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How to best care for AIDS orphans in Africa

During my travels in Kenya, I met a toddler named Mary Maishon who at one time had been a starved bundle of rags. She had been living with her sister and cousin under a piece of plastic and cardboard in the town of Gilgil. After her parents died of AIDS, she had been left in the care of her grandfather, who sorely neglected her. Mary was near death, traumatized and mute, when she was rescued by a pediatric nurse and taken to live in an orphanage in town.

I bring up this story in light of a new report on the front page of yesterday’s Sunday New York Times, which deals with the question of how best to care for the estimated 15 million children in sub-Saharan Africa who have lost parents to AIDS. The story quotes a study led by researchers at Boston University, who found that orphaned children living with desperately poor families in Malawi did well if these families were given small cash allocations - $4 to $20 a month - so that the families could provide the children with life’s essentials, such as food, clothing and schooling.

Other studies have shown that orphaned children are much more likely to do better if they are raised in an extended family situation. If it were possible to effectively extend support to families, as the Times article suggests, that would certainly be the ideal. But what if the family is so poor and dysfunctional that the child suffers, as Mary did? My personal experience tells me that orphanages can play a role as a home of last resort, particularly if held accountable and provide love and care.

Orphanages are a Western concept, alien to the African way of life, which is centered on family, community and tribe. An African child who goes to live in an orphanage may lose that important cultural link and have trouble reconnecting with the community when he or she is ready to leave the orphanage.

And yet I met a lot of Marys in my travels in Africa - orphaned kids who had been neglected or abused by relatives or who simply had no other options in life. At the orphanage where Mary now lives, the Saidia Children’s Home, the children get close attention and nurturing from a caring, well-trained staff, and the small shelter operates much like an extended family. Mary is well-fed and attends a good school. (For more on Mary and other children like her, check out my new book, Face to Face: Children of the AIDS Crisis in Africa:

The Times story points out that very little of the money being spent nowadays on orphans and vulnerable children actually filters down to families caring for these children. Rather, money tends to gravitate to institutions - orphanages - where the funds can be more readily monitored and results easily tracked. In the case of Mary and some other children I’ve met, that money is well spent.

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