Working in child welfare in developing countries, or any country for that matter, isn't a particularly easy or simple task, in fact it's quite the opposite. Child welfare cases can contain a menagerie of issues including health and hygiene, HIV, domestic violence, child labor, street living and/or working; the list goes on. These issues can be compounded in a country like Cambodia where there is often not the legal or government-lead structures or enforcement mechanisms that exist in countries with strong child protection systems.
Often when faced with these highly complex issues, people or practitioners can ironically regress to view situations in simple and stark terms. The area where I see this most dramatically in Cambodia is the removal of children from their families and placement in orphanages. Under the complexity of problems marginalized families face, a dramatically simplified view of 'cause' and 'solution' has emerged amongst some organizations, resulting in the systematic and unnecessary removal of thousands of children from their families.
I commonly see a view of a simple duality of options for vulnerable kids; 1) children remaining on the street or in unhealthy family units, or 2) children living in an orphanage.. This view can often be held in the general public; where the orphanage is an imperfect but necessary solution to 'unfixable' social ills. Framing of the issue in a binary 'either-or' distinction goes beyond just being incorrect, it facilitates harm to children by legitimizing the use of institutional care as a form of early intervention when it should be anything but. This view is also often held by those, mostly unqualified in child welfare, who establish orphanages in developing countries and those who fund them.
This perspective reduces family units to unsolvable, broken entities which children must be 'saved' from. It is a highly paternalistic form of intervention, and leads to the situation we have in Cambodia now, with thousands of children separated from their families when even basic support could have meant they would remain in the family unit.
Analyzing the ways in which people construct perceptions of vulnerable families is not a purely academic exercise; it has direct consequences in terms of the work organizations do on the ground in developing countries. Legitimizing orphanages as a form of early intervention care removes the family as the pivotal place for a child. It bypasses even the most basic, core alternative care options children in the West enjoy. I talk here of options such as children living temporarily with extended family, community care, foster care, or longer term options such as extended family placement or national adoption. It also ignores the possibility that families can indeed improve, that families can overcome problems -- a highly disrespectful assumption.
Certainly, providing holistic care to families, working with them to overcome problems and developing other options such as foster care systems is not easy. But as I said above, this work is extremely difficult. Difficulty does not allow us to ignore options that are in the best interests of the child.
This issue is not just occurring in my country of Cambodia, it happens across the developing world from Nepal to Uganda, East Timor to Eastern Europe. Literally, tens or possibly hundreds of thousands of children are currently being harmed and will have poorer life outcomes due to their institutionalization.
Across all indicators, children are disadvantaged when raised in an orphanage or residential centre. This ranges from slower physical development, lower IQ and cognitive development indicators, poorer socialization, to lower emotional development. This also speaks nothing to the societal impacts of children removed from their families and communities, and the impact of young adults leaving the centers without basic life skills and the ability to integrate properly in society.
This is a systematic process of placing children in dangerous settings, and at its core is the perception that long-term institutionalization is a legitimate form of early intervention.
The remedy to the above is a renewed focus on the importance of holistic family based care and the development of alternative care options for children that do not include long-term residential care. This not only must occur at the national and international levels (there have actually been strong developments in this area in recent years), but also at the local level amongst organizations and authorities working at the field level, and amongst the general public who fund orphanage centers.
There are some vulnerable children who do legitimately need long-term care, but they are a fraction of the kids currently in orphanages. Do doctors remove a leg when it has a simple infection? Do you check yourself into hospital for a common cold? These medical responses are ridiculous, so why is it that a similarly ridiculous response in social work, removing the child from their family, is viewed as an acceptable early intervention? The view of no other options existing for vulnerable children is what perpetuates this dangerous form of 'welfare.' In the tough work that child protection is in the developing world, easy solutions are rarely real solutions.