Children prove best carers to ease Africa's orphan crisis

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

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 two or three 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 programme 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 has at least 50 million orphans, the legacy of Aids and other diseases, war and high rates of death in pregnancy and childbirth.

Programmes like the one in Berega are the best way to cope with the numbers 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 programmes for Aids orphans had worked well in Uganda, looking after the children until age five 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. 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 ten to 25 children each.

The Berega orphanage is of that size, one small 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 labour and botched abortions – problems that can be treated or prevented with basic obstetrical care. But in Tanzania, 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.

The Berega Orphanage, 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 ten 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, Klatt said. In addition, the bintis, some of whom have never been to school, gain some education. Klatt provides elementary school books, she said, and the young women study and teach each other 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," Klatt said. "There were attachment disorders."

With the bintis, 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 Klatt, whom they called Mama Ute. Shy at first with visitors, they were soon competing for laps to sit in and hands to hold.

One young woman, Lea, looked after her two-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 labour 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.