In March 2016 MAM opened a small Children’s Home in Hlaingthayar Township, near two MAM clinics. In the past, several orphans with HIV, and receiving MAM treatment,were abandoned by their carers; along with a raft of other issues this has often caused an interruption in courses of anti-retro-viral treatment. However, it was the case of one specific orphaned HIV positive boy, abandoned by his relatives that provided the catalyst for setting-up the home. For the carer, MAM identified an HIV positive mother with no family members and she was happy to be recruited as a live-in ‘mother’. At the time of reporting we have 6 children living in the orphanage.
The objective of the MAM Children’s Home is to provide a safe and familial environment for those MAM child patients without any other care provision available to them. MAM is committed to ensuring the home helps only those with no alternative, avoiding any superfluous recruitment of more children from the populous suburb, from poor families preferring a ‘free boarding’ option, as has become a dangerous norm in various other SE Asian countries. The Children’s Home is understood as a long-term care-giving centre with an essentially medical remit of ensuring support in two key categories of MAM health coverage, allowing those children to have a routine lifestyle in a monitored environment. The two categories are:
The Children’s Home provides the following support and services to its residents:
All six children are going to school on a regular basis. Two children are at kindergarten, the rest are 3rd Grade, 5th Grade, 7th Grade and 8th Grade respectively. Furthermore they all receive informal education from the live-in carer such as life skills and arts and crafts.
During the week children have a routine structured like most children, around their schooling. They wake up at 6am, make their beds, wash, and brush their teeth. At 7 they receive their Anti Retroviral Therapy (ART) medication and eat breakfast. From 7:30 to 9:30 the children are given time to study individually; at 10 they are given household chores such as watering the plants and cleaning. At 10:30 they shower and get ready for the school day. The children eat lunch at 11 and attend school from 11:30. On a normal weekday, children come back from school around 5:30pm and enjoy some time for play and sport. At 6pm children shower again to freshen up before dinner. At 7pm, children receive ART medication again followed by an hour and a half of school prep, and then bedtime at 9.
On weekends, the routine is much the same, but between 11:30 and 3, children are given free time to relax and play. Activities during this time normally include watching T.V, drawing, and reading books. Then, at around 3pm, children do chores around the home. At 4pm, children take their second shower of the day and at 5pm children eat dinner. From 6 to 9 the children study with the exception of taking their ART medication at 7pm.
As to be expected from MAM, the children are given a rounded and nourishing diet as part of the Home’s care package. Breakfast (7.15-7.30) typically includes one or more of the following: fried rice, porridge, fried vermicelli noodles, noodles with egg, bread, oatmeal, beans and salad.
Lunch is given at 11am, and consists of a slightly higher protein content, normally through fish or meat or sometimes beans. At snack time, around 2pm, children are given milk and bread. Dinner is eaten at 6.30pm; it is always warm and has a balance of carbohydrates, proteins and vegetables. Additionally, every night, before going to bed, children are given a glass of milk.
The duration of stay for each resident of the Children’s Home naturally depends on their specific case, and key variables include age, condition, and other care options. If the child wishes to stay for a short-term period because of difficulties in drug adherence, Children home staff members must discuss with the respective MD, counselor and caretaker. This can be up to a 2 year time period. The same procedures are followed for all children coming to the Children’s Home and MAM will not seek to shorten a term where it is most appropriate for the resident to stay until capable of working or getting a job – essentially, health and the continued good health of the resident upon leaving is the most important criteria by which MAM assesses cases of existing and potential residents.
As noted there are now six children resident at the Home, and all are HIV positive orphans; they had all suffered adherence problems with HIV ART. MAM has witnessed big health improvements with the children since they moved into the Home and “some children who rarely smiled before now seem very happy, and have got their smiles back”. Now they are sharing their happiness between each other and facing the life battles with full energy and the kinship and support provided by the Home’s familial spirit.
The residents are as follows:
Aung Chan Nyein
Aung Chan Nyein is 15 years old and he attends Grade-8 at school. His mother died when he was very young, and by the age of nine Aung Chan had no parents left – after a battle with alcoholism his father also died. At this point Aung Chan, his grandmother and his elder brother all moved to his auntie’s house. However, as his health deteriorated due to HIV his auntie discriminated against him, and his grandmother was too frail to take care of him. Aung Chan began to attend Thazin Orchid Clinic less and less regularly, due to the cost of transport and eventually, the grandmother agreed for him to be supported by the MAM Children’s Home. Soon after his move, his grandmother also sadly passed away. He is now taking his medication regularly again, and has improved his condition significantly.
Chit Oo Maung
Chit Oo Maung’s father passed away before he was born. His mother died in early 2017, at which point he moved in with his grandparents. With only the grandfather’s small income to support the household the strain was too much and his grandma could not properly provide for Chit Oo’s specific healthcare needs. A few months ago he moved into the Children’s Home and will likely stay until the end of his education. He is currently attending Grade-7 at school.
Aung Sitt Naing
Aung Sitt Naing is 5 years old and has recently begun Kindergarten. Aung Sitt’s mother had been suffering MDR-TB for some time and thus he was put into the care of his mother’s friend. Since hospitalization, his mother has sadly passed away. The host family, upon learning of the Aung Sitt’s HIV, refused to continue caring for him. With no other known family, relatives, or close family friends, the child has been warmly welcomed into the Home.
Aged 11, Phoe Pyae will this year attend his first year of school and enter Kindergarten. His HIV positive older sister left him and is pregnant with her second child having moved to another township, and his father is a chronic alcoholic. As a result of Phoe Pyae’s dislocated and essentially homeless status and his medical condition (HIV) he has been welcomed into the Home. MAM strives to give him all the support he needs, despite his late start in life.
Kyaw Zin Latt
Kyaw Zin is attending Grade-5 at school. His one remaining adult direct relative – his aunty – is diabetic and suffers hypertension, furthermore, she lives a long way from the clinic, limiting his ability to attend as regularly as is requested by MAM doctors. His father died when Kyaw Zinn was 4 years old, and his mother when he was 7.
Chan Chan’s mother died as a result of her HIV status, and his next carer, his grandma, also recently passed away. His two aunties promised to take care of him but sadly failed in their duties, as a result he began to regularly miss appointments and failed to conform to his ART regimen.
It is with great sadness that we report the sudden passing of the original carer / ’mother’, Mrs Myint Tin. In April, at 43 years of age she died suddenly from a stroke. To replace Myint Tin, Yin Yin Cho joined the Home on 9th May. She is a 42 year-old widow from Bago division. Her one child died at the age of seven months. She is a patient person, has proved herself as an excellent cook, and has so far given great help to the children with their homework and non-formal education. She is now coming to the end of her orientation and we are delighted to welcome her to the team.
The orphanage also has a caretaker, Saw Maung Maung Soe. His duties include maintaining the garden, generator, the solar power system, and the water pump. He is responsible for the good maintenance and tidiness of all outside areas and the integrity of the building. He also supports the ‘mother’ where needed, and sometimes helps to deliver the children to school. Most importantly, he is the round-the-clock security guard. He continues to serve the Home since he was recruited when the Home opened in 2016.
As a result of the currently low recruitment rate of children to-date, we have managed to run the Home more efficiently than we originally envisaged. This has resulted in lower expenditures than budgeted.
By employing an HIV positive caretaker and mother both receiving ART, MAM is completing a holistic care opportunity for these patients. Thus, not only is the new Children’s Home a fantastic new tool at the disposal of MAM clinicians to ensure good ART adherence amongst complex and high-need child patients, but it is also a safe employment opportunity and routine-supportive environment for adult HIV patients with high HIV empathy levels.
The impact we have on the lives of the residents is clear: the children receiving the care of the mother, and benefiting from this fantastic new environment gives them the strong routine and opportunities that they need and crave respectively. We look forward to maintaining and improving the Home further. To maintain the Home’s strong positive impact, MAM remains committed to ensuring only the most in need children with no other care option receive its support. Growth of the home’s number of residents is not something that should be forced. The building and site have the capacity to house over double the residents there currently with little impact on the quality of life achieved / care given, though this would require extra staff, and further recruitment is something we will consider on a needs-basis.