ORPHANAGE CARE IN BULGARIA: A TWO-PART BLOG
PART 1: CHANGES TO INSTITUTIONALIZATION IN EUROPE
In Bulgaria as with other European Union countries, there is a movement which has been funded by the European Union’s Structural and investment Funds (ESIF) since 2014 to close orphanages and institutions in eight EU Member States (Bulgaria, Estonia, Greece, Hungary, Latvia, Lithuania, Poland, and Romania). The goal is to close all governmental institutions by 2022, including those for children with disabilities, by promoting the transition of youth from institutionalization to family-based care. A pan-European campaign with Eurochild, the Opening Doors for Europe’s Children Campaign has played a key role in securing funding for such child protection reform across Europe and supporting economically disadvantaged families. The reforms will prevent the separation of children from their families and offer high quality alternatives where separation is in the child’s best interests. It is also expected to demonstrate an expenditure to the government that is equal to or less than the current cost of running institutions while providing improved overall outcomes for families and children.
Why is this important to you, a prospective adoptive parent? Because change bubbling up in the institutionalized orphan population of Europe can mean eventual advantages for your adoptive child in experiencing a more home-like environment while in care, reducing the sometimes ill effects of institutionalization, allowing those children with disabilities more opportunities for social inclusion and focused development, and allowing economically disadvantaged children who should never have to be placed in an orphanage to begin with to reside with their biological parents who can begin to capably support them.
This particular funding is designed to address the plight of hundreds of thousands of children who are growing up in institutional care across Europe and runs through 2020. Considered a “once-in-a-lifetime opportunity” for these European nations, deinstitutionalization (DI) is considered “the core of building more inclusive, resilient societies.” [February 2015, Opening Doors for Europe’s Children] This EU focus on DI is also active in two Candidate Countries (Bosnia and Herzegovina and Serbia) and two Neighbourhood Countries (Moldova and Ukraine). Additionally, also involved are 4 additional member states of the European Commission: Czech Republic, Slovenia, Slovakia, and Croatia who also assisted in adopting the EC Recommendation on Investing in Children in 2013.
Systemic change is always tough. Convincing elected officials, child advocates, the general public, child care workers, institutional staff, and village governance to work together to address poverty, social inclusion, disabilities, ethnic minorities, children’s rights, and family supports is even tougher. You will have each representative group discussing cost, benefits, financial limitations, staffing needs, personal priorities, job accessibility, and other personally perceived barriers to achievement. Working together as partners in this endeavor will be difficult, but it is required by the European Code of Conduct on Partnership in relation to Structural Funds. Failure to abide by that or the ex-ante conditionalities (conditions which must be fulfilled) will result in suspension of the EU ESIF payments to these countries.
How are countries that MLJ Adoptions International works in for adoption, such as Bulgaria, affected by this movement?
In Bulgaria, many reforms have already begun and it is considered to be a priority investment. Bulgaria has developed a Partnership Agreement which highlights DI, along with health care, social inclusion, and poverty reduction. In fact, Bulgaria began work on this process during the 2007-2013 programming period! Bulgaria has also begun to focus on, in addition to DI, the development of early childhood development and early intervention services. The Bulgaria Long-Term Care Strategy focuses attention on marginalized groups (i.e. Roma population) and those people with disabilities. Representatives for Opening Doors note that because Bulgaria began this process in the previous funding period, they have “now reached a level of momentum that would be difficult to stop.” [Opening Doors for Europe’s Children, 2015] Bulgaria sees DI as one of the major instruments for combatting and reducing poverty and promoting social inclusion.
Bulgaria began with working groups formed by the government but included in them were CSOs (community service organizations), the various Ministries, and representatives from fields of Human Services, Education, and Good Governance who assisted in preparing a Partnership Agreement, advocacy efforts and operational programs. They set up channels of communication through the secretariat of the various working groups and information on both the Partnership Agreement and Operational Programs is publicly accessible via the internet for public interest. These initial efforts were by far the most extensive of the participating countries.
However, much remains to be done. Budgets need to be developed for funding the project long term. Concrete measures must be identified to achieve DI goals and establish family centered care. Nationalized procedures need to be tweeked. Capacity building and new projects must be included in both local and state funding streams. And most importantly, achieving a general understanding of the goals, roles and benefits must continue to be a country-wide educational advocacy effort if the regular citizenry are to become true and equal partners in the mission.
Sources: Opening Doors for Europe’s Children, 2015; Why it is crucial to end orphanage-style care systems in Europe by euractive.com; The Plight of Europe’s “euro-orphans” by martin Nejezchleba 2013; EU to Close 50 Romanian Orphanages, 2017, by Hope and Homes for Children.
PART 2: ONE OF THE LAST SPECIAL NEEDS ORPHANAGES
It was a busy 7am in Sofia, Bulgaria. Commuters crowded the highways and city streets trying get to work and public transportation busses and trolleybuses stopped regularly to pick up large groups of people. The hum of urgency was in the air. Overcast and damp today, the prior warm weather seemed to be slowly evaporating. We drove east from our hotel heading for the Kazanlak and Stara Zagora districts located in central Bulgaria and nestled deep in the Stara Planina mountains. The valley of Sofia with its modern city amenities began to change drastically as we progressively moved into the snow-capped mountains and tiny villages and farms. I settled in my seat in the car to absorb the new wonders of our 3 ½ hour drive to the orphanage.
Hidden in these beautiful mountains is the sweet-smelling capital of rose oil production, Kazanlak. Growing the fragrant Rosa damascena roses, this area serves as the source of Europe’s rose production. Although blooms don’t appear until May and June, we passed acres of rose bushes perfectly pruned and waiting to host this year’s crop. Delicate rose oils are used in everything from candles to lotions to jams and to liquors. I could only imagine what fragrant aromas would have been entering our car if we were traveling later in the year.
Soon we entered the tiny, quiet village of Buzovgrad. Small brick and cement homes covered in red tile roofs, some towering above the others on the hillsides, lined the winter streets pockmarked with potholes. Chimneys spouted billows of smoke as these homes were likely being heated and meals were being dutifully prepared. Dogs lazily roamed the neighborhood, cats perched precariously on fences and rooftops, and a few chickens could be seen wandering the yards. Farther up the hill, we slowly approached the orphanage property, taking care to avoid the roadway dips and crevices.
By now, the sun was out albeit somewhat masked. The grounds were quiet, but several cars were parked along the lengthy driveway. Trees and bushes surrounded the imposing two-story, pale pink and terra cotta cement structure housing the Home for Medical and Social Childcare, one of Bulgaria’s last remaining special needs orphanages. Another large two-story building was at the top of the driveway, as were a playground with well-equipped, modern apparatus and another one- story building. We later learned that the detached two-story building was now a community day care center and the one-story building was a Montessori education center.
After climbing the steps to the orphanage entry, we walked into a large, clean waiting area where a sofa, table, plants, and wheelchairs backed up to a winding staircase. We were welcomed by the Center’s Director and invited into her office adjacent to the waiting area. Brightly colored pictures of smiling children in various costumes, crowns, cowboy hats, and princess dresses lined the wall behind her simple desk. Dr. Panova, a gentle and experienced pediatrician, is the facility’s Director and has been for the past 25 years. Dr. Panova told us she also works part time as a physician in the city.
Dr. Panova smiles and welcomes us graciously, expressing genuine appreciation that we have come all this way to see the children and the special needs facility, especially since it is one of the only 14 remaining orphanages left in Bulgaria. This Home for Medical and Social Childcare used to serve 120 children as an institution–some special needs and others not—but now it serves only 22 medical and special needs children. Their other two-story residential building on the property has been converted to a day care center serving 25 local children, some who have been adopted domestically or are still in foster care. A few of these children also have severe special needs, including those with Spina Bifida, Autism and ADHD. The Center also provides Early Intervention services and out-patient therapy for children born premature or who are at risk for further damage. Dr. Panova proudly asserts “We see improvements in the children here.” Some children from another Home for Medical and Social Childcare in Stara Zagora also come here for therapy.
When asked about the European Union’s Opening Doors for Children campaign, Dr. Panova says that the idea of closing institutions is good, but she fears the quality of treatment for the children may suffer. Although several larger facilities such as her’s still wait to be shut down by the government, downsizing is the goal and she can see public opinion changing. They have opened the child care center and out-patient therapy program as part of this effort. Institution staff have tried to get jobs in the new group homes being established and often find they are the only experienced and professional caregivers. Most Bulgarians seem to worry that the EU’s funding for foster homes will end in 2020 and this is a concern because most foster parents in Bulgaria do it for household income, as jobs in the smaller towns and villages can be hard to come by. The onus then, is for local governments to pay foster parent stipends and provide resources for them, along with placing the children and hiring social workers to monitor the care. The local governments cannot do this without the ESIF (European Union Structural and Investment Funds) being provided to them.
Dr. Panova offers to take us on a tour. Our first stop is the outpatient therapy center. Two rooms hold a therapy table where staff work gingerly with the limb of a smiling little girl with Spina Bifida. Dr. Panova bends down to kiss her cheek and offer a hug which she gladly accepts. Another doctor works with a baby carefully examining her arms and legs and chatting informatively with her mother. Two nurses assist with the therapy. All staff are friendly yet professional and wear hospital scrubs.
The small motor skills development room is staffed with several ladies who individually attend to the three physically handicapped children lying on mats and using foam wedges to help them try to move their limbs or roll over. Another lady works with a very friendly but non-verbal little boy who smiles very big but is diagnosed with severe Autism. They are working with picture cards and he makes noises, waves uncontrollably and grins at us to get our attention. Once he has that, he gives us several of his cards and enjoys the visitor interaction.
The next area is for gross motor skill development and we enter the room to a loud chorus of “Merry Christmas” shouted by 8 or 9 running children. Also well-staffed and well-equipped by with colorful mats, climbing stairs, slides, balance beams, and other climbing structures, the children were running from one end of the room to the other and throwing and catching balls. Several stopped to give us big hugs and smiles. Dr. Panova noted that a year ago, several of these children could not run or even walk well. It was clear that progress is being made there.
We also saw the hydrotherapy pool which was currently in repair, but a very nice amenity for treatment. Upstairs, the residential area was separated by a glass door at the top of the stairs which helped to retain heat and minimize sounds from below. Small group children’s rooms housed some of the more severe special medical needs children. In one room, four children with severe microcephaly and Cerebral Palsy lay motionless in their beds with deformed limbs and fixed gazes. The rooms and beds were clean and well-staffed with the children getting individual attention. Two children lay in beds in the next room attached to breathing apparatus but closely monitored by a caregiver. The next room with three beds and a play/eating area held the two children we came to visit – two little boys identified for international adoption. One was playing happily with the staff member while the other child, diagnosed with Downs Syndrome, lay in his bed, apparently just waking from a nap. We held and played with the children, observed their capabilities, watched them interact with each other and showered some extra love on them during our time there. We asked many questions, observed the developmental screening of one of the boys, and got to see how mealtime was handled with the staff member feeding one of them. The meal consisted of bean soup, bread, mashed potatoes, dessert, and a drink. The facility, we were told, must follow a specific menu.
We also visited the Montessori educational building across from the playground, which had two children working on schoolwork using computers. The staff psychologist and another staff person were there. Still in development, this area is beautiful! Well-crafted tables, chairs, cabinets, and educational toys filled one room while another room housed the educational kitchen. It has all new appliances and work stations which will be used to teach children independent living skills such as cooking meals, baking, meal preparation, and grocery shopping. Two other rooms are still in development. Dr. Panova proudly explained that this area is being built solely on donations received from the parents of former children and local business people.
During her years at the orphanage, Dr. Panova has truly put her heart and soul into this place! She has made many improvements, all with the children’s special needs in mind. They even have a therapy dog! Dr. Panova’s caring and compassionate demeanor shines through as she affectionately greets each child, proudly discusses children’s success stories and wistfully discussed her fears for the possible future decline in treatment if this facility is closed. She gratefully thanked us for coming to visit the children and see the many advances they have made here.
While many orphanages are nothing like this one in Buzovgrad, it is heart-warming to see facilities like this one who are genuinely attending to special needs children and providing them with education, nurturing, medical treatment, developmental skills, opportunities for play, and attentive care. Orphanage directors like Dr. Panova are sometimes rare, not only in Bulgaria but all over the world. A visit to a truly good orphanage is worth its weight in gold. Let’s hope that the EU funding allows those facilities who meet and even exceed their goals to continue to exist in some form and continue to successfully meet the needs of special needs children.