostly jeans and t-shirts - no business attire, which socially contradicted my position of authority to donors, staff, social workers and others seeking audience with "the person in charge". Being a foreigner, I was unaware of what management looked like in a Guyanese context and I was often misled by staff 10 PERSPECTIVES OF GUYANESE CAREGIVERS members and social workers who sought to benefit from my ignorance. Compounded by the fact that I was in a foreign country, away from my family and friends and forced to live with four strangers, I was tired and stressed. BUT, but, but, but...I loved every minute of it! Despite my challenges the GRCS found I did an outstanding job and asked me to return for a second placement (with a stipend no less!).

Throughout my second placement, I felt as though I was wiser and "hipper" to Guyanese culture. I brought business attire that was easily washable (I still wanted to play with the children) and was much more comfortable and aware of the culture in which I was situated.

There were still many hurdles -my age, for instance -but my love for the children and the institution only escalated and so I submitted my application to become the permanent

Administrator following my graduation. Now armed with the advantage of experience, my job still was not easy. I had constant battles with staff, Ministry of Human Services and Social

Security (MHSSS) social workers and those neighbours who would rather not listen to 30-40 children crying for their mothers at night. I battled with hospitals and police in the name of fair treatment and equality for my children and their families and, of course, I battled with parents who were less than enthusiastic about their children living in an "orphanage" and the stigma attached to that label. Yet while my war waged on, with the most controversial situations being internal to the organization, I, as well as many others, still believed that CCH was an exemplar; a good home. I would defend my children, staff and organization publicly to the bitter end, while privately I held many criticisms. If, as I have just stated, I believed I held the most scathing criticisms of CCH, what was I defending and why did I believe it was a good orphanage? What did good mean anyway? How do we define a good orphanage and how do I know that the

Children's Convalescent Home fits into that category? 11 PERSPECTIVES OF GUYANESE CAREGIVERS

The following pages are an exploration of how Guyanese define a good orphanage.

Through a series of interviews with staff in an orphanage I identified components and facets that they see as integral to a good orphanage. I then reflected on my own experiences in analyzing their offerings and discussed my own analysis of the essential components of a good orphanage.

There is a paucity of information regarding orphanages in Guyana. The review of literature draws on international studies of orphanages, however, these studies create standards for orphanages that are written mainly from a Western viewpoint rather than local culture or ideas of what an orphanage in that particular country should look like. My purpose in this study is to explore what standards might look like in Guyana if generated from interviews with women who are engaged in caring for children in a local orphanage.

Before turning to the review of literature, I will provide a brief overview of the CCH. The

CCH is located in Durban Backlands, Greater Georgetown, Guyana. The area is considered a suburb that faces a lower middle-class housing development and backs onto a more affluent area.

The home's capacity is limited to 40 children, 5-years-old and under; however in recent times, this number has been exceeded. The CCH is unique in Guyana, as it is the only home that caters specifically to this age group. Most of the other children's homes in Guyana will only accept school-aged children; school begins for children at 3-years and nine months. Children are placed in the orphanage by government social workers called child protection workers. The child protection workers are assigned cases by district and are integral in admitting and discharging children from the facility. They are also tasked with monitoring that the children in the homes are well cared for.

Once a child at CCH turns 5-years-old they are transferred to another institution. Often children are not reunited with siblings they may have in other orphanages, because open (or 12 PERSPECTIVES OF GUYANESE CAREGIVERS vacant) spaces dictate which home a child is sent to. Also, many of the other more popular homes are often gender specific and religiously affiliated. For example, there is a Muslim boys' home and a Muslim girls' home, and a Catholic boys' home and Catholic girls' home. There is also a home that deals specifically with children who are suffering from HIV/AIDS. The fully female CCH staff number 22 and range in age from 19 years-old to 65 years-old. This number includes ancillary staff (cleaners and laundresses), cooks, caregivers and the housekeeper (who is responsible for overseeing all supplies and in-kind donations). Half of the women have served for 10 years or more. There is one staff member trained as a Nurse's Aide and another trained as an ECE Teacher, The ECE Teacher is responsible for the in-house playschool curriculum where she teaches those children who are under 4-years old and too young to attend formal nursery school, as well as the children whose birth-certificates are not available or identities are unknown and therefore cannot attend formal school. It is the responsibility of the child's caseworker to supply these essential documents, but this is not always possible.

A typical day at the Children's Convalescent Home begins at 5:00 a.m. when the children wake. Children are bathed, dressed, hair-dressed, given required medication, and allowed to play until 7:00 a.m. when they are served breakfast. Infants are given their morning feed by 6:00 a.m.

After breakfast, the children are returned to their dormitories to change their clothing if they have been soiled by breakfast and those children who are potty training must sit on the potty until they have used it. The infants are usually moved from their dormitory to the extra-large playpen where they are allowed some freedom from the confines of their cribs and time to play with toys while their caregiver disinfects the mattresses and changes the sheets. Those who are enrolled in nursery school are dressed and sent off with a mid-day snack, while those who are too young to attend or who do not have the proper documentation go downstairs to the playschool for lessons. 13 PERSPECTIVES OF GUYANESE CAREGIVERS

All clothing is shared among the children, even school uniforms. Mid-day snack is served followed by a singing circle or a nap for those who would like to take one. Infants are served their lunch meal, which usually consists of high protein and high nutrient puree taken from the

"family pot" as directed by the Guyana Ministry of Health child feeding guide. At noon, the school-aged children return and have lunch with the other children. This is followed by another potty training session and a nap for all children. At 2:30 p.m. the children are served a snack and then visiting hours begin. Family, friends, volunteers and visitors are welcome to visit the children from 3:00 p.m. - 5:00 p.m. Children play in the yard, participate in storytelling, or visit with loved ones during this time and at 5:00 p.m. a light dinner is served. Children are bathed and readied for bed and are usually asleep by 7:30 p.m. to recommence their routine early the next morning.

The CCH is funded primarily through the Guyana Red Cross Society which receives funds from private (businesses) donors, and receives strong support from community contributions. Public or government funding is present but only covers around 40% of costs, and the majority of that funding is used to pay staff. Staff pay levels are not sufficient to attract professionals or highly skilled staff and as a result many of the staff have only primary or secondary school education. As previously stated, the CCH depends on community and business donations for over half of its income. Most of these donations are in-kind and manifest as meals, toys, clothing, and other equipment (such as hygiene items, including disposable diapers). It is customary for Guyanese to celebrate their birthdays, holidays, and good fortune (getting a new job, for example) by making a donation to an orphanage. As a result of this practice the CCH in particular has become very dependent on these donations for the daily management of the home.

The home is governed by the Guyana Red Cross Board of Directors and managed by an 14 PERSPECTIVES OF GUYANESE CAREGIVERS

Administrator who is on-call 24 hours a day. Currently, the Guyana Red Cross is attempting to harmonize its existing standards and regulations with the government Minimum Standards and

Operational Guidelines for Guyanese Children's Homes, introduced in June, 2008. Monitoring of the standards is now being handled by government employees on a monthly drop-in basis. 15 PERSPECTIVES OF GUYANESE CAREGIVERS Chapter 2: Review of Literature

The phenomenon of unaccompanied children being placed in institutions is one that has emerged over the last 200 years. Before the 1700s there was no formal system for housing destitute children. Many countries in North America, Latin America and Africa employed an extended family caretaking tradition which saw to it that destitute, abandoned and orphaned children or others who could not be cared for by their parents were taken in by relatives

(Bartholet, 2006). In the colonial period, small children without parents were also taken in by relatives or cared for by neighbours, while older children were indentured to tradesmen as apprentices (Olasky, 1999). Unfortunately, the increase in the occurrence of war, famine and illness of epidemic proportions has caused practices such as these to become unrealistic.

Compounded by widespread global poverty and economic instability, those who once would have gladly taken in these children are simply unable to do so. Even with the availability of adoption, there remain more children than adults willing and able to care for them, resulting in the ever-present need for childcare institutions and orphanages worldwide. Every war, national disaster, and epidemic has created new orphans and has spurred new efforts to respond through the creation of orphanages - an act of benevolence originally organized by concerned citizens

(Olasky, 1999). The onslaught of economic instability and widespread poverty that many nations have faced has led to some deplorable acts of child warehousing. In 1989, at the fall of the

Ceausescu government in Romania, the world was exposed to the horrible orphanage conditions that have led many to paint all orphanages with the same tarnished brush resulting in a widespread Western backlash toward these institutions. Since the Romanian debacle, there has been a host of studies examining the reasons behind the extensive developmental problems documented in children residing in those orphanages and hospitals (Judge, 2005). The results 16 PERSPECTIVES OF GUYANESE CAREGIVERS have not been the most inspiring, leaving orphanages and institutions under constant fire from opponents.

Several studies outline the detrimental effects of prolonged institutional rearing to child development (Beckett et al., 2006; Frank, Klass, Earls & Eisenberg, 1996; Gesell & Amatruda,

1954; Judge, 2004; Kaler & Freeman, 1994). Wolff and Fesseha (1998) confirm that "there is a general agreement that unaccompanied children placed in institutional settings at a young age and for long periods are at greatly increased risk for psychopathology in later life" (p. 1319).

Other studies of orphanage-reared children focus on the positives and the "catch-up" that occur once a child has escaped the developmentally oppressive "belly" of the orphanage beast (Berlin,

2005; Dozier, Lindheim & Ackerman, 2005; Judge, 2004; Rutter and the ERA Study Team,

1998; Van Ijzendoorn, Juffer, & Klein-Poelhuis, 2005). These studies give hope for orphanage- reared children once they've been adopted or placed with a foster family; unfortunately, most children residing in these institutions are not adopted or fostered. Where is the hope for them?

As adoption and fostering is not always a realistic and culturally acceptable alternative to orphanages (Bartholet, 2006) and there are more children than available adoptive or foster families, it is clear that a large majority of children who enter orphanages will remain in institutional care. Yet, research devoted to how orphanages/residential child care institutions can help to curb the developmental degradation of its residents is virtually non-existent.

Almost no systematic studies have been carried out during the past five decades to

address this question, largely because nearly all orphanages in industrial nations have

been closed and replaced by adoption and foster care. Yet in Third World countries, 17 PERSPECTIVES OF GUYANESE CAREGIVERS

orphanages are often the only viable means of survival for thousands of orphans. (Wolff

&Fesseha, 1998, p. 1319)

Specifically, the question that Wolff and Fesseha (1998) pose is whether there are styles

of care that will "best meet the emotional needs...and foster...cognitive and psychological

development" (p. 1319) of institutional residents. In my opinion, an orphanage that meets the

above criteria (meeting emotional needs and fostering cognitive and psychological development)

has elements of being good; however, those elements do not solely determine (or do they?)

whether the orphanage is good or bad. As the scholarship on bad orphanages outweighs

information on the good, I will first review what leads the public to view orphanages as bad.

The Bad Orphanage

As a former Administrator of an orphanage and an avid member of the Guyanese

orphanage subculture, I have encountered more than a few instances of orphanages that I have

labelled "bad" and that I felt should have been closed. Although immersed in Guyanese culture, I

am not Guyanese and my viewpoints and opinions of good and bad are seated directly in my upbringing in Canada by Jamaican immigrants. The following examples of "bad" orphanage

attributes are from the literature reflecting a Western standpoint. These attributes may or may not be reflected in a Guyanese person's idea of 'bad', nor do they necessarily reflect my own ideas on the subject.

I will make the assumption that when the average North American ponders their understanding of the term orphanage they conjure up terrible images of orphanages as being abusive to the children residing there, overly strict, rundown and industrial. Developments such 18 PERSPECTIVES OF GUYANESE CAREGIVERS

as the Romanian disaster, where it was revealed that thousands of unwanted children were housed in sensory-depriving institutions resulting in many of those children developing some

sort of mental or physical delay, added to the already poor image of orphanage life portrayed in the musical hit Annie (Huston, 1982) and the film adaptation of Charles Dickens' Oliver Twist

(Lean, 1948). The images revealed in 1989 were horrifying and left an indelible mark on orphanage history, assuring that North American society would never return to that form of child welfare. Yes, orphanages remain unfavourable in North America as evidenced by the virtual elimination of the orphanage system in both Canada and the United States which is in large part due to influence from attachment theorists (Stalker & Hazelton, 2008) and the general public's understanding of the principles of attachment theory. In terms of child welfare, "the single most stable trend line.. .over the last 75+ years is the shifting ratio of children in foster family vs. residential care as a proportion of the total number of children in out-of-home care" (Whittaker,

2000, p. 19). These smaller and renamed orphanages have come under public scrutiny as recently as 1994, which saw a resurgence in the debate on whether residential care is appropriate for children (Whittaker, 2000). In James Whittaker's (2000) address to the 6th Congress of the

European Scientific Society for Residential and Foster Care for Children and Adolescents

[EUSARF], he brings to light the most current data, at the time, on the American orphanage.

Whittaker stated that less than 1% of the total population of American children was in substitute care and that up to 30% of those children lived in residential institutions, down from 57% in the

1930s. Whittaker maintains that though these numbers are small the children "are increasingly troubled and present multiple problems at intake" (p. 20). As such, there has been an increase in specialized facilities catering to a host of issues that children may suffer from, such as substance abuse or psychiatric problems. Surprisingly, Whittaker refutes the claim that there are fewer 19 PERSPECTIVES OF GUYANESE CAREGIVERS

residential facilities, revealing that there are more facilities but with smaller housing capacities.

However, he goes on to state that these facilities are often privately operated and are frequently

subject to mergers, closures and instability with respect to funding. Because of these financial

woes, he argued that many facilities have turned to models that include standardized child and family outcomes and specification of treatment and care procedures, in the hope of attracting and maintaining government funding assessed by way of psychiatric standards.

Though most argue that the shift to family-based care is "in the child's best interest", it is not feasible in many developing countries and many orphaned, abandoned and "at-risk" children do not get the opportunity to live in a family environment. Legal adoption is a fairly recent phenomenon, especially in non-Western countries (Bartholet, 2006). Political climate, public policy, cultural values and beliefs, and international law can all affect adoption and how or if it is practiced within a specific country. Cultural biases and beliefs, more often than not, affect the level of support or interest a government may put into the organization of local orphanages and residential facilities. For example, China's one child per family policy has caused an increase in abandoned baby girls in the country (Thurston, 1996). Unfortunately, Asian countries tend to value blood-related parenthood as well as male children, providing little opportunity for orphaned children to find new local homes. After the fall of the Ceausescu government in

Romania, a flood of international adoptions occurred but now, because of baby-selling-scandals and pressure from internal opposition parties, international adoption has been completely closed in Romania. Their economy remains fairly unstable and as a result there aren't many available and interested local adoptive parents (Bartholet, 2006). This grim reality reaffirms the fact that orphanages are here to stay, in Romania and other countries - worldwide. 20 PERSPECTIVES OF GUYANESE CAREGIVERS "Blessed is the chUd whose developmental annals are brief"

(Gesell & Amatruda, p. 342)

The way orphanage-raised children develop has been an area of study for many researchers interested in child development. The examination of physical, emotional and social development, along with attachment, has spurred investigators and readers alike to apply the bad label to orphanages, defining them as developmental assassins, if you will. We shall first examine why orphanages have been said to be bad for physical development then move on to the effects of institutionalization on emotional and cognitive development.

Physical development.

Stimulation is critical during several sensitive periods throughout a child's first six years.

Table 1 outlines some examples of neural development and the milestones with which the research studies show them to be associated. Understimulation can often be a problem for children residing in institutions. Institutional culture, along with lack of funds for childcare programs can sometimes leave orphanages and other childcare institutions without adequate resources or impetus to provide stimulus. As stimulation is essential for brain development, it is not surprising that understimulation leads to lags in development. Research has shown that children who remain in orphanages throughout their first two years or more, with little social contact and sensory stimulation, will develop delays in all domains of development (Frank et al.,

1996; Judge, 2004; Rutter & the ERA Study Team, 1998). Further, studies conducted in Eastern

European orphanages have shown that the earlier children are removed from the understimulating environment and placed with caring families, the faster they catch up developmentally (Berk, 2005). 21 PERSPECTIVES OF GUYANESE CAREGIVERS Table 1 Sensitive Periods in Brain Development

Age Cerebral Growth Location Developmental Milestone 2.5 - 4 months Visual cortex Infant displays social smiling 3-4 months Frontal lobe/ motor cortex Infant typically reaches for objects. 6-8 months Frontal lobe/ motor cortex Crawling and leg control

12-24 months Frontal lobe/ Broca's area Language flourishes (Compiled from Berk, 2005; Cole & Cole, 2001)

At birth, an infant's brain is closer to its adult size than any of the infant's other physical formations. At this point of development the brain is crowded with over 100 million neurons ready to form connections with one another through synapses to execute neural functions.

Throughout infancy (newborn - 23 months) and toddlerhood (24 months - 36 months), unstimulated neurons lose their synapses through synaptic pruning, a process which allows unused/underused neurons to revert to "an uncommitted state so they can support future development" (Berk, 2005, p. 170). As the neurons form synaptic connections, stimulation is imperative to their survival and to the development of the child. Stimulated neurons continue to establish new synapses forming progressively more complex communication systems leading to intricate abilities.

Generally, healthy infants will triple their body weight by the end of their first year and add 50% in length. Body fat, which is critical for an infant to regulate body temperature, will increase steadily and peak around the ninth month. "Heredity, nutrition, relative freedom from disease and emotional well-being all affect early physical growth," states Berk (2005, p. 178). 22 PERSPECTIVES OF GUYANESE CAREGIVERS

For children residing in an orphanage life begins with many more complications. Typically, children entering a residential institution are in poor nutritional health and may carry congenital

or acquired disease. They also may have been regularly neglected or abused which may affect their emotional well-being (Bailey S. C, 2007).

Ethnicity also plays a role in determining the rate and pace of development of overall body size in children. Typically, Asian children are smaller than North American children while

African (and African-Diaspora) children tend to be slightly above North American norms in size.

The average African-American infant first teethes at four months old, while Caucasian babies on average first teethe around six months. Children who teethe earlier are more likely to be advanced in physical maturity. Because children replace their first set of teeth with a set of permanent teeth, there is often little attention paid to these initial teeth, setting the path for early tooth decay and gum disease. Berk (2005) tells us that oral hygiene is frequently overlooked in institutions where providing the basics may be difficult because of underfunding, understaffing and lack of staff training. However, oral care should be looked upon as a basic necessity for all children. Poor oral care can also lead to infections such as thrush, and gum inflammation can cause poor feeding which can contribute to poor nutrition and physical wasting.

Nutrition contributes to physical development significantly during the early years. It is especially crucial during a child's first two years because of rapid brain and body growth. During these first two years breastfeeding is best for an infant. Breast milk is high in fat and low in protein and is ideal for sustaining the rapidly mylenating nervous systems. Bottle formulas attempt to replicate breast milk; however these replications often fall short. Common complaints regarding formula include its high iron content and added vitamins, which may interfere with 23 PERSPECTIVES OF GUYANESE CAREGIVERS

normal digestion. Breastfeeding also combats respiratory and intestinal infections in infants and

has been linked to lower instances of Sudden Infant Death Syndrome (SIDS) (Cole & Cole,

2001). According to Berk (2005), breastfed children are 6-14% more likely to survive their first

year than bottle-fed infants and are less likely to suffer from malnutrition.

Breastfeeding in institutions is usually not possible and therefore institutionally reared

infants are introduced to formula immediately, leaving them susceptible to bacterial infections

caused by unsterilized water and bottles. These infections can quickly become serious because of

the infant's already weakened immune, respiratory, and gastrointestinal systems. Overcrowding

and/or understaffing of an orphanage can lead not only to a spread of the infection but can also

lead to these infections becoming fatal through lack of care and attention (Frank et al., 1996).

Therefore, special attention to sterilization and proper formula is imperative for a child's steady

and healthy development. However, even with proper bottle formula, technique and focus on

nutrition in an institution, there may still be cases of malnutrition because many children are

admitted with moderate to severe malnutrition or starvation.

Malnutrition and related illnesses.

Malnutrition results from a lack of adequate and appropriate nutrient-giving sustenance.

A child can be fed everyday and still suffer from malnutrition if what the child is eating lacks the

nutrients necessary for healthy development and bodily function. As previously mentioned, when caring for their child, mothers or other family members who live in poverty will often attempt to wean a child from breast milk prematurely or substitute breast milk with cow's milk or a diluted

starch, like rice water, because they may need to return to work and may not have the funds to purchase infant formula. These alternatives are dangerously low in protein, fat, and other 24 PERSPECTIVES OF GUYANESE CAREGIVERS essential nutrients found in breast milk or infant formula and are core contributing factors to childhood malnutrition (WHO, 2000).

Prolonged malnutrition can delay all aspects of child development, from reaching to standing. As mentioned previously breast milk, which is perfectly suited for this time of development, contains vital proteins and antibodies that not only contribute to brain growth and development, but also carry sufficient energy for an infant to move about and explore (which in turn helps to develop the brain through experience-expectant activities). Lack of proper nutrition can also delay the age at which children cut their permanent teeth. The two most visible illnesses associated with malnutrition (specifically undernutrition, which is caused by lack of food energy

- not quality) are marasmus and kwashiorkor. These

two illnesses are a direct result of severe protein-energy

malnutrition (PEM) and appear during different stages

of development. Marasmic-kwashiorkor is a third

illness that is essentially a combination of the previous

two illnesses. They have not been differentiated

clinically by WHO (2000) because the approach to their

treatment is similar.

Marasmus affects undernourished infants in

their first year. It is described as a wasted condition

caused by a diet that is low in all essential nutrients,

,„,,,,, . ,. particularly protein-energy. Physically, the child Figure 1. Baby A has signs of severe wasting and appears to be developing marasmus. (Bailey, S. C, 2004) becomes emaciated exhibiting a loss of up to 80% of 25 PERSPECTIVES OF GUYANESE CAREGIVERS the expected body weight of the average infant at that age (Figure 1). The child loses pigmentation in the hair and shows severe wasting (classified as weighing <70% of weight-for-height recommend by

WHO) at the shoulders, arms, buttocks and thighs as well as visible rib outlines (WHO, 2000). They often exhibit irritability and fretfulness. Children with marasmus are at a high risk of dying from the illness and its associated symptoms. In the absence of death, many children suffer permanent neurological damage Figure 2. Baby 'B' shows signs of from this disease (Bee et al., p. 101). kwashiorkor, including loss of hair pigmentation and puffy cheeks. (Bailey, S. C, 2008) Kwashiorkor results from an unbalanced diet that is low in protein and lacking in amino acids. Onset occurs between the first and fourth years when the child has been weaned from breast milk. Physically, the child's stomach becomes distended and hair loses pigmentation, becoming greyish-red. Oedema (a condition where if pressure is applied to fatty skin a pit remains at the pressure site) in both feet becomes prevalent.

If the oedema is severe, "a flaky paint" dermatitis appears across the body and the child has a loss of appetite and commonly exhibits apathy. Some children with kwashiorkor also develop unusually large cheeks or a puffy face (Figure 2). By and large, the illnesses are treated by adding food-energy and protein to the diet through gradual feeding (gradual is stressed as a sudden influx in calories to an infant may cause cardiac distress or arrest) of high-energy milk feeds. 26 PERSPECTIVES OF GUYANESE CAREGIVERS

Survivors of these severe illnesses related to undernutrition commonly grow smaller in all body dimensions, and can appear stunted in growth. Prolonged exposure to malnutrition is so detrimental that it can even affect primary teething and permanent teeth cutting. Undernutrition usually occurs outside of institutions and is often due to lack of food, cultural feeding habits or inadequate education about nutrition. With the appropriate treatment these children can overcome their illnesses and conditions and can develop normally. Special attention should be paid to children who are recovering from any one of these conditions or illnesses as improved diets put these children at risk for excessive weight gain and heart failure (WHO, 2003). It is important to reiterate that most cases of kwashiorkor and marasmus occur outside of orphanage settings. Many children enter orphanages with some form of malnutrition or anemia, though it may not be as severe as the cases put forth above. In the good orphanage, these children are cared for with utmost attention and I've found, in my experiences in Guyana, staff are extremely proud and visitors impressed when they see a once malnourished child looking happy and healthy. It reaffirms for the staff that their labours are not in vain, but for the betterment of the quality and length of a child's life.

Attachment and physical development.

Attachment is not often linked in the mind of the lay-person to physical development.

However, it clearly affects several aspects of development, including the physical aspect (Cole &

Cole, 2001). Failure to Thrive (FTT), also known as Faltering Growth, can attack a child in any care setting. FTT is the slowing of overall growth in an infant. Children who fail to thrive don't receive or cannot ingest, retain, or make use of the food-energy needed to gain weight and grow appropriately. Unlike other malnutrition-induced illnesses such as marasmus and kwashiorkor, failure to thrive is a possible symptom of a host of underlying problems. Though FTT can occur 27 PERSPECTIVES OF GUYANESE CAREGIVERS from lack of stimulation or undernourishment, it can also be caused by social issues, such as poverty or neglect on the part of the parent, or medical issues such as infections or diseases.

Traditionally it has been diagnosed as organic (an internal biological issue) or nonorganic

(referring to parental/external issues), however doctors have now agreed that such distinctions are not valid because most children have mixed etiologies, meaning that organic issues could lead to nonorganic issues and vice-versa (Krugsman & Dubowitz, 2003). Lack of attachment is an underlying factor that can cause a child to waste. Frank et al. (1996) cite "poor appetite reflecting depression and subtle neuroendocrine changes related to a lack of tactile stimulation"

(p. 571) as commonly found reasons for impaired growth in orphanage-raised children.

Furthermore, Dozier et al. (2005) found that institutionalized children often have deregulated physiological issues, such as their neuroendocrine system producing unusual levels of Cortisol— a stress hormone. Most children show a peak of Cortisol levels in the morning that descend to near zero at night. Children residing in orphanages frequently show atypical patterns of production (unusually low, irregular or high levels) that are associated with particular types of psychopathology, for example post traumatic stress disorder (low levels), and depression and anxiety (high levels). It is unknown if infants who irregularly produce Cortisol at either level are apt to develop any of these disorders or have increased risk to develop them later. Even so,

Dozier et al. believe that such "obvious disruption in functioning of a major regulatory system is very troubling" (2005, p. 182).

Institutionalized children also have more trouble regulating behaviour patterns such as sleeping and eating than their home-reared counterparts (Dozier et al.,2005). It is common knowledge that sleep, during infancy and early childhood, is essential for growth development.

Sleep deprived children are less likely to grow to their full potential and are more irritable during 28 PERSPECTIVES OF GUYANESE CAREGIVERS their waking hours, putting even more strain on a potentially insecure attachment with their caregivers.

Several facets of institutionalization and factors that often lead to institutionalization predominantly affect physical development. It can be inferred from the research presented that stimulation of the neurological and the psychological aspects of a child must be appropriate in order to foster healthy growth and development. To summarize: appropriate stimulus, adequate nutrition, and secure attachment, none of which are mutually exclusive from the others, must be present in order for physical development to be optimized in children. Unfortunately, it has also been found that one or more of these criteria are regularly absent from residential child care institutions across the globe, causing severe delays and deprivation among the most disadvantaged of any society (Dozier et al., 2005).

Emotional/psychosocial development.

The effects of institutionalization are most identifiable in the physical and the psychosocial. Physical development is quite visible as we can actually see that a child is malnourished (sometimes) or physically stunted. Emotional/psychosocial development, however, is more complex with many contributing variables, and no one variable alone directly causing normative development or deficiency in the area. For this reason, no other facet of the institutional experience has generated as much interest as the behavioural and emotional outcomes of the institutionalized child.

Frank et al. (1996) indicate potential risks to infants and young children in orphanages in terms of psychosocial development. They insist that "infants and young children are uniquely vulnerable to the psychosocial hazards of institutional care, negative effects that cannot be PERSPECTIVES OF GUYANESE CAREGIVERS reduced to a tolerable level even with massive expenditure" (p. 569). Although the suggestion that negative effects cannot be reduced is currently being debated among scholars and will be discussed at length later in this document, it is important to note that historical accounts of orphanages and children's homes describe a time when negative effects were considered to be insurmountable. Sharon Judge (2004) concurs with Frank: "social and emotional development appears to be more compromised or more susceptible to long-term impacts. In particular, orphanage-reared children appear to be at increased risk for enduring behavioural problems and difficulties in peer relationships" (p.33), which she maintains is exhibited well into adolescence.

Judge (2004) conducted a study of 159 children adopted from orphanages and hospitals in Romania. Adoptive parents most often described these children as having high energy levels, to the point of hyperactivity. They constantly demanded attention, were impatient, easily frustrated and fidgeted. Judge believes that these behaviours "indicate a hyper-sensitive/active style of temperament and self-regulation that is exemplified by behaviour that is overactive to even slight environmental stimulation, impulsive, highly active, negative, and defiant" (p.40). It is possible (but unlikely) that these children were all born with such a temperament. It is much more plausible that their institutional lives played a significant role in how they reacted to their new environment. Reared in environments with relatively flat stimuli and limited novelty, the

Romanian children were not accustomed to the environment of their new homes. The consequence of the under stimulation of their brains may be that they interpret all stimulation as overstimulation. Judge also found that 20% of children studied rocked themselves; 35% wet the bed; 13% were oversensitive to touch, sight and sound; and 12% were under reactive to stimulation or pain (Judge, 2004), which demonstrate deficiencies in stimulation and regulation.

This could lead to a clinical diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD), 30 PERSPECTIVES OF GUYANESE CAREGIVERS which is characterized by understimulation of the brain resulting in a physiological attempt at overstimulation to negate the imbalance. ADHD can last well into adulthood (Heffelfinger &

Mrakotsky, 2006). Frank et al. (1996) also found several persistent traits that followed the institutionalized child, such as hyperactivity and disorganization, indiscriminate demands for affection and attention, superficiality of relationships, the absence of normal anxiety in reaction to failure or rebuke, and social regression.

Temperament.

Temperament is said to be one of the building blocks of personality. It is the unique way that people respond to their environment (Cole & Cole, 2001). Although temperament is moderately stable throughout the lifespan, it does not define the personality of an individual.

Personality, although influenced by temperament, is developed through life experiences, which are "gradually acquired as children's initial interactions with their environment are integrated with their developing cognitive understanding, emotional response and habits" (Cole & Cole, p.

375). The pioneers in temperament classification, Chess & Thomas (1982), found nine behavioural traits in infants that could categorize children as having one of three temperaments.

The traits were "activity level, rhythmicity (the regularity or irregularity of the child's basic biological functions), approach - withdrawal (the baby's response to novelty), adaptability, threshold of responsiveness, intensity of reaction, quality of mood (negative or positive), distractibility, and attention span or persistence" (Cole & Cole, p. 144). Together, these traits describe a child's temperament. Children's temperaments fall into one of three broad categories: easy, difficult or slow-to-warm. Easy babies tend to adapt quickly to new circumstances/stimuli.

They are playful and regular in their biological functions (sleeping, hunger, expulsion, etc.).

Difficult babies are more irregular in their biological functions and are more irritable. They often 31 PERSPECTIVES OF GUYANESE CAREGIVERS are resistant to new circumstances/stimuli and respond negatively to them. Slow-to-warm children are low in activity level. They often need more time to adapt to change than easy babies.

They tend to temporarily withdraw from new stimulus, but will eventually adjust (Cole & Cole,

2001).

Institutionalized children do not differ generally in temperament from their non- institutionalized counterparts (Cole & Cole, 2001). However, as mentioned previously, it is the combination of children's experiences along with their temperament that form their personality.

Easy temperament children would possibly have an advantage over children with other kinds of temperament as children with other temperaments would react negatively and/or withdraw in response to either being placed into the institution or being removed through adoption, fostering, or return to original family.

Attachment.

Attachment is defined as a type of "affectional bond where the person's sense of security is bound up in the relationship" (Bee, Boyd, & Johnson, 2003, p. 130). The first two years of life are chiefly considered to be the most sensitive period for attachment in human infants. The likelihood of an absence of secure attachment during these first two critical years is magnified when children have spent those years in traditional orphanages. Bee et al. (2003) state:

Children who are adopted after spending more than 2 years in an orphanage are more

likely to suffer from a disorder known as reactive attachment disorder than those who are

adopted in infancy. Children with reactive attachment disorder seem to be unable to form

close emotional relationships with anyone, including foster and adoptive parents. Even

children whose institutional care does not extend beyond the first 2 years are more likely 32 PERSPECTIVES OF GUYANESE CAREGIVERS

to display developmental delays and emotional difficulties the later in infancy they are

adopted, (p. 130)

It is the quality of the attachment and how that impacts psychosocial development that is significant for long-term development according to attachment theory.

Attachment theory is based on the work of John Bowlby, a developmental psychologist.

Bowlby's theory specifies that "for infant development to proceed normally, a selective, non- interchangeable relationship with a single adult primary "attachment" figure is required" (Frank et al., p. 573). This is extremely difficult to provide in a custodial institution with staff who rotate on and off shifts, take leave and vacation, or are fired as is customary in any other employment.

In Bowlby's theory there are three stages of development of attachment behaviour. The first is the preattachment phase where the infant shows no actual attachment to a figure. At this stage infants exhibit proximity promoting behaviours, such as crying, making eye contact, cuddling, and responding to being soothed. There is no specific person being targeted in this phase. The second phase of attachment behaviour begins around the third month of life and is termed the uattachment-in-the-making " phase. This stage sees the infant focusing on one or more figures for primary attachment. The child focuses their attachment behaviours on the primary caregivers, such as smiling more at mom or dad than at a stranger. Yet, at this stage,

Bowlby says there is still no full-blown attachment because children at this age typically show no separation anxiety or fear of strangers. The third and final phase, "clear-cut attachment", occurs around the sixth month (or when the child achieves self-locomotion) and is shown in secure base behaviour. Children change their attachment behaviour in accordance with major physical developmental milestones, like crawling. Instead of getting an adult to come to them 33 PERSPECTIVES OF GUYANESE CAREGIVERS

(proximity promoting) they go towards an adult (proximity seeking) because they can do so on their own. At this point children will use their primary attachments as a safe base from which to explore the world. At the final stage there is not always a clear single attachment figure (e.g. the child can be attached to both mother and father).

As mentioned earlier, once attachment is organized it is the quality of the attachment organization that has the greatest and most lasting effect on children. There are three types of attachment organization specified by Ainsworth, Blehar, Waters and Wall (1978): i) secure, ii) insecure: anxious/avoidant and iii) insecure: ambivalent/resistant. Bee et al. (2003) outline four kinds of attachment in their text. In the first type, secure, they agree with Ainsworth et al. that it is a pattern of attachment where an infant readily separates from the parent, but seeks proximity during separation distress, and uses the parent as a safe base for exploration. Secure attachments have been linked to positive psychological development in later life. Avoidant attachment is when an infant shows little reaction to the parent leaving or returning. When the parent returns the infant actively avoids contact with the parent and may cry or show distress when held by the caregiver. An ambivalent-ly attached child shows little exploratory behaviour and is greatly upset when separated from the mother. These children are clingy and fearful and are not easily comforted by the caregiver's return or reassurance. The final type of attachment is disorganized.

This infant seems confused and/or apprehensive and exhibits conflicting behaviour toward the caregiver, such as moving toward the mother while looking away from her (Bee et al., 2003).

Clearly, orphanage-reared children are at a disadvantage when it comes to development of secure attachment organization because of the very nature of their environment. It is easy to see why orphanages are not helpful to a child's development of a secure attachment according to 34 PERSPECTIVES OF GUYANESE CAREGIVERS both Ainsworth et al. (1978) and Bowlby's theories: the lack of caregiver stability makes it

practically impossible for a child raised in an orphanage to exhibit secure attachment behaviours because of the lack of a constant secure base from which to explore their world. Further, securely

attached infants and children have proven to be "more sociable, more positive in their behaviour toward friends and siblings, less clinging and dependent on teachers, less aggressive and disruptive, more empathetic and more emotionally mature in their interactions in school and other settings outside the home" (Bee et al., pp. 136-137). Avoidant attachment has been found to lead to less positive and supportive friendships in adolescence, as well as individuals who are more likely to become sexually active earlier and to practice riskier sex (Bee et al., 2003).

Disattachment.

The imagery that comes to mind when we conjure up thoughts of Romanian orphans and neonatal hospital wing residents is disturbing. Children surrounded by stark environments, rocking themselves and staring with vacant eyes at nothing or everything. This phenomenon of withdrawal from the environment is known as disattachment. Disattachment is "the state of indifference to others that children manifest when there is a continuing separation from their caregiver" (Cole & Cole, 2001, p. 236). This occurs most often during the first six months after a child is separated from their primary caregiver. Previously happy children withdraw from their surroundings, cry often, lose weight, and suffer from sleep deprivation. If a consistent caregiver does not replace the lost attachment figure, the depression deepens quickly (Berk, 2005). In

1946, psychiatrist Rene Spitz presented similar findings in his study of institutionalized children and named it anaclitic depression. Spitz observed that the depression's onset was after three months or more of separation from the main caregiver and only occurred after the first six months of life and led to similar psychological delays. Spitz also found that the condition of 35 PERSPECTIVES OF GUYANESE CAREGIVERS children who were reunited with their mothers within six months was completely reversed and they regained normal emotional fortitude. Unfortunately, it was also shown that those children who were not reunited with their mothers and lacked an adequate replacement did not improve, and eventually displayed agitation, mental retardation, and lethargy (Gale Encyclopedia of

Childhood and Adolescence, 1998). Spitz believed that "not even the best-trained caregivers could replace the level of interaction and reciprocity with infants achieved by mothers" (Frank et al., 1996, p. 572).

Cognitive development.

Cognitive development is known to be closely related to the physical development of the brain. Without the appropriate nutrients, synaptic pathways or correct chemical balances, cognition suffers in the developing child. Social interaction with peers and adults, as well as access to objects and other stimulants also plays a large role in achieving and maintaining optimal cognitive development.

As defined in the previous section on disattachment, anaclitic depression presents itself in infants after the first six months of life when separated from their primary caregiver, for a period of three months or more. Characteristically, these children exhibit withdrawal, refusal to eat, failure to thrive and delayed psychomotor development (Gale Encyclopedia of Childhood and Adolescence, 1998). In Frank et al.'s (1996) study on infants and young children residing in orphanages, the researchers found that the children's developmental deterioration occurred long before they were mentally able to show separation distress and occurred whether or not the children had ever been in the care of a primary caregiver and could not be attributed to distress at separation. This was not anaclitic depression. Instead, the consensus is that the developmental 36 PERSPECTIVES OF GUYANESE CAREGIVERS impairments found in those institutionalized infants resulted from a lack of sensory and social stimulation, essential to cognitive development, due to long hours spent lying in cribs without toys or interpersonal contact. Clearly social and sensory stimulation are as important for cognitive development as they are for physical development. Essential brain development and information assimilation cannot simply rely on adequate nutrients. It is here that we finally come to the realization that development is an interrelated occurrence and that physical, psychosocial and cognitive developments are not mutually exclusive of each other.

Cognitive deficiency and intelligence.

As is clear from the earlier discussion, physical, psychosocial and cognitive development are highly interrelated. No one facet can or does stand alone. Cognitive development is the best example of the interrelatedness of development. Physical brain development as well as social development heavily affects a child's cognitive processes. A deficiency in one or the other may inflict dire consequences on such processes. Frank et al. (1996) describe early scientific reports of orphaned infants and young children universally exhibiting progressive developmental deterioration. The researchers reported that by the second year of life, most institutionalized children functioned severely below average on standard tests and were considered developmentally "retarded". The prevalence of this substandard development was so evident that

Gesell and Amatruda (1954) published a timetable of the expected ages of materialization of developmental delays in institutionally deprived infants. Gesell and Amatruda were purposeful in not studying severely abused children or those who resided in substandard or unsanitary institutions. Instead they focused on those children who resided in the average institution. Their study found that infants were relatively unaffected by institutionalization because their physical needs can be (and are) met rather simply; however, as the child grows, so too do his 37 PERSPECTIVES OF GUYANESE CAREGIVERS psychological needs. This is often how cognitive deficiency begins: caregivers/institutions continue to meet physical needs, but only partially or not at all meet psychological needs.

Contrary to Gesell and Amatruda's findings, Frank et al.'s (1996) research found that deprivation that began in infants placed in an orphanage at birth or as young as two months of age resulted in delayed achievement of milestones, social apathy, and withdrawal. In the same study, reports of studies conducted in well-run, attentive, Scandinavian orphanages noted that:

although developmental test scores can be maintained within a normal range with a ratio

of one caregiver to three infants, a statistically significant decline nevertheless occurs in

the developmental performance of children institutionalized before 1 year of age,

compared with lower-class infants reared in their biological homes or placed in foster

homes from the first month of life. (p. 572)

When looking at more extreme cases, Frank et al. (1996) noted that lack of stimulation is intermingled with the developmental deficits resulting from undernutrition and recurrent infections. In their research on orphanage-raised children, they found that children who had been mechanically or impersonally stimulated did not improve developmentally in the absence of a specific caregiver with whom to form an attachment. These findings coincide with Harlow's study of rhesus monkeys and attachment, using the terry cloth surrogate "mothers" and the wire

"mothers".

In summary, the research evidence is fairly conclusive that orphanages can be "bad" for child development when they do not provide children with the amount of sensory stimulation necessary for physical brain development as well as cognitive and psychosocial development. 38 PERSPECTIVES OF GUYANESE CAREGIVERS

The Good Orphanage

As we have examined the devastating effects that orphanage life can have on a child's development and Judge (2004) and Frank et al. (1996) believe that no amount of funding to an orphanage can remove these issues, why am I so sure that the Good Orphanage exists? What would it look like? I am sure good orphanages exist because I've been to some! My experience of good orphanages is that the children are happy and engaging and exhibit socially appropriate behaviours. They are clean and wearing appropriate clothing and appear relatively healthy. The physical environment is clean, spacious and bright and has toys and games that are available for the children's use. The staff are attentive to the children and interact with them and the children and staff appear to have a comfortable relationship. How is this accomplished? I believe that developmental issues can indeed be mitigated, not simply through funding, but with the quality of staff involved at the orphanage.

The following pages detail how orphanage staff members can influence child physical, emotional and cognitive development for the better and how these supportive ways can produce happy, healthy children. I would also like to challenge stereotypic thinking by having readers think of orphanages not as a large, daunting institution, but as a place where committed and caring men and women invest their time and often their love.

Stimulating physical development.

Several facets of institutionalization and issues that often lead to institutionalization can affect physical development. It can be inferred from the research presented earlier that stimulation of the neurological and the psychological aspects of a child must be appropriate to 39 PERSPECTIVES OF GUYANESE CAREGIVERS foster healthy growth and development. To summarize: appropriate stimuli, adequate nutrition, and secure attachment, none of which are mutually exclusive of the others, must be present for physical development to be optimized in children.

In the section focusing on the negative impacts of residential institutions on physical development we have been warned about the dangers that understimulation present in the developmentally critical early years. In the "good" orphanage or the ideal orphanage situation, it is imperative to understand, however, that the cure for understimulation is not over-stimulation.

Berk (2005) warns that overstimulation and inappropriate stimulation can cause a child to

"withdraw, thereby threatening their interest in learning and creating conditions much like stimulus deprivation" (p. 175). She goes on to characterize stimulation as experience-expectant versus experience-dependant brain growth. Experience-expectant brain growth occurs naturally through everyday interactions and experiences with a caregiver, such as playing with toys, eating a meal or clapping hands. Presumably, the brain, through evolution, is hardwired to expect these universal learning experiences and is therefore prepared for such an acquisition. Experience- dependent brain growth occurs with the sophistication of established brain functions through practice and repetition, such as mastery of an instrument or reading. These experiences are individual to each child and vary from person to person and among cultures.

Staff members at good orphanage can help to appropriately stimulate their young charges simply through the interaction and skin-to-skin contact of feeding, bathing and playing. Having a few age appropriate toys present and allowing children to explore their own environments by crawling, rolling, reaching for objects and placing safe objects in their mouths all contribute to appropriate and adequate stimulation for the infant. Gesell and Amatruda (1954) found that 40 PERSPECTIVES OF GUYANESE CAREGIVERS younger children fared better in institutional settings because "they are on a schedule; they are getting regular and frequent physical care. This physical care coincides ... well with their current psychological needs" (p. 320). They maintain that the daily activities of a small infant (bathing, changing, dressing, rubbing, etc.) amount to a stimulating and exciting day, particularly because a child that age spends most of its time "in sleep, in staring, and in esoteric sensory experiences which are possible to a baby in almost any crib or bassinet anywhere" (p. 320).

Motor skill development requires a surprising amount of stimulation that can be acquired with relative ease. Basic stimulation, such as having an attractive object to reach for and grab, is the sole tool truly necessary. If there is no object for a child to attempt to reach or grasp the lack of stimulation can hinder development. If a child does not need or use a skill they will not exhibit that skill at the same time as others who have attempted to use it. In other words, a child who has never had to reach or grasp will not learn to reach or grasp unless they have motive or an opportunity to acquire it. This is true for all cases of learning, which is what I believe development truly is. However, having too many brightly coloured objects for one child leads to overstimulation, which often causes babies to look away and cry a great deal. Also, overstimulated children are not as advanced in their grasping/reaching techniques as their moderately stimulated counterparts, showing that there is disadvantage rather than advantage in overstimulating an infant. This can occur with any type of stimulation, not just reaching/grasping. Overstimulation with expectations that surpass a child's developmental aptitude can cause a child to "withdraw, thereby threatening their interest in learning and creating conditions much like stimulus deprivation" (Berk, p. 175). I find these ideas interesting because I've noticed a trend in North America in which children are inundated with educational videos and toys designed to increase IQ and promote early communication. Children are 41 PERSPECTIVES OF GUYANESE CAREGIVERS expected to watch and learn from sign language videos and reading videos at the ripe age of three months old. Yet the fact that overstimulation or an excess of videos and toys can actually set back development instead of jump-start it has not yet become common knowledge, and parents who can afford a plethora of development friendly toys often have them in excess.

Nutrition and development.

As previously explained, the first two years of a child's life are the most crucial as the brain grows exponentially in size and the body grows rapidly as well. It has already been established that breast milk is best for infants and bottle-feeding can increase the chance of SIDS

(Cole & Cole, 2001). However, as bottle formula is necessary in institutions it is important to note that when properly prepared, infant formula is a safe and nutritious alternative when breast milk is unavailable or compromised (by drugs or from maternal infections such as HIV). When children are ready to be introduced to solid foods it is important for orphanages to ensure that children receive a balanced and nutritious diet according to their country's prescribed food and nutrition guide.

Even with proper bottle formula, technique and focus on nutrition in an institution, there may still be cases of malnutrition. Many children are admitted with moderate to severe malnutrition or starvation. Institutions are traditionally thought to have poor access to good quality food and the amount of food that is available is insufficient. Furthermore, Frank et al.

(1996) offer another explanation for poor child development:

Most investigators suggest that growth failure historically noted in institutionalized

infants and young children did not necessarily reflect insufficient quantity and quality of 42 PERSPECTIVES OF GUYANESE CAREGIVERS

available food, but too few caregivers to assure that the available food was fed to those

too young to feed themselves, (p. 571)

This statement does not remove responsibility for malnutrition from institutions; however, it does challenge the "Oliver Twist" image of orphanages as purposefully underfeeding or giving children poor quality food. In my experience operating an orphanage I found that keeping a balanced diet for the children was difficult because of how the orphanage was organized. Meal donations were encouraged because they helped to alleviate the pressure and cost of feeding the infants and children. However, many donors thought that because the children lived in an orphanage they did not have access to childhood delights such as candy. As a result, the children were gifted cakes and candy almost daily (sometimes twice a day!) and staff that refused to give the children the donated junk food were badgered by the donors for being uncooperative and cruel to the children. At the sight of cake (which interestingly the children at the Convalescent Home do not enjoy) I've heard some staff sarcastically mumble, "Yay! More skin sores!", as it is common cultural knowledge that eating an excess of sweets will cause children to develop such sores.

Attachment and physical development.

In this section I will briefly reiterate what was learned in the first section about the bad orphanage with respect to attachment and physical development and then interpret how I believe that same knowledge can be used in a good orphanage.

I would like you to recall that children who exhibited the condition, "failure to thrive", were said to have one or another (likely a mix of the two) underlying causes for their stunted growth—organic (medical/biological) or nonorganic (social/parental) (Krugsman & Dubowitz, 43 PERSPECTIVES OF GUYANESE CAREGIVERS

2003). Also recall that lack of attachment is an underlying factor that can cause a child to

physically waste away. Frank et al. (1996) cited "poor appetite reflecting depression and subtle

neuroendocrine changes related to a lack of tactile stimulation" (p. 571) as commonly found

reasons for impaired growth in orphanage-raised children. Psychiatrist Rene A. Spitz (1946),

defined the same occurrence as anaclitic depression which refers to the phenomenon of

developmental regression in infants who been separated from their main caregiver for three

months or more during the second six months after birth. Spitz (1946) observed that without an

appropriate substitute the children would exhibit physical and psychological issues, such as withdrawal, insomnia, weight loss from refusal to eat, delayed psychomotor development and, after three months, physical rigidity. If not reversed within six months, children often suffered long-term damage from the depression. Without treatment, children could die of marasmus.

If a lack of tactile stimulation is what Frank et al. (1996) believes is the cause of these neuroendocrine changes in orphanage reared children, then a good orphanage could simply ensure there is adequate touching and physical interaction with the children by their caregivers in order to eliminate the problem. Spitz's (1946) notion of anaclitic depression caused by orphanage living could be challenged because if Spitz believes that if a child were provided with an "appropriate" substitute they would never develop these conditions at all, then providing children with caring and genuine adults would ensure they never develop anaclitic depression. I believe that caregivers can be appropriate substitutes for these children, and children can form healthy attachments to them, despite the opinions to the contrary.

I share the above information with you because in my opinion it is not impossible to overcome issues of insecure attachment with orphaned children. In fact, I don't believe it to be 44 PERSPECTIVES OF GUYANESE CAREGIVERS difficult at all because I have some doubts about ethological attachment theory's cross-cultural applicability, among other things.

First, I believe my aversion to attachment theory has developed because Bowlby's (1969) ideas have grown rather narrow and hard-set. Bowlby's own ideas around attachment were that a child could become attached to a caregiver once an emotionally available caregiver is present.

An emotionally available caregiver is one who is able and willing to form an attachment to the child and responds appropriately and consistently to the child's needs, or exhibits contingent responsiveness (Bee et al., 2003; Berlin, 2005). Further, it is not impossible for a child to develop attachments to multiple figures, as long as they are consistently present and respond positively and appropriately to the child's needs. Children often become securely attached to aunts, uncles, siblings and grandparents. To say then that secure attachment is impossible in an orphanage setting derails the entire notion of contingent responsiveness. If Bee et al. (2003), are to be believed, then I would further argue that working mothers, who may be away from their young child for up to nine or more hours a day, many of whom are placed in daycare institutions with multiple caregivers, must all have insecurely attached children, many of whom are showing signs of anaclitic depression and other ailments associated with a lack of consistent caregiving and maternal deprivation. Fortunately, that is not the case. Berlin (2005) suggests that "maternal" interactions are most critical to life experience. Although this language is debatable (inferring that a paternal interaction is less critical), we can agree that traditionally the main caregiver has been the mother. As such, it is then clear that consistent and positive interaction with a caregiver, be it paternal, maternal or other, is imperative for a life to develop normally and fully, but that it is not limited to a single figure. 45 PERSPECTIVES OF GUYANESE CAREGIVERS Furthermore, Frank et al. (1996) stated that

continuity of relationships to parent figures is especially important in the first few years

of life.. .children most at risk are those who experience multiple changes of parent figures

or who are reared in institutions with many attendants who have no special responsibility

for individual children [italics added]. Thus, there are dangers in delaying the adoption

of children abandoned by parents, in taking children in and out of institutional or foster

care, and in an impersonal [italics added]institutional upbringing, (p. 572)

From Frank et al.'s (1996) findings, I can only deduce that in this day and age when orphanages are a necessity and a safe haven for many children in the developed and developing world including Guyana, a good orphanage should have attendants who have a special responsibility for the care of individual children, and must have a very personal environment for the mental health of the children therein.

Another reason for my critique of attachment theory is that Ainsworth et al. (1978) did not test their measure of attachment and quality, the Strange Situation, cross-culturally. It should therefore not be generalized as a universal test for attachment.

One study in Japan identified a very high number of infants displaying a resistant

response indicating insecure attachment. This outcome could mean that Japanese children

are more likely to be insecurely attached, or it could mean that the Strange Situation is a

tool that cannot be interpreted similarly in Japanese children and American children. One

could argue that the Strange Situation caused the Japanese children much more stress

than the American children, simply because in Japanese culture children tend to be with

their mother all the time, whereas American children frequently have experienced 46 PERSPECTIVES OF GUYANESE CAREGIVERS

separations from their mothers. Again, further study is needed to establish guidelines to

interpret the results from the Strange Situation in varying cultures. (Pendry, 1998, p. para.

26)(Pendry, 1998, para.26)

Not only is the Strange Situation problematic in cultures where children are constantly

with their primary caregivers, it poses problems when evaluating the type of attachment of

children who are cared for in non-Western cultures by multiple caregivers. Some cross-cultural

studies have found that the attachment classifications developed by Ainsworth (avoidant, disorganized, ambivalent, etc.) were not useful. Children who were raised in cultures where certain expectations (independence, for example) were highly prized were scored as having an insecure attachment (Reebye, Ross, & Jamieson, n.d.). It should further be noted that although

Ainsworth et al.'s (1978) study was first conducted in Uganda and then with North American children, her sample sizes were small and biased (26 mother-child dyads from middle-class

America) and could not produce generalizable results (Pendry, 1998).

However, as a Western-educated woman, I did, in my time operating the Children's

Convalescent Home, encourage what could be viewed as attachment-promoting behaviours in the staff-child relationships. I believed - and still do - that having a comfortable and comforting relationship with their caregivers was important for the children's self-esteem and mental health.

I did not have to match children with specific caregivers, however, because each staff member already had favourite or preferred children that they gravitated towards naturally. The children reciprocated the relationship because they wanted these relationships and the staff made them feel special. As the Administrator, I believed it was my duty to make sure there were no children who felt left out and would either take them under my own wing, or encourage the staff using positive reinforcement to interact with the less favoured children more often. As children ran in 47 PERSPECTIVES OF GUYANESE CAREGIVERS and out of my office or clung to me when sad, visiting parties would wonder aloud, "Why do all of these children love you so much? This one hasn't left your side!" or some such observation.

To that I always replied it was because I loved them and I made sure they knew it. Writing this actually brings tears to my eyes. I miss the children so much and truly wish I could be there for them all the time, including this moment. My mantra was "Has somebody hugged this child today?" and so I distributed hugs and kisses without discrimination. In my own self-reflections I would note that it was me projecting my needy childhood self- who thrived from attention and affection, something I'm glad to say my mother doled out in spades - onto the children. For those children who were less interested in receiving kisses and hugs from me, I offered them anyway, ensuring that they knew that if and when they wanted or needed one, they could always be had.

Resilience.

Resilience is defined as "an ability to recover from or adjust easily to misfortune or change" by Miriam-Webster's Online Dictionary (n.d.). The question that interests us most with regards to resilience is what (if anything) determines a child's resiliency. What enables one child to thrive despite the harshest of conditions while another child withers under the same pressure?

Many researchers and philosophers believe that genetic, physical, and largely temperamental factors contribute to variations from one child to another in the same environment. It is also believed that these factors may cause different treatment of children by caregivers, leading some to receive a greater share of environmental stimulation than their less amiable counterparts

(Judge, 2004). All things being equal (that is that neither child has a biological affliction or impairment of any sort), for one child to succeed over another there must be a resilience in the child and an innate motivation to "utilise whatever environmental stimulation and caregiver 48 PERSPECTIVES OF GUYANESE CAREGIVERS

input... [is] available in the service of development" (Kaler & Freeman, 1994, p. 778). All this,

however, is simply speculation, and no one background variable or factor ensures resiliency. We

can, however, rest (slightly) assured that most children are indeed very resilient, especially with

regards to cognitive development. Rutter and the ERA Study Team (1998) found resilience of

cognitive skills to early environmental deprivation in a sample of children adopted form

Romania. The researchers found that most Romanian children adopted into families in the

United Kingdom following 24 months of severe deprivation were tested at a cognitively normal range at the age of four years. O'Connor et al.'s (2000) study results reinforced the findings in

Rutter's 1998 study. Children adopted from Romanian orphanages who had suffered severe deprivation in their first 24 months of life showed significant increases in cognitive skills at six years of age from their initial assessments at four years old. This also applied to children who were "late-placed" or adopted after the age of 24 months. The team found that cognitive catch-up was certain for these children, but found no consistent length of time necessary for the catch-up.

Yet, in the face of such hopeful discoveries, O'Connor et al. note lack of understanding of factors contributing to resilience to be a shortcoming of the study:

Perhaps the most important limitation was that we were unable to explain the substantial

individual differences in cognitive scores at age 6 years or the modest variance in catch­

up. It is certainly possible that, for instance, antenatal care and genetic influences, among

other factors, might play some role. However, although variation in these factors may

explain variability in individual differences in scores at age 6 years, they would not likely

mediate the association between deprivation and cognitive adjustment, (p. 386) 49 PERSPECTIVES OF GUYANESE CAREGIVERS

Another classic study was cited in Cole and Cole (2001). This long-range study of

orphanage-raised Lebanese children by Wayne Dennis (1973) demonstrated the effect of

environmental deprivation on cognition and aptly portrayed the resilience and ability to "catch­

up" that these children possess. The study followed a cohort of boys and girls who lived together

in an understimulating creche (orphanage) in Lebanon:

The children who remained institutionalized fared less well. At the age of 6, the girls

were sent to one institution and the boys to another. The girls' institution, like creche,

provided few stimulating experiences and virtually no personal attention. When these

girls were tested at 12 to 16 years of age, they were found to be so retarded intellectually

that they would be unable to function in modern society. They could barely read, they

could not tell time, and they were not able to dial a seven-digit telephone number or

count out change in a store.

The outcome for the boys was quite different. The institution to which they were

transferred provided far more intellectual stimulation and more varied experiences than

did the creche. What is more, the boys had frequent contact with workers at the

institution, who came from the surrounding communities. As a result, when the boys

were tested at 10-14 years of age they showed a substantial recovery from their initial

intellectual lag. Although their performance on standardized tests was below the norm

and below the performance of the children who had been adopted, it was within the range

that would allow them to function in society, (p. 266)

By ensuring that appropriate care through adequate stimulation, proper nutrition and contingent responsiveness is present at all levels of institutional care, we can help young children 50 PERSPECTIVES OF GUYANESE CAREGIVERS who have no hope of being adopted or removed from an orphanage to progress relatively normally in development so that they may function positively within the society of which they are a part.

Developmental Interrelatedness

Regardless of whether a child lives at home with her family or in a good or bad orphanage, their physical, cognitive and emotional development is interrelated and can affect attachment quality and style.

Kaler and Freeman (1994) found that children who are doing well in one domain of development tended to do well in all domains and children who are severely delayed in one area appeared to be similarly delayed in all others. This is consistent with the belief that development is interrelated, meaning that cognitive, social and physical development interact and affect one another. This idea of interrelatedness would then support the claim that proficiency in one area of development would transfer to all other domains, as it does with deficiency. Of course, it is possible to examine only one facet of child development, however, it is impossible to examine that facet without coming into contact with other areas that impact on the area of focus. For example, Castle et al. (1999) found "gross malnutrition ... to impede cognitive development through its detrimental effects on children's health and the children's responsiveness to social and educational influences, as well as directly through brain damage" (p. 425). The same research team also found that Romanian children adopted into families in the United Kingdom showed impressive physical and cognitive progress when evaluated at four years of age, attributing any residual cognitive deficiency to psychosocial deprivation. 51 PERSPECTIVES OF GUYANESE CAREGIVERS

With constant changes in politics and public opinion as well as economic constraints, thousands of children have been and will continue to be permanently raised in orphanages

around the world. It is imperative that orphanages become useful tools for society, not only to house unwanted or neglected children, but to foster the proper development of the future.

Children around the world living in orphanages still can - and should - have happy, full and developmental^ stable lives. I believe there is little reason, even without an abundance of resources, that orphanage-raised children should not have adequate access to the appropriate stimulation, nutrition and personal interactions necessary for healthy physical, cognitive and emotional development. In my experience, orphanage policies that encourage staff and children to eat together, play together and know each other in a more profound way can help to eliminate signs of developmental retardation, including anaclitic depression, failure to thrive and other socio-emotional issues mentioned.

As I write this I remember the staff at the Children's Convalescent Home and the amazing work they do to protect our children from these developmental maladies. These women are grossly underpaid and often undereducated, yet they have the compassion and common sense to know that a child in an orphanage is just like a child who lives at home with their families; they all need the same things. A hug, a smile, a kissed boo-boo, praise, some one-on-one time, order and discipline, tickles and some time to get messy and explore their own world. All of these things I believe the staff at the Children's Convalescent Home dole out to children generously. My study will attempt to address the absence of information in the literature about what makes a good orphanagefrom the perspective of frontline workers who are operating in an environment that appears to be successfully meeting the developmental needs of the children it serves. I know that good orphanages exist, as I've said, because I've been to some. I would very 52 PERSPECTIVES OF GUYANESE CAREGIVERS much like that to be reflected in the body of knowledge on orphanage care in Guyana and throughout the world. 53 PERSPECTIVES OF GUYANESE CAREGIVERS Chapter 3: Theoretical Framework

When I walked into the room I had a sinking feeling in the pit of my stomach. I had

already received feedback on my original proposal from my research methods professor and it was not positive. I'm not sure why, but that morning I woke up and dressed and pampered myself. Why hear bad news badly dressed? I thought. Though my outfit would do nothing to mitigate my feelings of dejection, I didn't think that the world needed to see my disappointment.

I stepped into the room with three brilliant women who had the power to crush my dream of writing a thesis on a subject for which I had great passion. As predicted, they were not thrilled with my proposal. The methodology was weak, the study should be done longitudinally in order to capture the true answer to my research question and I had omitted some important information in my literature review. What I had not anticipated was their continued enthusiasm for me to explore my subject and re-submit my proposal once more.

When my thesis committee suggested I approach my thesis from a qualitative, autoethnographic perspective, I nodded vigorously - though I had no idea what autoethnography was - and feigned enthusiasm. What else could I have done? Later, as autoethnography was explained to me in brief, I felt a wave of confidence wash over me. This was precisely up my alley and I was excited by the idea of casting off the restrictive formality of the replication of a quantitative study. At the close of the meeting I was ecstatic. I was still worried about the quality of my second proposal, but I was interested in reading about autoethnography and redesigning my proposal into something more personal and reflective. When I commenced my review of the literature on autoethnography I became even more excited and wanted to begin writing immediately - half-way through my first article by Ellis and Bochner (2000) - and so I 54 PERSPECTIVES OF GUYANESE CAREGIVERS

did. I am now wondering whether or not smiley faces and emoticons are allowed in

autoethnography, because I truly wanted to put a wink at the end of the last sentence, but I have decided to restrain myself with some form of professionalism.

Autoethnography

In Ellis and Bochner's (2000) chapter in the Handbook of Qualitative Research, they describe autoethnography as "personal, intimate, and embodied writing" (p. 734). Ellingson and

Ellis (2008) further define autoethnography as "research, writing, story, and method that connect the autobiographical and personal to the cultural, social, and political" (p. 448). An autoethnographic researcher "made themselves and their personal experience a central focus of their research" (Ellis & Bochner, p. 734). It is the exploration of a culture in which the author is a member from the point-of-view of the author and in relation to her internal dialogue and experiences (Ellingson & Ellis, 2008). I find this approach to research fascinating and see how it not only can enrich the field's knowledge regarding my subject of Guyanese orphanages, but it can also be used personally as a tool to better understand my experience operating an orphanage through the deconstruction of my personal journey. For my foray into autoethnographic writing,

I've chosen to write from the first-person (as is customary) and with "fragmented and layered writing, and social science prose" (Ellis & Bochner, 2000, p. 739), which contains academic citations and a more academic style of writing vocabulary. I like the idea of mixing my life and experiences with research done by others just to see how they might fit, intersect or diverge from what some espouse to be generalizable "truths". In truth, my research can be regarded as a hybrid

(of sorts) between autoethnography's reflexive ethnography and data reflection. Ellingson and

Ellis also warn against the limits of dichotomous thinking, referring to the socially constructed 55 PERSPECTIVES OF GUYANESE CAREGIVERS divide between art and science, among other things. Noting that, one might not understand why I have chosen to organize my essay into the differences between good and bad orphanages - clearly highlighting the dichotomy. Firstly, as dichotomies run rampant in Western thinking

(Ellingson & Ellis, 2008) I thought it would be easier for the reader to understand that orphanages can and have benefited children when operated well. Secondly, as most of the literature on orphanages maligns them and focuses on the negative aspects and outcomes as probable and not simply possible, I sought to create the opposite - a body of knowledge (if I am not overstating my actions) that highlights the positive side of orphanages and their efforts at caring for young children. Essentially, the Western perspective views good child-rearing as happening only in a middle class, nuclear family and as the majority of literature on the topic of orphanages is created from this viewpoint, orphanages will never be seen as suitable child- rearing alternatives. As someone who was raised "in two worlds" (Canadian and Caribbean), so to speak I am aware that the Caribbean perspective still holds to that old saying, "it takes a village to raise a child". It is not uncommon, nor is it seen as detrimental to a child's development to be raised by extended family. In fact, currently in my family home live my grandmother, my mother, my younger brother, my sister and her son, and my cousin. Growing up, my cousin, uncles and grandmother as well as family friends have lived with my family and have all shared in the child-rearing responsibilities. My family is neither middle-class, nor nuclear, yet I do not believe my upbringing was disastrous. An interesting argument could be that the nuclear family ideal eclipses the possibilities for a good orphanage and the possible benefits of other forms of child-rearing in general. Still, dichotomies tend to limit our thinking.

Ellingson and Ellis (2008) describe the three ways: 56 PERSPECTIVES OF GUYANESE CAREGIVERS

First, dichotomies present as opposites what are actually interdependent. Socially

constructed opposites actually depend upon each other for existence; without women

there would be no men, only people...Second, dichotomies limit the possibilities to two

and only two, negating the near-infinite possibilities present between any two poles. Thus

we can resist the limitations of femininity and masculinity as mutually exclusive

opposites and imagine them instead as poles between which there are many degrees of

androgyny, blended identities, and possible performances of sex, gender, and sexuality.

Finally, when we limit possibilities to only two, one will inevitably be valued over the

other. It is not possible to view the world in terms of equal opposites; one side is always

already privileged, (p. 447)

I completely agree! Orphanage quality is definitely on a continuum and children reared in them have varying levels of success. Even within the supposed 'good' orphanage that I have described, the aspects that I have identified can and will be implemented within their own continuum of quality. For example, staff may interact frequently with the children, but the quality of the interaction (brusquely and roughly vs. kindly and with love - yet another dichotomy!) can and will vary among caregivers, among children and among institutions. To their second identified limit of dichotomy I agree once again! Currently there are thousands of orphanages across the globe, no two the same. They vary in country, culture, policy and a host of other characteristics; however, those that have been highlighted and studied at length seem to reside at one end of the continuum exclusively, ensuring that those orphanages situated along the other end or down the centre of that same continuum are never discussed and are thought of to be exactly as those orphanages at the one end. To Ellingson and Ellis' (2008) third point, I say indeed that in dichotomies one is valued over the other, however, the simple word "orphanage" 57 PERSPECTIVES OF GUYANESE CAREGIVERS has been bogged down by association with so many negative attributes that it is very difficult for the average person to have any kind of appreciation or positive thought associated with it. The

"good" orphanage is a Utopia where all of its facets converge on the other end of the spectrum, the end that has been overshadowed for decades by its counterpart on the other side of the road, so to speak. Further, the orphanage I described earlier is the bare bones; the foundation upon which personality, culture and any other addition can be added to its betterment.

Ecological Systems

In the residential child care setting it is challenging to identify which elements of care have a positive effect on the children. When attempting to determine the effectiveness of a program this becomes even more relevant as the outcome cannot be attributed to a single element of care. This reality gives support to the theory that there is no single element of care that can be attributed to positive or negative outcomes, but that the elements combine in a myriad of ways, causing differential effects (Palareti & Berti, 2009). So how then can we attribute causality when examining the effectiveness of an orphanage program? We look at the whole. We examine "the context of the children in order to understand their development" (Palareti & Berti, 2009, p.

1081) and the best approach to understanding environmental influences may be an ecological one.

However, before we examine how we will evaluate an orphanage we must identify what aspects of an orphanage we are evaluating. In Palareti and Berti's (2009) article, Different

Ecological Perspectives for Evaluating Residential Care Outcomes, the duo share Emiliani and

Bastianoni's (1993) (as cited in Palareti & Berti, 2009) idea of "protective mechanisms"; what 58 PERSPECTIVES OF GUYANESE CAREGIVERS they believe are the aspects of a good out-of-home placement facility for children. The first

"protective mechanism" is the reduction of exposure to the stressor. For example, a homeless child must first be removed from homelessness and an abused child must be detached from the abuser, thus reducing the impact of the risk factor for developmental delays and social-emotional difficulties. Secondly, the program must aim to positively support and encourage the child's self- esteem helping the child overcome the social stigma that is often attached to their situation. This

"protective mechanism" may take the form of encouraging a child's educational goals, their hobbies and other self-actualizing activities and encouraging them to not be ashamed of living in an institution. Another aspect of protective mechanisms has to do with reducing or limiting "the chain of negative reactions" (p. 1083). Emiliani and Bastianoni give the example of healing/reversing developmental delay to encourage a return to normalized development, thus limiting the chain of negative reactions that can occur due to the initial stressor. The last two mechanisms engage the ideas of supporting children in developing self-esteem through positive and rewarding interpersonal relationships and by making opportunities for social and relational activities available, such as participation in sports, cultural activities and peer interactions. These factors will be examined further in the discussion section with regards to what format these identified mechanisms take in a Guyanese context or whether they even exist in that cultural context and what that means for the children residing in these orphanages.

This study is set in an ecological systems framework and draws from Palareti & Berti's

(2009) "Ecological Model for the Evaluation of Residential Care" (p. 1082). The model is based on a melange of Bronfenbrenner's (1992) Ecological Systems Theory and insights from developmental psychotherapy. Palareti and Berti's (2009) model is advantageous because it effectively allows for the understanding and evaluation of residential child care placements 59 PERSPECTIVES OF GUYANESE CAREGIVERS

"within and across cultures and contexts" (p. 1084). Though Palareti & Berti's (2009) ecological framework was initially created for the evaluation of group homes and other out-of-home interventions, including foster care, it can be applied to the modern orphanage as the orphanage is another form of group-based care and the framework will afford me a comprehensive view of the acting and interacting elements that are impacting orphanage children.

Urie Bronfenbrenner's (1992) theory encourages us to look at the person in relation to their environment, and emphasizes the effect of the interaction of socio-environmental systems

(micro, meso, eso and macro) on the individual or individuals in question. Based on this theory, the orphanage community is seen as an "ecological niche" (Bronfenbrenner, 1979) where certain settings prove to be favourable or unfavourable in terms of child development founded on the congruent interactions of inter- and intra-system elements (Palareti & Berti, 2009), including the child. Further, we must not limit our thinking in terms of what elements and interactions are included within the system that can bring about change. Indeed, the staff of the orphanage, the quality of food the children consume, and the children themselves play obvious roles, but "the actual realization of such processes does not solely depend on the direct actions that the residential staff...exert on the child" (Palareti & Berti, p. 1083). The previously mentioned environmental systems—micro, meso, eso and macro—all interact, within themselves and among each other, to sustain the process. Palareti and Berti (2009) give this example:

...school achievement is not just related to the staffs capacity to promote learning skills

and school attendance, but also the social services' capacity to guarantee placement

stability, practical and financial support provided by the welfare system, and the social

representations of the continuity and discontinuity in the developmental pathway, which

affect the level of expectations for the ability and potential of children in care. (p. 1083) 60 PERSPECTIVES OF GUYANESE CAREGIVERS

In keeping with the chosen framework and examining the whole, I will be taking into account the social and cultural factors that seem to affect the operation of an orphanage and perhaps its usefulness. "Overlooking or disregarding any of the subsystems can lead to a false or altered picture of the situation that in turn results in misdirected interventions" (Palareti & Berti,

2009, p. 1084). I will be conducting a series of interviews with staff who have worked in orphan care for 10 years or more. What I hope to ask these individuals, who I view as true experts in their field, is for their definition of a "good" orphanage. I already make the assumption that their answers will fall into the domain of organizational (orphanage) environment, mostly because I believe that the overall environment in an orphanage has the greatest effect on staff-child interaction, something I believe to be the cornerstone of optimal child development in an orphanage setting. I also believe that caregivers will make several references to staff performance, as I have. I am, however, open and excited to hearing the specificity the interviewees may use in answering questions about good orphanages. 61 PERSPECTIVES OF GUYANESE CAREGIVERS Chapter 4: Research Methodology

I struggled to write this section of my thesis because I felt somewhat constrained by its

traditional structure. In my first attempt at a thesis proposal, my methodology section was rather

harshly critiqued for, among other things, layout and organization. Now I feel as though I should

organize my second attempt to mirror that of the examples I read. My hesitation lies in the

simple fact that autoethnography does not follow any concrete set of rules. But I don't want a

struggle and I do want to move on and complete my research, and since I am unsure of how others outside of my thesis committee are going to react to my efforts I have conceded to use

several traditionally academic facets of a masters level thesis.

Research Questions

The research I conducted was intended to answer the following general question: How do long-term orphanage workers in Guyana define or describe a "good" orphanage? The term good was purposefully vague and left undefined by me so that participants would offer their own definitions and share their experiences and stories about what they believed was good about the orphanage system and when they have found orphanages to be good, if ever. The term orphanage, which has been used interchangeably with the words home and institution - as is a common practice in Guyana - refers to a place for unaccompanied children and children under care of social services because of parental negligence or abuse.

The specific questions asked of the Guyanese caregivers were:

1. Based on your experience, what makes an orphanage a "good" orphanage? PERSPECTIVES OF GUYANESE CAREGIVERS

2. Based on your experience, what makes an orphanage a "bad" orphanage?

3. How can an orphanage ensure the healthy development of its children?

a. Physical

b. Cognitive

c. Emotional/Relational

4. How does the "best care possible" look?

5. What can be done to ensure that children receive the "best care possible"?

6. What is the most important factor affecting whether or not an orphanage is "good" or

"bad"?

7. What can policy makers (administrators, organizations, government, etc.) do to ensure

that there is an increase in "good" orphanages in Guyana?

Research Design

The research was descriptive in nature and the methodology that I used was seated in autoethnography and described by Ellis and Bochner (2000) as reflexive ethnography. Reflexive ethnography focuses on culture or subculture and allows the researcher to use her "own experiences in the culture reflexively" (Ellis & Bochner, p. 740) and to enrich the knowledge of the culture being studied.

Sampling

Criterion sampling was used to select participants in this research. This non-probability, purposeful sampling strategy involves selecting participants based on who meets some criterion 63 PERSPECTIVES OF GUYANESE CAREGIVERS of interest (Bailey C. A., 2007). All the participants involved in this research currently work, or have worked, at the Guyana Red Cross Children's Convalescent Home. As was previously stated in my introduction, I have a long running relationship with that particular institution, as well as the caregivers who work there. More importantly, all participants had 10 years experience, or more.

I interviewed nine individuals who have worked long-term (ten years or more) in the

Guyanese orphanage system as caregivers. All participants were women ranging between the ages of 34 to 50 and had between 10 and 30 years of experience working at the Children's

Convalescent Home (CCH). The educational level of the women varied. All had completed secondary education. In addition, those who worked at the home longer had tertiary education in child development and institutional care through the government's "free education from nursery to university" policy. Participants were offered a token of gratitude (approximately $5 USD) for their time. I recruited participants by attending a staff meeting and explaining my research. I also posted the recruitment letter in the staff room and approached staff who I knew had worked in the home for more than 10 years to ask if they might have any interest in participating in the study.

Data Collection

Interviews were semi-structured and were conducted in informal places, like my apartment, the participants' homes, in available office space and in the staff lounge. Due to the busy nature of mornings, all interviews occurred in the afternoon or evening. Five participants agreed to be voice recorded while three declined. One participant was not willing to be 64 PERSPECTIVES OF GUYANESE CAREGIVERS interviewed, but wanted to participate by submitting a written response to the interview questions. Participants were given the opportunity to withdraw from the research at any time; only one individual who initially agreed to participate decided to withdraw before the interviews commenced.

The more specific questions listed in the Research Question section were used as an interview guide to direct the interviews. Questions were often read and explained to participants before the interview officially commenced so that they could feel more comfortable about their participation and reach deeper answers to their questions. Many of the younger staff who had not been educated past secondary school were very concerned about giving the "right" answers, as if the questions asked were a test. Reading the questions ahead of time made it clear that there could be no right or wrong answer and that it was their opinions that I sought.

Semi-structured interviews as a data collection method seemed to fit best within my autoethnographic approach. The flexibility of both data collection method and research framework allowed each interview to be flexible, unique to the participants and situations and made room for diversity of opinion (Zych, 2007). The semi-structured nature of the interviews was extremely beneficial to me because of the fact that one of the participants did not want to be interviewed but still wanted a method by which to participate. I believe her refusal to be interviewed stemmed from the culture of suspicion that exists in Guyana, as well as her usual dislike of picture taking and filming. Though I believe Guyana has many kind and caring people, the limited available resources makes for a difficult and somewhat dangerous reality. In the race to acquire some of the limited financial resources available much sabotaging and strategy can occur; it is only natural that peoples' intentions are scrutinized and examined. I believe that it is the same culture of suspicion that also influenced other participants to refuse audio recording. 65 PERSPECTIVES OF GUYANESE CAREGIVERS

Structured interviews or any other structured data collection method would not have been able to

accommodate the thoughts of the woman who chose to respond in writing, and her ideas were

among the most thought provoking for me. I chose to interview orphanage caregivers on their

opinions of what makes a "good" orphanage, because I believed they were in a unique position

to answer this question. I also found through my literature review that there was a great deficit in

the voices and opinions of orphanage workers and wanted to be able to give this population a

platform from which they could share their multidimensional perspectives.

I've also used self-reflection as a data collection method. Throughout my research I made journal entries and even audio-recorded my thoughts and feelings on specific interviews. This

will be an additional data source that informs my research.

Data Analysis

I found the data analysis portion difficult because I began with such limited knowledge of coding. I was struggling. I had even forgotten about the auto part of my autoethnography, so instead of writing about what was actually happening surrounding and within my research, I

spent many days staring dumbly at my computer screen. It wasn't until what I would consider the "eleventh hour" that I made the most auspicious trip to the library I think I have ever had.

During this last trip I found Carol A. Bailey's (2007) A guide to qualitative field research. Her

straightforward and to the point approach to qualitative data analysis was invaluable to me in my research and was the solution to my analytical rut. Through Bailey's direct advice surrounding coding I was able to get past the initial coding, move to more focused coding and finally I was able to identify themes which I believe accurately reflect the participants' perspectives. 66 PERSPECTIVES OF GUYANESE CAREGIVERS

Charmaz (2007) tells us that coding "requires us to stop and ask analytical questions of the data we have gathered" (p. 42). During the initial coding Charmaz tells us to continuously

ask the following questions: "What is this data a study of? What does the data suggest?...From who's point of view?" and, "What theoretical category does this specific datum indicate?" (p.

47). She also suggests that researchers move through the data quickly, with an open mind, while keeping the codes precise yet simple (Charmaz, 2007). The research presented was analyzed thematically, which "depends greatly on rigorous coding and recoding" (Bailey C. A., 2007, p.

154) and was initially difficult for me because I was not well versed in the activity. Bailey (2007) also aided me in re-focusing on my research question in order to identify appropriate and relevant themes throughout my interview transcripts. After my initial, "line-by-line" (Charmaz,

2007, p. 50), in vivo coding, I moved on to focused coding where I "further reduced the data into larger categories that subsume multiple codes" (Bailey C. A., p. 129). For example, my initial themes of cleanliness and nutrition were gathered under the umbrella term health. Focused coding is more conceptual and selective than line-by-line coding and is used to synthesize larger pieces of interview text (Charmaz, 2007). However, the majority of my conceptual themes evolved from the memoing process I began during my initial coding. I used the Word document for initial coding and then used the Nvivo program for all further data analysis. Please see

Appendix A for summary of coding.

Chang (2008) has suggested several strategies that can be utilized for autoethnographic data analysis. Most of these suggestions are typical of other qualitative data analyses, such as searching for reoccurring topics or themes and framing your findings within theories. Strategies that in my opinion apply uniquely to autoethnography were the following: "... connect the present with the past;... analyze relationships between self and others;... compare yourself with 67 PERSPECTIVES OF GUYANESE CAREGIVERS

other people's cases" (p. 131) and also, identifying cultural themes is considered "an important final step in the ethnographic process" (McCurdy, Spradley, & Shandy, 2005 as cited in Chang,

2008, p. 132). I am confident that you will see evidence of my use of many of these suggestions throughout the results section. Perhaps I could have utilized one or two more of Chang's

(2008)suggestions but, as he puts it, "researchers should take this list as helpful suggestions, not as a complete tool kit of data analysis and interview" (p. 131).

Ethical Considerations

The biggest ethical dilemma I believe I faced was my history with the participants. As

I've stated previously I was in the position of Administrator at the Children's Convalescent

Home and had worked in a supervisory role with all of the participants. I had anticipated that this would not be a problem. However, as I explained to the Ethics Review Board, Guyanese culture places much more emphasis on my age than on my employment status. In other words, my previous position as Administrator held little bearing as to whether or not the caregivers would participate in the study. Having me ask and conduct the interviews did not coerce them from a power perspective, as (1) I no longer held that power, and (2) my age, which was younger than all the participants, helped to redistribute any power imbalances that could have been present between myself and the caregivers. In Guyana, age is very important in terms of respect. Respect is automatically granted to older members of society and they are given much privilege and power as a result. Regardless of my previous position of authority, the older staff would never completely defer to me in their decision making. In fact, throughout my time as Administrator I was constantly reminded of my age and the fact that my authority was "optional" or

"conditional"; the older staff thought it was proper that the younger caregivers listen to my 68 PERSPECTIVES OF GUYANESE CAREGIVERS authority, but they themselves postured more as advisors than as employees. Also, I believe my past relationship with the caregivers, and the nature of the relationship (often very open and advice seeking from my end) also aided in putting the staff at ease about participating in the study, because they may have felt that my presence and research were motivated by genuine commitment to giving voice to their experiences.

Limitations

Limitations that I have identified are the following: I have been a member of the same orphan care sub-culture as the participants I sought to interview, which in and of itself is not a bad thing, except that in all cases I have worked with those who I interviewed in a supervisory position. There is, therefore, a possibility that answers may not have been authentic, or answers may be what they think I want to hear. However, I believe this has been circumvented because I did not ask any specific questions about their feelings towards management, nor were the questions asked directed at specific incidents, people or time periods. While confidentiality can never be ensured in a Guyanese setting, mostly because of cultural differences surrounding its importance, every effort was made to keep participants' identities private by me as the researcher. Though Guyana is a large country in terms of land area, the population is approximately 750,000, with the majority of the populace living in the capitol. People may live in the same house, in the same neighbourhood, burrow or village for their entire lives, along with their parents before them and their children after them. Life in a small village or even in a particular neighbourhood can be very insular. If you are not well acquainted with a person, you at least know their family in general (often by name, and sometimes by history) or recognize their face. In a setting like this, information about your neighbours translates into village lore or 69 PERSPECTIVES OF GUYANESE CAREGIVERS family history and certain information is regarded as public knowledge. Participants could choose when and where they were interviewed with some choosing to be interviewed in my home, others were interviewed at the Convalescent Home office or their own homes. Those participants who agreed to be voice recorded were first assigned numbers for the interviews but were then assigned letters after transcription to further protect their privacy. 70 PERSPECTIVES OF GUYANESE CAREGIVERS Chapter 5: Results

I would be lying if I said that I had no hunches coming into this research about what I would find. The analysis was much like a tulip breaking through soil: a particular seed was planted in my mind and the story that emerged corresponds to that. However, that tulip has a colour that has varied from the colour I may have been expecting and may have more petals or less than anticipated. And just like my research, a richer understanding of the process has developed because of the reflections of the participants and my own self-reflection. C. A. Bailey

(2007) states that, "qualitative researchers actively create the final product that they believe adequately represents their observations and interactions" (p. 127). All aspects of the research from the initial question to the writing of the manuscript are taken from the researcher's own actions, perspectives and decisions (Bailey C. A., 2007). So, for example, if I were given a seed and told that it grows oranges I would tend it as an orange tree. If it bore grapefruit, I might say that the oranges were pale and sour, pointing to the soil conditions or the weather as the culprit, instead of looking at the seed and my assumption that it would yield a particular type of fruit.

You might be scratching your head right now. Basically, I am saying that my research emerged from me and the findings of my research also have a great deal to do with me.

Throughout the previous chapters I've already made several assumptions with regards to my findings and I make no apology for this. However, one can never remain unchanged after an experience like mine. I had several ideas and convictions that have either been changed or completely rearranged, and my approaches to challenges within the orphanage care system and the broader societal system have also shifted as a result of this study. My initial ideas surrounding the research question led me to state that I believe staff members can influence child physical, emotional and cognitive development for the better and that their actions can produce 71 PERSPECTIVES OF GUYANESE CAREGIVERS happy, healthy children. In my review of the literature, Palareti and Berti (2009) seemed to support that very notion with their ecological systems approach to evaluating residential care settings. However, this study is not an evaluation of a single residential care setting for children; it is a study that aims to demonstrate that orphanage staff can provide useful ideas about how to promote healthy child development.

Range of Opinions

I found that several of the women interviewed—predominantly those who were older, had more education, and had spent longer periods of time working in an orphanage— were very passionate about the children and the orphanage system. There was a range of opinions about orphanages in general, spanning the continuum from hot to lukewarm to cold on the issue. One caregiver believed that orphanages should be abolished and, in my unrecorded conversations with her, pointed to developed nations as proof that the dissolution of orphanages would be best for society. Others were simply passionate about the need for change and the need to do better for the children before and after an orphanage is the only option for them. With the following passage I hope to convey some of the feelings that many of these caregivers have towards the situation in which their country and their children find themselves. At the close of this caregiver's interview she began to tear up at the state of Guyana's orphanage system and the fact that she believes the government does not care and is trying to cover up the magnitude of the issue. I take this quote as a personal challenge to me in terms of seeing through the fruition of this labour of love — because my success matters.

I get distressed when I think about it sometimes. I don't want to talk. I take it personally,

but I just go along with it because hopefully all this research you're doing can do 72 PERSPECTIVES OF GUYANESE CAREGIVERS

something about it; you know, in your powerful country. Think about it. Think on what

I'm telling you. It's a passionate situation. I don't like to talk about it because they are

saying it isn't happening in Guyana. That's the basic thing and all these people saying we

getting educated in this land...

I've presented the results of the thematic analysis in the following order: the perspectives of the women interviewed regarding what makes a good orphanage and the challenges they experienced in providing care that is consistent with these criteria. This is followed by my autoenthnographic reflections, comments and observations.

What Makes a Good Orphanage/Children's Home?

The overarching theme identified by the women interviewed was that a good children's home is one that raises happy, well-cared for children who grow up in a healthy environment for the future success of the country. "We want to make a good nation," said one interviewee, "This is the young generation; they're supposed to be taking over from us".

Specific themes identified that explained what staff meant by "happy and well-cared for" included: a nurturing physical environment; staff who are well-trained and suited to the work; and greater government involvement. Aspects of these themes will be further discussed in the following pages. Staff also indicated as a theme challenges to providing and maintaining good care in children's home, such as the consequences of financial stability and the lack of post- orphanage programs for children, for example. 73 PERSPECTIVES OF GUYANESE CAREGIVERS A Nurturing Physical Environment

In reference to a nurturing physical environment staff interviewed identified areas that benefited children developmentally. The following aspects can be organized into the most predominant categories of child development: cognitive, physical and psychosocial. I've also included health as an additional category, because I believe that good health contributes directly to the positive development of the other three categories.

Well equipped and maintained facilities.

Elaborating on what constitutes good care, many of the staff first identified physical aspects of an orphanage that they believed would create an optimal environment for the running of a good orphanage.

First of all, the appearance of the orphanage; the way the place is being kept... That's

what I would look for, because first impressions count and not anyone would want to deal

with an orphanage if they see it's not taken care of, or if it's shabby looking. I think the

general appearance first of all of the orphanage, the physical building and also the staff.

A second property of the physical aspects of the orphanage that was mentioned by many was the need for every orphanage to have the proper equipment necessary to make children and staff comfortable. "Basic needs of home should be there. Children and staff should be comfortable," said one staff member. Another added that, "the staff must be well equipped" to work with and for the children. By basic needs the staff meant equipment like gloves, soap, over- the-counter medicines and ointments, cotton swabs, etc. 74 PERSPECTIVES OF GUYANESE CAREGIVERS Cleanliness of facility and children.

The importance of cleanliness was emphasized by every participant in the study. This was with regards to the facility as well as the children and staff. An example of the importance of cleanliness follows: "the children must be cleaned from head to toe and the building must maintain good sanitation". When asked what she thought the most important factor affecting whether or not an orphanage is good or bad, another staff member responded, "Number one, surroundings...cleanly surroundings". In a setting with so many small children, it is imperative, that cleanliness be maintained to reduce the development and spread of communal illnesses. It affects all aspects of the care of the children, the operation of the home, and the impressions the visitors and donors receive of the home.

Onsite medical care.

Onsite medical care was another aspect of a good orphanage for staff."There should be medical care onsite, a doctor, or registered nurse all the time," said one caregiver. I found that those who mentioned cleanliness as an important factor of a good orphanage often linked it to medical care by professional doctors and nurses. "Always keep the place clean and have doctors come in to check on the children" and "keep your surroundings clean, give the children regular check-ups with a doctor" are two examples of that sentiment.

Good nutrition.

Aside from previously identified check-ups with medical professionals, nutrition was high on the list of priorities for providing good care. Several of the women interviewed even suggested daily vitamins as part of the children's diet as important. 75 PERSPECTIVES OF GUYANESE CAREGIVERS

I think first of all, they should look into the diet of the children. There should be a

dietician or someone that is experienced with preparing meals for children to ensure that

they get the right type of food - and apart from that they should be given supplements to

enhance and to help them.

Another caregiver added, "vitamins will help [the children]...if you don't have that, then you must have food vitamins and in Guyana, for you to have a well-balanced diet, to get all these nutrients in your body, it's hard".

Early education/playschool.

The role of education was also mentioned as an important aspect for children in an orphanage. Staff shared that it was important to have "a personal school in the compound, because the other schools discriminate against the orphanage children", which from my time as administrator I found to be true. In many of my interactions outside of the interviews I found that staff believed that a solid education could be the saving grace for institutionalized children as they are without the normal family advantages of their non-institutionalized counterparts.

Without family, orphanage-reared children would not be able to join or take over the family business or seek out employment through family connections.

Having the youngest children of all Guyanese orphanages, the staff did not believe they were exempt from providing supplemental early education to the children:

Some of them could play with educational toys and.. .match colours and shapes, those

kinds of things. I think every orphanage should have what we would call a 'playschool'

so, before the children get into the nursery part of school, they can already start some

amount of schoolwork. 76 PERSPECTIVES OF GUYANESE CAREGIVERS

As was mentioned previously, children at the Children's Convalescent Home do participate in a playschool when they are either too young to attend nursery school (3 yrs. 9 months - 5 years old) or do not have the official documents that permit access. In my visits to other orphanages that care for older children I was pleased to note that many of them focused on education and have arranged for their children's education to be supplemented by providing extra tutoring lessons and/or have arrangements with some of the leading private schools so that the children are able to attend free or with reduced costs.

Cultural outings and social activities.

A few of the women indicated that children in orphanages needed exposure to cultural outings and social activities. The children need to "go out and go for a walk and other activities, to places they've never been before," supplied one caregiver. "Remember some of them were poor; they weren't exposed to those things. Like [a] trip to the airport, you know, let them get exposed to society let them see what's going on [outside of the orphanage]". Further, another caregiver commented, "They [the caregivers] normally take [the children] to parties and go for walks. We don't keep these children housed up; we treat these children just like our own children. They get every single thing that a child gets at home". Taking children on outings is a huge task for the caregivers. In my time at CCH I've seen the children attend several parties, museum trips, and zoo outings and I can tell you with first-hand experience that organizing and dressing 30 or more children, drunk with excitement and anticipation for their outing, is an

Olympic feat that should be applauded. 77 PERSPECTIVES OF GUYANESE CAREGIVERS Staff Who are Well-trained and Suited to the Work

What I found to be discussed the most by the women was the quality of staff in the institution. Those interviewed called for well trained staff, as well as better hiring practices, nurturing staff, more male role models for both boys and girls to look up to, and staff who are dedicated to fostering the identity of the residents.

Well-trained staff.

The women interviewed placed great importance on the need for a good orphanage to have good staff. To them this meant well trained staff members who were educated in childcare and development. One staff suggested, "First, staff need education about child care. They need to go in depth about psychology; how they can affect children by simply screaming". "The staff must be well equipped and have proper qualifications and training - don't just take anybody," agreed another woman interviewed.

One staff member also emphasized the need for more transparency in the hiring process.

"Publish vacancies! People will come to work", she stated. Vacancies at the Children's

Convalescent Home are not made public in newspapers. Instead, individuals desirous of being employed at the home usually bring in an application in the hope that they are hiring. If they are, those applicants will be interviewed if their application is deemed appropriate. When no one has recently dropped off an application, the previous applications are looked through and persons deemed suitable are asked to come in for an interview. Publishing vacancies may attract employees with higher levels of education and training and who are more suited to the position, as opposed to those who are mostly just desperate for employment. Some of the women 78 PERSPECTIVES OF GUYANESE CAREGIVERS

interviewed even suggested that there should be a screening procedure during the hiring process to ensure the quality of staff and that they have no history of abuse towards children.

A woman interviewed expressed that when evaluating whether an orphanage was good, visitors generally observed the staff. "Look at the staff, how they go about their work. It's how people are going to perceive, and they're going to be 99% right," she commented.

In terms of visitors to the orphanage, which includes donors and prospective adoptive parents, several persons interviewed expressed the necessity that staff must be especially engaging, courteous and polite during their visits. This is important because of the high dependency that the orphanage has on external donations. Donors may cease to give to the orphanage, making it even more difficult for the staff to do a good job.

The caregivers' [behaviour is important]. The approach and how they deal with the

children in the presence of visitors, because you'll find.. .you might come today and meet

a caregiver and she's so arrogant and then you...might say, "I won't come back to this

orphanage anymore, because the environment is not nice"...the caregivers don't know

how to speak to you. Then tomorrow you might come back with a friend and you might

meet a different caregiver, someone who is approachable, and you'd want to give it your

whole heart.

Nurturing staff who are well suited to this work.

Following on the theme of caregivers as an integral aspect of a good orphanage, staff interviewed also added that love must be present at any orphanage for it to be considered good.

Caregivers continued to play a key role in imparting this aspect. Those interviewed often discussed this aspect as treating the children in the institution as if they were their own. "It's 79 PERSPECTIVES OF GUYANESE CAREGIVERS

supposed to be a home that has caregivers to love and care for children; treat them as if they are a

mother to a child. Nurture them." supplied one interviewee. "Just because they're orphans,

doesn't mean we have to treat them like that." Another added that individuals should be able to

sense the love and care that an orphanage has to offer: "When you enter my orphanage you must be able to sense the warmth, sense that there is a type of belonging here and the children feel

something". Bringing it all together are the following words:

I think first of all, for a person to open an orphanage or a children-home independently,

they must be a loving person, a caring person who will have the children's best interests

at heart and they wouldn't be opening this orphanage or home for gains for themselves. I

think once it starts with them, everything else will fall into place because they of

themselves will see the persons who are looking after these children are also caring, too.

To me, the previous quote addresses the need for orphanage operators and employees to be personally suited to the work. Staff should be responsive to children in order to foster a positive attachment. "You have to get more mature staff to work with these places [orphanages], motherly like staff; staff that are nurturing the young ones so that they too can be nurturing", said one of the older caregivers.

Several other points related to staff nurturing were brought up by caregivers. Though most of these points were individual, in that only one or two of the caregivers may have identified it as important, I believe they are aspects of a good orphanage that are important. One caregiver in particular stressed the need for caregivers not to become discouraged by distant children. 80 PERSPECTIVES OF GUYANESE CAREGIVERS

I know that sometimes no matter how much you reach out to some children, they still pull

away for a time. But if you constantly show that child love, show that you care for them,

after awhile you will find that child clinging to you. You [me, the interviewer] have

experience with that; we deal with kids and we know that sometimes you have a child,

they come into the home and they don't want anyone to touch them, they'll be

withdrawn. But after awhile, you keep going to that child, showing them love and telling

them nice words, like 'I love you'.

In addition to technical training, those interviewed also highlighted as an integral aspect of a good orphanage the behaviour of the staff towards both children and visitors to the home.

"The caregiver must be a role model to this child; to help this child to grow to become a good person," stated one woman. Another stated that caregivers who treat children in a positive manner would encourage the children to open up to them and develop bonds between the staff and children.

Male role models.

One caregiver mentioned the importance of having men present in some capacity at the orphanage. She thought it was extremely important for boys to have male role models because she thought the children were being too coddled by the all-female staff. "Boys need more man image - they are too surrounded by females...when they become men they behave feminine".

Again no other caregiver believed this to be important, but it speaks to the culture that that particular caregiver experienced. As she was one of the older participants, traditional gender roles could have been more traditional in her formative years. 81 PERSPECTIVES OF GUYANESE CAREGIVERS

Fostering positive identity.

Another theme raised was that of identity. Some of the staff interviewed believed that being able to provide the children with a sense of individual identity was important for their overall development. They identified the concept of ownership as an important method of instilling identity in orphanage-raised children. "I mean, we have very small children and they have to learn ownership. You know, because if I own something I am somebody" offered one caregiver on the topic. The idea of ownership equating to self-importance or self-esteem is culturally relevant. In a country where resources are fairly limited owning property or items is an important status indicator. The same caregiver went on state that it was also important for children to understand that they are a part of a community and Guyanese society as a whole.

"You got to let these children feel, you know, I am a part of something, I'm a part of this thing".

It is important to note that traditionally Guyana has been more of a coUectivist society, politically and culturally. However, the increased exposure to Western society has placed greater importance on individuality and it is a concept that seems to go hand-in-hand with the Western evaluation of progress. There seems to be a cultural struggle to balance the old (traditional coUectivist society) with the new (modern and progressive individualism).

Greater Government Involvement

I use the term government to refer to public funding because the people I interviewed refer to it in this way. Those interviewed emphasized the need for greater public funding and interest in the children's homes as well as further development and better monitoring of orphanage standards and regulations. 82 PERSPECTIVES OF GUYANESE CAREGIVERS More public funding.

The CCH is financially supported primarily through private funding from businesses and

from community donations. Public funding is provided, however it is minimal and does not

cover the home's major costs. For the women interviewed the importance of public support was

very important. "Well they [the government] have to play a vital role in whatever they're building," expressed a caregiver. One woman opined that the government not only must help

orphanages, but that they had to set the standard for helping orphanages in the country.

First of all, I think the responsibility is on the government of the country. Where the

running of orphanages is concerned, it's not left on an independent body, like the Red

Cross or any private person who wants to open an orphanage. The government should

play an important part in the development and running of orphanages in this country.. .1

think the government should really make their input and the orphanages would be far

better.

Further development and monitoring of standards for orphanages.

The need for further development and monitoring of standards for orphanages in Guyana was very important to the staff interviewed. It did not appear as though they were aware of the recently developed Standards for Children's Homes in Guyana, or at least did not recognize or note its implementation.'They have to put systems in place that when they come and check that the system is working. If it is not working they have to meet back again and rectify it and say,

'let's try something else different, we need to try again'".

Recently, a new set of standards and regulations has been introduced by the Ministry of

Labour, Human Services and Social Security; however, its implementation and monitoring is still 83 PERSPECTIVES OF GUYANESE CAREGIVERS

on shaky ground. After examining the standards, I remarked that it would be very difficult to

implement many of the new rules given the age of the children being served at the CCH.

Requirements such as posting telephone numbers of social workers for child access are not

useful in a setting where the children know neither how to read nor how to use a phone

appropriately. I also felt that the new regulations placed too much onus on the children in general

to report abuse and neglect to social workers and did not emphasize the need for social workers

to develop good relationships with their charges so that disclosures are more likely. Further, the

standards also place too much burden on the staff of the home in terms of responsibilities which

they are unqualified for, such as the expectation that "staff explain to the child the reason for

admission" (Guyana. Ministry of Human Services and Social Security, 2006, p. 6). Why

wouldn't the social worker placing the child in the home explain this instead of the caregiver?

The social worker is the first point of contact and has been trained to develop the skills necessary

to implement this activity. I found responsibilities for children's home staff to be unrealistic in

several of the other standards as well. For example, the standard regarding assessment and care plans is the responsibility of the Ministry social workers. They are often incomplete or never completed and they are rarely updated to account for changes in the child's or family's circumstance. In this area the orphanage staff are told that they have the responsibility to ensure that the care plan is carried out or expedited. In many cases and at the CCH in particular, staff do not have access to the children's care plans and their limited education and knowledge in social work make it practically impossible to expedite the actions in a care plan. They have no authority or training to assess parental readiness to take back their children, yet the standards place the responsibility to do so squarely at their feet. Staff interviewed believed that standards needed good supervision and follow-up to ensure not only that the standards are being upheld but also 84 PERSPECTIVES OF GUYANESE CAREGIVERS

that they were functioning appropriately. "When you put these things [in place], you can't just

leave them like that. You care [for] people and then you follow through to see if the things they

are being taught are being carried out or implemented," shared one caregiver.

Challenges to Providing and Maintaining a Good Orphanage/Children's Home

Staff interviewed not only provided information about what is needed to provide optimal care for orphaned and abandoned children, but also identified issues that they see as being counterproductive to that goal. The caregivers interviewed identified staff as paramount to creating and maintaining a good orphanage and discussed incidents where poor staff (either in quantity or quality) has had a negative impact on the children's home.

Persons have their own experiences in their own environment and sometimes when they

come into these orphanages they just want to put out what hurt them. They just want to

put it out on the children because as a child they were treated like that... With education

they can do better, they can know that their hurts mustn't transfer to somebody else; their

hurt must help them to see that the very thing doesn't happen to other children.

Also related to staff were issues of child abuse, which were often associated with administrative hiring practices.

If a person has a qualification they still don't screen them. They would just take them and

put them into an area where they have children that come from broken homes, abuse

homes and you would find a caregiver might be a person that's also abusive. That person

does not know how to love a child or nurture a child. You'll find that that same caregiver, 85 PERSPECTIVES OF GUYANESE CAREGIVERS

instead of nurturing and loving and caring for this child, they turn around and abuse that

child.

Supporting poor families to care for their children.

Several staff also indicated that in certain cases children and families were more hindered than helped by the orphanage system. Some of the women offered suggestions for alternatives that they believed government could take, but most only suggested that change was necessary.

Ok, let's use Guyana situation... you take a child from the poor, not from the poorest,

because of the living conditions... and you place them in an orphanage. Right? They get

family members.. .parents, who love and care for them, but because of the home

conditions .. .they take them children from their parents. Parents actually love those

children, but because they can't afford...and you gone take them and place them in an

orphanage. In that sense we're doing more bad more than good. The intention is to do

good but I feel, in my opinion, that it is bad.. .government must implement some kind of

thing so that parents' standard of living, like build a condominium or something, and give

them.. .a small fee for a rent and let the people house there with their children. Because

now remember, these children, it's not that they don't care for them, but they can't afford

a better living condition.

Consequences of financial instability.

Other important barriers identified surrounded government support and financial stability.

Staff emphasized that without more support from the government for these children, the institution can't achieve what it sets out to - that is, raise balanced, healthy and happy children.

One woman supplied, "If they're [the orphanages] not financially equipped they won't be able to 86 PERSPECTIVES OF GUYANESE CAREGIVERS meet the needs of the children and that could also affect the children. They are already being deprived of their mother and their father and then they come in here and the very thing..."

Another caregiver added:

So if the government gets more involved in having doctors come to the orphanage,

supplying more food for the children, letting the social workers come on a regular basis

and checking on these children's welfare and health and see how they're progressing -

you will have a better orphanage in Guyana and around the Caribbean. If they don't do

that, then it's going to stay just as it is now.

Up until recently, the Guyanese orphanage system has developed mainly by religious groups and individuals who wished to open an orphanage. There were no regulations surrounding the operations of orphanages and there was little government involvement in terms of funding and monitoring. With the introduction of the Minimum Operational Standards and

Regulations there has been a step towards improving this; however, the program is still in its early stages and it is not clear whether the standards are being achieved.

Post-orphanage programs.

In Guyana, children's homes care for children until the age of 18 years old. There has been much ado about what to do to help these older children, many of whom have spent their formative years, if not their entire lives, residing in institutional care. The orphanage is their home and the staff and the other children their family. Culturally, the majority of these children's non-orphanage counterparts are still expected to remain in the family or extended family home at this age. Many Guyanese do not move from their primary family homes until they are married.

Even then, many newlyweds remain in extended family homes or may build a home on the same 87 PERSPECTIVES OF GUYANESE CAREGIVERS family property. Expecting young adults who have been raised in Guyanese orphanages to move from their homes without adequate support is culturally inappropriate. Lack of government support often translates to a lack of financial support from government and also from the private sector. Without the financial stability provided by- these large economic entities, it is very difficult for Guyanese orphanages to provide the children residing in them with the tools they need to succeed after they leave the orphanage. Currently, there is still no program or plan of action in place to assist these young people to move on from the orphanage life.

They don't have no follow up when the children leave the orphanage. I was telling them

why they don't buy a piece of land and build the range houses and encourage, you know

some of them they don't have nobody and nobody cared for them so they had to grow up

in an orphanage. So when they reach age where are these children? On the streets! ... But

if they don't [have post-orphanage programs] and just send them from one orphanage to

the next and then out the door what's happening? Anybody knows? We need to know.

That was my point.

Having a say (empowering children).

Another interesting theme that was identified by the women was the idea that children were not given a say in matters concerning them. "They don't have no say. Even though they're so small you have to let them feel, "I am a part of this thing, I can say how I feel", you understand? So you got to get them to feel that, get them to trust you". A more senior caregiver also added this observation, "In an orphanage children have to eat whatever the man in the street brings for them to eat. Even if they don't want it, the caregiver insists they eat it. Sometimes even the staff refuse to eat the food". Many thought it was a shame that the children were not given these opportunities and expressed their distaste for the practice of requiring the children to 88 PERSPECTIVES OF GUYANESE CAREGIVERS

eat the food they may not want. Most of the meals served at the CCH are donated by the public.

This has been a contentious issue as staff would rather the donations be of the raw ingredients so

that they can prepare the food themselves, but many of the donors wish to prepare the meals

themselves for cultural reasons (they believe that they will be blessed).

Personal Reflections, Observations and Comments

Before I began interviewing the participants I conducted a self-interview asking the same

questions. In answering the questions, I reflected that some of my answers might address similar

topics as the caregivers I had yet to interview because we had worked together and shared many

similar views. I believe that my views were an amalgamation of my experience of the orphanage

and the various systems and sectors that interacted with it and my previous life experience as

being both a Canadian, and growing up in that society, and having a strong Jamaican background

and being raised in that culture. Although Guyana is in South America, the country is officially a

part of the Caribbean Community or CARICOM. Its population, historical background and

cultural activities align more with countries like Trinidad & Tobago or Barbados than Peru or

Brazil. For that reason, I do believe my Caribbean heritage and culture gave me a unique perspective: on one hand I am familiar with many of the cultural perspectives and mindsets of

Caribbean peoples, on the other, Guyana is unique and my own Caribbean cultural experience is

a hybrid with many Western influences.

First, my initial answers to what makes a good orphanage surrounded the happiness of the children and that the children needed to be "well taken care of. I referred to the need for

quality caregivers as the basis for all good homes, and touched on the need for government PERSPECTIVES OF GUYANESE CAREGIVERS

support and an integrated government approach to orphanages in Guyana, which calls for

multiple government ministries and agencies to be involved in orphanage management along

with the Ministry of Labour, Human Services and Social Security, such as the Ministry of

Health, Ministry of Education, and Ministry of Culture, Youth and Sports. However, I did not

stress the need for funding to accomplish all of these goals. The women interviewed seemed to look at the larger picture and one of them even referred to homes in the Caribbean as a whole, whereas I focused my ideas on children's homes in Guyana solely. In terms of staff training, I focused on child development as an important area of knowledge that caregivers should learn in order to care for the children more appropriately; however, I did not address staff behaviour towards visitors as integral in maintaining donors and child happiness. I believe that I assumed that staff would be gracious and have positive interactions with the children given training in areas of development, but in hindsight I see that that was an unwise assumption on my part. In reflecting on my own writing and thoughts at the time I could see that perhaps I did not give the staff enough credit. I knew they were rarely, if ever, asked their opinions on the operation of their workplace; yet, I ignorantly assumed that they had not thought about these topics in depth and at length.

This last interview, I think it was number seven, where the staff member was telling me

that professional development courses would really benefit not just the staff but how the

staff treat and interact with the children in showing them that their actions...the way they

treat the children now, affects how the children turn out in the future. It really shows

them that it's not simply coming and changing diapers, bathing children and making sure

that they eat, but it is building the foundation for the lives of these individuals. I think

that is amazing. 90 PERSPECTIVES OF GUYANESE CAREGIVERS

After conducting the first few interviews I found that the passion of the women I interviewed took me by surprise. "A lot of people seem to be very excited about it, and their eyes...you can just see the passion that some of the staff have, when talking about orphanages and the children and what needs to be done to improve their situation and staff situation...So that was really enlightening", I journaled after a series of interviews. I thoroughly enjoyed the interview process and it was clear to me that the participants did as well. Another entry in my journal seemed to capture the feeling that I observed about the interviewed caregivers:

They are very excited and happy to share their ideas and their thoughts; people don't

usually ask them. You can tell that it makes a difference to them that someone is asking

them. They have a lot of great ideas and a lot of great insights, and it just makes me

happy to see the excitement.

I've noticed the change in myself and my views and opinions since interviewing these nine women. My approach to how I would help vulnerable children has changed drastically and now I have a new battle plan that I think will not only be more holistic, but also be more humane and effective than my previous ideas. For example, I now think more broadly about my approach to child welfare and participate in less "mother-blame". I can see more clearly the gaps in service in the Guyanese orphanage system and am seeking ways that I can fill these gaps. I've also, already been in contact with a colleague of mine in Guyana who is an excellent social worker and who is currently interested in working with me to fill some of these gaps. I've learned to listen and to take information from each one of the participants, even when I may not agree completely with their views and ideas, I am able to better appreciate the consequences and history that fuels them and in turn I am able to step back from my own views and re-evaluate whether they still hold true and fit with my newly acquired knowledge. 91 PERSPECTIVES OF GUYANESE CAREGIVERS

Staff checklist for a good orphanage.

The following checklist summaries the key perspectives put forth by the nine caregivers,

each dedicated to the care of vulnerable children, each hoping for the best for these children, but understanding that for some of them the orphanage is the best place they could be. The checklist is as follows, in no particular order of importance:

• Adequate facilities appropriate to the age range of the children in the institution

and the intended capacity of the institution;

• Facility should have access to sufficient cleaning supplies that are as child safe as

possible;

• On-site access to nutritionally balanced meals, education, medical care and other

government services;

• Children should be exposed to various cultural outings and social activities

outside of the orphanage;

• Adequate staffing to maintain a reasonable child-staff ratio (depends on the age of

children);

• Continual and continuous staff training in the area of child development;

• Positive, nurturing relationships between the staff and the children at the

residence must be encouraged;

• Transparency in the hiring process by issuing public job postings, with a focus on

quality and quantity (but quantity of caregivers should never take priority over the

quality or suitability of an individual to perform as a caregiver);

• Improved screening of job applicants for history of prior incidents of child abuse;

• Better public relations/image management via staff and organization as a whole; 92 PERSPECTIVES OF GUYANESE CAREGIVERS

• That orphanage admission prevention strategies be developed to support families

to keep their children with them through the development of affordable housing

programs, employment programs and educational programs;

• That adequate public funding be provided to ensure that healthy, happy children

are raised in Guyanese orphanages who are prepared to take on responsible roles

in society when they leave the orphanage;

• That a post-orphanage plan be developed for orphanage "graduates" that supports

the young adult in a cultural, financial and social context prior to and after leaving

the orphanage;

• Ownership of personal clothing and other objects must be established among the

children for development of identity and self-respect; and

• Increase government/public involvement in the funding and regulation of

children's homes in Guyana.

In conclusion, the information and opinions garnered from the caregivers interviewed showed that the majority did believe that orphanages could be good and that they could benefit the children residing there by offering an appropriate and clean facility (including access to quality education and medical attention), continuous staff development, government support

(through policy, financial support and social worker intervention) and lastly but most importantly, by offering the children love and a sense of home. 93 PERSPECTIVES OF GUYANESE CAREGIVERS

Chapter 6: Discussion and Conclusion

My research sought to define a good orphanage from the perspective of frontline caregivers in Guyana, South America by way of semi-structured interviews. The research question, "How do long-term orphanage workers in Guyana define or describe a "good" orphanage?" was answered by nine women who are or were employed as caregivers at a local orphanage. The women were all between the ages of 30-60 years old and have worked between

10-30 years in the Children's Convalescent Home.

In preparation to write this section I reviewed a few discussion sections of other completed theses and studies. I didn't like them. The discussions I read felt too much like a second literature review supporting the data garnered from the study in an attempt to validate and generalize the researcher's findings. I do not seek to generalize and I believe the validity of my research is sound because of who I interviewed and their relationship to the topic. I don't think I could find more valid sources and information about the usefulness of children's homes in

Guyana than to ask those who have been working, running and caring in them for a decade or more. And although I myself have not been a part of that sub-culture for quite as long, I do believe my years of service in and amongst that culture and setting makes my viewpoints somewhat unique, but valid nonetheless.

What I will do is examine how the results of the research align with Palareti and Berti's

(2009) evaluation of residential care, as well as look at responses that were shared regarding creating a good orphanage in terms of physical, emotional/psychosocial and cognitive development, with a focus on attachment. Finally, I will be discussing what I believe the 94 PERSPECTIVES OF GUYANESE CAREGIVERS

information means: to me, to the caregivers interviewed and for the future of Guyanese

orphanages. Also, anyone who knows me knows that I cannot keep my opinions to myself,

especially opinions I am passionate about, so I will be concluding with my recommendations for

change which will take on the form of a checklist for creating and maintaining good orphanages

in Guyana developed from the information garnered from the women interviewed.

The evaluation of residential care framework put forth by Palareti and Berti (2009)

referenced Emiliani and Bastianoni's (1993) five aspects that they believed were essential to

create a good residential institution for children. Those five aspects are: reduction of exposure to

stressor; child self-growth; negative reaction reduction; positive interpersonal relationships; and

social and relational activities.

Reduction of Exposure to a Stressor

The reduction of exposure to stressor aspect refers to the "reduction in the impact of the risk factor by means of a lesser exposure to the situation that implies stress and malaise (e.g.

detachment from the family and encounters in protected contexts)" (Palareti & Berti, 2009, p.

1083). This simply evaluates how well the establishment can remove the child from the unfavourable situation. Many of the caregivers I interviewed expressed this same aspect of reduction of exposure to the stressor as a major reason of why orphanages were a good thing.

"What would become of these children if there were no orphanage? Some parents ill-treat their children.. .1 would say an orphanage is a good place", stated one caregiver interviewed. Staff also

stressed the importance of well-trained caregivers to maintain the safety of the children and the role of the administration in providing security measures and staff training. 95 PERSPECTIVES OF GUYANESE CAREGIVERS

Child Self-esteem

The second aspect found in Palareti and Berti's (2009) article, child self-esteem, refers to

the "reduction in the impact of the risk factor through a change in the meaning that the child

attributes to his/her own unfavorable condition (e.g. support in the process of emancipation from

the stigma of being a social case)" (p. 1083). The interviews did not seem to mention this aspect directly; however, as mentioned in the results section, the idea of ownership as an important contributor to individuality and good self-esteem was brought up by a couple of the caregivers.

Another idea that I believes relates to this aspect is the idea of a follow-up plan for the children once they leave the orphanage. Without a good follow-up plan for those who have grown up in the orphanage system the ability to emancipate themselves from the stigma associated with their past is extremely difficult. "What do you do after the orphanage?" one caregiver asks, "When you go out on the road you got to eat, you got to drink! How are they going to contribute [to

society]?"

Negative Reaction Reduction

The third aspect mentioned in the article refers to negative reaction reduction. This aspect highlights the importance of recovery from developmental delays that children may have due to their pre-institutional life. This is an attempt to aid the children with "the normalization of the school process" (Palareti & Berti, 2009, p. 1083). Several of the staff interviewed touched on the educational aspect for children in children's homes. There were multiple mentions of having on- 96 PERSPECTIVES OF GUYANESE CAREGIVERS

site educational facilities to help reduce the stigma children face at schools; however, none of the

staff directly associated the use of in-house schooling with developmental delays.

Positive Interpersonal Relationships

Having positive interpersonal relationships was yet another aspect that Emiliani and

Bastianoni (1993, as cited in Palareti & Berti, 2003) put forth as integral in creating a positive

out-of-home experience for children. In order to establish an environment with this aspect, one

must set up "a positive feeling in regard to self-esteem and personal effectiveness" (p. 1083) for the children. This entails creating nurturing interpersonal relationships and supporting children when they encounter difficult issues or activities. Staff interviewed spoke a great deal about providing love and care for the children. Many stressed the importance of the relationship between child and caregiver.

Social and Relational Activities

Finally, providing institutionalized children with appropriate social and relational activities was also mentioned. Many staff members interviewed did mention the need for the children to participate in outings and social and cultural activities. I did not get the sense that they believed overwhelmingly that it was central to providing good care for the children, but several of the women interviewed mentioned taking children out to local activities as important for their healthy development. The women shared that the children attend birthday parties and

Christmas parties that individual members of the public and some private businesses may hold. I 97 PERSPECTIVES OF GUYANESE CAREGIVERS was also told that the children go on trips to the local creeks, the airport, the zoo and the

Botanical Gardens, and to other cultural and historical monuments around the city.

Physical Development

My review of literature on physical development of children in orphanages firstly examined nutrition and then moved on to attachment. I found that nutrition was a very important topic for the staff interviewed and they mentioned the need for dieticians or nutritionists as part of a good orphanage. The link between physical development and attachment that Krugsman and

Dubowitz (2003) and Frank et al. (1996) identify, however, was not made by the caregivers, though one caregiver did seem to touch on it briefly:

If you take away that child from a loving environment and you put that child in a place

where he/she is not comfortable, it will take time for that child to grow accustomed to

that area and you'll find that the child will have stopped eating or will eat meagre

amounts. That child would not have enough nutrients going to their body...if you play

with a child's emotions, you play with their health.

Emotional/Psychosocial Development

Judge (2004) and Frank et al. (1996) believed that residential children's homes were not able to overcome the psychosocial developmental damage they supposedly inflicted on children even given unlimited finances. This is a statement with which I highly disagree. The notion that all orphanages can only provide flat stimulus, I believe, is ludicrous. My experience at the 98 PERSPECTIVES OF GUYANESE CAREGIVERS

Children's Convalescent Home provided me with a unique first hand observation of children engaged in activities with caregivers and volunteers that encouraged positive emotional development, such as playing, swimming, dancing, singing and nurturing touching, to identify a few. A caregiver expressed, "we the staff will try to give them the normal exercise like outdoor games, indoor games, the running, jumping and doing all the stuff that would make them happy."

Staff and volunteers were encouraged to show love and physically engage with the children in everyday care practices. Moreover, as previously mentioned children are taken on social outings and are able to interact with other adults and children in "normal" settings, such as parties, and walks around the neighbourhood. I would challenge that a school setting is also an institution where all children spend the largest part of their day and close personal relationships with teachers are discouraged, yet these institutions are not seen as psychosocial pariah. Why is that?

Good orphanages can surely overcome the deficits commonly attributed to them by encouraging interpersonal relationships and providing social and relational activities as Emiliani and

Bastianoni (1993, as cited in Palareti and Berti, 2009) suggest, as well as hiring caring and well- trained staff as the women I interviewed suggest.

Cognitive Development

Finally, the focus of my research was qualitative and so I was not interested in comparing the cognitive development of the children residing in CCH with some normative scale, and so I am unable to truly comment on whether or not the research found in the literature review coincides with what was learned from the interviews with the staff members. However, I would argue that Frank et al.'s (1996) findings of children who are severely developmentally delayed due to lack of sensory and social stimulation can and has been overcome as caregivers (and I) 99 PERSPECTIVES OF GUYANESE CAREGIVERS identified stimuli in various forms as integral to maintaining a good residential institution.

Moreover, I will reiterate my observation of plenty of interaction between infants and their caregivers as well as those who volunteer at the orphanage.

Attachment

The idea of attachment for children in orphanages was one that I had the most trouble with. In a previous chapter I discussed how I disagreed with Ainsworth et al.'s (1978) interpretation or perhaps addition to Bowlby's (1969) work. The attachment types put forth by

Ainsworth et al. seem to me too rigid. The types of attachment that are regularly given to orphanage-reared children are insecure disorganized attachment and reactive attachment disorder

(Bee et al., 2005). These attachment styles are characterized by distance, ambivalence and/or clinginess to the parent and are believed to have negative future outcomes, such as increased use of drugs and alcohol and inability to forge lasting relationships with peers (Bee et al., 2003).

While at CCH I observed that many of the children were not visited by their birth parents regularly. I also noted that of those children whose birth parent was a regular visitor, that child would usually cry and have great anxiety at being separated from their parent, which indicated that those children were attached to their birth parents. However, I also saw this happen with several of the children and caregivers. My observation was that many of the caregivers had their favourite children and vice versa. The youngest children (those under 24 months) always appeared to have the strongest secure attachment to their preferred/usual caregiver indicated by their pleasure at seeing them re-enter the nursery room, whereas the older children seemed to be accustomed to the caregivers coming and going and would only be distraught by their departure when they were in an unusual situation (such as being left with strangers, leaving the orphanage 100 PERSPECTIVES OF GUYANESE CAREGIVERS

grounds with strangers or when they were sick). This could be related to the age-appropriate development of the child as older children are more able to tolerate separations from attachment figures because of more developed cognition and "internal working models". What I found to be taking place was much more of that proximity seeking behaviour described by Bowlby (1969) than the avoidant and ambivalent attachment styles theorized by Ainsworth et al. (1978).

Children sought out the caregivers that they felt closest to and simultaneously, those caregivers who were open to having nurturing relationships with the children would reciprocate, as supported by the attachment transmission model supplied by Berlin (2005) in Figure 3:

Parental Internal Parenting working models Behaviours b) (c)

(a)

Figure 3. The Transmission Model explains the relationship between parental internal working models and child attachment (from Berlin, 2005).

What this means is essentially, "parenting behaviours contribute directly to the quality of the child-parent attachment" (Berlin, 2005, p. 4) and are often determined by the parent or caregiver's internal working model of attachment. The internal working model is said to influence parenting behaviours by steering the parent's response to the child's needs. To me this proves that laying the deficiency squarely at the feet of the physical environment where a child is raised is faulty and that, as the caregivers interviewed stressed, quality caregivers must be 101 PERSPECTIVES OF GUYANESE CAREGIVERS

present in any child care setting for it to be deemed good and beneficial to a child's

developmental success. At the CCH, over 50% of the staff have been employed at the home for

10 years or more. This commitment from staff members and low turn-over rate is a strength that,

according to attachment theory, contributes to secure attachment formations between caregivers and children. Stalker and Hazel ton (2008) explain that attachment theory maintains that

"psychological problems derive from disturbances, deprivations, or disruptions in early caregiving relationships" (p. 150). The fact that the CCH is able to minimize disruptions and disturbances in the caregiving relationship by having stable staff may be a major factor in the orphanage's success. Further success for the entire children's home system in Guyana could be achieved by way of attempting to minimize all unnecessary disruptions or severances with attachment figures, for example banning or restricting age limits or cut-off ages for children's homes so that children who have long-term stays within the system reduce the trauma associated with moving from home to home.

Recommendations for Guyanese Orphanages

As stated earlier, the staff checklist summaries the key perspectives identified by the caregivers with regards to necessities in the orphan care system and within their particular children's home that are integral to it being a successful entity. Below is a re-presentation of the checklist generated by the interviewed staff members.

Good Guyanese children's homes must have:

• Adequate facilities appropriate to the age range of the children in the institution and the

intended capacity of the institution; 102 PERSPECTIVES OF GUYANESE CAREGIVERS

• Facility should have access to sufficient cleaning supplies that are as child safe as

possible;

• On-site access to nutritionally balanced meals, education, medical care and other

government services;

• Children should be exposed to various cultural outings and social activities outside of the

orphanage;

• Adequate staffing to maintain a reasonable child-staff ratio (depends on the age of

children);

• Continual and continuous staff training in the area of child development;

• Positive, nurturing relationships between the staff and the children at the residence must

be encouraged;

• Transparency in the hiring process by issuing public job postings, with a focus on quality

and quantity (but quantity of caregivers should never take priority over the quality or

suitability of an individual to perform as a caregiver);

• Improved screening of job applicants for history of prior incidents of child abuse;

• Better public relations/image management via staff and organization as a whole;

• That orphanage admission prevention strategies be developed to support families to keep

their children with them through the development of affordable housing programs,

employment programs and educational programs;

• That adequate public funding be provided to ensure that healthy, happy children are

raised in Guyanese orphanages who are prepared to take on responsible roles in society

when they leave the orphanage; 103 PERSPECTIVES OF GUYANESE CAREGIVERS

• That a post-orphanage plan be developed for orphanage "graduates" that supports the

young adult in a cultural, financial and social context prior to and after leaving the

orphanage;

• Ownership of personal clothing and other objects must be established among the children

for development of identity and self-respect; and

• Increase government/public involvement in the funding and regulation of children's

homes in Guyana.

My own recommendations for an orphanage checklist were generated from my self-interview. I identified several similar aspects as the staff, such as the necessity of having adequate facilities and proper health care. What I have identified apart from the staff I have included below. I would like to acknowledge that my recommendations have been influenced by the literature review and those researchers who have gone before me.

• Harmonized government support by way of policy, regulation and financial backing must be

developed in the country;

• A daily program that includes a reasonable amount of sensory and social stimuli;

• Children must have access to personal belongings in order to foster a sense of identity and

belonging;

• Government should mandate that all children's homes accommodate a child for the entirety of

their stay in the welfare system (from admission to discharge) so as to minimize the occurrences

trauma due to separation from attachment figures;

• Safety for children, staff and property via a security system or guards in conjunction with

appropriate policies and procedures regarding safety; and

• Children should be able to participate in social activities of interest to them in an effort to support

their development. 104 PERSPECTIVES OF GUYANESE CAREGIVERS

Many of the recommendations I have made above are already included in the new

"Standards for Children's Homes in Guyana" document. What I have found, however, is that

those that are already included in the standards have no implementation strategy or support for realizing the standard. The "life book" idea, for example, is echoed in the standards; however, there have never been any guidelines or materials given to create a "life book". Who should create this book? If it is the orphanage staff or administration, when would they truly have the time to create and maintain these books? Where would they get pictures of family members of abandoned children? How detailed should the "life book" be? These questions, in my mind, have not adequately been considered by those who created the standards. My call for a harmonized government approach to the current system is in an effort to give it the support necessary to carry out its mandate. Participation from multiple government ministries and agencies in the children's home system is needed in order to effectively implement and maintain the standards set out in the document.

Creating a comprehensive and culturally appropriate post-orphanage care program is needed to support those children who have spent the bulk of their lives in residential care. It completes the orphanage care system and makes it more functional and holistic. I believe that a post-care program is essential for preparing orphanage-raised children to integrate into the adult world in a society that would not normally expect such a level of independence from their young adults. Finally, to combat overcrowding and what the staff believed was unnecessary placement, an admission prevention program must be developed in order to assist families to stay together and reduce the need for orphanage placement. 105 PERSPECTIVES OF GUYANESE CAREGIVERS Conclusion

As we conclude this leg of my journey (because it must be a journey, one that I have barely even begun!) I am excited about the future. I am pleased because I know that the information given to me by those I interviewed was valuable and can and will be used to shape children's homes in Guyana, and perhaps around the world. I've grown as a researcher and as a social worker and I am eager to apply this newly acquired knowledge to my world and to the worlds of institutionalized children everywhere and anywhere. In the future I hope to continue my research in orphanage care and orphans. I would love to do a study of child development outcomes of orphanage children before and after introducing the changes mentioned in the recommendations offered above.

Orphanage-rearing is not the ideal. It is not the stories of children living in orphanages that keeps me warm and tucked in at night. I wouldn't want any of my children to have to grow up in an orphanage or any kind of residential institution. But many times there are situations that develop that are outside of our control. Famine, flood, war and social and economic degradation can all cause a child or a family to become vulnerable. Parents die, families become separated during chaos and poverty swallows many of us. The orphanage is not ideal, no, but it is necessary. And while it is necessary we should make every attempt to create in it a suitable, beneficial and positive environment for the children who it serves. As one of the caregivers mentioned, "We want to make a good nation", I'd like to take that one step further and state that we want to make a good world. When we give orphanages an opportunity to show that with the proper supports they can have a positive effect on child development, that they can be good for children who need them, I believe we will improve the outcome for these children 106 PERSPECTIVES OF GUYANESE CAREGIVERS developmentally and socially. But there must be a start point, a beginning. And for the sake of these children and for the world, I hope that day is today.

The Children's Convalescent Home is a wonderful orphanage. The staff are caring and from my observations, the children feel safe and happy. When I first went there I fell in love!

The only problem I could see was that I was not there to help to give these children a loving, nurturing childhood experience, and that was why I knew I had to return. The longer I worked there the more I saw that children do not only need love and hugs; they need so much more. But they weren't the only ones who needed support at the CCH. The staff also needed to be supported in their view that it was much more than changing diapers and wiping noses that they had been employed for, which some of them did not seem to understand. They needed support to understand that these children needed the same care, attention and stimulation as other children in order for them to develop into healthy adults. Even with all the challenges to providing good care, I believe the staff at the CCH truly do their best to make a good home for these children and with adequate funding and support they would be able to do even more for Guyana's most vulnerable population. PERSPECTIVES OF GUYANESE CAREGIVERS Appendix A Summary of Coding

Research Question Theme Categories Quotes or Aspects What makes a good • Cognitive • Early Education/Playschool orphanage/children' s A nurturing physical development • Cultural and Social outings home? environment • Socio-emotional • Good Nutrition development • Onsite medical care • Physical development • Cleanliness of facility and children Health • Well equipped and maintained facilities • Staff Training & • Well-trained staff Staff who are well- education • Nurturing staff who are well suited trained and suited to • Interactions with the to this work the work public • Male role models • Staff hiring practices • Fostering positive identity • More public funding "The government should play an Greater government important part in the development and involvement • Further development running of orphanages in this country". and monitoring of standards for "They have to put systems in place that orphanages when they come and check that the system is working; if it is not working they have to meet back again and rectify it". Challenges to • Supporting poor "Parents actually love those children, but providing and families to care for because they can't afford...and you gone maintaining a good their children take them and place them in an orphanage/children's orphanage. In that sense we 're doing home • Consequences of more bad more than good". financial instability "If they're [the orphanages] not financially equipped they won't be able • Post-orphanage to meet the needs of the children and that programs could also affect the children ". "But if they don't [have post-orphanage programs] and just send them from one orphanage to the next and then out the • Children Having a door what's happening? Anybody say knows?" "They don't have no say. Even though they're so small you have to let them feel, "I am a part of this thing, I can say how I feel", you understand? So you got to get them to feel that, get them to trust you". PERSPECTIVES OF GUYANESE CAREGIVERS Appendix B Consent Form

WILFRID LAURIER UNIVERSITY INFORMED CONSENT STATEMENT

Finding a "Good" Home: The Role of the Orphanage in Guyanese Society from the Perspective of Orphanage Workers

Principal Researcher: Shaneika C. Bailey Research Supervisor: Dr. Anne Westhues

You are invited to participate in a research study. The purpose of this study is to give a voice to those who have worked for extended periods in the orphan care system in Guyana, South America with a view to influencing government policy and procedures in orphanages. Participants will be asked in semi-structured interviews to define or describe what a good/bad orphanage is in their own words, experiences and terms.

The primary researcher, Shaneika C. Bailey is currently a student in the Faculty of Social Work's Masters level graduate program at Wilfrid Laurier University.

INFORMATION The study consists of a one (1) hour interview in which participants will be asked questions about their definition of the ideal or "good" orphanage. Interviews will be conducted individually at a time convenient to the participant. Participants may be contacted later for clarification of their statements or to elaborate on a particular point the researcher deems important to the study.

The study will consist of up to ten (10) individuals who will be similarly interviewed. Each interview will be audio-recorded so that the researcher can use appropriate notes and quotes from the interviews in writing up the study.

RISKS Risk to the participants is minimal. However, participants may express regret over personal information or stories they have shared with the interviewer. The interviews may also cause 109 PERSPECTIVES OF GUYANESE CAREGIVERS disruption of the participants' regular routine on the days that they are to be interviewed. Participants may experience group pressure to participate in the study.

BENEFITS The research is intended to benefit the Guyanese orphanage system as a whole, in particular the children who live in the orphanages. Finding out what makes a good orphanage from a Guyanese frontline worker gives us a perspective that is often discounted or overlooked in the current research. Further, the information collected in this study can help in the formation and reformation of social policies concerning orphanages in Guyana. Also, as there is little information or research conducted in Guyana in general or on orphanages in Guyana in particular, this research will add to the body of knowledge both generally and specifically and will bring to the forefront the Guyanese perspective on orphan care and orphanages.

CONFIDENTIALITY Participants' identities will be kept confidential and anonymous by referring to them by new names and by removing any and all information contained in their quotes or stories that might enable them to be easily identified. Access to data/information collected will be restricted to the primary researcher, Shaneika C. Bailey, and her advisor, Dr. Anne Westhues. Data will be kept secure on an external computer hard drive in a password protected document. Upon the completion of the project the information will be destroyed after a maximum seven (7) years. Results of the study will be provided to participants upon request. Results will also be provided to the Government of Guyana Ministry of Labour, Human Services and Social Security's Child Protection Unit as well as the Guyana Red Cross Society. Quotations will be used in write-ups and presentations; however, every effort will be made to remove identifying data from the quotations to ensure confidentiality and privacy.

COMPENSATION For participating in this study you will receive $1,000 GYD which will be awarded to you at the completion of your interview. If you withdraw from the study prior to its completion you are not required to return the monies.

CONTACT If you have questions at any time about the study or the procedures, (or you experience adverse effects as a result of participating in this study) you may contact the researcher, Shaneika C. Bailey, at [email protected], 592-602-7856 or 519-590-5306 (after Jan.l, 2011) or you may 110 PERSPECTIVES OF GUYANESE CAREGIVERS contact the research advisor, Dr. Anne Westhues, at [email protected] and 519-884-1970, extension 5222. This project has been reviewed and approved by the University Research Ethics Board. If you feel you have not been treated according to the descriptions in this form, or your rights as a participant in research have been violated during the course of this project, you may contact Dr. Robert Basso, Chair, University Research Ethics Board, Wilfrid Laurier University, (519) 884-1970, extension 5225 or [email protected]

PARTICIPATION Your participation in this study is voluntary; you may decline to participate without penalty. If you decide to participate, you may withdraw from the study at any time without penalty and without loss of benefits to which you are otherwise entitled. If you withdraw from the study, your data will be removed from the study and destroyed. You have the right to omit any question(s)/procedure(s) you choose.

FEEDBACK AND PUBLICATION The results of the research will be shared through journal articles and presentations. An executive summary will be sent to participants summarizing the results. If you would like a full copy of the report you may indicate to the researcher at this point of your preference. The Executive Summary and finished article will be available in June 2011.

CONSENT I have read and understand the above information. I have received a copy of this form. I agree to participate in this study.

• I agree to be audio-recorded. D I do not wish to be audio-recorded, but would still like to participate. • I would like to receive an Executive Summary_of the research report for this study. Ill PERSPECTIVES OF GUYANESE CAREGIVERS Participant's signature Date

Investigator's signature. Date 112 PERSPECTIVES OF GUYANESE CAREGIVERS Appendix C

Oral Script/ Recruitment Letter

INVITATION TO PARTICIPATE /RECRUITMENT LETTER

Hello, my name is Shaneika Bailey and I am a Masters of Social Work student at Wilfrid Laurier University.

Currently, I am conducting research to determine how people who have been working in orphanages in Guyana for ten years or more define a good orphanage and what they believe should be a part of a good orphanage environment for children. The results will hopefully be used to develop orphanage policies in Guyana and will add to the body of knowledge about Guyana in general and orphanages in Guyana in particular.

The interview will last approximately one (1) hour in length and can be useful to you, as a participant, as your ideas, stories and experience can help to improve the situation of orphans and orphanages across Guyana, and perhaps across Latin American and the Caribbean region. Foreseen risks are minimal with the slight risk of group pressure to participate in the study, however, you may withdraw from the study at any point if you wish to do so and you are in no way obligated to participate in this research if you do not wish to do so. Participation is entirely voluntary. If you agree to participate you have the right to refuse to answer any question and end the interview at any time. Your participation would be kept confidential and your responses would be screened for items that could possibly identify you as a participant. If any are found to identify a participant they will be paraphrased to disguise identity or not be used in the final report. Your interview will be voice-recorded with your permission only. You may still participate in the interview if you decline to be voice-recorded.

As the primary researcher, I, Shaneika Bailey, will have the main access to the information contained in your interview. My Advisor, Dr. Anne Westhues may also review transcripts of the interviews. Your name and other personal information will not be recorded or appear on the transcript of the interview. The data collected will be stored on an external hard drive in a password protected file and will be stored for a maximum of seven (7) years after the study's completion. This interview has been approved by the University Research Ethics Board, and you may contact the Chair of the Research Ethics Board Dr. Robert Basso, Wilfrid Laurier University, (519) 884-1970, at extension 5225 or [email protected] if you have any questions about the ethics of this study. 113 PERSPECTIVES OF GUYANESE CAREGIVERS Upon the full completion of this project an executive summary will be sent to participants summarizing the results. If you require a full copy of the report you may indicate to the researcher at this point of your preference.

If you would like to participate in this study please contact the researcher, Shaneika Bailey, at 226-1910 or 602-7856 by October 15th, 2010.

Thank you! PERSPECTIVES OF GUYANESE CAREGIVERS Appendix D

Interview Schedule

1. Based on your experience, what makes an orphanage a "good" orphanage?

2. Based on your experience, what makes an orphanage a "bad" orphanage?

3. How can an orphanage ensure the healthy development of its children?

a. Physical

b. Cognitive

c. Emotional/Relational

4. How does the "best care possible" look?

5. What can be done to ensure that children receive the "best care possible"?

6. What is the most important factor affecting whether or not an orphanage is "good" or

"bad"?

7. What can policy makers (administrators, organizations, government, etc.) do to ensure

that there is an increase in "good" orphanages in Guyana? 115 PERSPECTIVES OF GUYANESE CAREGIVERS References

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