Psycho-Social Support

Psycho-social responses from the community

Helpful Responses

It is quite clear that the extended family can no longer adequately provide for the basic needs of children who have lost a parent. “The community is the next safety net to provide essential support” to these children as described by Helen Jackson (2003) in ‘Children in Peril’.

It is also imperative to analyze and critique all the helpful assistance that the community can provide to orphans and other vulnerable children.

Helpful responses can be defined as any action or activity that heavily matches the drastic impact of HIV/AIDS on children. Such an action should reinforce the child’s capacity or strength in handling and coping with the fact of being orphaned or at risk. Such an action or response should lead to problem acceptance. A helpful response should integrate the child to various social networks and the community as a whole. Helpful responses are deep rooted in the principle of holism (holistic approach) that seeks to be multi-dimensional in helping the child out of his or her social, psychological or emotional situation.

Below is a discussion on the various responses that might be helpful to orphans or other vulnerable children:

(a) Capacity building – helping communities to talk more frequently and freely about HIV/AIDS.

Helping communities to talk more frequently and freely about HIV/AIDS is an important element of capacity building. Lack of knowledge and misinformation on issues relating to HIV/AIDS has lead to the stigmatization of people both infected and affected with AIDS. People have formed certain attitudes about HIV/AIDS and in some spheres those infected and affected are sometimes labelled and isolated. People associate the condition of HIV/AIDS people with certain behaviors they disapprove. In many situations such stigma has left HIV positive children and those orphaned by AIDS without care. Information can help the community dispel all the myths, misconceptions and attitudes that surround the issue of HIV and AIDS in the country. Community dialogue and involvement is essential in fighting the stigma. Children should be important participants in the whole process of raising awareness. Existing community structures like the church, schools and youth clubs should be involved in initiating HIV related dialogues. These structures should be possible channels of information dissemination.

(b) Peer education and play therapy

According to research, the separation between orphaned children and children with parents are distinct and obvious especially in a classroom setting. There is need for orphaned children to be integrated with the rest of the children through social clubs and play activities. Peer education should aim at giving “orphaned children the same opportunities as those of their non-affected peers, where possible, to uplift the entire community” (UNAIDS case study, 33:2004).

Plays should focus on issues related to HIV/AIDS, sexuality, death and stigma. Such plays should not deviate from the issue at hand. It is through these plays that children will eventually build trust in each other and acknowledge their plight. These plays are also a powerful means of communication where children orphaned by HIV/AIDS can also integrate and interact with the non-affected.

The essence of adventure or experiential learning is to enable children to cope through skills development and playing. This form of learning fosters social growth, relief and relaxation. It is an important form of giving life skills to orphans and any other vulnerable children of our communities.

In adventure or experiential learning, recreational activities like mountain climbing, hiking, cycling and swimming, are used to strengthen children’s interpersonal and communication skills.

“The theory behind these adventure activities is that they represent life: they are almost impossible, they challenge the mind and body, but once the children overcome their fears they can conquer the obstacle and face the challenge feeling confident and strong”.

Through these adventure activities, children learn the importance of rules, cooperation and problem solving. Some of the activities might even require the mathematical judgement of the child. In so doing, the child will develop essential life skills.

(d) Children’s involvement in solutions.

It has been noted that the donation of money, clothes and food is not enough to enable children to survive.

“They must also acquire certain skills, such as hygiene, interpersonal skills, self–esteem, and responsibility, in order to maintain a healthy and successful life style”.

Orphans sometimes lack the courage and confidence of making meaningful decisions on their own. They need to be involved in individual decisions. Puzzles and jig –saw exercises could be ideal as this allows the children to be more involved. They feel more responsible and encouraged in making empowered decisions.

Children need to be encouraged to generate their own ideas and this will make them claim ownership of any course action that they will eventually take.

(e) Developing children’s understanding on death and dying

Children need to effectively participate in all rituals surrounding death. They need to be encouraged to talk about death and how they feel about it. In some circles, children are denied the opportunity to talk about death. They need to have some understanding of death so that they really understand that death is an “a pattern of nature”. They need to know that “people also have a life cycle. All people are born, grow up, may have their own children and usually grow old before they die.” (Ramsden: 43: 2002)

In some cultures, children do not participate in issues that have got to do with death. They are kept away from funerals or graves. Moreover, discussing or talking about death is often perceived as a social taboo. In these societies, talking about death is seen as too painful for the children and they cannot handle it themselves. Secondly, “the child’s grief can evoke memories and strong feelings in the adults that they are not ready to deal with”.

To avoid all this, adults opt to be silent and move away from talking about death related subjects with children.

According to a UNAIDS Case study, “talking to children about death in advance gives them time to get used to the idea and gradually loosen the bond of attachment”. It helps dispel children’s fear and worries. This can even make them more able to cope.

(f) Children’s participation and involvement in extensive grief and memory work

The memory book can be defined as “a journal of facts and memories for children who are facing loss or separation from a parent including divorce, any terminal illness or adoption, and it is appropriate for any culture or background”.

The memory book helps the parent and the child to deal with the present, past and future life of the child. It has no formal procedure of doing or completing it. The parent or the child can complete it. The book can also include photographs, letters, or even material substances like pieces of cloth or buttons. All such things will help the child to remember how life was before death or separation of the family member (parent).

Children’s participation in memory work need to be scaled up. It can also include family maps and family trees. These maps and trees will help the child locate possible channels or people who can help them in times of need, care or support. Filling in the memory book can help the children open up on issues to do with HIV/AIDS. It is difficult to discuss death, and completing the memory book can help the child express all his or her feelings. Thus, the completion of the book brings out the sensitive issues that the child is not ready to talk about.

Extensive memory work has been acknowledged for successfully dealing with problems of disenfranchised grief in children. Doka defines disenfranchised grief, in Mortality Volume 10: number 1: Feb: 2005:87, as

“Disenfranchised grief refers to a loss that cannot be openly acknowledged, socially sanctioned or publicly mourned. The individual experiences a loss but can neither shares the full circumstances of the death nor receive subsequent support”

Through the children’s involvement in grief and memory work, the child can acknowledge the loss of a parent and will even share the circumstances of the death freely without any worries and regrets.

Case example

In this section, I present an example of a child who successfully benefited from the grief work exercises. I formed a strong working relationship with the client while I was on field work placement at Island Hospice and Bereavement Service in 2005. However, for ethical reasons, the name of the child is a pseudo one.

Case presentation: Thoko is a form four student in Harare. She is living with her grandmother after her mother had died in 2003. She did not have a chance to see her father because he had also died when she was only 2 months old. When her mother died she was in Mutoko and she only came two weeks after she was buried. This was because in their culture, children are not allowed to attend funerals. Her worry is that she feels she never grieved over the death of her mother.

Analysis: Does grief work help in Thoko’s case? Absolutely, she can be helped grieve over her loss.

From, the initial session, Thoko highlighted that she is angry at the society for not allowing her to attend her mother’s burial. It was hard and traumatic for her to believe that surely her mother was dead. We agreed with her that she should write a letter to her mother highlighting all she wanted to say. This she did and we collected all the pictures for their family and she put them in a small shoebox.

Grieving over her loss still remained a major issue for her. We then agreed that she should take the letter and burn it. The smoke from the burning letter will symbolise her mourning over the loss. She cried when she saw the smoke rising to the open sky. She was uncontrollable and after some minutes, she managed to say “Goodbye amai muzondirangarira”, meaning goodbye mum, please do remember me.

Thoko’s case proved therapeutic and since then, she has managed to cope and she is now well focused at school. She is even hoping to come with distinctions.

In short, such grief work exercises can be a helpful response that might help children or orphans who have lost parents to HIV/AIDS. There is need to continuously encourage children’s participation in all grief work projects.

(g) Bereavement Counselling

The death of someone close to the child will be received with painful reactions from the child. Such a death will ultimately affect the outward behaviour of the child. Death can leave the child more susceptible to major depression and personality problems in adult life. Bereavement counselling is thus essential so that the child can acquire or get strength in dealing with it. Most importantly, “bereavement services to children allow the emotional bond the child once had with the deceased person to have a positive effect on his or her future”.

Bereavement counselling has got several dimensions. At Island Hospice and Bereavement Service, the following are essential components of children bereavement counselling:

(1) Family and play therapy – children learn how to effectively deal with feelings in their families. They also learn how to talk about death and how to communicate. Family ways of how to handle grief are also shared among other children.

(2) Children’s loss work groups – these can be literally known as bereaved children’s groups. These groups include those children who have lost a parent, guardian, sibling or any significant other. According to Island Hospice and Bereavement Service newsletter, “Bereaved children’s groups are appropriate for both well adjusted children as well as ‘problem’ children those who are ‘acting out’ because of a death.

(h) Upholding the rights of the child

Upholding and respecting the rights of children to life, protection and care is essential for the growth and development of the child. They should be involved in decisions affecting their lives. In so doing, children we will be part and parcel of the society that look upon them for future leadership and transformation.

(i) Community Care.

Supporting community care for children without parents or any form of family support is essential. Community care for orphans and vulnerable children need to be scaled up and promoted in any given situation. The different forms of community care to orphans and vulnerable children are discussed below,

Foster Care – many have often questioned the idea of residential care since these residential homes tend to be temporary. They are only valuable if they aim at integrating the child back into the community.

The only effective way of helping orphans and vulnerable children is through what Jackson (2002) described as “organised community fostering”. According to her, “fostering in the community will be a more sustainable and appropriate option if the cultural taboos against fostering can be overcome and if families or single women are supported to undertake this role”. She argued that supported foster care could be useful and valid for “income generation, meeting the needs of far more orphaned children than could be met through an institutional response, and providing foster parents with a source of income that could assist women to avoid, for example sex work, to survive”(283-4)

However, the gradual breakdown of the extended family is rendering all efforts towards foster care impossible.

Adoption – formal adoption is one-way society can support orphans or vulnerable children. Individuals or couples who are childless should be encouraged to adopt. However, “many African individuals or couples who are childless are unwilling to adopt children because of fears that this will anger ancestral spirits”. In Zimbabwe, there is need for society to overcome these cultural barriers. Secondly, Jackson (H:2002) also argues that foreigners living in the country should also be encouraged to adopt children as long as all legal issues and procedures are followed.

Taboos about adoption need to be fought so that the community can effectively care for its own orphans and vulnerable children. Commenting on the distinct or competitive advantage of community care over residential care, Jackson H (2002) highlighted that “in community care, however, the risks of loss of cultural identity and dislocation are much lower, and the dramatic transition from institution to community is achieved.

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