A Peacock or a Crow: Stories, Interviews, and Commentaries on Romanian Adoptions
by Victor Groza, Daniela F. Ileana, and Ivor Irwin

Published in January 1999 by Williams Custom Publishing.

Chapter 3:
Dickens, Boys Town or Purgatory: Are Institutions a Place to Call Home?

Institutions for Children in Romania

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.

Normal Child Development -- Keeping Perspective

By understanding what is typical, healthy development, we can better understand how life can be complicated for children growing up in an institution where there is an interruption in the normal path of development. Normally, children develop and grow according to a set schedule. Growth and development begin prenatally and we know that maternal health, nutrition, exposure to stress or toxic chemicals, and the quality of life in general have a profound effect on the developing fetus. After birth, while children vary in their rates of development, they all proceed through the same sequences.

Normal development is governed by intrinsic maturational factors and environmental conditions. Initially, there are rapid changes and gains made in physical development -- children gain weight and grow -- as well as the mastering of physical tasks such as the gross and fine motor skills that allow children to eat, cry, smile, turn over, crawl, stand, walk, jump, etc. To maximize normal growth and development, children need proper nutrition, sunshine, hygienic conditions, warmth, stimulation, attention, and love. At the same time as this is occurring, attachments begin developing, usually between mother and child. At first, the infant becomes attracted to all objects; it is only after several weeks that they begin to prefer humans to inanimate objects. Children will, from birth, give cues to their needs, that, if they are well cared for, will be met by a parent or whoever cares for them. For example, when they are hungry or uncomfortable, they will cry. When they express a need and the need is met in a consistent and timely manner, this results in a foundation of trust for the child toward the attachment figure who is fulfilling their needs. From the first weeks of life, there is a clustering of attachment behaviors that influence both how the child responds to the parent or caregiver as well as how the parent responds to the child. While, initially, children do not differentiate between caregivers, at three-months-old an infant begins to smile more at his primary caregiver than at strangers. By the end of the first six months of life, they learn to discriminate between familiar and unfamiliar attachment figures. From the first year of life, approximately up until the age of three, children will begin to protest when attachment figures leave them and they will engage in various behaviors to remain close to the attachment figure. If an infant develops a trusting relationship with the primary caregiver, the infant will desperately seek to always stay with that one attachment figure. This attachment will enhance the parents' effectiveness in the later socialization of the child. 8

In addition to attachment behaviors, as a child's cognitive abilities develop, he or she develops ideas about relationships and the manner in which the world works, based on these experiences. These changes in their cognitive and intellectual development affect their personality, moral reasoning, and critical thinking skills.

During the first year of life, children begin to acquire language skills. The first skills are sounds such as cooing, crying, laughing, etc. Often they are introduced or reinforced by the primary caregiver. At a later point, children begin to organize the sounds that will eventually become language.

Finally, all these developmental tasks and activities -- physical growth, attachment, cognitive development, the learning of language -- influence the child as a socially skilled being. Obviously, social skills are important for the development and maintenance of the social relationships that are to soon follow. This includes relating to siblings, peers, extended family members, neighbors and community members at large. Social skills are important by the time children are ready to navigate and negotiate their way to preschool, kindergarten, and other activities outside the home.

This overview of a reasonably normal childhood is important as we look at what happens to children who are institutionalized at an early age. More often than not, they are not exposed to the stimuli of relationships or placed in an environment where the usual needs can be met and the average tasks of childhood are not accomplished.

Recent research strongly suggests that many of the tasks and developmental achievements, those which are not organically or physically based, influence the neurological and biochemical development of the brain. Unfortunately, such ideas are largely based on theoretical models and related research on animals. The degree to which they accurately reflect the capacity of children's brains to be able to reverse childhood trauma is not well known.

In 1996, a new round of sensationalism was added to the media coverage of the problems associated with children who have been institutionalized before adoption. Family tales of suffering and soft science met on TV programs. Adopted Romanian children were treated as guinea pigs as the news media touted brain scans for children who had been institutionalized early in life. Despite all those visual images of all-black brain scans and patches of blue and red activity areas in their brain, most children look good. This type of information, black brain scans, was taken from a very small group of children and is meant to be gathered for research. Indeed, the information from this type of research is still very much in the early stages. The danger, concerning the media in this case, is that it gives the public a skewed, simplistic view of an issue that is as complicated as the brain itself. Knowing that a part of your child's brain isn't functioning doesn't give you any information about what you can do differently. It creates anxiety and fear, but doesn't tell a family or a practitioner what can be done to improve upon the actual problem. Children's brains have amazing recuperative powers. The fact is, that despite the media's relentless attempts to sow panic among a susceptible public, it's still too early to come to any absolute conclusions.

What is certain is that the quality of a family and social environment is crucial. If we accept that a family is an ideal environment for a child, then we need to understand what happens to children who spend their formative years in some kind of group or institutional setting.

The Effects of Institutionalization

The negative effects of early institutionalization have made headlines in England and America for the past 90 years. Institutionalization early in life interrupts the parent/child cycle of bonding, which results in attachment difficulties as well as slowing emotional, social, and physical development. 9 Early deprivation can affect a person's ability to make smooth transitions from one development stage to another throughout life.

Henry Dwight Chapin 10 was one of the first researchers to examine child development in institutionalized settings. The director of pediatrics at Columbia University Medical School, Chapin began his work after realizing that, by the turn of the century, the infant mortality rate in institutions had reached an astonishing 100%. Chapin discovered that there was a critical period for development in institutionalized infants -- that the first year of life is absolutely crucial for normal development and the first six months even more important than the second. 11 He reported that the first noticeable effect of institutionalization was a progressive loss of weight. If weight loss got beyond a certain point, no change in the amount of food intake or environmental change could save the child. Dryness of skin, loss of hair, and dehydration accompanied this condition. The predominant cause of death was not starvation but pneumonia.

Chapin became convinced that infants were at a great risk for developmental difficulties and a quick death when placed in institutions. In the early 1890s, he opened the first hospital social service in the United States. He believed it was essential that infants only be institutionalized briefly, if at all. Acting on this belief, Chapin began a boarding-out or fostering system in 1902, where hospitalized infants were placed in the homes of private families. This was one of the forerunners of the foster care movement in the U.S.

Society took note: humanitarian changes were made in the U. S. system of institutions. Still, despite serious improvements in hygienic conditions and sanitary practices, increased knowledge of infection control, and better food, the mortality rate of infants in institutions did not substantially decline. The single most important factor, Chapin felt, was a lack of proper individual attention, care and stimulation; that which, under normal circumstances, were provided by maternal love and care. 12 He also concluded that it was not the length of time spent in an institution, but the age at which the child was initially placed: the younger the child, the more serious the effects and greater the risk of negative effects.

Once the family foster system was properly established, the high infant mortality rate declined. Photos and data from Chapin's research clearly show how children looked on the day they were removed from institutions and then how they looked six months after they entered a foster home. The most drastic change was weight gain. By 1917, Chapin had concluded that this effect was a consequence of close individual care, especially the holding of infants when they were fed (as opposed to just holding the bottle in an upward position and feeding the infant in its crib without any physical contact). 13

Subsequent to Chapin, several researchers did seminal work in the areas of the effects of institutions on early growth and development. There is ample evidence that early institutionalization can result in severe emotional and behavioral problems as well as fundamental problems with learning, reading ability, and basic intellectual functions. 14 Behavioral problems included aggressive or antisocial behavior, and difficulty in forming close, intimate relationships. Still, such results have had no absolutes; there have been many cases of remediation or the reversibility of early trauma. For example, in one of the earliest studies conducted, Professor Goldfarb in England 15 concluded that some children adjust well socially and emotionally despite their negative experiences of institutional deprivation in early childhood. Other researchers also found that prolonged institutionalization does not necessarily lead to emotional problems or character defects in all children. 16 This suggests that there will always be some children who fare well, who are resilient, regardless of their experiences in early childhood. However, these earlier studies should be viewed with caution. The institutions in these studies were not prototypical of Romanian institutions. Children in these studies who had been institutionalized had access to individual space, good nutrition, education programs, and adequate child-to-staff ratios.

Still, this work leads to certain conclusions. It certainly is a fact that, while children can be positively affected by moving from institutions to families, the effects of the past do not necessarily disappear over time. 17 Just as is the case with typical families, beyond issues of economic well-being, environment and social class, one comes to a clear conclusion that most of us already know instinctively: a lot depends on parental willingness to devote a great deal of time and attention to their children to help them recover.

A helpful set of studies, for the sake of perspective, is one involving twins done by Jarmila Koluchova in 1972 and 1976. 18 These twins, born and raised in a conventional family setting with the appropriate care up until the age of eighteen months, had then been institutionalized, isolated and neglected until the age of seven. Despite initial diagnoses that were pessimistic, by age eleven the children had made amazing progress. These children ultimately performed at average levels in school. Within four years, they attached strongly with a mother figure and a carefully trained, networked team of multi-disciplinary professionals. Koluchova found that, with good stimulation and care over the first two years of life, children can recover from subsequent bouts of neglect and isolation. A unanimous opinion of experts involved in these early studies is that the children who adjust the least well of all when it comes to coping with separation are the ones who are institutionalized before the age of one.

A specific problem, of concern to parents and professionals, is the effects of institutionalization on attachment. Attachment is a term you'll hear a lot. It applies to a durable, lasting relationship between a child and one or more persons with whom he or she interacts regularly: ideally a family and other siblings. Attachment serves a variety of functions, such as basic nurturing, interaction, discipline and affection. Attachment is the connection that allows parents to teach values and expectations, and for children to accept these values and expectations.

Attachment develops over time; it is not a static process, but a continuum from weak to strong, influenced by life's experiences, that has to be labored at and developed. So, it changes over time. The impact of institutionalization on long-term attachment patterns is not well known. It is clear that institutionalization places children at-risk for attachment problems, and this contributes to fear and anxiety among parents and professionals.

When we walked into the room, about a dozen children, ages two and three, were sitting on the floor. About half of them immediately got up and ran to us with outstretched arms to be picked up. They were persistent, trying to climb up our bodies if we were not quick enough to pick them up. Some of the bigger or stronger ones would push the smaller ones away. They would touch our face, look at us and say Mama or Tata (father). They were indiscriminately affectionate. There were a few children who just looked at us blankly and continued to sit on the floor. They would avoid our attention if we looked at them. They made no attempt to move towards or away from us. But a few children looked at us, screamed, and ran to their nurses for protection and comfort. The reactions of these children, all in the same setting with the same experiences, represent different patterns of attachment. What we could not tell potential families is which of these patterns would change.

John Bowlby, who worked for the World Health Organization early in his career, provided the basis for most of attachment theory and practice. He argued that institutions fail to provide children with the intimate, warm, and continuous relationships that primary caregivers (usually mothers) can give. According to Bowlby, such a relationship is an absolutely necessary condition for successful human development. If a child is institutionalized for long enough, he or she may become incapable of forming the breadth and depth of human relationships necessary for survival and development. Attachment also provides the foundation of a conscience. In a "normal" home, attachment to parents results in the child wanting to act in ways that please the parent. If early connections are weakened or problematic, there is a decrease in the desire to please the people important to us -- because people are just not that important to us. Related research has identified children with histories of early childhood abuse or neglect as being at greater risk for experiencing attachment difficulties. 19

We were told that the Institutions for the Irrecoverables were the training ground for Securitate. It was the perfect place to raise children into mindless, guiltless puppets who would rob, torture or kill for a reward. As an example, one of the children in the institution was considered educable, even though he had some retardation. While we were there, he had been taken to a farm for training. The farmers taught him how to string up and butcher a pig. The next night, he put his skills into action. All night long we had been kept awake by the pitiful howls and moans of a dog. When we asked one of the guards, he said it had been a dog in labor all night. One of the nurses told us, outside the hearing range of the guard, that he was a liar. The boy who had been taken to the farm had taken a dog, strung it up, and tortured it -- using the butchering of the pig as his guide. He did this to the jeers and encouragement of the guards. What we heard that night was the suffering of the dog, who after hours of torture was left to die on her own. The next day the boy was beaming as he was praised by the guards, and relished the fear shown by the nurses.

Adults who formed healthy attachments during early childhood will have the capacity to experience healthy adult life. Children who were emotionally deprived, however, will continue to remain emotionally isolated as adults, have difficulty with relationships, and may act in deviant or delinquent ways. They are all too often manipulative in their behavior, using others for their emotional support without reciprocating or letting anyone get close to them emotionally. Some are haunted by loneliness. As adults they often cannot hold on to either jobs or relationships.

These studies clearly have many implications concerning the health and development of children from Romanian institutions. These children can be considered at risk for health and developmental problems. Families adopting them need to be prepared for their special needs. We are still learning to identify the trauma that is reversible and the trauma that is manageable, since the effects of some trauma are long term and unlikely to change.

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.

GABRIELA 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."

CHARLES DICKENS: Oliver Twist

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.

Notes from chapter 3

1 Johnson, A. K., Edwards, R. L., & Puwak, H. C. (1993). Foster care and adoption policy in Romania: Suggestions for international intervention. Child Welfare, 72(5), 489-506.

Stephenson, P. A., Anghelescu, C., Bobe, N., Ciomartan, T., Gaistenau, M., Fumarel, S., Goldis, C., Georgescu, A., Ionescu, M., Iorgulescu, D., Lupu, R., McCreery, R., McKay, S., Manescu, V., Mihai, B., Moldovanu, F., Moldovan, Z., Morosam, I., Nanu, R., Nicolau, A., Palikari, G., Pascu, C., Popa, S., Popescu, P., Raican, A., Stanescu, A., Stativa, E., & Stoica, M. (1994). The causes of childrens' institutionalization in Romania. Child Care Health and Development, 20(2), 77-88.

2 UNICEF. (1997). Children at risk in Central and Eastern Europe: Perils and promises. Florence, Italy: United Nations Children's Fund, International Child Development Centre.

3 Romanian Monitor News, August 7, 1997.

4 See also Johnson, A., & Groze, V. (1993). The orphaned and institutionalized children of Romania. Journal of Emotional and Behavioral Problems, 2(4), 49-52.

5 Johnson, A., & Groze, V. (1993). The orphaned and institutionalized children of Romania. Journal of Emotional and Behavioral Problems, 2(4), 49-52.

6 Sloutsky. V. M. (1997). Institutional care and developmental outcomes of 6- and 7-year old children: A contextualist perspective. International Journal of Behavior Development, 20(1), 131-151.

7 Harrison, L, Rubeiz, G., & Kochubey, A. (1996). Lapsele Oma Kodu (bringing abandoned children home): A project from Tallinn, Estonia to reunite institutionalized children with families. Scandanavian Journal of Social Welfare, 5, 35-44.

8 Hetherington, M. E., & Park, R. D. (1986). Child psychology: A contemporary viewpoint. New York: McGraw-Hill.

9 Bowlby, J. (1951). Maternal care and mental health. World Health Organization Monograph No. 2. Geneva: WHO.

Bowlby, J. (1969). Attachment and loss: Attachment. New York: Basic Books.

Bowlby, J.(1973). Attachment and loss: Separation, anxiety and anger. New York: Basic Books.

Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. Routledge, London: A Tavistock Professional Book.

Frank, D. A., Klass, P. E., Earls, F., & Eisenberg, L. (1996). Infants and young children in orphanages: One view from pediatrics and child psychiatry. Pediatrics, 47(4), 569-578.

Freud, A., & Burlingham, D. T. (1944). Infants without families. New York: International University Press.

Goldfarb, W. (1943b). Effects of early institutional care on adolescent personality. Journal of Experimental Education, 12, 106-129.

Goldfarb, W. (1955). Emotional and intellectual consequences of psychologic deprivation in infancy: A re-evaluation. In P. Hoch & J. Zubin (Eds.), Psychopathology of childhood (pp. 105-119). New York: Grune & Stratton.

Provence, S. A., & Lipton, R. C. (1962). Infants in institutions. New York: International Universities Press.

Spitz, R. A. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1, 53-74.

Tizard, B., & Joseph, A. (1970). Cognitive development of young children in residential care: The study of children aged 24 months. Journal of Child Psychology and Psychiatry, 11, 177-186.

Tizard, B., & Rees, J. (1974). A comparison of the effects of adoption, restoration to the natural mother, and continued institutionalization on the cognitive development of four year old children. Child Development, 45, 92-99.

Tizard, B., & Rees, J. (1975). The effect of early institutional rearing on the behaviour problems and affectional relationships of four-year-old children. Journal of Child Psychology and Psychiatry, 75, 61-73

Tizard, B., Hodges, J. (1977). The effect of early institutional rearing on the development of eight-year-old children. Journal of Child Psychology and Psychiatry, 19, 99-118.

10 Chapin, H. D. (1911). The proper management of foundings and negleted infants. Medical Record, 79, 283-288.

Chapin, H.D. (1916). A scheme of state control for dependent infants. Medical Record, 84, 1081-1084.

Chapin, H. D. (1917). Systematized boarding out vs. institutional care for infants and young children. New York Medical Journal, 105, 1009-1011.

11 Gray, P. H. (1989). Henry Dwight Chapin: Pioneer in the study of institutionalized infants. Bulletin of the Psychonomic Society, 27(1), 85-87.

12 Gray, P. H. (1989). Henry Dwight Chapin: Pioneer in the study of institutionalized infants. Bulletin of the Psychonomic Society, 27(1), 85-87.

13 Chapin, H. D. (1917). Systematized boarding out vs. institutional care for infants and young children. New York Medical Journal, 105, 1009-1011.

14 Freud, A., & Burlingham, D. T. (1944). Infants without families. New York: International University Press.

Goldfarb, W. (1943b). Effects of early institutional care on adolescent personality. Journal of Experimental Education, 12, 106-129.

Goldfarb, W. (1955). Emotional and intellectual consequences of psychologic deprivation in infancy: A re-evaluation. In P. Hoch & J. Zubin (Eds.), Psychopathology of childhood (pp. 105-119). New York: Grune & Stratton.

Provence, S. A., & Lipton, R. C. (1962). Infants in institutions. New York: International Universities Press.

Spitz, R. A. (1945). Hospitalism: An inquiry into the genesis of psychiatric conditions in early childhood. Psychoanalytic Study of the Child, 1, 53-74.

Tizard, B., & Joseph, A. (1970). Cognitive development of young children in residential care: The study of children aged 24 months. Journal of Child Psychology and Psychiatry, 11, 177-186.

Tizard, B., & Rees, J. (1974). A comparison of the effects of adoption, restoration to the natural mother, and continued institutionalization on the cognitive development of four year old children. Child Development, 45, 92-99.

Tizard, B., & Rees, J. (1975). The effect of early institutional rearing on the behaviour problems and affectional relationships of four-year-old children. Journal of Child Psychology and Psychiatry, 75, 61-73

Tizard, B., Hodges, J. (1977). The effect of early institutional rearing on the development of eight-year-old children. Journal of Child Psychology and Psychiatry, 19, 99-118.

15 Goldfarb, W. (1955). Emotional and intellectual consequences of psychologic deprivation in infancy: A Re-evaluation. In P. Hoch & J. Zubin (Eds.), Psychopathology of Childhood (pp. 105-119). NY: Grune & Stratton.

16 Pringel, M. L., & Bossio, V. (1960). Early, prolonged separation and emotional adjustment. Journal of Child Psychology and Psychiatry, 37-48.

Wolkind, S. N. (1974). The components of "affectionless psychopathy" in institutionalized children. Journal of Child Psychology and Psychiatry, 15, 215-220.

17 Wolkind, S., & Rutter, M. (1973). Children who have been "in care" -- an epidemiological study. Journal of Child Psychology and Psychiatry, 14, 97-105.

Tizard, B., Hodges, J. (1977). The effect of early institutional rearing on the development of eight-year-old children. Journal of Child Psychology and Psychiatry, 19, 99-118.

18 Koluchova, J. (1972). Severe deprivation in twins: A case study. Journal of Child Psychology and Psychiatry, 13, 107-114.

Koluchova, J. (1976). The further development of twins after severe and prolonged deprivation: A second report. Journal of Child Psychology and Psychiatry, 17, 181-188.

19 Bowlby, J. (1951). Maternal care and mental health. World Health Organization Monograph No. 2. Geneva: WHO.

Bowlby, J. (1969). Attachment and loss: Attachment. New York: Basic Books.

Bowlby, J.(1973). Attachment and loss: Separation, anxiety and anger. New York: Basic Books.

Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. Routledge, London: A Tavistock Professional Book.

20 Ames, E. W., & Carter, M. (1992). Development of Romanian orphanage children adopted to Canada. Canadian Psychology, 33(2), 503.

21 Johnson, A., & Groze, V. (1993). The orphaned and institutionalized children of Romania. Journal of Emotional and Behavioral Problems, 2(4), 49-52.

22 Bascom, B. B., McKelvey, C. A. (1997). The complete guide to foreign adoption: What to expect and how to prepare for your new child. New York: Pocket Books

23 McMullan, S. J., & Fisher, L. (1992). Developmental progress of Romanian orphanage children in Canada. Canadian Psychology, 33(2), 504.

24 Sweeney, J. K. & Bascom, B. B. (1995). Motor development and self-stimulatory movement in institutionalized Romanian children. Pediatric Physical Therapy, 7, 124-132.

25 Ames, E. W., & Carter, M. (1992). Development of Romanian orphanage children adopted to Canada. Canadian Psychology, 33(2), 503.

26 Johnson, A., & Groze, V. (1993). The orphaned and institutionalized children of Romania. Journal of Emotional and Behavioral Problems, 2(4), 49-52.

27 Wolkind, S. N. (1974). The components of "affectionless psychopathy" in institutionalized children. Journal of Child Psychology and Psychiatry, 15, 215-220.

28 Macovei, O. (1986). The medical and social problems of the handicapped in children's institutions in Iasi. Bucharest, Romania: Pediatrie -- Ed. Didactica si Ped, Institutul de Igiena si Sanatate Publica.

29 Johnson, D. E., Miller, L. C., Iverson, S., Thomas, W., Franchino, B., Dole, K., Kiernan, M. T., Georgieff, M. K., & Hostetter, M. K. (1992, December 23/30). The health of children adopted from Romania. Journal of the American Medical Association, 268(24), 3446-3451.

Johnson, D. E., Miller, L. C., Iverson, S., Thomas, W., Franchino, B., Dole, K., Kiernan, M. T., Georgieff, M. K., & Hostetter, M. K. (1993, April 28). The health of children adopted from Romania. Journal of the American Medical Association, 269(16): 2084-5.

30 Judy Siegel. (1990, February 9). Health Ministry Recommends Testing Adopted Romanian Children for AIDS. The Jerusalem Post.

31 Kaler, S. R., & Freeman, B. J. (1994). An analysis of environmental deprivation: Cognitive and social development in Romanian orphans. Journal of Child Psychology and Psychiatry and Allied Disciplines. 35(4), 769-81.

32 Sweeney, J. K. & Bascom, B. B. (1995). Motor development and self-stimulatory movement in institutionalized Romanian children. Pediatric Physical Therapy, 7, 124-132.


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