Medical Resources :: Common Diseases :: Developmental Issues :: Development Issues in Russian Children

Worldwide Orphans Foundation.Orphan Rangers
Dr. Jane Ellen Aronson
Executive Medical Director

Orphan Rangers Program

• Mission: To send students abroad to live, work, and do research in orphanages
• Students must speak the language of the culture
• Students must be respectful of cultural differences
• Students must have a passion for children

First Orphan Ranger Summer 1998

• Lydia Stickney, senior at American University, majoring in music, international studies, pre-med
• Spoke some Russian
• Lived in Japan with a family when she was 16 yo
• Dreamed of working in Russian orphanage

Udmurtia Republic

• Southwest of Perm in the foothills of the Central Ural mountains
• Three orphanages-Glazov, Izshevsk, Votkinsk
• 24 hours on the Transiberian railway with a backpack and her violin, Lydia made her way to Udmurtia

Glazov June 5-17

• "I cannot love them as I would love my own daughters."
• Small town of 100,000 people
• Site of military plant during communism
• Zirconium ornamental metal industry now
• Unemployment hovers around 30 percent

Glazov Orphanage 0-4 yrs.

• Home for about 60 children/6 groups
• 70 employees paid $20-$30 per month
• Laundry girl, electrician, heat technician, driver of orphanage van, cooks, maids, educators, massage therapists, speech therapists, aerobic exercise coaches, a music teacher (never seen working with children), nurses, director, and her personal staff

Glazov

• Director & pediatrician, Stalina Nikolaevna
• Little interaction with children or caretakers
• Orphanage is 75 years old
• Overall condition of building quite good
• Outside play areas in disrepair
• Children exposed to dangerous exposed wood and metal from old equipment
• Physical discipline was virtually unobserved in the orphanage
• Older children have stopped feeling pain
• Older children know that they are orphans
• Caretakers are called "auntie" and they know what a mommy and daddy is
• They confront the reality of being an orphan every time they look through a picture book or watch children on the other side of the gate walking hand-in-hand with daddy
• Depression is common in the older children
• Children who become bonded to a caretaker appear to be more depressed
• Schedules for babies are rigid
• Groups differ greatly in the care depending on different personalities!
• Parental visits occur for about 10-20% kids
• Visits are not recorded
• Visits from parents who drink worry the staff
• Educators and orphanage staff display a certain degree of discrimination against mentally or physically impaired children
• Children who are handicapped are attended to after healthy children
• Within the group of disabled kids, the less disabled are attended to first
• Older group of children-Boys are favored during lesson time
• A boy is more apt to be called upon than a girl
• A boy is more likely to be rewarded with verbal praise or a pat on the back
• Children are forced to eat
• If soup is spilled "too bad"
• Plates are taken away within minutes
• Mashed potato and carrot is a popularly hated item
• Eat now or forever hold your peace!

Izshevsk-June 22-July 10, 1998

• Antithesis of Glazov
• Large, impersonal, and cold
• Izshevsk is the capital city of the Udmurt Republic, 3 hours from Glazov
• 1 million people mini-metropolis
• Unemployment is high and failure to receive paychecks is common

Izshevsk

• 90 children divided into 7 groups
• Out-patient clinic and a children's neurological hospital are part of the complex
• Ludmila Yuriyevna is the director
• Tatiana Livovna is the pediatrician-opposed to international adoption
• Wives' Tales abound regarding medical conditions in the orphanage
• Children are not permitted to sit under 7 mos. because their spines will be damaged- "cervical trauma" is the diagnosis
• Massage therapy is popular-babies love it

Izshevsk Politics

• Olga Petrovna-head psychologist who was passionate about making changes in the education of orphans
• She studied the Russian Denver that Lydia brought with her and wanted Lydia to teach the Denver to staff
• Director Tatiana Livovna did not permit this to occur!
• Izshevsk Conditions
• Nutrition is poor, rickets is common, cloth diapers are never used, no screens leading to badly infected mosquito bites
• 24 hr. shifts for "Vospitatelis"-caregivers in orphanages
• 1 day on, 2 days off, and often workers take days off forcing other workers to work back-to-back 24 hr. shifts leading to resentment

Izshevsk and Growth Charts

• Olga Petrovna had never seen a growth chart until Lydia brought them to Izshevsk
• "We measure the children and read about what the numbers signify, but with your measurement charts it's so easy. I can just look and know!"
• Growth charts became known as "Look and know charts"

Infection Control in Izshevsk

• "There are two purple, neon lights in the room, one above each door. Each day while the children nap, they turn on the lights for about 20 minutes, usher everyone out of the room, and wait for the neon lights to kill all the germs!"

Feeding in Izshevsk

• Nurses often propped the bottles so that they could play video games, or cards
• Shoveling food down babies throats is rationalized by caregivers as allowing more time for play!

Boredom in Izshevsk

• Kids spend much of the day just lying on the floor, staring at the ceiling
• Toys are ridiculous, stand-up plastic dolls which provide no opportunity for creativity or manipulation
• Staff are proud of cupboards filled with these useless toys

Karapuz Group in Izshevsk

• The director did not allow Lydia much time with this special group of infants
• Great staff work in this group and they play games like "Name that Animal" and Hide-and-go Seek"

Special Needs in Izshevsk

• Very exceptional staff work with children who are blind, deaf, mentally retarded, hydrocephalic, have congenital infections and cerebral palsy
• Speech therapist Olga Petrovna comes everyday to work with kids to develop their skills of recognizing shapes, colors, animals

Votkinsk July 20-August 1, 1998

• "If the orphans in Russia had a choice, they would all vote for living at the orphanage in Votkinsk"
• Small town of 80,000
• Caretakers are called "Mama" rather than "auntie" as in Glazov, Izshevsk

Votkinsk

• Caregivers bring fresh fruit from their own gardens when money is scarce
• They sew their babies clothes and create new toys and games
• Mamas love their babies in Votkinsk
• Director, Lydia Vasilevna has worked there 28 years-distant from staff, attentive to babies

Votkinsk Orphanage

• Started in 1945 and at its current location since 1985-60 kids/6 groups
• New Building was promised last year, but the city broke its promise
• Lyena Smakaeva is the head speech pathologist and has worked there 15 yrs.
• Her salary is $120 /month

Education in Votkinsk

• Lyena Smakaeva has designed a curriculum for the school year from November to May
• She works on pronunciation skills, shapes, colors, counting, animals, emotions, and poetry memorization with the four year olds
• Lessons are planned during the summer

Infants in Votkinsk

• Babies are fed, changed promptly, and bathed every afternoon
• They each have their own beds, own towels, and own pacifiers
• The room is kept cleaned and the playpens washed to avoid a urine stench

Older children in Votkinsk

• Children cry when they fall down which differs from kids in Glazov
• Children walk outside the orphanage for hours at least once a week
• They hike through the forest, wade in the pond, go into town to explore the shops
• They go to Votkinsk amusement park

Special needs kids in Votkinsk

• Buratino Group-8 kids
• Physically exhausting, emotionally draining
• Main educator has worked with special needs kids for 25 years and loves the work
• Congenital malformations, down syndrome, mental retardation are common diagnoses

Behavioral issues in Votkinsk

• Zaika Group consists of older children who have disciplinary problems or other delays
• "Group for children without promise"
• Caretakers appear to care less
• Caretakers sit and gossip while children play
• No cuddling or holding

Evaluations in Udmurtia Republic

• Glazov-59 children out of 60
• Izhevsk-44 children out of 80-90
• Votkinsk-51 children out of 60
• Total children evaluated = 154

Ages/gender of children

• Range of ages 2.5 mos to 54 months
• Mean age=20.6 mos.
• 92 males
• 62 females

Failure to Thrive in Udmurtia Republic

• Data on 151 children available
• nl wt/ht<5th% 29/151 19%
• nl ht/wt<5th% 5/151 3%
• ht<5th%/wt<5th% 36/151 24%
• nl ht/nl wt 81/151 54%
• Failure to thrive (FTT) 46%

Head Circumference in Udmurtia

• Head circumference less than 5th%-microcephaly
• N=145
• 56/145=38.6 %
• No significant differences among the 3 orphanages for microcephaly

Head Circumference in Votkinsk

• N=51
• 19/51=37.3 % less than 5th % (microcephaly)

Head Circumference in Glazov

• N=51
• 20/51=39.2% less than 5th % (microcephaly)

Head Circumference in Izshevsk

• N=43
• 17/43=39.5% less than 5th % (microcephaly)

Orphan Ranger Summer 1999

• Meredith Holtan-graduate of University of New Hampshire in May 1999
• Russian scholar
• Ph.D candidate at Berkeley in Fall 1999
• Major interest is "attachment"
• St. Petersburg orphanage #13, #12, #7 and Borovichi orphanage
• Early intervention institute in St. Petersburg