Homeward bound? How to fix a damaged system
It’s a drizzly afternoon in the middle of Pchum Ben, and most of the teenagers who live at one state-run orphanage on the outskirts of Phnom Penh are at home, with their families. Aside from the patter of the rain, the grounds are quiet.
But 19-year-old Sophorn* remains behind. She’s not meeting her mother until Friday. Sophorn has lived at the orphanage – which houses around 60 young adults, most over 18 – since she was 2. Lately, she’s heard rumours it might close; after all, most of the residents are old enough to leave.
“Honestly, I am worried, but we have to accept reality,” Sophorn says. “We cannot depend on the centre forever. We have to depend on ourselves.”
A few hundred metres up the road, in a privately funded orphanage, a couple of dozen children younger than Sophorn sit for an art class, minded by a flurry of foreign volunteers – each in the Kingdom for a two-week stint. Few of the kids are in a position to leave the centre, says Channa*, the orphanage director.
It’s a reality that is at odds with policy. In 2006, the government deemed institutional care a “last resort”, and early last year it committed that by 2018 it would significantly reduce the number of institutionalised children.
That is some ambition: at last count, there were 117 orphanages in Phnom Penh alone. And between 2005 and 2011, the Ministry of Social Affairs (MoSVY) recorded a 75 percent increase in orphanages nationwide, evidence of the business end of a social issue that often targets tourist dollars.
Young adults like Sophorn are members of a generation of Cambodian children institutionalised amidst a growing number of outfits worldwide that provide residential care, fuelled by the good intentions of the Western donor community.
Most are not “true” orphans – because they have at least one living parent – but they live at an orphanage as a means of escaping poverty, and in pursuit of opportunity. Many of Cambodia’s so-called orphans keep in contact with their families.
A statistical survey published in May by researchers from Columbia University targeted the human scale of the issue: it estimated there are nearly 49,000 children living in residential care in Cambodia today.
The Columbia survey found more than half were between 13 and 17 – meaning nearly 25,000 youngsters will be old enough to leave within the next five years.
And yet adolescents face particular challenges in rejoining communities, says Sarah Chhin, the country adviser at M’lup Russey, an organisation that works with reintegrating children from orphanages and reunifying families.
They are, indeed, lost.
Between 2007 and 2010, Chhin’s organisation interviewed residents over the age of 15 and found that – aside from other harms of institutionalisation, like delayed development – many were anxious about the outside world. They believed they wouldn’t be required to leave the orphanage without a job, and expressed fears: of domestic violence, of discrimination, of starvation, of not being able to find a spouse.
“With no policies for preparing young people for leaving the orphanages, and no strategies for helping them to begin to manage their own affairs, it is a continual uphill struggle to counter the level of dependency the young people display,” M’lup Russey’s research concludes.
There is, however, now some movement: in February 2015, MoSVY announced its goal to cut the number of kids in orphanages by 30 percent over three years in the five provinces that are believed to have the most children in residential care. Back then, though, it wasn’t clear how many children that involved.
A preliminary mapping report of the five provinces (Phnom Penh, Siem Reap, Kandal, Battambang and Preah Sihanouk), conducted by the ministry and released in March this year, found 11,788 children in 267 facilities. Remarkably, nearly half of those places were unregistered, uninspected and otherwise unaccounted for.
MoSVY’s goal, as currently stated, therefore requires reintegrating around 3,500 children by 2018, all with the aid of a tangled network of NGOs and local government stakeholders. The goal receives full support from UNICEF, which provided technical assistance for both the mapping report and the Columbia study, says UNICEF spokesperson Iman Morooka.
The network includes 3PC, a group of over 50 child-protection NGOs and partners helmed by Friends International and aimed at prioritising family-based care, and they want it done fast. (3PC works in collaboration with the government and UNICEF.) Over the course of one year, 3PC worked with 717 children, says James Sutherland, Friends’ spokesperson. One hundred and sixty-one have been “fully reintegrated”, he adds.
3PC also works closely with Family Care First Cambodia (FCFC), a family-focused initiative launched with a $6.5 million grant from USAID.Reintegration is a drawn-out, difficult process. Sarah Chhin, whose organisation often works on sensitive cases, says it is best viewed as a marathon – not a sprint.
“Some people think that reintegration means finding the children’s parents or family and then sending them home,” she says. “In fact, reintegration is a long and complex set of processes which starts when a child is separated from their family, and does not end until that child is safely living in the community.”
A model transition
Organisations in the Kingdom don’t have to look far for a now-glossy success story: Tara Winkler, who co-founded and manages the Cambodian Children’s Trust (CCT) in Battambang, fully transitioned the small orphanage to community-based care in 2012. Today, CCT works with over 200 children in 100 families.
Winkler, an Australian, first travelled to Cambodia as a tourist in 2005, visiting orphanages; she returned to volunteer long-term at one, and found it to be riddled with “gross neglect”, from embezzlement to sexual abuse. In 2007, with the assistance of provincial authorities, she removed 14 of the children and founded CCT.
“I thought there was just this really bad situation happening in one really bad orphanage,” she says.
When she learned Khmer, Winkler discovered that most of the “orphans” had families, and exhibited signs of attachment disorders; her team brought in a psychologist, and began the process of family tracing soon afterward.
Winkler has told her tale time and again to raise awareness of the perils of institutionalisation: in Australian media, in a memoir published this year, in a TED Talk this June. (“That’s the part of my job I like the least,” she says of the public advocacy.) But Winkler is both savvy and handy with her statistics: children who are institutionalised are more than 500 times more likely than their peers to commit suicide, for example.
When CCT began the process of reintegration, there was little precedent. “There haven’t been a lot of organisations that have transitioned their model,” says Winkler.
At first, there wasn’t much success: some of the kids didn’t feel they were ready to leave, and CCT didn’t have enough social workers on board to facilitate the process. (The organisation now has nine on staff.)
“The thing with reintegration is that once you’ve separated family... and once these kids have been institutionalised for years, [they don’t] even know their parents anymore,” Winkler explains. “And it’s a really difficult process to put a family back together.”
So, they kept working, recruiting foster carers and training social workers in order to connect kids with parents, kin or the next available option.
Take, for example, Khun, now 17. Six years ago, he ran away from his family’s farm in Pailin – where he had little chance of getting an education – and ended up on the streets in Battambang and, soon after, in residential care at CCT.
During its transition period, the organisation placed Khun in temporary foster care. CCT was ultimately able to bring Khun’s parents and three siblings to Battambang, enrol the children in school, and support the family.
“After we separated, we never expected to be united, to be a good family like this,” his mother, Sokhom, tells Post Weekend. “Before, there was no proper school. Now I just want to see [my children] get a good education.”
Winkler has been approached by the government for assistance, and currently supports four orphanages around the city working to transform their models.
“Nothing surprises me,” Winkler says. “We actually reintegrated a couple of kids out of the government orphanage, and they were living in there with their grandmother.”
But, Winkler points out, there are still some 50 orphanages in Battambang alone – and they get their support from beyond Cambodia’s borders, where awareness of the problems of institutionalisation, despite growing publicity, often seems scant. Many of the largest institutions in the country are foreign-run. A preliminary report conducted this year by advocacy group ReThink Orphanages in Australia found that more than half of Australian universities still advertised volunteer opportunities in orphanages abroad.
A decade on, Winkler still seems a little surprised by her trajectory. “Really, I am just a product of this whole problem. If there was not this huge boom in institutions…” She trails off. “Those kids shouldn’t have been there to visit in the first place.”
Trains to homes
Devising an alternative to institutionalising children is hardly a new challenge. In the mid-19th century, American philanthropist Charles Loring Brace engineered “orphan trains” to carry abandoned, homeless or orphaned kids westward from crowded East coast cities to foster-care homes.
The program ended in 1929 as the US developed an organised foster care model. Orphanages began closing after World War II; by the 1960s, foster care was getting government funding.
In the UK, Victorian-era institutions dwindled as adoption was legally recognised in the 1920s. Mid-century policymakers supported foster families and quicker adoption. To find an orphanage in the West would today seem an anachronism – Dickensian, even. But in many developing countries, including Cambodia, the number of residential care institutions for children is climbing.
Decades of research have proven their harm – including a seminal study from post-Soviet Romania. When the Ceaucescu regime fell in 1989, tens of thousands of children were languishing in state orphanages, drawing international outrage. (Child-protection reform was made an explicit condition of Romania’s EU membership; institutionalisation remains a problem.)
Beginning in 2000, the Bucharest study documented 136 kids: half in orphanages, half placed in high-quality foster care. Eight years later, most of the 136 children still exhibited attachment disorders; but those in institutions also displayed severe deficits in cognitive development. For those in foster care? Near “complete recovery” in terms of cognitive development.
Regarding attachment disorders, researchers found the earlier children were placed, the better.
Cambodia could look to Indonesia, which had some 3,899 institutions in 2011. Save the Children piloted a program in West Java with local government that focused on bolstering the country’s family-based policy: enabling conditional cash transfers; training social workers; and strengthening laws for domestic adoption and foster care. The program supported 1,350 children in families in 2014.
Such programs are indicative of a broader movement toward demanding alternatives for the 8 million children in residential care worldwide – 90 percent of whom have at least one living parent.
For advocates like CCT’s Tara Winkler, changing minds needs a shift in perspective: “We don’t have orphanages in our own countries. The paradox is that it’s still supported here. I don’t think most people have this firm belief that an orphanage is a good place for a kid; they just haven’t really thought about it.”
Scaling the model?
In Cambodia, replicating a transition like CCT’s – implementing reintegration on such a large scale, with scant resources – seems daunting.
First, there’s not only a lack of awareness in the donor community; there’s basic miscommunication between national and local policy in Cambodia itself. The signature of a village chief is required to send any child to an orphanage, and they are often quite willing to give it.
“A big part of the problem is that MoSVY have these great policies on alternative care, but on a local level, the social affairs department [doesn’t] understand the MoSVY policies,” Winkler says. “So they’re still sending kids to orphanages all the time.”
Furthermore, to determine whether a child can return to his or her parents, be placed in kinship care, or is eligible for long-term foster care requires family assessments, risk assessments and individual assessments. That requires a strong force of social workers, which Cambodia does not have.
Indeed, the Royal University of Phnom Penh graduated the country’s first college-trained social workers only in 2012.
Many others – including some those who work at CCT – have completed a number of high-level training courses.
Still, nationwide there are not that many of them: just one for every 6,646 children in Cambodia, says UNICEF’s Iman Morooka. The recruitment of more social workers – especially in light of the government’s reintegration goal – is a “matter of urgency”, she says.
The private orphanage run by Channa, which opened in 1997, has eight social workers, she says, and is committed to reintegration. But it’s had limited success, likely because reuniting families is a fickle, individualised process.
“Besides spending money, time and [human resources], sometimes the children don’t want to live in their families,” Channa explains. “We don’t have the time to understand each family, especially if they cannot support themselves.”
“The government released the idea, and the policy, but they don’t help us in the process at all,” she continues, adding that local authorities often don’t understand MoSVY policy. “The government policy is good, but it is hard to make it happen in reality.”
The challenges are real: over the last six months, for instance, MoSVY has struggled even to register all of the orphanages uncovered by its March mapping report. Under a 2015 sub-decree that came into force a year ago, all residential care institutions were ordered to register with MoSVY within six months. (Previously, and confusingly, institutions often signed memoranda of understanding with separate, and multiple, ministries.)
The new registration form includes a simple tick-box to denote whether an institution would like to begin a transition toward family-based care. In June, Ros Sokha, the head of the child welfare department at the ministry, told the Cambodia Daily that only 364 institutions had filed their forms ahead of an already-extended deadline. (Consider that the Columbia survey projected 1,658 residential care institutions nationwide.)
Despite repeated requests, ministry representatives were unable to provide Post Weekend with updated registration data. It seems likely that many – and perhaps most – organisations have missed the deadline.
More positively, says Friends’ Sutherland, emergency orphanage closures – ordered by the ministry in cases of abuse, dried-up funds or failed inspections – are becoming more frequent. They require emergency (or “transitional”) shelters for children.
In an interview with Post Weekend in May, MoSVY’s Ros Sokha – who is a trained social worker – explained that the first focus for reintegration would be with “pre-selected” institutions, though he declined to name names.
“But the first thing we need to do is process these forms,” he added, referring to a pile of registration papers on his desk.
It takes a village
Just outside Phnom Penh, a modest home is decked out with decorations and red balloons left over from two-year-old Panha’s* birthday. The air is heavy with jasmine, which her foster mother, Sotheary*, sells to earn a living.
Panha’s biological mother died shortly after childbirth, and the local authorities deemed her remaining family unfit to raise her.
However, Panha, unlike many Cambodian children in difficult circumstances, was not institutionalised. On the spectrum of “reintegration”, most organisations in Cambodia view long-term foster care as a last option. (There is currently no capacity to process domestic adoption between non-relatives, which is why Panha is effectively in long-term foster care.) But it’s one that, like kinship care, doesn’t seem too different from a traditional model.
“In the past in Cambodia, the traditional way [to care] for vulnerable and orphaned children was in kinship care, very much with the philosophy of ‘the village raising the child’,” says CCT’s Winkler. “And that’s the way it should be everywhere.”
Sotheary and her husband were united with Panha though Children in Families (CIF), one of the largest foster-care placement providers in the country, which often works with children from the toughest situations.
With 10 to 15 families on the waiting list each month, the operation is still quite small.
And even with the government’s reintegration pledge, scaling this model could be difficult. “One of the unknown challenges is finding a larger number of high-quality families,” says Jesse Blaine, CIF’s general manager. “They exist, but we have to go find them.”
But successful foster care, like community-based care as a whole, offers an end to the cycle of poverty-induced institutionalisation that is based on carefully considered – not just good – intentions, and mobilising resources for an easy transition.
“There are many Cambodian people who cannot have children,” says Sotheary. “We Cambodians – not just foreigners – can afford to foster children.”
Holding Panha, Sotheary breaks into a broad, self-assured smile.
“She is an easy child,” Sotheary says. “I am very certain that when I am old I will have someone to be with me.”
*Names have been changed to protect identities.
Additional reporting by Kong Meta