Anne McNicholas
Head of Health Aid UK
Anne is head of the organisation Health Aid UK, which is the parent organisation to Health Aid Romania. She is in the middle of the archive photo shown, with house-mother Mihaela to her left, at a celebration organised for the children in the hospital. .
Tell us about Health Aid
Health Aid started in 1985. We already had a project in Ethiopia. I read an article about the vast numbers of HIV+ children in Romania – that was 1990. We were working giving medical and nursing support in Ethiopia, then.
It’s very small. But our aims are the relief of suffering, the provision of humanitarian aid, and working alongside people [nurses, etc] after a humanitarian crisis.
We’ve also been involved during the first Gulf war. We also responded to Rwanda. Sri Lanka after the tsunami. But Romania has always been a constant.
This [Romania] has been our longest project. Usually we’d have a much shorter duration. It took quite a long time to find adequate personnel to look after the children. We were breaking new ground – these HIV+ children in Romania are totally unique.
As a result of the way that they were infected, their abandonment, we were presented with a situation where we felt we couldn’t walk away from them. We had to implement ongoing care. We started out saying it was TLC for the children, and education for the staff. As time went on, we realised it was education and training the children would need, and the staff would need tender loving care!
What made you decide to take your projects into Romania?
Most people in the west were delighted with watching the fall of Communism that Christmas. Prior to that my knowledge of Romania was not extensive at all. The situation with the children and the furore of the international media – institutionalised children in dire circumstances… orphans seemed to be the word of the day.
That alone wouldn’t have drawn us in – other organisations would have been better equipped… …It was about February when I read an article in the times. There seemed to be a lack of nursing personnel. Within minutes I had a team of people ready to go. We were motivated by the children that nobody seemed to want. And I don’t mean adoption – these children were desperately ill. Why should these children have HIV? Large numbers of babies – it seemed unbelievable…
I (tracked down Colentina Hospital) – and they said: ‘please come yesterday’. For the first five months we lived in the hospital, with the patients. Ate there. It allowed us to cement our relationship with the Romanian medical authorities. We had lots of company – cockroaches, rats, mosquitoes…
It was a very depressing place. A depressing city. Few people smiled. The children were incredibly silent. It was like going back to Dickensian times. Dark, satanic, unfriendly buildings. With little attempt to make things pleasant for the children or staff.
A lot of Romanian people were criticised for their care of the children in the early days. I’d like to put on the record that a lot of those people volunteered to work those wards, and sixteen years on are still there. And the lack of resources was not their fault. The health ministry was totally under-funded.
What was medical training like?
The doctors are very well trained. Their knowledge is on a par with anywhere. Their resources are limited. The nursing training… probably is similar to Poland or France. Their role is cleaning. Not medical.
We started with cleaning. The hospital had a wish list – they wanted equipment. We wanted the basics.
How many children did you care for at that time?
In the first days there were less than a hundred. Probably thirty. But as the world went in adopting children, and it was mandatory for the children in the orphanages to be tested for the HI virus… the institutions, if they found a child positive, didn’t want to keep that child.
So our hospital became a dumping ground from all over the country. At one point we had 120 – 130 children. All of whom were bottle fed; all of whom were under three… and some of whom were in a dreadful condition.
It was hard. There was a tremendous emotional factor. And certainly no treatment. It was a matter of treating opportunistic infections as they arose. And it’s not rocket-science to know that with that many children all together – if one is coughing and spluttering, within a week they all will be.
And also, we were saddened – still are – about the fact that so many of the treatments the children need seem to have to be given by injection. To see injections being given to little ones with scrawny legs and arms…
We were told that Romania produced oral medicines, but they were being exported - and couldn’t be afforded for their own use. And I thought that was sad.
…We didn’t have a really high contact - with the Ministry of Health in England - working with Romania. In Romania they never lasted long. They were changing every six months.
Can you talk about the social stigma connected to working with HIV+ children at that time?
I think, again – I pay credit to the Romanian nursing staff, who didn’t tell their husbands, partners, exactly which ward they worked on. They were very courageous. Just as people were horrified by images of the Ethiopian famine, in was horrible to see withered and wasted babies who’d died of AIDS…
The media focussed for a while on the negative, fear mongering. They developed this ignorance. They were painting with just one wide brush.
How did you find the country when you first arrived?
We were surprised in the very early days by the amount of hospitality extended by the doctors… they’d take you to their house and feed you and – whatever they had, they shared. Even the patients on the ward shared. We were unusual – living on the hepatitis ward with the patients… I’m sure we were discharged a few times! When they looked through the door and saw we weren’t yellow – “she can go home!”
It was difficult surviving. Today it’s a cosmopolitan city – restaurants, everything… in those days you’d struggle to buy fresh fruit, bananas. Right until the first Christmas you struggled to buy OJ, milk. There were long queues of people outside all day long.
Part of the communist propaganda had been how well the farms worked, how rich the farmers were… of course the tragedy was that the grain stores were depleted. It was hard for the children because their diet was incredibly monotonous. The milk got thicker and thicker, the holes in their teeth bigger and bigger. It was surprising how long before you could find meat and cheese in the shops.
…Eventually we were given accommodation [at Colentina Hospital]. We had a tremendous group of volunteers – police, etc… we replaced three hundred cots, painted the walls… We struggled in the early days to find paint and brushes. You prayed for supermarkets and places like B&Q.
And then we found it was possible to rent an old house, which needed refurbishment…
Tell us about that decision to establish social-houses
…I wouldn’t take credit for the idea. We were trying to improve conditions for all the children, all the time. We could see that some of the children were in a better condition than others. We introduced special needs teachers. Some people (organisations) took bricklayers to be carers, etc. We kept people in the role they were there for. Of course they mixed with the children, but in the hospital, we kept things very professional.
I think initially I couldn’t see how it would function. At that time the HA volunteers were propping up almost the whole staffing set-up. It didn’t matter so much changing volunteers in a hospital – but in a home, it would be another rejection for the children.
There was no example to follow for this plan. Once I realised we were employing more and more good Romanian people who had a good attitude toward the children, it became possible…
Tell us about finding house-parents
We actually took as the first Romanian house parents a couple who were already married, with a child of their own. They worked in the hospital as educators. And the second couple – she worked as a nurse, and Cristi was an educator…
It almost became family and word of mouth. We also advertised, which raised some interesting social issues. They came, saw the children, saw the house, thought it was wonderful – then we mentioned HIV, and the hands went up in horror…
But the house parents – they and the children are the stars. They’ve had a difficult road to go down.
In the early days we had problems with our conscience about how to select the children. We had to show the outside world that these children were okay - and why should they be in a hospital? We heard a horrific story about a family with an HIV+ child in an apartment who were told if they didn’t leave they would be burnt out… and these people knew because somebody who worked at a clinic had told them…
I think we had to try to show that these children looked reasonably healthy. And that they looked – I hate to say the word – normal as any other child. That still left us with pangs of conscience about some of the children with special needs. Though a house was ultimately opened for some of those children.
They were all roughly the same age group. Ideally there would have been children of different ages – but because of when the crisis had taken place, this wasn’t possible. In a normal home you don’t usually get eight children of the same age…
How did you cope during those first, difficult years?
…We were very defiant in the early days. We didn’t believe everything we were told. That all of these children would just drop into this dreadful black hole, and be eliminated. It just didn’t seem possible. Although many – including our British health officials – felt that was on the cards. Tried to prepare us for looming disasters.
And we did have disasters – we cannot forget the children who died. But the big black hole never came, and I think that we were right to argue, and to let the children live outside an institution. To badger the authorities to feed them – you know? These are Romanian children – we didn’t import them. You can’t ignore them. Who clothes them? Puts shoes on them?
We tried to stop this trucking of things from the UK because our children were at an age where everything they were wearing was second hand and – we were trying to normalise things for them. For someone to be forever handing them shoes, trousers…
…We decided early on that – although I would coordinate with the authorities –we needed a Romanian manager… …We decided to put the admin very clearly on a Romanian footing. Tina [Rotariu, head of Health Aid Romania] came from Unicef, and thank God she did. When she worked with Unicef it was very easy – everybody opens the door to Unicef. But now it’s – ‘who are you’? We established early on that we wouldn’t bribe. She would spend hours waiting in corridors…
What is the funding situation like with Health Aid now?
With regard to HAR, they’ve been encouraged to seek donors from countries other than England. At the beginning there was a lot of interest from UK, which waned, but other countries are still interested. They get support from Canada, the US – a small amount – Germany, Austria, a Dutch organisation… It’s taken a burden away from HAUK. There are people from Scotland supporting, religious organisations….
Over the last few years it’s been very difficult. I think Romania probably still gets bad press. Some deserved, some not. And people have very short memories. People say things like – ‘are they not ok now?’ or ‘it was ok at the beginning, but why do they still need help?’
And it’s true that the care ought to come from within Romania. At the beginning we said – we’ll put the jam on the bread, but you put the bread there’ – but often they didn’t. However, things are improving… but there’s still not that freedom to plan a year or two in advance.
We’ve opened some independent living schemes. The ministry of health are late in payments, late in implementing strategy. At the start two apartments were planned. The second only came last year with a tremendous input from the UK. I’m sure that when the Bill Gates foundation came to this they didn’t expect that the weakest partners would be the state, the government.
What’s the legal situation like in terms of the children’s rights and status?
They change the goalposts every six months. The same people don’t stay in power. In this country if we appoint house parents, they know where their responsibility begins and ends. They can take a child for a holiday, or…
In Romania the authorities say – ‘have you got permission of the parents?’ Well, these children haven’t seen them for 16 years. And the children are [Health Aid’s] care! But they’ll say they need the parent’s signature for a passport…
the parents seem to have rights, but the children don’t. They’re happy to know the child is cared for, but they don’t want the child back. Why then does this father have to be the one to sign the paper allowing the child to leave the country?
How is the situation changing in Romania in general?
An awful lot of things have changed. For the better. At one time the people you would meet would be aid workers from other organisations. Now you meet a few tourists. And business people. They see Romania as - being a place coming into the EU – a good place to do business with. There’s a lot of international companies there. Fashion shops. Marks and Spencers. Porsche. Land Rover.
I think for the ordinary people, they have a basic salary – and what’s happening now, I’m not sure if it’s progress, but a lot of the people get food coupons as part of their salary… there are supermarkets… debit cards…
And how about the children? How are they changing in relation to society?
They want - which I think is tremendous – they want to be the same as other teenagers. To dress the same, to look the same. They dress very nicely. They’ve got an eye on style – incredibly coordinated. When I think of the ramjam of clothes they started in. And the incredible friendship between them. There must be sibling jealousy – that’s normal - but how it manifests, I don’t know…
[Since some of the children started attending state school] I think the parents have been pretty shocked by some of the things the kids have come home and said. I think B---- in particular has come home and asked for an explanation of some sexual things…
…We can’t prepare society for them. We have to prepare them for society. They should be dating, kissing… the danger I fear is – will they say something to somebody too soon, and be rejected? Or will they be mature enough to form a relationship, and mature a relationship, before anything takes place? Because they can have relationships, can have children… which I think surprised them. Because they’ve lacked their own parents, they must wonder – what kind of parent will I be?
Once they know that medically they can – well, it’s a quantum leap, isn’t it? Meeting someone, dating, then – do I tell you? Or not? Knowing the vulnerability of the children, I don’t think they’d ever harm someone intentionally. But if they’re rejected time and time again… there’s lots of stories now, “I have a boyfriend, I have a girlfriend” - lots of play – but at 18 and a half, good looking young people, mixing now in a college environment – it’s round the corner, isn’t it?
And who’s prepared us? Of course we have the booklets but – in this country it’s a very different thing. A lot of the sex education materials say things like ‘you may have already lost a parent to AIDS…’ – well, our children have all lost their parents, and not to AIDS!
What are the difficulties in preparing the children for mature relationships, and indeed, sexual relationships?
They’ve made efforts at producing their own materials [to teach the children]. But everybody pulls back from putting anything into very plain language. I know the doctors feel uncomfortable – I know they don’t say ‘if you have sex, da da da’. I think they’re uncomfortable – they know these young people so well that they’re almost and extension of their own family. But it’s the children leading the program again, isn’t it? They ask very sensible questions.
I remember Mihaela in Snagov saying I’m terrified that one of these days I’m going to walk in and one of these girls will say – “I’m pregnant”. And I said – once upon a time your greatest fear was that you’d walk in and one of them would be dead. Pregnancy we can live with.
Dr M---- in Constanta [another care-giving organisation in another town] has 18 pregnant young girls. I think I’d commit suicide if we had 18! But – they have to be prepared. Only by developing the conversations, the visits… it’s better than formal sex education.
Who are the children – where do they originally come from?
They really come from a diverse background. The vast majority of the older ones were abandoned either at birth or slightly after. They might have a handicap, in which case the mother would have been advised that the hospital was the best place for the child to be. I think that would only cover a small percentage of our kids…
Now we know more about the parents, it would seem that some were young, but some were married – and it seems it was almost culturally acceptable to abandon children in those days. If they found they were pregnant it would be acceptable to leave that child in the maternity hospital… then go on and marry and care for whatever children they had…
…Parental pressure on the pregnant girl would suggest – you’re not capable of caring for the child… it seemed to be that the state was there to take care of the child. Children in England going into care tends to be family breakdown, etc. We take them at a later age. In Romania there are hundreds of babies going in to institutions… Perhaps even now, culturally, it is acceptable that a baby is left in the maternity hospital…
With the children in the care of HAR, 95% were not abandoned because of HIV – they were already abandoned. One or two have different reasons – one boy the parents worried about infecting his brother. Another, the mother had five kids already…
We were never promoters of international adoption. If children are to be internationally adopted, as much as is possible ought to be known about their background. There’s very little paperwork… it’s going to be a can of worms when it’s opened…
What we have done, which I’m proud of, is - any snippet of information about a family member, we’ve always kept. With a view to passing on to the children should they wish to know. There has to be a link.
Sometimes I think they almost feel ashamed of their parents. Because they’re almost apologising to us that we love them, their house parents love them, but their parents didn’t. And we say perhaps they were very poor, perhaps… but look at what nice kids you are… but I’m sure it’s hard.
Some of these children were found on the street – so how old is he? Well, it’s like buying a horse, isn’t it? Look at his teeth… and having HIV they’re so thin and… some of the children knew only a name. How must they feel? How much worse to abandon a child on the street than at an institution… children with no dates of birth or names…
One of the things that used to be very sad for us was when a child died, the first thing needed was a birth certificate. Because without this, there was no death certificate. And in some hospitals, dead infants lay in the mortuary for six months so that someone might come forward. How unnatural, that a boy of four should lie six months in a hospital.
What were the biggest challenges facing you on first arriving in Romania?
From a nursing perspective, one of the greatest challenges was weaning babies and children who didn’t want to be weaned. They had to have an improved diet. In another hospital they still had big children getting all their nutrition from a bottle. We didn’t want to remove the comfort of sucking from them.
If you have a group of babies between the ages of six and nine months, they automatically put things in their mouths. We discovered that if that process wasn’t established by ten months – it’s very difficult to go back. It was heartbreaking at times, but – we were fighting for them to survive. To have four little ones sitting in a cot, and none of them knew to put their fingers in the bowl [and feed themselves] - and they screamed and screamed.
To sit and feed and sit and feed – they had no understanding this was food, and they were screaming… Let them rock, let them scream, but get the food in. All babies know that they can get the food in their mouth but – here the children didn’t know that that was food.
And seeing children behave like patients in a mental hospital. They walked by the side of the wall, with no spatial awareness – because they used to be confined to bed, that was their security. Children of five walking with their hand to the wall…
And nurses leaving the cot side down – but the children never moved. They stayed right where they were in the middle of the cot.
And they walked in groups sometimes, you know? And that’s unnatural… seeing children who came to hospital with measles… and that was a diabolical decision…
They all had profound hearing loss, and they were frightened…. Our favourite fallback for everything was bananas. Just get bananas. In 1993, here in Romania, we had children who didn’t know how to peel a banana. And that says a lot…
And you’ve got to pity the staff, who continued to come here. They can’t have had job satisfaction.
And for the children who died – the bizarre burial… there was no state system. We were carrying children in the back of a Lada in an open coffin, to a ceremony that left you completely cold. And just a cross with the date of birth burnt on…
Thank god, we’ve had no deaths now for five years. But now, within the hospital compound, an old ward has been painted up with beautiful fresco paintings. If a child dies now we have a ceremony there, and just the stout hearted ones go to the burial. With the grave diggers sitting, drinking wine and watching us…
I think that kind of civilization and socialisation has improved. Horrible memories.
You still have problems in getting the children accepted into mainstream school –
And some of the reasons for not allowing them into the school… They picked on one of our boys – they said ‘he doesn’t look normal! He’s too small!’… They weren’t happy. In the end, we sat round the table with them, and we felt the director was prepared to help.
And the argument we’ve always used is don’t worry about our kids – they know how to look after themselves. You’re assuming that everybody else is negative. The PE teacher said – I have a responsibility, what if this, that…
…They have to be advocates. I think they’re very concerned about [other] children who live in poor circumstances. I say to them, don’t grumble, be agents of change.
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