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Dickens, Boys Town or Purgatory:
Are Institutions a Place to Call Home?

By Victor Groza, Daniela F. Ileana, and Ivor Irwin

The impacts of instutionalism on adopted children of Romania, along with a discussion of the history that lead to this sad state of affairs. Part Two of Chapter 3, "Institutions for Children in Romania" from the book "A Peacock or a Crow : Stories, Interviews and Commentaries on Romanian Adoptions."

Return to Part One

Part Two Contents
A Description of Romanian Institutions
Studies of Romanian Institutions
Summary: An Institution Is No Place to Call Home!


As mentioned in Chapter 1, the Ceauscescu government developed a solution for families who were unable or unwilling to keep their children at home. The solution to the problem was institutionalization. The exact figures are as yet unavailable and may never be known, but, by the end of the Ceauscescu dictatorship in December of 1989, it is estimated that there were 600-700 institutions in Romania that provided residence for an estimated 100,000 children.1

Just as problematic as the number of children residing in institutions under Ceauscescu is the number of children placed in institutions after the dictatorship. According to UNICEF, following decreases in the number of children in institutions in 1991 and 1992, by 1994 the numbers had increased and become greater than the number of children in 1990. UNICEF reports that in 1990, about 86,000 children were in institutions. In 1992, only about 73,000 children were in institutions, largely due to international adoption. By 1994, however, the numbers had increased to over 98,000 children. 2 In these institutions, about 24% of the children are under the age of 8, 20% are 9 to 11, 31% are 12 to 15, 19% are 15 to 18, and about 6% are over the age of 18. 3

Children continue to be abandoned, mostly in the maternity hospitals. Mothers will deliver at the hospital and, simply, walk away. The hospital staff can tell who is most likely to abandon their child. There is a typical profile. It is a women who shows up at the maternity hospital, ready to deliver, without her official papers. She will be from out of town. She will be a single mother or a mother who already has several children. Once she delivers her baby, she may give the child a name but often does not. Without a name and the official paperwork, the child is instantaneously placed in legal limbo. You can't track the mother because there are few social workers to do outreach and you don't know if you have the correct information. The child cannot be adopted because, under Romanian law, the child is not legal -- he or she is nobody's child.

(From Victor's diary and notes): Ancuta was 19 years old, from a village near Brashov, in Transylvania. Her water had broke by the time she arrived at the maternity hospital. She had traveled in the morning by train, arriving at Gara de Nord (the north train station and main station in Bucharest) around noon. She told the doctor that she was in a rush after the contractions started and forgot her papers. However, she promised that her family would be bringing them when they came for a visit after the baby was born. Ancuta was unmarried and the father of the child refused to marry her or claim the child. In fact, they had broken up over the pregnancy. She had a previous pregnancy a year ago that she terminated with an abortion -- it was so painful she decided not to have a second abortion. She worked on her parents' farm. The interview was interrupted when her contractions increased and she was taken for delivery. A day after she delivered, the mother was gone and the little girl, whom she named Ana, was left in the maternity ward -- with a name but with no registration and no way to track the mother. She would stay at the hospital for about a month and then be assigned to one of the state orphanages.

The hospitals will keep children up to three months, but then they must be moved. It is chilling to walk into the nursery at a maternity hospital. Instead of hearing children crying and seeing them move around, they are quiet -- too quiet. It's not natural. The children, if their eyes are open, stare blankly into space. While the wards are generally clean and the necessary medical supplies are available, they are eerie -- silent and abnormal without child activity.

There have been many official and some unofficial reports about the structure of the child institutions in Romania. The following has been pieced together from official documents, unofficial reports, and personal experiences. 4

Under the old regime, up until the age of three, children were placed in institutions called orphanages or leagane. These residential facilities were under the direction of the Ministry of Health. It appears that, at around the age of 3, the children in these orphanages were divided into two or three groups. The first group were 'normal children.' Children were classified as normal if they could pass an assessment conducted by a physician or, in some institutions, a team of professionals. There was little training in child development for the persons conducting the assessments and a lack of uniformity in assessment techniques; children were generally considered normal if they could talk, were toilet trained, and suffered no apparent physical difficulty. These children were sent to training schools where they were fed, clothed, sheltered, and received an education. Interestingly, few gypsy children were judged normal. The "normal" children were under the guidance of the Ministry for Education until the age of 18.

The second group was made up of those children who had minor handicaps. There was one school for the deaf, one school for the blind, and other schools classified as "special schools" or "special hospitals." "Special school" may have been the words used to describe the place, but there was nothing "special" about the program. They were not as well supplied as the normal schools, but these children were still at least seen as salvageable and educable. These children were also under the Ministry of Education.

The children who belonged to the last group were diagnosed with physical, medical, or psychological problems that were considered too severe for either of the placements mentioned above; therefore, they were sent to an institution for the 'Irrecoverable.' These were children who were considered unsalvageable. The children in this group included those with major mental and physical defects, as well as children with medically correctable handicaps such as crossed-eyes or club feet. 5 The main purpose for sending these children to institutions of this sort was to hide them away, helping only to maintain the belief that Romania did not have any social problems or handicapped children. These children were under the direction of the Ministry for the Handicapped.

I remember that first year so vividly as we drove from Bucharest to the Institution for the Irrecoverables in Videle. After two hours of driving, through black, oil-drenched fields where cows walked around the oil slicks, we arrived at the village. We stood at a large compound of white buildings that, from the outside, looked like they needed a lot of work. The paint was chipped with big splotches of unpainted cement. Electric wires were dangling and blowing back and forth. Many of the windows were missing. Between bricks, mortar was gone. It was hard to believe that anyone could live here! The front gate was probably about 8 feet tall; next to the gate was a guard station and a large fence circled the entire complex.

We were escorted from the front gate to the back of the complex by the guard and an official from the Ministry for the Handicapped. At the very back of the complex, surrounded by raven-colored fields on three sides sat another of those white, three-storied buildings with a large white stockade fence that fortified the alcazar. You could see the faces of children peering through heart-shaped grates, black and rusting, which covered the windows and the doors -- vacant eyes, older then they should have been, looking at us through black, rusted hearts. More dismal then the building was the screams and cries that echoed out and through the gates while we waited to enter. Here were the Irrecoverables -- hidden from most of the populace and obscured in the back of a large compound, children screamed from the pain and purgatory of institutional life.

The three-tiered-system of institutions had very different physical conditions as well as child care standards. The most horrendous conditions were found in the institutions for the Irrecoverables and the images seen in the media such as those presented in the "20/20" special "Shame of a Nation" were from these settings. Romania was not unique in this system of institutions. It appears that there are similar institutions and tiered systems in Russia 6 and the Baltic States, 7 with a range of quality in their atmosphere, staff, and programs.

A Description of Romanian Institutions

A more formal description of these institutions is necessary to gain an understanding of the devastating impact these orphanages and institutions had on some of the children adopted from Romania, as well as the continued risk that they pose for children still surviving in them. In must be mentioned that there were differences among the various institutions -- some had bigger budgets and better qualified personnel. Still, in layman's terms -- it was a case of bad to worse, the rock in competition with the hard place, the devil doing a doggie paddle to prevent drowning in the deep blue sea.

We pushed the buzzer and waited to be escorted into the building. We were immediately swarmed by children, some half-dressed, many with obvious physical handicaps, coming to see the straine (strangers). They were shooed away by the guards and we were ushered into the Director's office. Since this was our first meeting, after introductions we were all served tzuica with selzer water. Of course, it was 10 AM but this is the hospitality of Romanians. Besides, the staff were more interested in Americans than the children under their care. We were then left alone and our escorts left the premises. We were told to make our report to the Ministry for the Handicapped when we completed our work. The Director left his office and said he would return. With nothing else left to do, we waited. This is what you do a lot in Romania, you wait. Often, you wait for nothing. Several hours later we were shown to our rooms -- two rooms on the ground floor that were big enough to be a classroom for 20 children -- joined by a smaller room with a sink, toilet and shower. The walls were painted mustard-brown. The water, when it ran, was brown. On one side was a pig farm; on the other side the sewer drained on to the playground, and in the back were large garbage dumpsters. Surrounded by sewage, garbage and pigs -- a clear metaphor, if this was the "wrapping," you can only begin to imagine what was inside.

The orphanages were colorless, shockingly quiet and devoid of any of the usual visual or auditory stimulation that children usually receive from bright colors, pictures, and displays. Walls were painted in dark browns, to hide the dirt. The paint absorbed any light -- when there were working light switches and light bulbs -- making halls and bedrooms darker. It seemed as if the entire building was sucking the souls of the children, and perhaps the staff that worked there. There were no toys. There was no exercise or exposure to the outside. 20 Most of the time, the children did not have enough to eat or drink. Consequently, most children were below the twentieth percentile for height and weight compared to normally developing children. 21 One consequence of low height and weight is greater susceptibility to diseases. While official data were not available, some staff said that mortality rates in the winter could reach 40%. Recent information suggests that 50% died within the first 24 months. 22

In the back behind the dumpster was a small field with a fence all around it. In a farm village, all land is used. But this small area was speckled with little mounds that were grown over with grasses, weeds and wildflowers. We asked the staff about the little field. They said it was nothing, just unused land. Then, one of the children, an "irrecoverable" with spina bifida who had learned to speak English, said that it was the field of the dead children. After speaking to some of the volunteers and the local school teacher who taught English, we learned that when children died, they were buried in this field in unmarked graves. These children had no families, so there was no sponsor to have them baptized. If they had no families and were not baptised, they could not be buried in holy ground. Besides, even if the families knew the children were here, they couldn't afford a burial. So, the little mounds were graves. It was as the bitter Romanian saying: lucky for the dead, their ordeals are over.

In addition, children in orphanages were exposed to stunningly inadequate child-to-staff ratios ranging from 8:1 to 35:1. This allowed for an absolute minimum of personal interaction. 23 Crying was ignored, both as policy and as a natural reaction to so few staff caring for so many children. The staff provided minimum touching and handling of the children; the children who were left lying in cribs were not changed in position or stimulated for most of the day. 24

The first day that we were to conduct assessments, the Director had set us up in a room at the end of the hallway on the first floor of the institution. The first floor housed all the children ages 3 to 6, our target group for assessment. We were on time for our program and waited for the translators to arrive. They were an hour late. We went with the translators to the first room, which had 8 beds and 12 children. The nurse was directed to bring the first child, a little boy of 5 named Florin, with her for the assessment. She picked up the child; he pushed her away. As she got to the door to go down the hall, he started crying. By the time we had walked about 100 feet to the office, he was inconsolable -- screaming, crying and trying to get out of her arms. We were shocked -- we asked the translator to explain to us. First, the nurse said it was because we were strangers. However, we pointed out that we had been in the bedroom with him and he had been curious about our presence, not upset. After going in circles for almost an hour, what we discovered was that this child had never before been out of the room. Can you imagine? Five-years-old and only to have known the same four walls! Children only distinguish between what is familiar and unfamiliar to them. This child was frightened and distressed by the unfamiliar surroundings. Since most of the children had never left their rooms, we changed our protocol and conducted the other assessments in the rooms where the children had lived most of their lives.

However, on a bizarrely positive note, jobs are hard to find in Romania, thus staffing was and remains very stable. The same people were involved with children over time, and, one can surmise, that, even if the quality of care was extremely poor, the children were familiar with the staff who "took care of them."

It was never clear if there were expectations for the staff to do something with the children. We would see them standing together at the end of the hall, smoking cigarettes and drinking coffee, once the Director left the premises. The children were put in bed after dinner and just lay there. If the television was on, it was usually for the staff, although sometimes the older girls were allowed in the staff's room to watch TV. At night, while we sat in the room, we could hear children crying, followed by a slap, and silence. It wasn't unusual the next morning for us to see a bruised child, reportedly caused by one child hitting another child.

The only time the children were allowed out of bed or outside was when the foreign volunteers came. But the volunteers (from Ireland) did everything while the Romanian staff just stood by and watched. Did they just watch because they didn't care? Did they watch because it didn't matter what they did, they would have the same job at the same wage for life? Or, did they just watch because they felt no ownership in what was going on? A disempowerment from strangers who did not know the Romanian reality, strangers who would leave and go back to the comfort of their rich countries while nothing really changed here? With so many children, who belonged to no family, and a guaranteed job regardless of what you did -- as long as you showed up -- why do anything?

With so many children and so few staff, the children received minimal routine care. Educational and recreational programming was virtually nonexistent -- no activities for children to stimulate them or for fun, no school or specialized programs designed to help them grow and develop. Children were left to their own devices for stimulation. Many would become autistic-like -- having a blank stare, rocking back and forth, and looking constantly at their hands. Those children who were too active in exploring their environments were restrained -- either physically with straps or chemically through tranquilizers. 25 Proper hygiene often could not be practiced due to a lack of hot water, soap, washing machines, clean bed linen, and an inadequate number of cots and beds. It was not uncommon for children to lay in their feces or urine. Having two children in the same bed was typical. In addition to a lack of running water, sewer systems were often inoperative.

What I remember is the smell. Having had nasal surgery a decade before I went to Romania, I suffered some damage. If I could smell it, I couldn't imagine how others were experiencing the smell. The staff would start to wash clothes, then the water would cut off. So, they would take the half washed clothes -- most of which were covered with feces or soaked with urine -- and leave them in the tubs until the water came back on. Sometimes, they stayed in their watery trough for days and a fetid film would develop. At times, when they ran out of bed clothes, they would put them in the dryer regardless of where they were in the wash cycle. The heat from the dyer would spread the smell throughout the whole building and the sheets would return with huge stains as well as the dried-in smell. So, our experience was open sewer on one side, pig farm on the other, pools of fetid water in the basement, and the hot air of human excrement. Some days we would have to walk to town. We could escape. The children could not.

The physical structure of these institutions was also a problem. Most windows had neither screens nor glass. In the summer, flies would swarm the rooms and rainstorms would flood the floors. In the winter, children suffered frostbite due to a lack of heat and an inability to keep cold out of the wards and rooms.

Problems with administrative records added to the horrifying physical conditions. Birth records, medical histories, and information about biological parents would obviously have been invaluable to such children and their care; but, because so many children had been abandoned at the hospital, this was an impossibility. Most charts in Romanian institutions were found to only have two lines, created by the institution itself. 26 When children were moved from institution to institution, which was a common practice, their charts rarely followed them. In many cases, if parents wanted to find their children again, it became an impossibility; they were lost to the system. Even more diabolical was the fact that, after Iliescu took power and the adoption chaos began in 1990, the law insisted that no adoption could take place without parental consent. So, you had children with no records and parents who didn't know where to find their children, often having no contact with them for several years.

We spent one day just reviewing children's records with our translators. You have to keep in mind that these children were between the ages of three and five. Typically, there was a one-page record. We did get some information, however, from these records: about 60% of the children were there because of poverty -- the parents couldn't afford to keep them. But, then there were all these diagnosis that we had never heard of -- nor had the translators, both who were college educated in Romania. It seemed that under communism an entire nomenclature of diagnosis had been established that had no relevance to western treatment and made little sense to the Romanians. Even if the Romanians understood the "diagnosis," there was no treatment or plan for treating the diagnosis given. The saddest thing is that we found almost nothing in most of the files about the families of these children.

Staff hired to work in the orphanages and institutions were not required to possess any special qualifications that might improve their interactions with these children. Job descriptions, rewards for excelling, and organizational charts were not available. Penalties for failing to perform tasks were not enforced, which only served to enable incompetent staff members.

It was obvious that the only person in charge was the director. So, when he was in his office for a break or left the building, the children were ignored. The staff, who were mostly unskilled peasant women, would congregate around the television to drink coffee, smoke and laugh with each other. Usually, one of the older children was left to oversee the other children, or else the door to the room was shut and the children would not dare open the door. One day, when we came back from doing our daily shopping at the piata (market place) in town, we found all the children on one floor huddled under the steps of one of the landings with one of the boys standing over them. They cowered silently while he glared at them. If they moved, he would grunt and lunge at them -- forcing them to cower back under the stairs. One of the children obviously had challenged his authority and was left bruised and bleeding. It seemed that the Director had left the grounds for the day, so the one child was rewarded with cigarettes and candy to "watch" over the other children.

Since the closing of social work programs in the 1960's, there were no social workers to conduct permanency planning, crisis intervention, extended family foster care services, domestic adoption, or home-based care. When abandoned children became ill, despite socialist propaganda claims, hospitals would oftentimes refuse them based upon insufficient means of official family identities. These children had no advocates, so it was common for them to remain in institutions and receive little or no medical care for their illnesses. It was no wonder they had to have a burial field for the children whose only escape was through death.

Studies of Romanian Institutions

"A whole people, not yet born
Is condemned to be born."
Gabreiela Adamsteanu, 1990

The veracity of Ms. Adamasteanu's verse cannot be doubted. There are more children institutionalized in Romania than ever before. The Romanian government, despite the elections that set "democracy" in motion, still plays shell games when it comes to information access for visiting foreign social workers and the media. Nevertheless, the anecdotal evidence gleaned from scores of interviews and off-the-record conversations with English, Irish, French, German, Canadian and American social workers, nurses, physicians, lawyers and adoption consultants -- many of whom have been regularly in and out of Romania for the past seven years -- and accounts such as the United Nations Report on Children in Eastern and Central Europe, 27 shows that, although conditions are slightly better in some institutions, the number of incarcerated children has risen. The much publicized Orphanage Number One -- patronized and filled with toys by the pop music icon Michael Jackson -- may look great in the thousands of sound-byte broadcasts put out around the world, but it's all cosmetic. Help is still desperately needed.

Several studies were conducted in various institutions and orphanages in Romania. Studies were conducted prior to and in the immediate aftermath of the "revolution," and over the past seven years since. The findings of these researchers are remarkably similar to those first published by Henry Dwight Chapin at the turn of the century.

Olimpia Macovei, 28 a Romanian scientist, assessed the developmental delays of institutionalized children in the district of Iasi from 1976 to 1986. The delays she noted included less physical growth, decreased social and motor skills, and lags in psychological and intellectual functioning. These findings were corroborated by Dr. Dana Johnson and colleagues 29 when a group of 65 adopted children from Romania were examined at a clinic in Minnesota. Dr. Johnson and colleagues reported that only 15% appeared to be developmentally normal and in good health; head circumference, weight and height had all been negatively affected by institutionalization.

Two other problems of institutionalized Romanian children, reported as early as 1990 by the Center for Disease Control, were the predominance of the human immune deficiency virus (HIV) and hepatitis (HBV) infections. As of 1990, the incidence of pediatric AIDS ran second only to the number of cases reported in the U.S.

Consequently, because of the lack of knowledge about infection control and a denial of the existence of the virus by the Romanian government, universal precautions were not practiced. It appears that the infections children acquired, along with those passed on by blood transfusions, came from syringes that weren't properly sterilized and were used repeatedly on as many patients as possible. As early as February 1990, two months after the revolution, families adopting children from Romania were encouraged to have their children tested for HIV/AIDS 30.

As the world's attention focused on the orphaned and abandoned children in Romania, many organizations and individual volunteers entered the institutions. From these efforts, several reports were generated about the children from these institutions. Some researchers suggested that the children in the orphanage displayed clear deficits in social and cognitive functioning compared to same age children attending kindergarten. 31 On the basis of these differences, researchers predicted that these children would have learning difficulties in the future. Yet, the way in which these children utilized one another during testing -- constantly adapting to each other as "friends" even though they were deliberately rotated from room to room and, sometimes, from facility to facility -- showed major coping skills and strengths. Also, once international groups arrived, the vast majority of children made tremendous positive changes in their growth and development. Some promising results have been reported that offset many of the harsh effects. Programs that involved changing the institution and training community volunteers to stimulate children can improve children's functioning, even if they continue to reside in institutions. 32

Summary: An Institution Is No Place to Call Home!

"Please, sir. I want some more."
Oliver Twist, by Charles Dickens

Institutions, regardless of the quality of care, have profound negative effects on children that may well last a lifetime. At a minimum, the regimentation of institutional life does not provide children with the type or quality of experiences they need to be healthy, happy, fully functioning adults. In group care, the needs of any individual child are secondary to the requirements of group routine. Relationships between adults and children are superficial and brief, with little or no warmth or affection. Institutional staff do not connect emotionally or physically in nearly the same way families connect with children. In developing countries like Romania, early institutional care will likely lead to institutional care for the rest of a child's life. Prevention of institutionalization should be emphasized because some children may not ever be able to completely overcome the negative effects of institutionalization.

Hope is there, however. Some children are just plain ol' resilient, regardless of the sticky experiences and circumstances of their early lives. Children leaving institutions can be positively affected by the quality of the family life they enter. The effects of institutionalization are very much influenced by the age of the child when they enter and the length of time spent incarcerated. While this evidence has been accumulating for many years, the children of Romania offer us a unique opportunity to review what we know and further examine until we know for a certainty which trauma is reversible and which is at least manageable.

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