From Maid to Mother: Transforming Facilities, Staff Training, and Caregiver Dignity in an Institutional Facility for Young Children in Nepal

Abstract

This article provides a case study of a project to improve the health, safety, and development of children birth to 6 years old in a large orphanage in Nepal. Two interventions were conducted: improvement of physical infrastructure and training, mentoring, and support for caregiving staff. As a result of these interventions, positive outcomes in terms of children's health and development have been observed, including reduction of communicable diseases and increased social interactions with caregivers. As part of the new training initiative, the caregivers began to meet regularly to share their ideas and experiences, and came to realize their vital role in the holistic development of the children in their care. One important change was a greater sense of dignity for the caregivers. The caregivers were formerly called Maids (Aaya), but asked to be called Mothers (Aama). The project also faced challenges, including communication barriers related to organizational structure.

Guatemalan family-style orphanages: A grounded theory examination of caregiver perspectives

“…The theory that emerged from the interviews focused on the importance of the familystyle structure to foster a sense of belonging and hope for the future. Building on research that aimed to improve the quality of caregiver-child relationships (Groark et al, 2013;Wright et al, 2014), the shift to family-style care is a viable option in order to improve orphanage care on a structural level. Interviews indicated that caregivers perceived children as finding a sense of belonging in the 'casa' and/or school, and the structure of the family-style orphanage (as well as the school) helped children work toward a future that valued religion and education.…”

“…Although there is some evidence that children may prefer that caregivers do not attempt to act as their family (Anglin, 2004), the understanding of fictive kinship already present in the culture may ease the acceptance of family-like relationships. An intervention in a Nepalese orphanage demonstrated improved health and development outcomes for children after providing support to caregivers' while changing the caregivers' titles to encourage a greater sense of dignity ('maid' to 'mother'; Wright et al, 2014). This change in title impacted the way in which the caregiver viewed herself and her interactions with the children.…”

Global Research, Practice, and Policy Issues on the Care of Infants and Young Children at Risk: The Articles in Context

“…Wright, Lamsal, Kshetree, Sharma, and Jaffe () describe an attempt to improve four wards for infants and toddlers in the largest orphanage in Nepal. The description of this institution and its care for children before the intervention is heart‐wrenching, and conditions rival those of the 1990 Romanian institutions.…”

“…While Wright et al (), Walakira et al (), and Lecannelier et al () represent “bottom‐up” attempts to promote welfare reform, two articles report more top‐down strategies in which government was involved from the beginning to change services in a large geographic area. Johnson, Dovbnya, Morozova, Richards, and Bogdanova () describe a unique collaboration between the government Ministries of Health and of Social Policy, KPMG financial services corporation (http://www.kpmg.com), and the private organization Firefly International (http://fireflyinternational.org/) to introduce early intervention (EI) and family support services in the Nizhny Novgorod Region 260 miles east of Moscow, Russian Federation.…”

“…All have achieved some success in one or another aspect of such a transition. Wright et al (2014) describe the situation for vulnerable children in Nepal, an exceedingly low-resource country. Although the government has signed the United Nations Convention on the Rights of the Child (1989) and other local documents that prescribe appropriate care of vulnerable children, in practice it does nearly nothing.…”