Responding to the special needs of children: educating HIV/AIDS orphans in Kenya.
While Fagerlind and Saha (1989) stressed the complexities affecting the link between education and developmental, more recent studies have highlighted the long-term positive developmental effects of education (Barnett, 1995; Haveman & Wolfe, 1995; UNICEF, 2003). As enrollments in schools continue to rise, some researchers are predicting an increased demands for education as well as a need to serve children who present increasingly diverse needs (Hernandez, 1995; Odiwour, 2000). Developing countries that are faced with the HIV/AIDS pandemic have additional challenges to address. How does Kenya, a country faced with economic, social, and health challenges, educate and care for those "special needs" children who have been orphaned by the HIV/AIDS pandemic?
The purpose of this article is threefold. First, it will provide a brief overview of facts about the spread of HIV/AIDS. Second, it will characterize HIV/AIDS orphans and discuss indigenous initiatives in Kenya to educate and care for those children. Third, the article will describe the Nyumbani Children's Center, a successful comprehensive model for best practice in responding to the special needs of HIV/AIDS orphans in Kenya.
The Global Context of HIV/AIDS
The HIV/AIDS pandemic continues to claim millions of lives around the world, generating a serous humanitarian crisis that threatens to transcend all other health problems (International Crisis Group, 2001). Those most affected by the pandemic include children orphaned or otherwise burdened by its devastating toll. An estimated 3.2 million children worldwide are infected with HIV/AIDS, with 2,000 new cases each day; by the end of 1999, 13.2 million children under the age of 15 worldwide had lost their mothers or both parents to AIDS (UNAIDS, 2002b). Additional estimates by the Pediatric AIDS Foundation indicate that an estimated 5.6 million children will have died of the epidemic and over 25 million will be orphaned by the year 2010 Pediatric Aids Foundation, 2003).
One of the biggest misconceptions about HIV/AIDS is that children born to HIV/AIDS mothers are automatically infected with HIV, the virus that causes AIDS (pediatric AIDS Foundation, 2003). These children carry the mother's antibodies and thus are not necessarily HIV-positive. Current medical advances confirm that two doses of a drug called Nevirapine administered to an HIV-positive pregnant woman can successfully prevent transmission of the HIV virus to the child and reduces the chance of the infant being born with AIDS to 47 percent (Pediatric AIDS Foundation, 2003). This information is both encouraging and crucial for educators and caregivers, especially in Africa, where one of the largely unarticulated consequences of the HIV/ AIDS pandemic is the stigma associated with the disease. Children whose mothers are infected or have died face discrimination even if they are not infected themselves. This discrimination often results in the children being denied the special attention and care that they desperately need.
The Regional Context of HIV/AIDS--Africa
The statistics on HIV/AIDS infections indicate that 26 million adults and 2.6 million children are infected with HIV/AIDS (UNAIDS, 2002a). In addition, about 95 percent of all AIDS orphans live in Africa, where more than one child in every 10 has lost a parent to AIDS (UNAIDS, 2002b). UN Secretary-General Kofi Annan (2000) predicts that sub-Saharan Africa will be home to 40 million orphans by 2010, largely because of AIDS. Consequently, the pandemic is threatening community and social cohesion (Spectar, 2003) by stretching the traditional and critical extended family support systems. There is even an alarming contention that HIV/AIDS is fast reversing some of the economic and social gains made in Africa over the last 40 years (The World Bank, 2002).
The National Context of AIDS--Kenya
Kenya is estimated to have the ninth-highest prevalence of HIV/AIDS in the world; about 14 percent of the adult population is infected with the virus (World Almanac, 2002). Currently, 2 million adults and 100,000 children under 15 years are living with AIDS in Kenya. About one million children have been orphaned as a result of HIV / AIDS, and the number is rising (UNAIDS, 2002a).
Taxonomically, the HIV / AIDS pandemic raises three human security issues (Spectar, 2003). On the personal security level, the pandemic damages the individual's ability to sustain him-or herself and the family, as the terminal illness and/or death of a breadwinner reduces or ends income. In terms of economic security for the country, the disease results in loss of jobs, loss of productivity, and loss of expensively trained manpower. From a community security standpoint, the society must absorb the losses and the attendant social and cultural consequences, including the breakdown of extended families and other support systems to which orphans traditionally have turned (Human Rights Watch, 2001).
Kenya has one of the best HIV/AIDS surveillance systems in Africa, with many programs put in place to mitigate the disease (UNAIDS, 2002b). These programs range from volunteer counseling and testing (VCT), the National AIDS/STD Control Program (NASCOP, 2001), training of trainers (TOT), condom usage, adolescent and youth education, and mother to child prevention (MTCP). In addition, Kenya has passed legislation that facilitates the importation of more affordable drugs (Siringi, 2002).
Very few programs, however, address the needs of HIV/AIDS orphans. Most mitigation programs focus on institutional or home-based care for adult patients, adolescent sexuality education, and income-generating activities for caregivers. Therefore, a gap exists in meeting the special needs of affected and infected orphans, especially their education and psychosocial needs.
Gachuhi (1999) defined the pandemic as a war, with the education sector at the frontline. Kelly (2000) conceptualized and summarized HIV/AIDS as having the potential to affect education in 10 different ways, number one of which is meeting the special needs of the increasing number of orphans.
Living As an HIV/AIDS Orphan
There are a number of definitions of HIV/AIDS orphans. According to UNAIDS (2002b), an HIV/AIDS orphan is a child who has lost his or her mother to the disease. However, a more inclusive definition refers to a child who has lost one or both parents to HIV/AIDS (Lusk & Ogara, 2003). Other definitions expand the term to include children abandoned by parents and children beading households (Ayieko, 1998). These children may be infected by HIV or have AIDS, they may be affected by HIV/AIDS through the loss of one or both parents or siblings, or they may be at risk of infection.
These orphans may be vulnerable, isolated, depressed, stigmatized, discriminated against, and uneducated; some live in the streets (Odiwour, 2000; Oywa, 2003). Ayieko (1998) says that these orphans may be resented by wealthier relatives with whom they are sometimes placed. Orphaned children in Kenya usually have only four choices of where to live (Odiwour, 2000). First, they may stay in their parents' house to look after themselves, with a relative a short distance away. Second, they may go to live with grandparents, uncles, or aunts, who "inherit" them. Third, they may go to more distant relatives or to non-relatives and neighbors. Fourth, they may go into some kind of institutional care. Underscoring the plight of HIV/AIDS orphans, Caldwell and Caldwell (1993) note evidence of orphans being removed from school on the grounds that they must help with their own support.
The health, development, and psychosocial wellbeing of HIV/AIDS orphans are at risk long before either parent dies (Juma, 2001). The psychological trauma these orphans might undergo includes tending to a dying parent and taking care of siblings.
Indigenous Strategies for Educating HIV/AIDS Orphans
Making inroads against the effects of HIV/AIDS in any country depends on having access to appropriate resources, clear information on prevention, and treatment and care for affected and infected persons, especially young children. Young HIV/AIDS orphans, however, need direct and special attention to health, education, and psychosocial care. While poverty may mitigate many initiatives dealing with HIV/AIDS, Kenyan communities have embraced the daunting task of educating and caring for HIV/AIDS orphans through community mobilization, based on a longstanding philosophy of "harambee," which means "let us pull together." Key to this idea is the recognition that the care and education of society's children is a responsibility shared by the entire community. Families, caregivers, and educators share an ethical and moral responsibility to promote the optimum conditions for the well-being of all children, especially HIV/AIDS orphans.
According to Lo and Mbugua (2000), the concept of special needs is socially constructed; because each society is unique, each will develop their own meaningful concept of special needs, ways to identify gaps in services, and plans for attendant service provisions. A variety of community programs are in place in Kenya that involve the care and education of HIV/ AIDS orphans, including village school houses, family care, and community preschools. An important dimension to these community efforts is that of catering to the overall mental health of the orphans. A discussion of preschools will highlight one of these strategies.
Benefits of Schools for HIV/AIDS Orphans
Through education, young children are provided with school readiness skills, stimulation, basic education, and socialization opportunities. The additional benefits of preschools serving HIV/AIDS orphans in Kenya include health care and psychosocial adjustment. Achieving balanced nutrition through an enriched diet is a particularly important benefit derived from enrollment in these preschools. Some of the children enrolled are simply in need of a sense of belonging, acceptance, and appreciation. Essentially, the schools offer the orphans hope for a viable future.
Current Educational Policy
In January 2003, Kenyans reached a notable milestone by voting to make primary education free and compulsory (Integrated Regional Information Network, 2003). With this initiative came an unofficial policy that requires all children under the age of 6 to possess school readiness skills in order to be enrolled in primary school. As a result, numerous private and public preschools catering to all children, including HIV/ AIDS orphans, have been established. In some cases, the Kenya government provides preschools within regular primary schools. These schools charge a small fee and also require families to buy school uniforms. Unfortunately, once these fees are added to the costs for books, snacks, and School supplies, many families are unable to send their children to school. Preschools that fall outside of the purview of the government still require fees and school uniforms. On average, the cost of preschool (school fee and provision of a snack) is 100 Kenya shillings (US$ 1.18) per child, per month, or 1,200 Kenya shillings (US$14.16) per child, per year (Academy for Educational Development, 2002).
Preschools catering to the needs of HIV/AIDS orphans differ in terms of setup and resources, due to regional disparities. It is not uncommon to find children who are older than 6 attending these preschools. All preschools, however, make every effort to provide a safe, supervised group experience for the children. Some preschools are better equipped than others. Rural preschools tend to be poor compared to urban and suburban preschools (except those in slum areas). In terms of staffing, communities often call on retired teachers, mothers, high school drop-outs, and volunteers, who provide their services free of charge or at a minimal salary.
Preschools for HIV / AIDS orphans are, in many cases, established through community efforts. English is used as the main medium of instruction in all schools. In addition, Ki-Swahili, the national language, is also used. Nongovernmental organizations, church groups, and local/international donor agencies often complement/ augment these community efforts by providing financial, social, and medical services. Preschools provide a needed break for caregivers, whose time is now freed to attend to household routines and engage in gainful employment.
At the primary school level, many HIV/AIDS orphans are educated under the auspices of established government schools. Although official policy states that these children should be educated with their peers, there are concerns that the orphans are being discriminated against and denied admission to the regular schools. HIV/AIDS orphans are often enrolled in "preschool" settings, run by community members, that serve their special needs. In this instance, age plays a secondary role compared to the dire need for socialization and provision of the basic necessities for normal growth and stimulation.
Stumbling Blocks and Paths to the Future
As in many developing countries, the barriers to education in Kenya often appear to be overwhelming. Children who are orphans continue to be denied admission to public schools. When they are admitted, they face stigmatization, discrimination, and physical and emotional neglect, which has a negative effect on their education and care (UNESCO, 2003). In addition, overcrowding and the lack of trained staff in community-based preschools are pressing challenges. Efforts to deal with the anxiety, grief, and depression that most of these children undergo are insufficient. Financial support, access to and availability of testing services, and availability and costs associated with medication are additional stumbling blocks. Despite these challenges, a cadre of professionals are working on behalf of young children affected by HIV/AIDS. Some of the progress that they have made can be seen in the Women's Groups and the Children's Homes in Kenya.
Women's Groups. Women's groups are integral to the education and care of young children (Mbugua-Murithi, 1997). These groups are ubiquitous in Kenya and play a significant role in society. They are known by a variety of names, such as "rotating schemes," "merry-go-rounds" (Kabiru, Nienga, & Swadener, 2003), or "katibas." Recently, the women's groups' efforts have been complemented by the work of Women Fighting AIDS in Kenya (WOFAK), an organization that functions at both the community and political levels to advocate for vulnerable women and children.
All the women's groups have one goal in common: raising funds and resources to support community members and community programs that cater to the educational and socioeconomic needs of young children. in effect, these groups help in the education and care of orphans through payment of school fees and purchase of snacks (enriched porridge), school supplies, school bags, and the compulsory school uniforms. In the low-income areas, trash bags often substitute for backpacks.
Nyumbani Children's Home. Nyumbani, which means "home" in Ki-Swahili, epitomizes the indigenous initiatives for the care and education of HIV/ AIDS orphans in Kenya. Located in Nairobi's suburbs, Nyumbani Children's Home, a non-profit company, was founded in 1992 by Dr. Angelo D'Agostino, S.J., and recognized as a home by the Ministry of Home Affairs in 1995 (Nyumbani Children's Home, 2004). Currently, Nyumbani houses over 100 children (newborn to age 20) who were orphaned by the HIV/AIDS pandemic. The stigma placed on these children often precludes them from being resettled in their communities.
Recognizing the importance of family in fostering a sense of belonging for children, and keenly aware of the rising number of HIV/AIDS orphans, the Nyumbani Children's Home founders developed a unique and holistic model. They focused initially on providing institutionalized comprehensive care for the orphans, and later utilized a community mobilization approach for home-based care.
The institutional approach to the care and education of HIV/AIDS orphans strives to re-create an environment as close as possible to that of a family in a community. Through its services, Nyumbani works to prevent the dire consequences of neglect, stigmatization, and abandonment that often affects HIV/AIDS orphans. The Children's Home is a village-style
set-up of five duplex houses, with two family units and other service buildings. A surrogate mother or uncle lives with four or six children, based on the size of the house.
This model of living helps meet the basic needs of the orphans through the establishment of "homes," a school with a well-equipped play yard, a diagnostic laboratory and clinic to monitor the orphans' health care (especially nutrition and immunizations), a church, a garden, a community hall, and a graveyard. Cadres of volunteers, both local and international, have adopted a multi-disciplinary approach as they give their time and expertise to work with and care for the HIV/AIDS orphans at Nyumbani. Among the volunteers are doctors, nurses, social workers, lab technicians, religious personnel, teachers, and students.
In order to meet the educational needs of the younger HIV/AIDS orphans, Nyumbani Center has its own school home. Older children attend local schools. The school home's curriculum focuses on the physical, cognitive, and psychosocial developmental domains. In line with Vygotsky's emphasis on social interactions and socially constructed knowledge (as cited in Taylor, 2004), the school emphasizes a play-centered and child-centered approach to education and care. Both indoor and outdoor learning environments reflect these ideas. Early childhood education professionals from Kenyatta University provide early childhood development inservice training for staff and caregivers.
The community mobilization aspect of Nyumbani, the Lea Toto community-based intervention program, was started in 1998 (www.leatoto.com). The goal of the program is to mitigate the impact of the pandemic by mobilizing, equipping, and empowering communities to care for children affected by HIV/AIDS and their families. This is in response to the increasing numbers of HIV/AIDS orphans and the complex demands for service and care placed upon Nyumbani. Research shows that institutionalized care for HIV/AIDS orphans, while still widespread in many parts of Africa, is not a developmentally ideal or financially appropriate option on a large scale (Academy for Educational Development, 2002). A better alternative is devoting resources to creating an enabling environment in which communities can care for and educate the orphans.
This alternative is accomplished through satellite offices in the slums of Nairobi. Orphans affected by or infected with HIV/AIDS are identified by the community and become eligible for quality home-based care and counseling services. Community members also receive these services, in addition to training in caregiving skills. The overarching goal is to bring together the key stakeholders within the community to build and sustain the programs and services.
A Typical Day in a Preschool for HIV/AIDS Orphans TIME ACTIVITIES 8:30 free activity, outside play (enriched porridge for needy children) 8:45 pledge of allegiance and a song 9:00 letter/number recognition and recitation 9:30 drawing, often on the sand outdoors or drawing on coloring books and papers 10:00 snack (enriched porridge), outdoor play health care and immunizations-mobile vans 10:15 poetry recitation (poems are written by community members) 10:30 puppetry and storytelling to complement reading, due to shortage of books in many areas (storytelling is also a literacy strategy of preference that is culturally sound and encourages sharing of feelings and the development of oratory and public speaking skills) 11:15 puppetry, drama, and riddles 12:00 leave for home
Puppetry As an Educational and Psychosocial Therapeutic Exercise. Puppetry is a unique strategy used widely in preschool and regular school settings for HIV/AIDS education. Community members utilize their talents, locally available materials, and culturally sensitive puppetry to create an educational and clinical tool. This approach provides a creative learning strategy that allows children freedom of expression while stimulating learning through play (Synovitz, 1999). Because young children love to pretend play and engage in dramatic characterizations, using puppets affords them the opportunity to manifest these behaviors.
As a tool for counseling, puppetry helps in reducing stigmatization of HIV/AIDS orphans. More important, the technique aims at catering to the emotional needs of the orphaned children by getting them to express feelings. Through manipulation, the inanimate puppets can be given "life." They provoke emotions, dance, laughter, and reflection as they interact with the audience. Puppets also can offer sympathy, when needed. Community members develop the puppetry themes based on their observations and conversations with the orphans and their families.
In spite of the ravages of the pandemic and its socioeconomic impact on society, communities in Kenya have undertaken the invaluable task of responding to the special needs of HIV/AIDS orphans. The essence of the indigenous initiatives to educate and care for the vulnerable orphans in the community are succinctly captured in the words of Fr. D'Agostino, S.J. "The education and care of children with an as yet incurable disease may not seem a "profitable enterprise,' but it cannot be surpassed as a humanitarian and spiritually rewarding endeavor. Providing a stress-free family life experience has been proven scientifically to mitigate the ravages of HIV infection" (Nyumbani Children's Home, 2004).
Indigenous efforts by communities in Kenya need to be acknowledged and validated as unique endeavors that complement long-established local and international institutional efforts to educate and care for HIV/ AIDS orphans. This is of particular importance in the wake of renewed and robust global attention to the HIV / AIDS pandemic.
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