"Death Outside the Dying Rooms"

There is much debate as to how accurate BBC's 1995 documentary "The Dying Rooms" was. The idea that children were neglected to the point of death is hard for many to accept. But perhaps there is a more common explanation for infant mortality in the orphanages -- not a result of outright neglect so much as a result of ignorance and laziness.

The following story was sent to me by a Western Aid Volunteer working in a large orphanage in northern China. This volunteer has assisted the orphanage for over half a decade, and has seen this issue upfront and personal. Their story offers an interesting insight into this problem, yet an insight that encourages us to support organizations such as "Love Without Boundaries" and "Half-the-Sky" in their work to surgically repair children with cleft pallets, for example, and to educate caregivers in how to provide proper care for special need children. Issues remain, but these and other programs are making a difference.

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The “Dying Rooms” report by BBC over a decade ago made the claim that orphanages in China regularly made conscious decisions to let children die of starvation. There have been many records released of the children’s deaths in various facilities and survival rates published that proved that these orphanages had zero population growth. "Zero population growth" means that the number of children under the authority of the CWI does not increase. In other words, the number of adoptions, deaths and transfers (when the children age out) are equal or greater than the number of incoming children. I know in the orphanage I worked in that the number of children coming in was around 200, sometimes 250 per year. Only recently have the number of adoptions reached 50 (and 2008 might be close to 100). Of course, I do not have numbers for other orphanages, but I assume they are similar. In any event, I do know that adoption was less frequent 1995-1999, and the number of incoming children was about the same. Yet, the population of the orphanage did not increase. As adoptions and "age out" transfers are done according to known standards, this requires a lot of deaths, most of which are preventable.

I do not want to contradict the report; in fact, I do not doubt that it could have happened. However, in my personal experience, zero population growth in Chinese orphanages could have several other reasons that would not be immediately evident to casual observers.

I came to China in 2000, long after the Dying Rooms report and after several orphanages had begun to make major changes. The city I came to is in northern China, and almost 95% of the children at the CWI are special needs. I worked with an organization that provided caretaker salaries, surgeries and supplies, as well as allowed volunteers, both foreign and Chinese, to help with the care of the children.

The two most common special needs that we saw (and still see) were cleft palates and cerebral palsy. The CWI at this time was just beginning to have positive survival rates.

One of the groups of children who would often not do very well were the cleft-affected children. They would often die of malnutrition. Foreign volunteers regularly volunteered here, and if there had been a “dying room”, we would have been able to find evidence. However, the caretakers, through a lack of training and proper equipment, were unable to get enough nourishment down the children. There were several reasons for this.

The first is that a cleft palate affects a child’s sucking power. Caretakers used to feeding NSN kids would place a bottle in their mouth and then wonder why they were not drinking. After a few minutes, they would claim the child was not hungry and give up.

The caretakers were not maliciously harming the child, but their lack of training, overwhelming number of children to feed, and, at times, laziness affected the children. I do not believe this to be a “dying room” situation, in that no one picked out children to die and never touched them again. However, these were very preventable deaths.

The first solution our organization had to this problem was to get the children into foster care with foreign families. Over a period of around 10 years, a large number of expatriate families in this city fostered and eventually adopted cleft-affected children from the CWI. However, this method was labor-intensive and could not reach all of the children in need.

Our next solution was for training. We negotiated with the director, leadership, and caretakers to teach them about how to feed the children properly. This meant that the caretakers had to put more effort into their jobs. This was not accepted by all very easily, but they eventually came around.

We also provided equipment -- specifically cleft-palate nipples that provided for one-way flow and eliminated the need to suck. These nipples (at least the brand we bought) could not be obtained in China.

Another major problem that led to the preventable deaths of several of the children was poor positioning while feeding. Almost all children who could not sit up by themselves were fed lying flat on their backs. Even for a healthy person, this makes swallowing difficult. For children with cerebral palsy, whose muscle control and swallowing reflexes are poor, it is dangerous. Often, the children would aspirate food, develop lung infections or pneumonia and eventually die.

In contrast to issues with cleft palates, I believe this issue to be much more the fault of the system and individual caretakers and supervisors than just ignorance and bad luck. Sitting a child up for feeding is not terribly difficult or counter-intuitive. However, I do not believe that back feeding was done in order to harm the children, but simply because the caretakers were too lazy and/or unconcerned.

However, what makes these issues relevant to the community of those involved with China’s Welfare Institutions is that both of these situations existed long after the light of foreign media had some to China’s orphanages, and was only changed with the direct supervision of foreign personnel. For orphanages where the majority of children are handicapped, laziness and ignorance could easily account for zero population growth much more easily than outright euthanasia.

I am certain that these conditions exist in other orphanages in China. The path of improvement does not lie with freshly painted walls, children who know how to put on a lovely performance, or even tons of foreign money. All of these things are good, but to truly change the lives of the children, we will need to change the hearts of minds of the caretakers. teachers and supervisors who care for them.