Nobody Ever Listened to Me - Chapter 6 "Health"

CHAPTER 6 - HEALTH

UN Convention on the Rights of the Child:
Article 24: “State Parties recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health……In cases where no parents or other members of the family can be found, the child shall be accorded the same protection as any other child permanently or temporarily deprived of his or her family environment for any reason, set forth in the present Convention.”
Article 33: “State Parties shall take all appropriate measures, including legislative, administrative, social and educational measures, to protect children from the illicit use of narcotic drugs and psychotropic substances as defined in the relevant international treaties, and to prevent the use of children in the illicit production and trafficking of such substances.”

It may seem fairly obvious why street children are vulnerable to poor health. If they live in slums, all too often they have to cope with lack of clean water, open sewers, lack of hygienic toilet facilities, lack of waste disposal services, pollution. For lone street children, detached from their families and communities, care for their own health seems to come low in their priorities. These children live one day at a time. Their obsession is to get food or money and to survive the day. They rarely think of the long term, which for many of the children is the next day or next week. If getting food means rummaging through a restaurant’s or hotel’s waste bins, they will do that. There is no such thing for them as a ‘sell-by date’. Often their greatest chance of a drink is the water left at the bottom of a discarded water bottle; or from a street stand-pump; or from the waterpipes that supply a railway carriage or bus cleaning plant. Or rainwater accumulating in filthy puddles.

For children whose full time home is the street, one priority is to dull the senses to be able to bear the pain, the hunger, the cold, the danger. The vast majority of such children succumb all too easily to the lure of drugs, stimulants that they can afford. In Latin America it is ‘shoe glue’; in India the children find solace in inhaling ‘whitener’, the fluid still used to correct typing errors and easily available to children in shops that sell simple stationery materials. In Russia, alcohol abuse is just as common as drug abuse. In their drug-intoxicated state street children are even more careless of their health and hygiene practices, and ignore the potential long term harm to escape their present situation through a sought-for continuing ‘high’. For older youths with their ability to earn more, all too often they will progress to harder drugs, or become part of a drug distribution criminal network. Drug criminals will use young children to act as ‘runners’ or distributors’ and get the children hooked on drugs so that they find themselves dependent on their abusers.

Few of these children have access to adult health care. A survey conducted in Mumbai several years ago of over a thousand street children found that less than 5% knew how to get adult help. Half of the children looked to another street child for help when they were ill or injured, the rest just put up with, or tried to ignore their problem and let nature take its course. All too frequent an allegation was the impossibility of a street child being accepted for treatment in a hospital unless accompanied by an adult who would be accountable for any costs incurred. Most hospitals in the world - even if purportedly free - still require costs for food and medicines or for adults to supply these to the hospitalised person. Many sick street children report being chased away from hospital entrances unless they are obviously severely injured.

Those NGOs that have facilities for treating sick street children report a multitude of common ailments that the children are prone to. Because of lack of hygiene, sores and skin diseases are common. Bruises and infections from wounds caused in fights and beatings, chest infections from exposure to dampness and pollution, malaria in South Asia and Sub Saharan Africa are rife. You will still find crippled children from the effects of polio or birth abnormalities abandoned on the streets and stations of India begging for a living - partly because their family cannot cope with their upbringing, sometimes because the family has taken advantage of their state to put them to begging for family income.

Throughout Africa, many children are on the street because of the ravages of HIV/AIDS among their parents or extended family of that generation. Older street children themselves fall victim to the same infection through casual and unprotected sex and many street children the world over are vulnerable to HIV because of sexual abuse by infected adults or older street youth. NGOs working with street children find increasing evidence of HIV infected children in Latin America and the Indian sub-continent. In Russia and parts of Latin America, infection from the use of shared needles by children who are using hard drugs is becoming very common. It is often difficult to test children to check if they are HIV+ without infringing their rights and with no adults prepared to take legal responsibility for them and therefore it has been hard to produce the necessary evidence to convince major AIDS programmes to treat street children as a priority vulnerable group. NGOs can often only assess the risk and likely prevalence of HIV by noting the extent of sexually transmitted infections that the children display. Most programmes for children are run through schools or communities from which street children by definition are excluded.

One or two NGOs have built hospices for children suffering from AIDS related illnesses - one such in Andhra Pradesh in India, with beds for twenty children, had to admit 26 on the first day it opened. After initial assessment and treatment, the children able to return to the street or their slum families did so; but they had immediate access again if their illness reached a critical or terminal stage. They were not left to die in the gutter which would probably otherwise have been their fate. Attempts to raise awareness of the disease and its risks are often difficult and even taboo subjects in certain cultures. One NGO found its partner organisations’ local staff were reluctant to tackle sexual matters openly with the children and found it more effective to train some of the teenage boys who became effective peer educators. Interestingly, these 14 and 15 year old boys became the ‘experts’ to the local adult community as well as to other street children and their credibility gave them respect and enhanced their feeling of self-worth.

Accidents among street children are common. In order to gain some advantage over their peers in earning a meagre pittance from some of their activities, they will take risks we would consider unacceptable, rushing into crowded streets, jumping onto or hanging on the outside of moving trains. You will often see beggars who have lost a leg or arm in such escapades - often supported by their ‘family’ or gang of street children. The injured child will often share their takings with the group as they rouse greater sympathy of the occasional passer-by.

___________________________________________________
Subu was six years old and was already a street child travelling at will round India’s vast railway system. He was with a group of boys hanging out on a long distance train near the city of Visakhapatnam in Andhra Pradesh, when a BBC cameraman came upon him and began to film as the interviewer from Sport Relief began to talk to some of the older boys. The 50 mph train suddenly lurched and young Subu fell from the open door (many Indian trains run with wide-open doors). The film crew pulled the emergency chord and all rushed back expecting to find a corpse – but Subu was still alive though badly injured. After hospitalisation, Subu was taken to Railway Children’s partner which was being filmed for showing in the BBC Telethon later that year, and miraculously, he made a complete recovery.
Subu, India – Railway Children
___________________________________________________

Some injuries are less of an accident. In parts of Africa in particular street children are found with injuries deliberately inflicted. In war torn countries, rebel groups and sometimes even government troops recruit children to fight their battles and war wounded children are left on the street when some sort of peace is finally imposed - often rejected by their communities because of atrocities they have been forced to commit - or even suspected of having committed. In Nigeria and parts of the Democratic Republic of Congo many children are accused by their superstitious families of being witches and are deliberately maimed or injured during horrendous forced so-called exorcisms and then rejected by their communities. In some countries in Central America there is evidence that street youths have been tortured and murdered by the police or groups of vigilantes - often off duty police hired by business groups or communities to rid themselves of boys they see as threats.

___________________________________________________
Andrew was brought to Retrak from the International Hospital Kampala. A week earlier he had been found lying half dead along Kampala’s railway line, a train had run over his left leg and crushed it. The medical staff at the hospital were wondering how this could happen until a peculiar behaviour surfaced - convulsion from fits. It was established that Andrew suffered from epilepsy and must have been crossing the railway when he went into an epileptic attack. He received excellent care, but nevertheless needed to have his left leg amputated. On coming round after his operation he had amnesia and could not believe he had only one leg and found it hard to adjust his movement and coordination accordingly. It was clear he would need intensive psychological and physical therapy.

With no possible way of identifying his family, or hometown, hospital staff referred Andrew to Retrak where medical staff provided him with counselling, support and a stable loving environment to recuperate. Over time this care enabled him to accept his medical condition, make friends and gain confidence in participating in educational and sporting activities. The Retrak nurse was able to identify a paediatric neurologist who was able to treat Andrew’s epilepsy; slowly his fits reduced and became manageable.

Following his excellent physical recovery Andrew eventually remembered his father’s name and felt ready to return home to his family. Although he couldn’t remember the reason why he had run away, Retrak staff set off to resettle him in his home town near Lugazi. His family explained that he had run away following a family dispute and couldn’t believe - having feared the worst - that he had returned home safely. He was so happy, calling out to his siblings saying “am back!” Following his traumatic accident on the railway line Andrew is now happily resettled with his extended family and has reintegrated successfully in the local community.
Andrew, Uganda - Retrak
___________________________________________________

Many of the street children suffer from the self inflicted abuse of drug addiction. Any child who has spent any length of time on the street finds it hard to resist the short term lures of cheap drugs - solvents or other substances that can be inhaled to give a temporary relief from boredom, pain and hunger. A child joining a gang of other children for protection will soon find themselves pressured to join the others in taking some form of drug if only out of camaraderie. And once hooked, they find it difficult to leave. There are very few drug de-addiction facilities that specialise in helping children. There is one in Moscow that has been dealing with drug addict and alcoholic children for several years. There are a couple of organisations in India that will accept the occasional child alongside adults having treatment, but they admit it is difficult without a two-three month residence with intensive follow-up away from the street children environment before the young person can by restored to their home or given a skill to enable them to be self-sufficient.

___________________________________________________
A Cambodian NGO, M’Lop Tapang, has a drug rehabilitation programme. This starts with offering a safe place for kids to go during the day. This is a separate location from the main street kids facilities. This allows children to arrive high and to sleep off drugs at anytime of the day. They receive counselling, food, help, medical care and have access to regular exercise and group sports programmes. The on-site, specialised staff get to know them closely and visit them on the streets at night. They know their routines, friends, family, drugs of choice. Once a child starts to show signs of tackling their addiction and committing to trying to stop, the programme intensifies. Children and youths are encouraged and if they show a change in attitude after regular visits and counselling sessions, they are then introduced into other M’Lop programmes such as vocational training or education. They continue to be monitored and to work with their original care workers. Relapses happen often and kids disappear often for periods of time. But over the years, the pattern is that they always return and ask for help again. Long-term success rates are high. Programmes have also been set up to help parents of street children – alcohol and drug-addiction support groups.
International Childcare Trust, Cambodia
___________________________________________________

___________________________________________________Anderson first came to Viva a Vida in Salvador when he was just 13 years old. He had lived on and off the streets since the age of 8. His mother often went looking for him and brought him home several times, but he never stayed long as he did not get on with his stepfather. On the streets he started glue sniffing and smoking marihuana at an early age. By the time he was 12 he was addicted to crack. He would spend his days begging at traffic lights near a neighbourhood known locally as “crack-land”. As soon as he made enough money for a crack crystal he would purchase one, smoke it and when the effect wore off, usually after 10 minutes, he would be back at the traffic lights begging in order to buy more.

It was his mother who first brought him to Viva a Vida, soon after it opened in 2005. Like others, Anderson struggled to overcome his cravings for crack and went in and out of the programme four times before graduating. The first few times he stayed from 2 weeks to one month, always leaving because he said his drug cravings spoke louder. One particular time, his mother brought in a banjo that he enjoyed playing. The next day he ran away with banjo in tow. To him that banjo ended up representing money for crack. He sold his banjo and bought several crack crystals. As he says, “I smoked up that banjo”. Nevertheless Anderson kept coming back. He always said that he had suffered enough on the streets and did not want to suffer anymore. He participated in individual and group therapy sessions as well as other educational, creative and recreational activities designed to help him build on his strengths and to understand and address his addiction. Anderson went back to school and managed to finish his first year of primary school. At Viva a Vida he also discovered a passion for cooking and now had dreams of becoming a chef. Now at the age of 18, Anderson is drug-free, lives alone in rented accommodation and is doing what he loves: training to be a cook. He still has his difficulties and his moments of self-doubt, as the road to recovery is a long one, but with determination and support he is working towards his dream.
Anderson, Salvador, Brazil - Viva a Vida
___________________________________________________

Some street children are abandoned to the street because of some abnormality or strangeness which may be caused by mental illness - or diagnosed as such. Other children suffer mental stress because of the trauma they experience on the street. A psychiatrist at a recent meeting in Delhi said that frequently a child with apparent mental health problems could be treated with simple medication, but that the opportunity for such children to have that chance is rare.

This catalogue of woes seems grim. Despite such risks, it is remarkable how resilient some street children seem to be. Some of course do not survive. But many others cope with the exposure to disease and injury and seem hardened by it. Some children do take advantage of the attempts by NGOs to support them. NGO staff take such children to hospital and become accountable for them. Many programmes have a sick bay, perhaps a resident nurse, and many have a philanthropic doctor who will visit the project and dispense medicine in his own time and at his own cost. One NGO I knew trained some of the street children in first aid and each week nominated one of them to be ‘doctor’ for the week on the local railway station, equipping the chosen boy or girl with a first aid box. That same NGO then persuaded a couple of doctors from the local private hospital to hold a surgery in the station concourse twice a week amid the swirling throng of people buying train tickets - the waiting room was a carpet on the stone floor - serving up to twenty or so street children from around the station every day they came.

___________________________________________________
A few years ago a fire broke out in an illegal slum settlement beside the railway line in a Calcutta suburb. The fire, started by an overturned oil stove, spread rapidly through the 200 strong community and devastated the slum - the only building left standing was a simple bamboo school where the local NGO gave informal lessons to the children who spent most of the time on the street. Many people, including children, were badly burned and one child died. No fire engines, no ambulances came, no help, other than the project’s visiting Irish and UK trustees. One went with a local doctor and bought all the medicines and first aid equipment they could afford from rapidly pooled cash they all had on them. The trustee from Ireland and the Irish nurse who was advisor to the project applied the best treatment they could give, following diagnosis by the doctor, to the queue of patient stoical men, women and children who had been injured. The other trustee sat on the scorched earth of the little school acting as medical orderly trying to find the right medicines, or cutting plasters and cotton wool, amid the cacophony of Bengali, Hindi and Irish accents. Just as the last patient victim had been treated, after some 4-5 hours of toil, a local politician turned up with a TV cameraman to try to claim public credit for what had been done to assist.
Edith Wilkins Street Children Foundation / Railway Children - Calcutta
___________________________________________________

One enterprising NGO in Delhi, whose founder believes strongly in children fighting for their own rights, has formed a ‘Health Co-operative’. Over a hundred street children pay a rupee a month to belong and hold their own meetings at which they invite medical experts to come and talk to them about the risks and prevention strategies for various types of illness or injury. This is perhaps the ultimate - and positive - expression of what street children do nearly all the time. That is, to take responsibility for their own health or lack of it. I would dearly like to know the impact of such a ‘Health Co-operative’ over the years - whether the children belonging to it have experienced improved health as a result. Fluctuating membership and the itinerant nature of so many street children makes this hard, but it would be good to have an independent evaluation to encourage replication of such an initiative.