06/06/2011 06:27 pm ET | Updated Aug 06, 2011

Effectiveness of WWO's Bulgarian Granny Program

Journal from the field #3, June 1, 2011
Dr. Aronson in Bulgaria, May 28-June 2, 2011

The WWO Granny Program is very successful as reflected in the qualitative quarterly reports from our team in the 10 orphanages in Bulgaria. The first phase of the program, however, shows the damage that has already set in for the babies. The first phase is about repair of the already powerful and damaging influence of lack of parental love and commitment. The babies internalize their responses and stop crying or their cries are weak, as those cries go unanswered. The children no longer have a sense of their internal regulation abilities and soon they have no sense of their needs and wants. The lack of parental/adult responsiveness leads to the baby's lack of ability to connect and be intimate. The child no longer has a sense of self and lies still and the gaze becomes empty and disconnected. The baby's spirit has been nullified and betrayed. Children no longer have a sense of their emotional and physical needs.

The most extraordinary moments from my June 1 trip to Varna, Bulgaria occurred once we got upstairs and were in the beautifully sunny and cozy room now renovated and assigned to the grannies and the toy librarians. The wooden cases with shelves and toys in order based on age are managed by two pedagogues who are truly scientists. What we experienced was an amazing team approach to the early intervention of the toddlers in the care of the grannies and pedagogues.

A lengthy discussion occurred as we all sat and began to talk with one another in the room. The discussion revealed that there was a natural evolution of a coordinated effort among the grannies, pedagogues and the psychologists. They had worked out a system without much outside assistance that was revealed to us right there during our visit. First, the grannies introduced themselves and their assigned child and then the psychologists began to talk about the challenges of the program.

We heard about how the grannies were heartbroken when their granny work would end and they would be assigned a new child... or when their child was having trouble emotionally and the grannies and pedagogues were sad that the child was depressed and hurt. The pedagogues revealed that they had discovered from their training how to use the toys scientifically and that they could help the Grannies to reach the children when the child appeared delayed and hurt and disconnected. So I nicknamed the troubleshooting of the pedagogues "Developmental Prescriptions." They understood this concept and liked it. I affirmed their skill and understanding of how the "play" could help the child achieve competency in a developmentally-delayed milestone and how that competency was building the child's self-esteem.

The conversation was very lively and interactive... grannies, psychologists and pedagogues were exchanging their ideas and actually showing their pride in their work with the children. It was an emotional time for all of us. I was very proud of this team and told them about how special their work was for the children. I also discussed the training of the orphanage psychologists in the Bayley-III (standardized psychological/cognitive test that WWO is licensed to translate into Bulgarian, Vietnamese and Amharic) for next year and the possibility of grannies and pedagogues from different orphanages benefiting from collegial meetings in the future.

A celebratory luncheon for the Varna team was in order, and I suggested this for the team after we leave and before many of them go off to their summer vacations as a reward for their dedication. I shared this with Dr. Djankova that night in Sofia and Emilia, WWO's program manager, will coordinate this event. It is essential for us to reward and develop the initiative of the Early Intervention programs so that the grannies can grow and feel good about their work. They are precious to the children and, frankly, responsible for saving the mental health of these at-risk children living in the worst place possible... the orphanage. Every time I visit the programs we support around the world, I am reminded about how damaging institutional care is and I am renewed in my desire and ambition to de-institutionalize in the years to come.

Yet emptying institutions -- although desirable -- cannot happen carelessly and swiftly. It must happen with loving care and strategic planning over a decade. During that process, the children who live in residential care facilities must be served and they must be treasured and revered; they must be enriched with loving attention from grannies, pedagogues and trained staff; and they must receive an excellent education at an early age as well as top notch medical care. Concurrent planning has been WWO's strength from the start. Now, more than ever, I see the great essence and value of our work. The children we have served these 14 years would not have received any services while waiting for the orphanage to close if WWO had not been there to help them.