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Health and Social Care
Textbooks, monographs and policy-focused books on our Health and Social Care list push forward the boundaries of teaching, theory, policy and practice. The list covers areas including global health, health inequalities and research into policy and practice.
Key series include Transforming Care which provides a crucial platform for scholars researching early childhood care, care for adults with disabilities and long-term care for frail older people, and the Sociology of Health Professions, offering high-quality, original work in the sociology of health professions with an innovative focus on their likely future direction. Our leading journal in the area is the International Journal of Care and Caring.
IntroductionA Romanian proverb says that ‘a child with many midwives will end up with their umbilical cord uncut’ meaning that once a child is the job of many, the essential tasks of child rearing will be missed. Other countries have somewhat similar proverbs. The Dutch say that ‘many midwives, the child will be lazy,’ the Germans that ‘the child looked after by seven nannies is lost.’ Popular wisdom seems to suggest that as soon as several professionals are responsible for the child, the child stands no chance to succeed in life. In other words, odds are not great for children who, once entering care, become the job of many. Attempting to replace the assumed parental love which is ‘grounded in human nature’ (Dingwall et al, 1983, p 87) in the extreme circumstances when parents are unable to raise their children is not an easy task for any state.
In this chapter, I draw on the learning from this study to make suggestions for policy and practice, emphasising the current disconnect between children’s needs and states’ offers to them, between children’s voices and the global policies for children in care. This study suggests that the UNCRC provisions, if understood and applied, will help meet the children’s needs. However, practice appears to be often disconnected from the children’s rights paradigm. Although several studies (including this one) indicate that care works for many children, the discussed findings also indicate that many young people who grew up in the care system faced instability, discrimination and abuse while being in different types of placement.
As shown in the previous chapters, since 1990 Romania’s ‘silent babies’ have been research subjects for international scholars, particularly in the field of psychiatry, who saw in them a research opportunity to study the effects of deprivation in early childhood. They have been described by mass media, state and private actors as ‘orphan’, ‘unwanted’, ‘unloved’ and ‘uncared for’. In 2020, the BBC published the latest results of the English Romanian Adoptee study: the brains of the Romanian adoptees were 8.6 per cent smaller compared to English born adoptees despite having received ‘top-notch care in loving adoptive families’. But although the article seems to suggest causality between early adversity and problems with motivation, organisation and memory, the researchers admit that ‘it is hard to work out the effect of other early life traumas such as abuse or being a refugee’. Presumably, that means to dissociate between the impact of neglect during their time in institution and the impact of the intercountry adoption. We now know for example that mother tongue is the language one hears during the first six months of life (Gauthier and Genesee, 2011) and that in itself suggests that the change of environment might impact more than we think on the child’s development. Moreover, narratives about Romania’s children referred constantly to what they had lacked for their development, with hardly any reference to what had sustained their lives and development (Dickens, 2004).
Since the time of the interviews, I have stayed in contact with several of the young people and, alongside that, social media accounts have made me a silent witness for how their lives unfold. Undoubtedly, interviewing them in a few years’ time would bring new learning. Among those who have stayed in contact, some went on to have their own children. They are each a committed parent as every child should have. Some of those who grew up in residential care since birth and who did not speak of any romantic relationships during the interview, have started relationships. One has invited me to his wedding. Some emigrated for work, something they could do since Romania became a full member of the European Union. Andi is one of them. After some initial struggles in his new country, he is now in full-time employment, providing cleaning services and earning enough to live and look after himself. His past experiences still haunt him but he has a small number of friends and a strong faith in God. He received the necessary state support to pay his rent when he could not work due to COVID-19 restrictions. For him and many others who experienced abuse in care as he did, a truth commission or some kind of restorative justice is necessary and a moral duty for Romania. Veronica also emigrated and has saved enough to buy a house (in Romania), her most important aspiration at the time of the interview. Some of those adopted internationally continue to struggle in different ways.
The previous chapters provided insights into the participants’ care experiences during childhood, teenage years and early childhood. This chapter provides an insight into how the research data was analysed and takes a holistic approach to examine those elements of the care experiences that had an impact on young people’s well-being in adult life drawing on identity literature and using dignity as core concept borrowed from moral philosophy and employed in human rights and capabilities.
Altogether, the life histories the research participants have shared cover just over 1000 years of life. Making sense of such a large amount of qualitative data is not an easy task. The purpose of the study was not only to transfer this knowledge to the academic world but also to contribute to a better understanding of the subtleties of care so that policy makers and practitioners who meet children in care can make more sense of what they might like to say but often choose to remain silent. All interviews have been transcribed verbatim into English after running a back-translation with a proficient user, anonymising them at the same time. After reading and annotating 20 interviews by hand (four in each cluster) to get a feel for the emerging themes (Miles and Huberman, 1994), I uploaded all of them in Nvivo.
In 1999, working for the European Commission’s office in Bucharest, I was given responsibility for overseeing the European Union’s financial assistance for the reform of the child protection system in Romania. That role placed me in a unique position: being inside the European Commission allowed me to develop an understanding of the Commission’s demands to Romania in relation to children in care; at the same time, being Romanian myself, I was able to communicate with professionals and children in care in an informal manner, and to develop an understanding of why children ended up in institutions.
As part of my work, I travelled to every local authority; I visited children’s homes, talked to child protection directors and to staff of the institutions. Conversations with the children could not go much beyond a short and friendly exchange, although I learned a lot from my visits. It was only when I met and befriended a number of teenagers who were in care that I really understood the subtleties of the care system. They were winners of ‘Edelweiss’, a talent competition for children in institutions that I had suggested to the government as part of the wider public awareness campaign ‘A Children’s Home Is Not a Real Home’. The aim of the campaign was to promote foster care and domestic adoption as alternatives to residential institutions. The competition had nine different categories – such as arts and crafts, sports, computer science, creative writing – and it brought together young people from all over the country with very different skills and different care experiences.
The 1989 Christmas was not just another Christmas with news about festive lights and gifts. Anyone who was old or young enough to watch the news will remember the execution of the Romanian dictator Nicolae Ceaușescu and his wife, Elena; followed shortly by the black and white images of malnourished children in institutions. They were the so called ‘Romanian orphans’ and they were going to be portrayed by the media for many years to come. No other Eastern European country overthrew communism so violently or had an ‘orphan crisis’ that the international media picked on. So, what was so special about Romania?
A member of the European Union since 2007, Romania has a population of 20 million people. It includes several ethnic minorities, the largest being the Hungarian minority, located in Transylvania, followed by the Roma. Romanian is a Latin language which makes the country a linguistic island in the region. It is one of the most religious countries in Europe, with Orthodox Christianity being the main denomination (80 per cent). The country is rich in resources and before World War Two (as a result of which communism was imposed in the country) Romania’s care for vulnerable children had been provided by philanthropists, churches and monasteries. According to Bejenaru (2017, p 172), Romania had then ‘one of the most modern European welfare systems’.
Most young people in this study were born in 1990, a remarkable time from many points of view: the United Nations adopted the UN Convention on the Rights of the Child, the Cold War came to an end and Romania opened its borders to the West; and, coincidently Tim Burners-Lee invented the World Wide Web. All of these were going to open new approaches, opportunities and new ways of thinking. The world was about to change dramatically, not least for Romania’s vulnerable children. They were the silent babies who shocked humanitarian workers, journalists and researchers. They became adults in 2008, soon after Romania’s accession to the European Union, at the dawn of the global financial crisis but also a time when smartphones became accessible devices and much of people’s social identity moved online with the emergence of social media. Their welfare had not only been a concern and a condition attached by the European Union to Romania’s accession but also a clash between different schools of thought about what was right for them, with intercountry adoption being a hot potato between different international players as I have explained elsewhere (Neagu, 2015). Those who stayed in residential or foster care received the protection enshrined in the Children Act adopted in 2004, and are able to receive protection from the state until 26 years of age if they are enrolled in some form of education.
In 1990, disturbing television footage emerged showing the inhumane conditions in which children in Romanian institutions were living. Viewers were shocked that the babies were silent. The so-called ‘Romanian orphans’ became subjects of several international research studies. In parallel, Romania had to reform its child protection system in order to become a member of the European Union.
This book sheds light on the lived experiences of these children, who had become adults by the time the country joined the EU. Uniquely, the book brings together the accounts of those who stayed in institutions, those who grew up in foster care and those who were adopted, both in Romania and internationally. Their narratives challenge stereotypes about these types of care.
The reasons why children enter care vary and are closely connected with the social, economic and political context. For example, when Western societies were dominated by religion, children out of wedlock would be taken into care and often placed with religious families in foster care or adoption. Lemn Sissay’s My Name is Why? (Sissay, 2019) and Jeanette Winterson’s Why Be Happy When You Can Be Normal? (Winterson, 2012) are just two of the autobiographies that provide us with insights about care from a lived experience perspective.
Children are no longer taken into care because their mothers are not married. Nowadays, the reasons for going into care are neglect or abuse, although poverty is often an underlying cause in many cases. In countries like Romania, poverty remains the first reason why children will end up in care. The formulation of causes reflects how states respond to the most vulnerable families.
When taking a child into care, the state takes parental responsibility for the child; and even if parents keep parental responsibility, in practice they are no longer involved in their children’s lives. Formal as well as informal barriers limit or prevent the time they can spend with their children (Sen and Broadhurst, 2011). Despite evidence that maintaining links with people who were important and safe to them before entering care (Boyle, 2017), more often than not, children are ‘lost in care’ (Millham et al, 1986), become estranged from their families, friends and others in their precare network.
The topic of ableism in music academicism is gargantuan. In this chapter I highlight at least some of the problems facing disabled people within academic musical environments. Most of my focus is geared towards issues with the conservatoire/music college environment, as I have had most direct interaction with this form of institution in higher education. However, the issues within these institutions relate to all professionals in the music industry, as performers and composers have to interact with this on some level. All musicologists started as musicians, even if only enthusiastic amateurs, meaning all experiences of performing music are directly influencing the musicological environment – even if the means of discourse has changed. What must be considered also is that the field of musicology is an observation of the professional music world, meaning that if the professional world is devoid of disabled people, musicologists will not have any disabled musicians/artists to observe either. There are four key problems within the academic and professional environment that need to be addressed for disabled musicians, composers or musicologists to begin striving for some sense of real equality (McKay, 2013; Kivijärvi, 2012; Cain, 2010; Meekosha, 2000). They are as follows:
lack of representation;
lack of historic figures to draw upon;
lack of aesthetics that encourage disabled creatives;
lack of general awareness within the musicological environment.
From a promotional perspective, the lack of representation is symptomatic of a constant rolling problem starting with the question.