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Despite all the difficulties of caring for abandoned children in group settings, many orphanages make heroic efforts to provide good care under extremely difficult circumstances. Many orphanage workers dearly love and have deep compassion for the children in their care. At their best, orphanages provide physical safety and material needs, and promote health, developmental function, academic achievement, and psychological well-being.

Various systems of care have evolved in different regions of the world, reflecting local cultural beliefs, financial constraints, and developmental awareness. For example, in Cambodia, most children share a single caregiver with two or three other children. The caregiver frequently holds or carries the children, and usually sleeps with them in a hammock. In many Russian orphanages, a multidisciplinary approach is taken. Orphanage staff often includes educators, speech therapists, physical therapists, and music therapists in addition to caregivers, medical staff, and support staff. Children spend part of each day with the specialized therapists alone or in groups, and have the opportunity for individualized attention and to form an attachment to someone who will be consistent despite changes in group assignment.

Many of the interventions that improve child welfare are low cost, and can be implemented even under difficult circumstances. This was demonstrated in Eritrea, where restructuring of the Solumuna Orphanage resulted in remarkable reductions in neuropsychiatric symptoms among the children. The orphanage was restructured to mix the ages of the children, the staff lived with the children, children had personal possessions, spaces, and time, and orphanage policies were designed to promote the children's autonomy. In contrast, another orphanage in the region had the same staff to child ratio, was segregated by age, policies were designed to promote security and predictability, and the staff functioned in a supervisory role. These children had more frequent behavioral symptoms, especially mood disorders.


From THE HANDBOOK OF INTERNATIONAL ADOPTION MEDICINE by Laurie C. Miller. © 2004 by Oxford University Press, Inc. Used by Permission.


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