Now That He's Safe, The Healing Can Begin... Right?

We sit down on the mat, colored pencils and an unopened folder between us. He excitedly picks out his favorite colors as we chatter back and forth about his day. I open the folder to reveal a picture of a little boy wearing underpants and say casually, “ooh, look, this coloring book is about our bodies!”

And so begins the most challenging fifteen minutes of my day. He looks at me, unsure. I take an orange pencil and, unaffected, begin to color the boys toes. “I think I will color his toes and his feet orange. Do you want to color his knees with your red pencil?” He relaxes and nods and starts to sing a song about feet. He makes big, dark lines with his red pencil. 

I begin to color the boys hands and say, “I think I will color his hands orange, too. Orange is a happy color!” My mind is spinning as I try to remember all of the psychologist’s recommendations for him and the information I’ve learned in the past five years about talking to children who have been abused.

As he colors the arms red, I color the boy’s head orange and say, “Juan, there are some places that are okay for our friends to touch us. There are some places that are only for us to touch. Some parts of our body are just for ourselves.” He stops coloring and looks up at me attentively. I point to the boy’s underpants. “What is this part of his body called?” He smiles and uses a slang term for his genitals. 

As the psychologist instructed me, I correct him. “Those are his ‘pene’ and ‘testiculos.‘ Those are only for you to touch. Other children and other grown-ups should not touch you there.” He is still staring intently, listening. I continue. “If a grown-up touches those parts, you can tell them NO. Your body is for you to touch. And you can tell another grown-up. It’s okay to tell grown-ups if someone touches you.”

I color the little boy’s underpants black. 

He continues to color the other pictures in the book... The nose, the ear, the leg, the arm. We talk about anything and everything else. A few minutes later, our photographer Ray comes up to the playroom. Shortly after, Juan goes to the stairs and begins trying to unlock the gate. I tell him he needs to wait for me; to help me clean up if he wants to go downstairs. I simply don’t want him climbing down the concrete steps alone, but he becomes combative. 

He clings to the gate and tries to unlock it, hitting my hand away as I hold it shut. “Juan, please, listen: we will go downstairs in one minute. I cannot let you use the stairs alone.” He begins to cry and hit at me. The social worker, on her way upstairs, opens the gate and picks him up. He clings to her, arms around her neck, legs around her waist, and turns to glare at me. 

I want to tell her ‘No, don’t hold him like that, the psychologist said...‘ Instead I stammer that he was upset with me for not allowing him down the stairs alone. She nods and brings him downstairs. I clean up the colored pencils myself, feeling like a failure. His rejection concerns me; did I push him too far? Did I say too much? Where is the line? And how have I become the person responsible for this confusing re-education?

An hour later, we are in the playroom with two other volunteers and two other children. Juan has established an iron grip on the handlebars of the scooter Alberto is riding. The volunteer behind Alberto is gently asking Juan to let go. He doesn’t loosen his grip.

I kneel down in front of him. “Juan, Alberto is riding the bike right now. We can play on the slide, or with the big ball, or the other toys. After Alberto has a turn, you may ride it. We need to share and take turns with our friends.” He glares at me again and tightens his fists around the plastic handlebars. I calmly and firmly repeat my treatise. No response.

“Juan, I am going to move your hands off of the bike now. You may have a turn when Alberto is done.” I pry his fingers off of the bike, holding back one hand until the other one can be pried free. He lashes out at me for the second time today. I gently push his hand down and say, “We use gentle hands with our friends.” I pick him up under the arms and place him down, standing, a few feet away.

He stares at the ground. He looks so, so very sad.

I sit in front of him and put my arms around his waist as I talk to him.

“Juan, I am not angry with you. It’s okay if you are angry with me. I understand that you want to ride the bike. In a few minutes, it will be your turn.”

He looks over my shoulder, staring at the wall with hollow eyes. His eyes begin to fill with tears as he stands in front of me. 

I rub his back and say quietly, “It’s okay to cry, Juan. You can cry if you need to. I know you are sad It’s okay to be sad. I still Iove you. Would you like a hug?” He nods and climbs onto my lap. I rub his back for a few minutes as silent tears fall down his cheeks. He says nothing. I say nothing. 

Alberto gets off of the scooter. I tell Juan excitedly, “It’s your turn to ride the bike now! If you are ready to play, you can ride it. If you want to sit for a few more minutes, that’s okay too.” 

Wordlessly, he nods, climbs off of my lap, and begins riding the bike. After a few minutes, he his back to his ‘usual’ self- laughing, smiling, chattering away. 

It is significantly longer before I feel like I can breathe again.

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Working with a child who has been recently abandoned and has a past history of sexual abuse is an indescribable challenge. Working with that child in a consistently inconsistent environment, where I can be present only a few hours each day, is an insurmountable challenge. 

Children who suffer the loss of a caregiver, whether it be through abandonment, death, or any other horrible circumstance, are absolutely devastated by that loss. Regardless of how attentive or loving that person was, they were an important pillar of that child’s life and their sudden absence is confusing; upsetting; scary. 

Many children develop attachment disorders. They begin to favor unfamiliar people over familiar ones; are indiscriminately affectionate with strangers; push away and reject their  main caregivers. There are a myriad of ways that these attachment issues express themselves, but the underlying subconscious logic is this: ‘Mommy/Daddy/Person X’ loved me and took care of me and kept me safe. And now they’re gone. Whoever is loving me and taking care of me and keeping me safe now might leave and hurt me, too.”

Watching a young child cope with their abandonment; watching these attachment issues and symptoms begin to express themselves in some quiet and some not-so-quiet ways, and knowing the limitations of what we can do for him, is heartbreaking. Children recovering from abuse or abandonment need ONE caregiver who understands their needs and can help them to learn that the world is safe again; to learn what is “good touch” and “bad touch” and to trust that they won’t be violated or deserted again.

Though I was one of the first faces he saw when he arrived and spent the most time with him, after about a week, he began to reject hugs and attention, turn away and ignore me when I arrived. Each time, I calmly and cheerfully assured him that I was excited to play with him, when he was ready. Each time, he watched me closely from across the room for a few minute before running over for a hug. His actions say clearly- he has formed an attachment to me. The connection he feels to me is scary for him. As sad as this is, it gives me this tiny hope that I can use the connection between us to help him, somehow.

Casa Jackson is an incredible place for the children we serve. But we are not a home. We are not a mother, or a father, or a family. Our volunteers are loving and kind and affectionate, but they leave. Our nurses are diligent and dedicated, but overwhelmed. We cannot provide this child with the informed, patient caregiver he needs to begin truly recovering from the trauma he faces right now. 

In a week and a half, this little boy will be moved to an orphanage. There, he will be lacking that same consistency. In a country where foreign adoptions have been halted due to trafficking and kidnapping of babies to sell to dishonest agencies, few local families are able or willing to take these children in. There aren’t enough foster families for the “easy” kids; the cute babies; the low-needs children. There are virtually none for children who need the type of attention and support that this little boy needs.

It’s hard to maintain hope in the face of so many impossibilities. The mother of a child with special needs once explained to me, “The cruelest thing you can do to a person is to take their hope away, no matter how impossible it is. That hope might be all they have keeping them afloat. Let them have their hope. They will adjust and accept what they’re facing on their own time.”

I am usually a strict proponent of realism. Call things what they are; be honest with yourself and embrace the ugly truth in front of you, no matter how awful. 

For once, I give myself permission to hope.

A Difficult Post for a Difficult Day

In every way, sexual abuse of children is an atrocity. It’s reprehensible, unforgivable, and disgusting. It’s a vile attack on the most innocent, trusting members of any society- the ones trusting us, the “big people,” to keep them safe. 

Unfortunately, it is not uncommon. Often, the abuser is not just a trusted adult in the child’s life, but a member of their own family. The abuser manipulates the child into believing that the abuse is normal, or that it is somehow the child’s fault. The abuser takes an impressionable child, learning so much about the world around them, and robs them of any true chance to know, instinctively, what their boundaries are; what is okay and not okay. They become even more helpless.

It is something we hear of often down here. Each time, it’s like a punch to the stomach. An uncle, a brother, a father... Someone that this child, who we have come to know and love so much, trusted in that innocent, complete way that children trust; someone violated this child. Sometimes, desperate mothers sell their children to strangers for sexual acts. Several children in the program were victimized this way before the age of five years old.

Working with sick children, with disabled children, with abandoned children, with the poorest of the poor’s children... It’s all challenging. As a caregiver, and someone who is in some way temporarily responsible for some aspect of these children’s daily lives, sexual abuse is the one issue that absolutely undoes me.

I think I speak for many people when I say that, in this field, you develop a fortitude that you never thought possible. You hear and see so much that, years before, living in your home country, you would be so affected by. You would cry; you would be angry; you would feel helpless. Working on these sorts of social service projects, you become able to listen to a horrible, tragic story calmly. You don’t lose your wits; you employ them to meet the task at hand, and deal with your emotions later.

Yesterday morning, I requested some support from our psychologist to determine if one of our children at Casa may have been sexually abused prior to his arrival. The extremely sad answer was yes. Not maybe, not probably, but a very resounding yes. He was abused. He was violated. He was betrayed by one of those “big people” who should have been protecting him.

Over the course of the day, I cycled through so many emotions. I am not a crier. I spent much of the day holding back tears. I was filled with a murderous rage aimed at the family member who violated this child. I was overwhelmed trying to understand how best to help this child, and how to ensure the consistent support he needs in a very inconsistent environment. I was sick with the mental images and video that played against my will all day, imagining this sweet young child in this horrible, traumatic experience. 

I was furious with myself. I couldn’t fathom or accept my own limitations. How can it be that this is so common here; that due to poverty and almost no supervision for many children growing up more or less in the streets, this child is far from alone. How can it be that this is happening, and we are here, and we can’t do anything to stop it?

How can it be that I hold this child, and hug him, and make him smile and laugh... but I can’t protect him? How? How does one sleep at night knowing this? 

On a good day, when I am not looking into the eyes of a child that I cannot protect, I can answer those questions calmly and rationally: You cannot save every child. You cannot save even one. You can only help, in whatever way you can, to provide safety, love, food, and some shelter for this child. You can be part of the solution; you can employ the skills that you have, and trust that others will do the same. You must simply accept that you are doing something- and that is better than nothing.

Yesterday was not a good day. Today is not a good day, either. I know that in time, the fortitude I have thus far developed will grow further; my ability to hear horrible news about a child’s past and still be unshaken enough to be effective will improve. I know this. I have no doubts that I can handle this, and I will. I know I’m doing all that I can, and I recognize that there are limitations that neither I nor anyone else can overcome- as a group, or as an individual. 

I have known this for a long time. I have accepted this for a long time.

But when I look in this child’s eyes, when I see him smile and laugh, when I see him and know that right now, he trusts us to keep him safe, I can’t help but feel the weight of my own limitations; my own failure to be everywhere at once, keeping every child safe from every horrible thing that may befall them. 

We all know what it’s like to read or listen to a story about a child being abused and be overcome by our own disgust and anger and sadness for that child. Nothing can prepare you for hearing that story about a child that you love. 

The What, the Why, and the Who

After posting a few pictures from Casa Jackson today and getting "like" after "like" after "like" after "like," I realized how many people are, on some level, interested in the wonderful little faces they're seeing and wondering what's happening in our tiny little corner of this tiny little country. I also realized how infrequently I actually discuss what it is that I'm doing, what Casa Jackson is doing, and the massive "why" behind the effort. 

Obviously, I feel like what we're doing is really important. These babies and children are just as deserving of a chance at a healthy, happy life as any other, but they and their families face massive challenges that are practically incomprehensible to most of us. So... for anyone who has looked at the smiling faces in my pictures and thought, "how cute!", it would mean so much to me if you could read on and learn about who these little faces are and why they come to us.

Casa Jackson is a center for malnourished children. Our small, 20-bed hospital is one town and a short walk over from Antigua, Guatemala. Antigua is sort of this magical Disneyland bubble of Guatemala where people can walk around safely (day or night!), drive down the street with their windows open, and basically live their lives without a very legitimate fear of being robbed, raped, or worse. 

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M A L N U T R I T I O N

(a.k.a., the "why")

 Malnutrition is one of the gravest public health issues affecting Guatemala. The statistics speak for themselves:

• 49.8% of all Guatemalan children under the age of 5 are chronically malnourished
• 1/3 of all deaths occurring in childhood are caused by under-nutrition
• 4 out of 10 children in non-indigenous families are malnourished
• 8 out of 10 children in indigenous families are malnourished

By chronic malnutrition, I mean that these kids are not experiencing periods of difficulty getting proper food due to a bad harvest year, or their parents losing jobs. These children are growing up without receiving the calories or nutrients they need to grow properly nearly every day of their lives. 

In addition to the risk of dying from malnutrition, kids who grow up malnourished often have lower IQs and smaller bodies. They are less able to take advantage of the handful of educational or work opportunities that may come their way, if they're fortunate. They are born poor, and because they are physically and cognitively disadvantaged due to malnutrition, they stay poor.

Anyone living in an area with many Guatemalan immigrants can probably identify with the following assumption: Guatemalans are short. Not so! An incredible study followed siblings of Mayan descent that were separated. One sibling was raised in the US, the others stayed behind and grew up in Guatemala. This study showed that on average, Guatemalan children from the same family growing up in the US were 6-8 inches taller then their siblings by the time they reached adulthood. The results were similar when examining siblings who grew up in Mexico and Guatemala. The Mexico-raised siblings were still taller, despite not being in an overly developed, wealthy country.

Guatemala is not the poorest country in Latin America, yet our malnutrition rates here are nearly double that of every other country. Honduras, Nicaragua, and El Salvador are more impoverished (based on gross national income), yet Guatemala has twice as many children whose growth is permanently stunted (interrupted or stopped) due to malnutrition. This begs the very big, very legitimate question- WHY?

Basically, Guatemala is the "perfect storm" of malnutrition. The gap between the rich and poor is very large. The rich live in/near cities with big shiny shopping malls; the poor are spread throughout villages and dangerous towns across the country without decent roads, sanitation, schools, or medical clinics. There is widespread illiteracy and little access to any real education.  

Most importantly is the role the government plays- or doesn't play. Guatemala is extremely corrupt and few social programs exist to support or empower the poor or hungry. It has a horribly dark history involving a 30-year civil war, ending in the 1990's, that saw the military slaughter their own civilians. The government perpetrated a genocide against the indigenous population, who stood to gain the most should the guerillas have won and thus seemed to the government to be the guerilla's "natural allies." Simply put, for the indigenous community (hardest hit by malnutrition), the government is useless at best- criminal at worst.

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W O N D E R F U L   B A B I E S  &   F A M I L I E S

(a.k.a., the "who")

We get a lot of different types of infants and children at Casa Jackson. They come from all over Guatemala and from all different types of homes. Some have parents who love them and are trying desperately to care for them despite the horribly scant information and resources available to them. Some have parents who aren't quite as concerned with their well-being. Some have been abandoned. Some of our patients have medical and developmental issues; some have alcoholic, abusive fathers who complicate their mother's efforts to keep them healthy, safe, and fed. Each of them has a family with unique struggles that are complicating their efforts to care for their child. All of them desperately need help.

A few 'typical' stories...

Axel
(fully recovered- look at those cheeks!-the day he returned home with his mother)

Axel came to Casa Jackson at 2 months old, weighing just under 7 pounds. His mother, 23-year-old Maria, was eating coffee and tortillas three times a day, with beans, rice, or vegetables when she and her husband could afford to purchase them. She became pregnant, eating exactly the same throughout her pregnancy. Axel was born slightly early and underweight. His mother tried to breastfeed him but she was so poorly nourished that her breast milk couldn't satisfy him. She tried feeding him a variety of things (soda, locally-made corn and milk drinks, etc) to satiate him and help him grow. It didn't work.

Axel stayed with us for 2 months. During that time, our nutritionist taught his mother about her own nutrition, and how to properly breastfeed little Axel. She began to breastfeed Axel again, and with the formula feeds he received as well as her breast milk during her twice-weekly visits, he gained quickly. Axel returned home, healthy and ready to thrive in a home with two parents who now have a better understanding of their own nutrition, Axel's needs, food safety and sanitation, and how to budget their scant resources wisely to ensure that all members of the family are as nourished and healthy as possible.

Magaly

Magaly came to us for the first time in early 2010. Magaly has microcephaly (small head size, associated with cognitive and other delays) and was born with a congenital subluxation of her hips (her hipbones weren't in their sockets and she couldn't move her legs). She was a malnourished but cheerful toddler. Several volunteers fell in love with her, and raised enough money to build her family a new home to replace their dirt-floor shack as well as buy all the supplements needed to get her through her first six months after being discharged.

Magaly's father was an alcoholic who became very violent when he drank. He beat Magaly's mother, sold the home that was built piece-by-piece, and sold all the supplements that had been donated, to finance his drinking habit. Magaly returned to Casa Jackson in 2010, sicker and not quite so cheerful. 

Magaly's mother lived with her at Casa Jackson (as many of our abused mothers do) for several months while she tried to find stable employment and a safe place for her and her two other children to live. While at Casa Jackson, Magaly got the surgery she needed to reconnect her hips into their sockets, and fully recovered from her malnutrition. Although Magaly recovered from her malnutrition in a matter of months, it was a little over a year before Magaly's mother was ready and able to bring Magaly home to a safe, loving home free from the abuse and control of her estranged husband.

"Jose"

Jose came to us exactly two weeks ago today. The bomberos (firefighters) arrived one Friday morning with this little bundle in their arms. Jose was exhausted, trembling and crying for his "mama."

His "mama" had left him outside the bombero station in Chimaltenango (an incredibly poor urban area a few hours away) the night before. He had spent part of the night outside before being discovered and brought into a bombero's home to spend the remainder of the night. He had a horrible case of bronchitis and a low fever. 

Jose is one of about 10 children Casa Jackson cares for each year that are abandoned by their very desperate parents. We don't know the exact reasons that Jose was abandoned. Anyone holding and hugging him and seeing him wave his chubby little hands at new volunteers and say "hola," or watching him grin and try to clap along to 'patty-cake,' would have a hard time imagining a reason dire enough to give this sweet little boy up. As easy as it is to judge his mother for abandoning her son, the reality is that whatever circumstances lead her to leave her 18-month-old(ish) son must have been truly terrible.

Because of the stop on foreign adoptions put into place several years ago due to many legitimate cases of babies being taken forcibly from poor women to sell for adoption and other such fraudulent practices, Jose will almost certainly grow up in a foster home or in an orphanage. Adoptive families in Guatemala are few and far between and the foster care system is horribly overloaded. 

Unfortunately, we have no control over Jose's future. We can't choose his placement when he leaves us. In these heartbreaking situations, our role is this: love the heck out of these babies from the moment they arrive until the moment they leave. Jose will bear the emotional scars of his abandonment for the rest of his life; he will likely grow up without knowing what it's like to be part of a family that loves him. It hurts to hear him cry for "mama" every evening. It hurts to see him smile and laugh and know that he will never know the stability and consistency and love that children need to thrive.

So we do the only things we can. We feed him, and we love him.

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C A S A    J A C K S O N   P R O G R A M 
(a.k.a., the "what")

In the interest of keeping this short (too late!), I won't delve into all the specifics of what we do at Casa Jackson. It involves a dedicated medical staff who sees to the kids medical and nutritional needs, a constant supply of volunteers who give love and affection and attention to each child, a coordinator who is borderline obsessed with the quality of the kids experience while in Casa Jackson, a social worker with immense patience, strength, and sensitivity, and a lot of people who support us from afar.

We provide free health screenings for any family that brings their child to our center; high-quality inpatient care to the sickest children; follow-up visits and education to their families; donations of food, clothing, and medication to our most impoverished, desperate families; a temporary home for our abused or homeless mothers and "safe haven" for abandoned children; outreach in the community to find the children and families who need help, and will hopefully be branching out into some prenatal/preventative support and education in the coming year. 

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I am the luckiest girl in the world. Working at Casa Jackson is heartbreaking sometimes, but I am grateful every day that I have an opportunity to play such a significant role in the daily lives of these amazing children while they're in our care. These children and families, and the thousands other like them across the country, are incredible. I'm honored to get to be a teeny, tiny part of "the solution" to this massive problem that affects so many here. 

It's also amazing to me how many people are supportive of me, despite knowing the details of what I'm doing, and without really knowing me on any real personal level. Family, friends, acquaintances, and complete strangers have expressed their support since I began coming down here in January. I appreciate the support and the kind words, and humbly ask that you remain interested and supportive. Just knowing that so many people in different places are aware of what's happening here, and care about these kids that my world more or less revolves around, means so much to me.

(for pictures and bios of all of our current patients, visit www.godschild.org/casa-jackson)

November 2nd, 2011

I am sitting on a plastic chair in a small, lemon-yellow room. The sunlight fades outside and slowly, darkness falls like a blanket over me and the baby in my arms.

He lifts his head up momentarily, eyelids heavy from the combined exhaustion of spending a night in the street outside the local fire station, and his constant, anxious crying for “mama.” He creeps a tiny hand underneath the bottom of my mask, settling it underneath my chin, and drops his head back onto my chest. His other arm finds its way around my neck, in my hair, and he rubs it between his little fingers and settles into  my arms.

I rub his head, rub his back, pat his bottom and rock him gently. We sit, quiet, save for his occasional weak moans and choked murmurs of “mama.” I can’t even begin to process what this little baby must be thinking. At a year and a half old, he is old enough to know his mama. Old enough to look for her in every face that enters his room. Old enough to remember her and want her arms around him for comfort, not those of a stranger. Old enough to be scared and confused and traumatized, not just due to the physical experience of being abandoned and the loss of his familiar caregiver, but by his thoughts and confusion surrounding it all.

I put my hand to his cheek, feel its fullness in my palm, and try to imagine what sort of horrible circumstances or tragedy must have led his mother to abandon this beautiful, sweet, perfect, loving eighteen-month-old boy outside of a fire station several hours away. We pass two afternoons like this before he’s comfortable enough to sit within arm’s reach of a volunteer or nurse and play with another child.