Crisis Foster Care in an Age of HIV and AIDS: Experiences of the Queen Mothers of Manya Klo, Ghana by Bright Bensah Drah A thesis submitted in conformity with the requirements for the degree of Doctor of Philosophy Department of Anthropology University of Toronto © Copyright by Bright B. Drah 2011 Crisis Foster Care in an Age of HIV and AIDS: Experiences of the Queen Mothers of Manya Klo, Ghana Bright Bensah Drah Doctor of Philosophy Department of Anthropology University of Toronto 2011 Abstract Older women in communities ravaged by HIV and AIDS in sub-Saharan Africa have been hailed as constituting the most effective response to the growing number of orphans, which has overwhelmed the customary mechanisms of support. Over 80 percent of orphans in Ghana are fostered by women, because an orphan’s kinship networks - and particularly the female members of the networks - are expected to assume responsibility for her/him. Unfortunately, in the Manya Klo Traditional Area of Ghana, AIDS, poverty and other factors have weakened kinship support and cooperation, resulting in patchy external responses to physically frail and economically disempowered traditional female leaders (queen mothers) acting as caregivers. Most of the existing research about orphan care has focused exclusively on the woman-child dyad, thereby obscuring other forms of care. In particular, the “grandmother-led household” has become a self-fulfilling truism that has blinded researchers to other relationships of care. Moreover, the analyses of the situation of orphans are based on frameworks that ignore orphans' perspectives and the social context in which fostering is negotiated. ii In this study, I employ mixed methods to analyze an orphan care project run by the Manya Krobo Queen Mothers Association (MKQMA) and address three issues: (1) What is the socio- economic and cultural context in which queen mothers foster orphans? In particular, how do queen mothers’ positions as traditional leaders, HIV and AIDS, poverty, and external assistance programs (state and NGO) all shape the organization of orphan care? (2) What are the challenges for depending on the Queen Mothers Association to support orphans? (3) How are orphans’ needs identified and described (from the perspectives of the caregiver, the orphans and those who assist them). In particular, can community-derived measures of childcare rather than the current measures typically used in international development and children’s projects provide better indices of the needs of children after losing a parent? iii ACKNOWLEDGEMENTS Working on this dissertation could be likened to embarking on a very long journey to a sometimes elusive destination. I have benefited from the support of so many people along the way without them, I still would be wandering. I am most indebted to my advisor and supervisor Professor Daniel Sellen. I appreciate your keen interest in my academic work, and more so in this project. I appreciate every contribution that you made to ensure that the research and, in fact, the entire academic program was successful. I owe Professors Holly Wardlow and Girish Daswani, members of my advisory committee tons of gratitude for their advice, support and encouragement. I am extremely grateful to my external examiner, Professor Thomas Weisner of the University of California, Los Angeles, for his critical comments, advice and encouragement. It has been a huge a privilege to have your input in this project. I would like to acknowledge the immense contributions and support from the chiefs, queen mothers, elders and people of Manya Klo Traditional Area. I appreciate the great opportunity to conduct the study in the area. I am especially grateful to my ‘grandparents’ Konͻ Nene Sakite II (paramount chief) and to Manyengua Nana Mamle Okleyo (paramount queen mother). Thank you very much for the honor and for your blessings. I would also like to acknowledge the commitment and hard work of my outstanding ‘assistants’ Manye Maku (Kpong) and Manye Larkwor (Akwenor) for paving the way on the many occasions that I was ‘stuck’. I appreciate the support I received from Manye Nartekie, Manye Osieku, Manye Makutsu, Manye Gladys, Manye Kuah, Manye Narki Gome, Manye Matseyo, Manye Aku and Mama Sophia Sakite. I thank all the queen mothers, their family members and the citizens of Manya Klo for having me in their homes and for participating in the study. I was fortunate to have had Okyeame George Boatey and Okyeame Sackitey Offei share their rich knowledge on Manya Klo childcare practices with me, and for organizing the group discussions. I am most grateful for your advice regarding interactions with traditional leaders. I am especially grateful to Okyeame Boatey for your help in spite of the challenges with your health. I appreciate the assistance from Erica Sackey with the Dangme translations. To my special friends, all the children who participated in the study, I thank you for your support. I iv honor your request everyday; I keep praying for you. Each one of you will some day be ‘somebody’. I am particularly grateful to Professor Heather Miller, Graduate Coordinator at the Department of Anthropology (UT) for the immense support that you gave me. Thank you for the very prompt responses and advice. I am also very grateful to previous Graduate Coordinators, Professors Gary Coupland and Bonnie McElhinny, and the Chair of the Department of Anthropology, Professor Janice Boddy for their support. I appreciate your efforts in constantly seeking an avenue of support on my behalf. Natalia Krencil the Graduate Administrator at the Department of Anthropology had all the answers (almost all) and helped me to find out so much more. Thank you. I am also grateful to Kristy Bard (Chair Secretary) and to Roger Bulgin (Department Manager) for your support. I would also like to express my gratitude to the following UT professors for their support: Sandra Bamford of UT Scarborough Campus, Donald Cole (School of Public Health) and David Zakus (formerly of the Centre for International Health). I appreciate the critical comments from fellow doctoral candidates at the Department of Anthropology on drafts of two introductory chapters, as well as support from all the students and visitors who shared time, space and ideas at Professor Daniel Sellen’s lab throughout the years, especially Drs. Jennifer Levy and Aimee Girard for reviewing some of my grant applications. To Professors Lisa Butler and James Slotta, and your children Safia and Julien, I owe you much more than you will ever know. It is a long story, but I am grateful for your support and for the doors you left opened. Thank you for sharing. I am grateful to Olivia Chow, Member of Parliament (Trinity-Spadina, Toronto) and your staff for your continual support and encouragement. I would like to thank Professor Peter Arthur (Dalhousie University, Halifax) and your family for your encouragement and support throughout the years. In the course of this journey, Eugenia N. Dadson blessed me with a wonderful gift for which I will always be grateful and Eugene Dadson remained a great friend all the way. I am also grateful to my ‘grandparents’ at Knox Presbyterian Church, Malcolm and Helen Soutter for your prayers and friendship. v I am very thankful to my ‘families’ in Washington D.C., Virginia and Maryland; David Mannah Barnett, Ms Rose Sesegula and family, Seli Susu (and family) and Francisca Awo Sarfo, and others. Thanks to all of you for the great times that we shared together during the many stressful moments. I am indebted to Esther Afari, Greg Casey and friends in Tucson, Arizona, USA. Thank you for the wonderful memories. I appreciate the support I received from the following people in Upper Manya and Lower Manya Krobo districts: Ms. Theresa Tetteh, the late Michael Angmortey, Bimbal Nsanya (and staff at the Records Department of Atua Government Hospital), Eric Teye, Theresa Tetteh, George Bruce-Gaskin, Dorothy Sika Kweku, Belinda Doe, Cynthia Hevi, Joyce Serwah Narteh and Joshua Narteh. I am also grateful to Mrs. Matilda Asante-Akomaning and staff of the Manya Krobo Traditional Council, Shadrach and Berenice Nartey Plan Ghana (Asesewa) and the OIC Ghana staff at Odumase. I am very thankful to the district directors of health services Mrs. Irene Ofei (Lower Manya) and Dr. Francis Akoto Ampaw (Upper Manya) and Mr. D. K. Yeboah, administrator (Atua Government Hospital). I appreciate the support from all the health workers, the staffs of the districts’ Department of Social Welfare, and the district assemblies. Dr. Samuel N. Cudjoe of the University of Ghana provided support during field work, Mr. Lawrence Ofori-Addoo of the Department of Social Welfare of the Ministry of Manpower and Employment provided data and insights on the interventions for Ghanaian children, Dr. M. Price, Rev. Mrs. Emma Sepah of the Ghana Statistical Service, Professor A. S. Amoah (ex- director, Ghana AIDS Commission) and Florence A. Quartey (Department of Children) also provided critical comments on the data collection tools, and offered some useful literature on children. I am grateful to all of you. I would like to express my profound gratitude to Dr. Peter Lamptey, Dr. Joshua Volle and Mary Lyn Field-Nguer (Family Health International, Arlington, Virginia) for the opportunity to contribute to the global fight against HIV and AIDS. This project was born out of your encouragement and continual support. I am indebted to my ex-bosses Carol Larivee, Audrey Sullivan (Academy for Educational Development, Washington DC/Ghana) for the great opportunity and encouragement. I am most grateful to Mr. Emmanuel Boadi (UNDP, Zimbabwe) for urgently responding to all my requests. You were never too busy. vi To my mother Ametorwoyor Vormawor and father Sam A.A. Drah, thank you very much for your support and prayers. I just remembered that the story of the children could be yours as well, since both of you were fostered as (single) orphans.