Archives For children at risk

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I recently spent some days in Mumbai with our team there who are working to establish what will be a critical collaborative voice to help combat child sexual abuse (CSA)  in India.

Aarambh will be in first order a National Resource Centre on child sex abuse and, at the same time, will have the capacity to access legal and other support for victims, as well as provide training to communities, relevant government bodies and NGOs on the topic. The Resource Centre, which will gather education materials, promote awareness and best practice, is scheduled for launch in November.

Aarambh is a joint initiative of the ADM Capital Foundation and Mumbai partner, Prerana, which for two decades has provided support to the children of sex workers and is led by Priti Patkar, who is a respected authority in the field.

We are extremely excited to have Prerana as our partner in building Aarambh in a country where a 2007 government-sponsored study that included 12,500 interviews with children in 13 Indian states said 53 percent reported having been sexually abused in some way. Only three percent of the cases were reported to the police.

Last year, a Human Rights Watch report said the government’s response to CSA has fallen short, both in protecting children and in treating victims.  At the time the HRW report was released, Meenakshi Ganguly, the director of Human Rights Watch in South Asia, said in a statement: “Children who bravely complain of sexual abuse are often dismissed or ignored by the police, medical staff and other authorities.”

The government did not dispute HRW charges that India’s child protection system was flawed. The head of one government agency was quoted as saying at a news briefing that frequently police or court officials didn’t accept that rape or incest had occurred.

Besides Prerana’s deep knowledge of CSA in India, Aarambh builds on ADMCF’s long partnership with Philippines-based Stairway Foundation, which has produced excellent training materials and animated films on such topics as incest, trafficking and sexual abuse more generally.

ADMCF helped Stairway foundation translate the films and other materials into several Thai languages and facilitated trainings of NGOs and other groups there before turning most recently to India, where education, discussion and action on the topic is equally critical. The moment for change seems particularly right given India’s two-year old law on CSA known by the acronym POCSO. There exists confusion related to how to implement that law nationwide.

Uma Subramanian, who has led ADMCF in India over the past few years, is leading Aarambh with Prerana. She is building a team and the network of partners that will form the initiative. Indeed, the vision for Aarambh is that it is a collaborative effort, bringing together organizations working on the topic of child sex abuse from many perspectives, beginning with the Mumbai Child Safety Network.

In terms of helping to implement the law, for example, there ought to be specific medical units within hospitals set up to receive children who have been victims of abuse. There also needs to be training and special provision within the courts and police force nationally. At the same time, there will be space to comment on aspects of the law to make sure it functions effectively to protect children.

Some of this work is ongoing regionally, but the Aarambh National Resource Centre hopefully will help to spread best practice throughout the country.

Among Asia’s most discriminated people are the Rohingyas. About 1.33 million of the Muslims of South Asian descent live in Myanmar, where all but 40,000 are stateless. Myanmar’s 1982 Citizenship Law considers Rohingyas illegal Bengali immigrants – despite the fact that many have lived for generations in the western state of Rakhine, which borders Bangladesh.

Fortify Rights, a human rights organization, said recently in a new report, Policies of Persecution , that restrictions placed on Rohingyas by the Burmese government are presented officially as a response to an “illegal immigration” problem and threats to “national security”. Yet Rohingyas as a group live in unimaginable poverty due to deprivation and displacement.

Since 2012, with easing of political restrictions in Burma, there have been several bouts of violence between the Rohingya and the Buddhist ethnic-Rakhine, who claim to feel threatened by the muslim population. Both sides have sustained casualties in the fighting but, according to Fortify rights, several hundred men, women and children have been killed and muslim communities razed.

As a result, tens of thousands of Rohingya now live in crowded camps in Burma, Bangladesh, Malaysia and Thailand, where they haven’t faired much better.  Just to reach their new destination, they risk death at sea in overcrowded and unstable transport arranged by human traffickers who take advantage of their poverty and statelessness, often forcing them into bonded servitude.  Killings and other ill-treatment is also not uncommon, Fortify Rights and others have said.

The most recent example of egregious discrimination against Rohingyas started with the latest census, data collection for which began on March 30th. The census, however – a first since 1983 for the population estimated at 60 million – makes use of a list of 135 recognized nationalities yet excludes Rohingyas. Initially, they were told they could write in their ethnicity but later the government backtracked and said they should self-identify as Bengalis, according to news reports.

This census simply compounds what is already an untenable situation in Burma for the Rohingya population, which suffers Burmese policies that Fortify Rights describes as, “designed to make life so intolerable for Rohingya that they will leave the country.”

Among the restrictions enshrined in state policy that the Rohingya face in Burma are those on movement, Fortify Rights said in its report. They cannot travel within or between townships without authorization and only under exceptional circumstances travel outside the state, according to 12 internal government documents obtained by the rights group. Among other restrictions are those relating to marriage, childbirth, home repairs and construction of houses of worship. There are severe criminal punishments for Rohingyas who  violate restrictions, including often years in jail and fines, according to Fortify Rights.

The report calls for the Myanmar government to abolish its discriminatory policies and accord Rohingya full rights under Burmese law, including the right to protection from violence. The international community should not sit by and watch the persecution of Rohingya ahead of next year’s critical election when the military generals are expected to cede power. All Burmese, regardless of ethnicity, should share in the government’s promised reforms.

 

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Always the challenge for an organization working with marginalized children in Asia is how to really alter an existing imbalance – for example to provide education or skills to working children otherwise deprived of learning and a childhood in a way that will make a meaningful difference to their futures.

It is not so complicated to establish an educational program or direct children into government schools – when these exist or there are places. There is real desire among those for whom education is not a given, to live the dream and to learn.

But even when education can be made a reality, it is often not enough to just put children in school, or sit them in front of a blackboard and teacher for a few hours a day. There are so many factors that act against the instinct to learn: lack of food or safe drinking water, cold weather when children don’t have enough clothing, hot weather when they must learn outside or in rooms without windows, absence of sanitation and healthcare, little support from parents, and family pressure to work, among them.

In India, where, along with support from a UK-based partner, ADMCF has been working with a local organization to encourage children out of what is often hazardous work and back to school, the challenges for learners are myriad.

The NGO works with marginalized urban populations in the worst conditions imaginable. The problem remains: can it offer education without thinking about nutrition, healthcare, encouraging family support (not financial) and expect permanent results in the children’s lives? Can we expect, particularly in the most challenging communities that access to education alone will lead to a better future?

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This has been particularly true in the wake of India’s well-intentioned Right to Education Act, which determined in August 2009 much as the name suggests that all Indian children should be in school from 6-14.

This meant that our partner organization, which had established drop-in centres as way stations between work and school, was forced to rethink how it worked with children who had never attended school or had dropped out years previously.

Instead, after a brief transition, all children had to be quickly enrolled in government school, whether they were ready or not. They no longer had the luxury of longer preparation in a safer environment ahead of enrollment.

This was tricky enough in major urban areas, where there were schools and places and children could be supported in after-school programs in the same centres. But in the poorest urban slums in India that are home to significant Dalit or untouchable populations (many migrants from rural areas), there are often no government school options – despite the fact that according to official statistics, 96.6 per cent of children in India ages 6 to 14 are now enrolled.

IMG_5184If there are schools, there are no places. If there are places, the classes are massively overcrowded or there is discrimination against Dalits. If there is no discrimination, the teachers don’t show up for class. In any case, for the poorest children, there frequently is little learning to be had in official schools.

Enter our partner NGO, which provides that stepping stone to education but faces the many questions above. They now must mainstream their primary and secondary school children into schools that don’t exist, or where they don’t learn. Their own centres must not be schools. So what is the learning path?

For a child with enough money there is a proliferation of private schools stepping into the lacunae created by failing government education. But how does an education NGO step in to provide support to ALL marginalized children, not just the brightest, how does it make sure that all children it contacts receive the education to which they are entitled under Indian law yet can’t access?

Then, at the same time, how does an organization in a country as vast as India, where marginalized children are easily discarded by law and society, provide the conditions for learning given limited resources and India’s education act?

Clearly, there should be more provisions made to support education for India’s poorest children, particularly in a country that traditionally has placed such value on learning.

 

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Angkor Hospital is the spectacular facility in Siem Reap, Cambodia I have written about in previous blog posts. Last year, the hospital offered 157,000 treatments to children free of charge, ranging from physical therapy and dental care to heart surgery. The boy above is an AHC heart patient who prior to surgery could hardly walk. When I came across him with his mother in the packed waiting room – back for a check up – he was running across the courtyard. His mother wanted to show me his scar.

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The hospital includes an incredible team of 49 Cambodian doctors and 149 Cambodian nurses, not to mention an equally dedicated support staff of 130. Although foreign teams do sometimes assist and train in more complicated procedures, there are only two full-time foreign doctors and two full-time foreign nurses at AHC. Above is the ER team comparing notes on patients.

The AHC budget for this year is US$4.5 million U.S., which works out to a cost per child of US$23. This compares to an average cost per child in the U.S. of US$1,853. Throughout this year, an average of 1,400 children were visiting the Emergency room at AHC and its satellite clinic thirty kilometers away, while 290 patients required admission. On average, the hospital’s three surgeons performed seven surgeries daily.

Those numbers have increased over the past few months, however, with a regional dengue outbreak and a larger number of patients seeking quality medical care they can’t find or afford elsewhere. In some cases, patients have had to rest on mats in the corridor for lack of ward space, while others have been sent to other hospitals.

A new four-floor building is now under construction. This will help improve medical care and create an additional 250 sq meters in the main hospital. Among the additions will be a neonatal ward, a new ward for recovering children, an expanded ER and labs (including the research lab, which is a partnership with Oxford University). Beyond the recent pressure from larger numbers of patients, an April medical audit identified a lack of adequate space, the small ER and lack of neonatal unit as the top three weaknesses of AHC.

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AHC works hard to provide the quality of medical care and compassion that a sick child would receive in a developed world context. The type of treatment offered at AHC, which is free of charge, is rare in Cambodia. This includes support to chronically ill patients, physiotherapy and palliative care for very sick children.  A home care program follows up with many such patients and includes a social work team.

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Some patients and their parents who aren’t able to see a doctor on the day they arrive must wait until the next day. The hospital provides cooking facilities, clean water and mosquito netting, which, innovatively, is tied between benches in the waiting area.

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These two children were waiting with their mother and a sick sibling, who needed medical attention.

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Beyond providing medical care and support to government hospitals around Cambodia in developing their medical and nursing protocols, AHC helps educate communities about issues related to health care. Some of the main causes of sickness, the main reasons that patients end up at AHC’s gates, are drinking contaminated water, poor sanitation and poor nutrition. In the context of working in one of Cambodia’s poorest regions where malnutrition is surprisingly still rife, AHC staff teaches children and their families the basics to keep them healthy.

I recently spent a week at Angkor Hospital for Children in Siem Reap, Cambodia with Francesco Caruso, director of ADMCF’s Children at Risk program and Ryan Glasgo, our new finance director. Both are working hard to help bring the hospital to the point where it can become a fully Cambodian institution.

When the hospital was founded in 1999 by Japanese photographer Kenro Izu and then was nurtured into being in partnership with an American board as a free pediatric hospital, Cambodia was a very different place.

Now there is a growing middle class, many of whom would be fully able to pay something for medical care. AHC for now, however, is still entirely free to any Cambodian child.

At the same time, the hospital in 2012 has a talented and dedicated medical and administrative staff that is fully capable of taking the hospital forward.

There is now an almost entirely Cambodian staff of 149 nurses and 46 doctors, including AHC’s executive director. Only two doctors and two nurses are foreign.

Last year, the hospital treated more than 150,000 children for illnesses ranging from acute diarrhea to tuberculosis. The Outpatient Department sees between 400 and 600 patients daily, while the Inpatient unit of 40 beds is almost always full.

An emergency room has eight beds, four of these in a separate isolation ward. There are plans to build a separate neonatal ward since on any day 10 of the patients are babies and many have suffered birth trauma or are premature.

Surgeries in the one operating theatre range from hernias to heart repair.

A pediatric Satellite clinic that is part of the government hospital in Sotnikum, 35 kilometers from Siem Reap, last year treated 12,300 Children. The Satellite staff works closely with the government hospital to build the quality of care offered there, with a focus on assisting the lab, X-ray unit and pharmacy, which the clinic shares. The clinic also has  installed an emergency button in the delivery room to summon a Satellite  doctor to assist any baby in distress.

AHC  also has become northern Cambodia’s premier pediatric teaching facility. The Medical Education program includes a three-year residency program for every doctor who joins and then on-going internal education and fellowships abroad.  ME also offers internships and trainings  for medical staff  from other hospitals.

“What we are developing is to be shared,” the hospital’s executive director, Dr. Bill Housworth emphasized, explaining the hospital’s full engagement via the AHC External Program with both the Ministry of Health in Phnom Penh and directly with many of Cambodia’s government hospitals.

The AHC Capacity Building program works with rural Health Care Centres and communities to provide education on nutrition, hygiene, sanitation and relevant disease – some of the main challenges for the AHC patient population.

The hospital, Satellite, Medical Education and  CB programs together cost US$4.5 million last year. This amount is covered almost exclusively by donor funding and is a challenge for the hospital to raise each year.

Consequently, AHC is of necessity looking at revenue-generating programs and already for a fee provides hospital services to the children of some local NGO workers and airport staff in Siem Reap.

Although public hospitals are not free in Cambodia, about 30 percent of the rural population has what is known as a Health Equity Card, which establishes that they are poor and reimburses some of the medical costs and travel expenses to get to the hospital. But even then, it is not uncommon for doctors and hospital administrators to ask patients for payment ahead of treatment.

Private clinics are expensive and don’t necessarily provide a better quality of care, underlining the importance of a hospital like Angkor for the population that just cannot pay medical costs.

Research shows that the most common reason for impoverishment in Cambodia remains emergency healthcare costs, which force families to enter an often unending spiral of debt. For families who have a child with a chronic disease, healthcare costs can be devastating.

In Cambodia, an average of one in 20 children die before their fifth birthday, compared to a rate of one in 120 found in developed nations, according to UNICEF. And four children out of five live in rural areas, where the mortality rate is much higher at 64 deaths per 1,000 live birth.

Government census data shows that in 2010, 40 percent of children under five were too short for their age, stunted by malnutrition. Roughly 30 percent of Cambodians live on less than $1.25 per day, which the World Bank has established as the poverty threshold.

Indeed, Siem Reap province, better known abroad for its 11th century temple complexes and lavish hotels replete with Western tourists, has the third-highest poverty rate among the Cambodian provinces at 52 percent.

For a province of 1 million people, the total health budget of Siem Reap this year is about $2.8 million, according to provincial health officials, and almost two-thirds of that represents support from large foreign government donors.  None of that makes its way to AHC.

Clearly, part of the problem with provincial hospitals is that the government can afford to pay only low salaries to its health workers. Thus doctors, who might earn as little as $100 a month, often supplement their incomes with private clinics that take precedence over any hospital care.

Still, Cambodia is making headway in medical care on offer, in part with the support of AHC.

Part of the problem is the legacy of destruction leftover from the 1975-1979 Khmer Rouge rule, when medical professionals and other educated people were singled out for slaughter. In all, an estimated 1.7 million people were killed or died from forced labor, starvation or disease over the period.

When they marched into Phnom Penh and other cities, the Khmer Rouge emptied the hospitals, eliminated the doctors and then left the care of sick and injured to untrained young soldiers who favored traditional Cambodian remedies over Western medicine.  By the time the Vietnamese ejected the Khmer Rouge from power, there were only an estimated 40 doctors left in the country.

Decades of war and isolation followed, leaving the medical infrastructure in shambles. In the 1990s, NGOs simply took over the health care system without trying to build anything indigenous, and change only began in earnest with the end of the Cambodian Civil War in 1998.

Angkor Hospital is working hard to be part of the solution.

I keep hearing about how expensive sustainable fashion inevitably is and that since we are used now to so-called fast fashion, it’s just not practical to think we will easily give up cheap apparel. But is greener fashion really more expensive? And how can we educate consumers  on this topic? These were two issues discussed during a panel I moderated last week as part of the Redress Forum in Hong Kong.

Among other featured topics during the day of presentations were, the business of sustainability, eco-labelling, best practice and inspiring the next generation.  The sense after a day of conversation was that there is still far to go in terms of really producing apparel that is truly sustainable for a mass audience and that the myriad eco-labels are often confusing to the buyer, designer AND the consumer.

In terms of waste, there is little that helps a consumer understand the recycled content of clothing and Hong Kong-based Redress announced it was introducing a new consumer-directed label that would help. A major fashion brand will be introducing this label shortly along with a new eco collection that includes a high percentage of recycled textiles – an exciting development here!

Although in the UK, for example, the sense among younger designers is that sustainable is the future, in Hong Kong, whether to wear fur even in summer seems more of a concern than sourcing green clothing, according to HK Tatler fashion editor, Arne Eggers. In the land where luxury is king and brands are everything, even the Tatler Green issue struggles for advertising, he said.

Still, also on my panel, “Educating and Engaging Consumers” was Tobias Fischer, regional CSR  manager Far East for H&M and he said that for his company sustainable equalled cost-saving. He became irritated every time sustainable fashion was described as more expensive, pointing out that sustainable involves saving costs on energy, water, chemicals, textiles etc.

“Current manufacturing is not factoring in the true cost of production,” said Filippo Ricci of UK’s From Somewhere and co-founder with Orsola de Castro of Estethica, established five years ago to showcase young designers committed to working eco sustainably as part of London Fashion Week.

And of course he’s right. In developing nations with few enforced regulations, the factory dying process causes untold damage to rivers and downstream populations when waste is simply pumped into waterways. Meanwhile, excessive chemicals used to grow cotton pollute the topsoil, groundwater and again damage the health of agricultural workers.

Heavy use of energy, often from coal, to produce apparel that satisfies our seemingly uninsatiable appetite for clothing means power plants must pump out waste emissions that pollute our air. Excessive consumption of water, particularly in already water-scarce regions (many of these in China) further limits supplies for future generations.

With consumption of clothing 60 percent higher over the past decade and the cost of clothing lower than ever, it just is not realistic to think that factories can continue to pump out product that doesn’t factor in any of the social or environmental costs of production. Already, with labor prices in China rising as living standards improve and regulation there tightens, inevitably costs  even of fast fashion will have to rise.

Meanwhile, however, many brands are simply taking their business elsewhere – looking to Vietnam, the Philippines and Indonesia among others to maintain the rock bottom prices we have come to expect, particularly from discount stores such as Target and TJ Max in the U.S.

ADMCF recently spent time in Patna, in India’s Bihar state where we were looking at how we might work effectively with the Musahar community, which ranks at the bottom of the dalit or untouchable caste.

We found that there is apparently relatively little concrete information about or assistance given to the Musahar, whose name translates quite literally as the “rat-eaters.” Estimates of their numbers in Bihar and other states range from 2 million to as high as 5 million.

The Musahar fall so far down the well of the Indian caste system that by all accounts its people live in modern India much as they did 2,000 years ago. In an initiative that was perhaps telling about the regard in which the community is held, in 2008 the Indian government acted to help the Musahar by allowing the commercialization of rat meat.

A brief portrait of their situation gleaned from what is available online and through conversations in Bihar: In the villages around Patna in Bihar state, India, child marriage at 13 or 14 is still common, although illegal in India.

In the rural areas, Musahar are primarily bonded agricultural labourers, but often go without work for as much as eight months in a year.  Children work alongside their parents in the fields or as rag pickers, earning as little as 25 to 30 rupees daily.

The Musahar literacy rate is 3 percent, but falls below 1 percent for the women. Yet it is cast discrimination rather than parents that keep Musahari children away from schools. That said, the schools to which they have access apparently offer so little in the way of education that perception among the community is that schooling doesn’t offer them anything. And it is certainly true that even if they do manage an education certificate, discrimination means few manage to find jobs anyway.

By some estimates, as many as 85 percent of some villages of Musahars suffer from malnutrition and with access to health centres scant, diseases such as malaria and kala-azar, the most severe form of Leishmaniasis, are prevalent.

Besides eating rats, the Musahars are known for producing a good and cheap alcohol so not surprisingly alcoholism is rampant among the community, particularly the men.

Government development programs provide very little support to the Musahars. They are not recipients of housing schemes because generally they do not possess title deeds for their land. They are also the lowest number of recipients of loans from revolving funds within government schemes.  Thus the social support system bypasses them, as do private donations since so little is known about them.

The Dalit community in Bihar as a whole suffers frequent and often unpunished human rights violations. In the ten years before 2003, for example, 4243 cases of Dalit atrocities were registered in police stations, including 694 cases of murder, 1049 of rape, 1658 of severe injury and 842 cases of insult and abuse.

Into this picture walked Sudha Varghese 26 years ago, a nun who wanted to give voice to India’s dalits. The Musahars were the least advantaged of the dalits she could find and she moved into their community to truly understand their needs and way of thinking.

her organization, Nari Gunjan, was born to give voice to the Musahar women in particular. The organization now runs 72  primary education centres and a residential hostel/school for girls. Nari Gunjan promotes social, political, and economic empowerment for the women and girls. Beyond education, some of the centers provide vocational training and assist with micro-credit for Musahar women.

A decade ago, recognizing the need also to represent Musahar women in the courts, Sudha sent herself to law school and returned armed with a new skill set she has used to pursue the prosecution of ten rape cases that without her would have gone unpunished. In each case, she lead a column of Musahar women to the police stations to persuade officers to make the right arrest and in each case she has succeeded in putting the perpetrators behind bars, she says.

Known as the “bicycle nun” Sudha visits the various communities on her bicycle, and her fragile appearance belies a ferocious determination to provide Musahar children with education, self-esteem and purpose, its women with hope. For her courage, India’s national government recently awarded Sister Sudha the country’s highest civilian award, the Padmashri.

During a visit, the difference between children who attend her education centers and those who don’t was immediately apparent. Still, like any organization working in difficult circumstances that has been around for some time, achieving a constant flow of funding, even at the modest scale Nari Gunjan requires, is extremely hard. Some of the education centers have gone unfunded for 10 months although the teachers continue to work and the children appear.