Originally published in Massage Bodywork magazine, December/January 2007. Copyright 2007. Associated Bodywork and Massage Professionals. All rights reserved.
Their stories break your heart. Babies abandoned because they are the wrong gender. Toddlers given away when another new mouth comes into the family. Infants struggling to survive after they've lost both parents. We can't change their stories, but we can give them hope and a fighting chance says Vonda Jump, senior research associate at Utah State University's Early Intervention Research Institute. It is her belief in that notion that has led her to create and teach relationship-based intervention programs, including infant massage, in orphanages in some of the world's neediest countries.
It was nearly four years ago when we first introduced you to Jump (February/March 2003), fresh from her research investigations into the effect of massage on the often-compromised health of children in Ecuadorian orphanages. From that 2002 research project funded by the Massage Therapy Foundation to her harrowing and enlightening visits to Haiti and India, Jump has spent years asking questions about the world's abandoned children, all while advocating the use of massage as a therapeutic tool in the health of the at-risk and deprived. What she's found is that despite the geographic and cultural chasms between the orphanages she's visited, their issues remain the same.Haiti's Despair
When Jump took her research to poverty-stricken Haiti in 2003, she knew it would be difficult to stomach the suffering she would undoubtedly see. And she wasn't wrong. "To be honest, I've seen some of the worst things I've ever seen in Haiti," Jump says. She cites Save the Children estimates that ten thousand children live on the streets in this small country, eight thousand alone in the capital Port-au-Prince. Another three hundred thousand children are considered restaveks, or child slaves, often abandoned by their poor parents and left to work for the more affluent families in what are dire circumstances. "Haiti is a country in severe crisis," Jump says. And the children, she emphasizes, suffer the consequences.
Of the estimated one hundred orphanages in Port-au-Prince, Jump found one in which to test her infant massage and relationship-based intervention for one month, similar to the protocol she initially researched in Ecuador. What she saw broke her heart. "Babies were malnourished and cried constantly; they would just lie on mats all day, with flies landing on them. Babies had a hard time interacting with people, as they were not accustomed to doing so, and often could not make eye contact. When you picked up a baby, they would cling to you; or, if they were upset, just try to get away from you. When I would focus on looking at a baby and try to feel what they felt, I just cried. There is so much suffering."
A vivid example of that suffering was the baby girl Jump worked with whose neck was swollen from the larvae left behind after flies laid eggs in her ears. This would be one of several Haitian children who could not overcome their circumstances, and later died, despite the intervention.
In Haiti, like Ecuador, Jump found that orphanage staff members and volunteers cared deeply for the children in their charge, but many didn't have the tools, skills, and certainly not the funds to improve the circumstances of these children. In most Third World orphanages, caregivers are overwhelmed and typically uneducated about child development, Jump says. They work in a reactionary mode, moving from crisis to crisis, baby to baby.
"Staff members are not well trained and are, frankly, quite overwhelmed by their responsibilities. What I saw was desperation. Working in an orphanage is extremely hard work, and staff members are often paid very low wages for this important job." Jump says caregivers do their best to feed babies three times a day, bathe them, and keep them in clean diapers. Most of the orphanage staff feel stretched beyond their own boundaries and are consumed with the circumstances.
What Jump found in other orphanages was parallel to the situation she found in Haiti. She says infants were only given physical care, merely trying to ensure the child's survival, with little or no attention to their emotional needs. In fact, when Jump was teaching the Haitian caregivers how to massage the infants, she encouraged them to talk to the babies throughout the process. But none would. "After about two weeks or so, I was talking to a baby who was responding by cooing and interacting back with me. I looked up momentarily, and there were two staff members watching my interaction with the baby in amazement. They had never seen the magic that can be created by responding appropriately to a baby and the strength of babies' return responses."
The results after working one month with the caregivers and the children at this Haitian orphanage were telling. Jump tells us about the failure-to-thrive baby who gained over a half pound during the intervention. Or the two-year-old girl who went from rocking herself and banging her head on the floor to smiling and exploring her environment. One of Jump's favorite stories is the little girl who, after the second day of receiving massage, began to feel her own foot. It was unusual because these babies, who also didn't communicate outside their extremes of crying and silence, didn't typically touch their own bodies. "It was as if she was figuring out it was a part of her," Jump says.
Despite the horrors she saw in Haiti, Jump says she's still optimistic about the results of her research there. Like her previous work in Ecuador, Jump found massaged babies were sick less often than babies who were not massaged. But what she also witnessed, with the implementation of massage and several other tools, were powerful changes in the children's abilities to engage. "What I saw was that overall, all babies improved in their ability to interact with others."The Birth of a New Idea
When Jump left Haiti, a mysterious illness left her fatigued and weak for the next two and a half months. She spent a great deal of time in bed trying to recover, an ordeal she says helped her gain perspective. "I count being sick as a blessing," she says. "When I first returned from Haiti, I was discouraged because I didn't know how or where to start intervening, as the situation is so extreme. Being sick allowed me time to reflect on my experiences and to think about where to begin."
The concept Jump emerged with was to create a protocol for training in simple developmental understanding. "The main premise behind my training program is to allow more consistency and continuity for babies by having consistent caregivers who respond appropriately and in a timely manner to babies' needs," Jump says. "There may be thirty-five babies and four caregivers who just respond to all the babies haphazardly." This lends itself to the anxiety evident in the lives of these children, something she saw in the Haitian orphans, who, she says, seemed as if their brains were in total chaos. "I advocate assigning caregivers to certain babies, so in this instance it would be one caregiver for every eight or nine babies. She would be responsible for their needs, and would receive training in ways to signal babies what is about to happen--like putting her fingers to her mouth to signal that the baby is about to be fed."
Of course massage is a fundamental element in the training. It's a primary avenue for connecting with the babies and letting them reconnect with themselves. Jump continues to utilize the massage techniques endorsed by Infant Massage USA, formerly the American Association of Infant Massage, for her protocol.
Jump says caregivers also learn how to respond properly to the babies' needs, use general interaction and communication skills, understand appropriate child development and how to facilitate optimal development in infants, and, overall, see the children in a different light. "Rather than seeing the babies as 'this thing I need to get done,' see them as babies with needs," Jump urges her students. "As I meet their needs, they cry less. It's a process of restructuring the caregiving environment." She says it's all about creating predictability in the babies' lives so they can calm their disorganized little brains through routine and order. Not only does structure reduce the sense of being overwhelmed for both child and caregiver, it creates recognizable cues for the babies, teaching them some critical self-regulating skills they've not had an opportunity to learn because of their circumstances.
Jump explains that children with families go through an initial stage where they are entirely dependent on a parent. Next they learn self-regulation. Babies in orphanages, however, don't have a primary caretaker who will respond to their needs, Jump says. "Very often what happens to the baby depends on staff needs and organization needs, not the baby's needs." She explains the assembly line mentality of care in most orphanages: children are fed at X, Y, and Z, and changed at one, two, and three. Jump says caregivers need to make time to stop and have a moment with the child; see the child for the life that it is, and nurture that spark in what can otherwise be a wholly unfathomable life of abandonment.
She encourages others to imagine the tasks of these orphanage staff members. "Caregivers are overwhelmed. It's chaos in orphanages, and it's not just having to take care of one crying baby, but all the babies crying," she says. "Right now, children's outcomes are being compromised. If staff were to learn basic principles of child development and health and sanitation routines, the physical and emotional health of infants in orphanages could be dramatically improved, and perhaps outcomes for children who are adopted could be improved as well."India's Enlightenment
The timing to put her new program to work was perfect in February 2006 when Hands to Hearts International (HHI) asked Jump to work with the orphanages they supported in Chennai, India. The project was supposed to last a year, but government officials ended up closing down the orphanage Jump was using as her research site. Still, after only a month of data collection and training, she returned knowing her intuition about her work was correct. This would also be the pivotal moment in redefining her research. She broadened her questions from those that conceptualized massage as having health implications to those that acknowledged massage as having health implications and social attachment benefits.
Just as Haiti gave her the impetus to find fresh solutions, India confirmed that the overwhelmed mentality of caregivers is not an isolated event, and children everywhere are paying the price.
"Caregivers in India cared for children based on their schedule, not the babies'. The babies were fed at certain times, not according to when they were hungry. They were picked up to have their nappies changed, not when they cried. Their food was basically shoveled into their mouths without any regard for infant cues of readiness. The babies' physical existence was cared for mechanically, on a schedule, and no awareness of infant signs of needs for physical care were recognized. Babies' emotional needs were not recognized at all." But Jump also acknowledged that it was the only protocol these caregivers knew to keep the babies alive.
Jump could see that caregivers knew no other way to deal with the massive number of infants in their care, so the mechanistic took over the humanistic. Jump saw the same thing in Ecuador, where the pressures of the work were causing the staff and even the American volunteers to act in an increasingly regimented, automated way.
In India, most of the women Jump tutored didn't believe babies had emotions or social capabilities. "When they told me babies were not social and then watched a two-week-old baby respond to a voice, they began to believe. When they told me babies don't like to be sung to and then watched two fourteen-month-old babies stop what they were doing and watch me the entire time I sang "I Had a Little Turtle," they believed a little more. When they watched how babies would stop crying and respond to social interaction when they were picked up, they believed even more. They eventually began to see that babies not only have emotions, but that part of their jobs was to respond to those emotions."
Jump says she was stunned by how quickly caregivers changed their perspectives of the children. "They went from a very mechanical form of caregiving to a baby-centered system quite quickly, and it appeared naturally." And almost overnight.
Although just as challenging as all her research visits, Jump says her trip to India was especially powerful. "I had more full participation, honest searching, and spirited debate in my time with the caregivers in India than I have had in any other learning situation in my life," she says. Together, Jump and the caregivers were doing things that would forever impact the lives of those children in their care. "I watched the orphanage go from a mechanical, schedule-oriented facility to one that embraced my training and implemented a relationship-based model, based on babies' physical and emotional needs and cues. The outcome was that the babies were much happier, more interactive, and cried a lot less." But the benefits go much further than the obvious.
"Theoretically," Jump says, "caregivers should be happier because of happier babies; and babies are happier because of consistent care from consistent caregivers."
A precious memory for Jump--and one to create balance in light of her experience in Haiti--came on her last day in India. "I snuck into our training room early in the morning, and I heard the babies start to wake in the next room," she says. "I then witnessed one of the most beautiful sounds I have ever heard. As the babies began to wake and cry, the caregiver began to sing and hum a beautiful hymn to calm them. The babies stopped crying so they, too, could hear the beauty and calm in her voice. I felt such peace and love, and so much power from the meeting of our minds and concern for the babies. I knew the babies were in good hands." She knew she'd made a difference.So Much To Do
So where is Jump taking her research next? Right here at home, she says. With the support of Utah State University, Jump is looking at the influence of massage on health outcomes in a sample of U.S. infants (three to five months). "We are trying to recruit families with multiple children, as other children in the home is a risk factor for babies getting sick more often. We will be looking at antibody levels before and after the intervention, as well as how often babies are sick." She's hoping to find the statistical information that will help her advocate best practices in orphanages around the world.
After that, Jump says she has more questions to ask. "I'd like to look at the influence of infant massage on health outcomes for babies born with Down's syndrome, as these babies are sick much more often than the general population. If a simple intervention could help improve their immune status (and sleep status, as many of these babies have sleep issues), why not encourage parents to do it?" Parents don't want to feel powerless in the health of their children, she says. This protocol would give them a vehicle for their support, healing, and nurturing.
Slowly, but steadily, Jump's training program is progressing in India. A dozen or more orphanages have received the caregiver training, and U.S. visitors involved with orphanages there are returning with reports of phenomenal results. Jump hopes the program will continue to spread throughout the global orphanage community. "I have found that orphanage directors have embraced the training, as they want what is best for the babies in their care, but often don't have the resources or know-how to do things differently. In resource-limited countries, the burden is even greater."
The work Jump does is not for the faint of heart. You can't help but see the brutality of poverty and insidiousness of despair in the eyes of these children. What drives Jump to continue on? "Rene Spitz discussed the horrible reality of babies in orphanages sixty years ago. We have a lot of research that confirms his findings--that babies need caregivers who respond to their needs in order to grow and thrive. Babies in many orphanages still receive the same type of care they received sixty years ago, despite our knowledge that this wastes their human potential. I think this reality is horrific, and my goal is to change the system of care babies receive."
Often working on her own time and using her own resources--financial and otherwise--Jump is saddened she can't do more. "I am limited in my funds and have only been able to do so much, so far. I will continue, but not at the breakneck pace I would like." That reality tugs deeply at her heart. "There is so little time, and so many babies are suffering."
For more information about Vonda Jump's work, e-mail her at email@example.com.