June 26, 2009

Death in Birth

Fragile Tanzanian Orphans Get Help After Mothers Die
Published: June 24, 2009

BEREGA, Tanzania — The Berega Orphanage, a cluster of neat stucco
cottages in this village of red dirt roads and maize plots, is a far
cry from what the name suggests. The 20 infants and toddlers here are
not put up for adoption, nor kept on indefinitely without hope of ever
living with a family.

More than half a million women a year die during pregnancy and in
childbirth, largely from problems that can be treated or prevented.
This is the third of three articles on efforts to lower the death rate
in one African country, Tanzania.

At the Berega Orphanage, girls care for younger children until they
can go live with relatives.

Most of their mothers died giving birth or soon after — something
that, in poor countries, leaves newborns at great risk of dying, too.
The children are here just temporarily, to get a start in life so they
can return to their villages and their extended families when they are
2 or 3 years old, well past the fragile days of infancy and big enough
to digest cow’s milk and eat regular food.

And, in an innovative program designed to meet the infants’ emotional
as well as physical needs, many have teenage girls from their extended
families living with them at the orphanage.

Africa is full of at least 50 million orphans, the legacy of AIDS and
other diseases, war and high rates of death in pregnancy and
childbirth. With the numbers increasing every day, Africans are
struggling to care for them, often in ways that differ strikingly from
the traditional concept of an orphanage in the developed world.

Programs like the one in Berega are “the way to go” in Africa, said
Dr. Peter Ngatia, the director of capacity building for Amref, the
African Medical and Research Foundation, a nonprofit group based in
Nairobi, Kenya.

He said similar programs for AIDS orphans had worked well in Uganda,
looking after the children until age 5 and then sending them back to
their families or volunteers in their communities.

“In less wealthy nations, people are being very creative,” said
Kathryn Whetten, an expert on orphan care from Duke University. She
had not seen the orphanage in Berega or encountered others like it.
But that did not surprise her. Little is known about orphan care in
Africa, she said, because little research has been done. On a recent
trip to Moshi, a Tanzanian city of about 150,000, she said, local
officials knew of three orphanages. She and her colleagues found 25
there, most with 10 to 25 children each.

The Berega Orphanage is of that size, one small, apparently successful
attempt to cope with the aftermath of more than a quarter-million
deaths of women each year in pregnancy or childbirth in Africa.

They die from bleeding, infection, high blood pressure, prolonged
labor and botched abortions — problems that can be treated or
prevented with basic obstetrical care. But in Tanzania, which has
neither the worst nor best medical care in Africa, but is similar to
many poor countries, everything is in short supply: doctors, nurses,
drugs, equipment, ambulances and paved roads. By the time many women
get to the 120-bed hospital here, it is too late to save them.

Their babies may be saved, but their survival hangs in the balance.
Often, the father or other remaining relatives cannot take care of
newborns. Without breast milk, infants here are in real trouble.
Formula and baby food are not widely available, and cow’s milk is a
poor substitute. Malnutrition and infection are constant threats. An
orphanage can provide basic needs, but to thrive, babies need
dedicated caregivers, and their extended families may live in distant

The orphanage here, started in 1965 by United German Mission Aid, an
evangelical Christian mission, began recruiting relatives to move in
about five years ago. Ute Klatt, a German missionary and nurse who has
been director of the orphanage for 10 years, said she learned about
the practice from another orphanage in Tanzania. Now many of the
children at the orphanage are cared for by a teenage girl from the
extended family — a binti, in Swahili — often a sister, cousin or
aunt, who lives with them and learns how to take care of them.

The young women come to love the children, and will look after them
when they leave the orphanage, Ms. Klatt said. In addition, the
bintis, some of whom have never been to school, gain some education.
Ms. Klatt provides schoolbooks, she said, and the young women study
and teach one another in the evenings. Many arrive illiterate and
leave knowing how to read. She also teaches them the basics about
health, and they learn sewing and batik, and share the cooking in an
outdoor kitchen.

“Before we had this system, the families weren’t visiting, and it was
hard to reintegrate the children,” Ms. Klatt said. “There were
attachment disorders.”

With the bintis, Ms. Klatt said, life becomes less institutional and
the children grow up more normally, as they might at home.

On a recent visit to Berega, the children seemed to be thriving.
Dressed in shorts, T-shirts and sandals, they looked well fed and were
bursting with energy as they chased one another around the patio and
competed for attention from Ms. Klatt, whom they called Mama Ute. Shy
at first with visitors, they were soon competing for laps to sit in
and hands to hold.

Ms. Klatt said the infants were fed formula, and the older children
ate food grown or raised nearby: bananas, mangoes, cereal made from
maize, chicken, goat, and tomatoes, greens and other vegetables. They
attend nursery school at a nearby church.

Late one afternoon on the patio, 10 bintis gathered with the children,
and shyly told what had happened to their families. They spoke in
Swahili, and Ms. Klatt translated.

One young woman, Lea, looked after her 2-year-old cousin Simoni, whose
mother gave birth to twins and died on a bus on the way to the
hospital. She had been in labor for “only a few days,” Lea said, and
did not know she was carrying twins. It was her first pregnancy.
Simoni’s twin died a few days after birth.

Another binti, named Happy, took care of twin cousins, Jacobo and
Johanna, whose mother, Paulina, died after giving birth at home.
Before that, two of Paulina’s other children had died, one at 5
months, one at 9 months. Others told similar stories, of mothers dying
at home or in cars on the way to the hospital.

Ms. Klatt said it had been her dream since childhood to work as a
missionary in Africa, though she had never imagined running an
orphanage. She said one of her greatest rewards was when older
children who had been in her care came back to visit, and were
obviously healthy and happy, living with their families back in their
home villages.

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