Imagine as a 10-year-old child being left in a village to fend for yourself, ripped from your parents in the present by their inescapable duty to provide for your future.
In the U.S., it’s the stuff movies are made of. In China, it’s daily life for an estimated 60 million “left-behind children” of the migrant workers upon whose backs China’s economy has ascended over the past three decades.
Building on a long history of training Chinese health professionals and enacting participatory health programs, Atlanta-based nonprofit Global Health Action is trying to help fill this gaping hole in Chinese society.
While the country is rapidly urbanizing, it still has an internal “floating population” of some 250 million people, depending on which estimate is to be believed. They toil in construction, manufacturing and service jobs, often separated from their children by a crude economic conundrum: China’s hukou system ties free educational benefits to their home villages, meaning urban schools charge tuition fees high enough to largely negate the purpose of migrating in the first place.
That means students are often left in villages with aging grandparents who sometimes can barely take care of their own needs, says Robin Davis, president and CEO of Global Health Action.
And some kids have no one at all, leaving schools largely responsible for their welfare and positioning teachers and administrators almost as surrogate parents. Rural chools even have basic housing set up for students who find themselves displaced.
“On average, some of these children see their parents maybe twice a year, during the holidays or break time. This creates many concerns and issues,” Ms. Davis said.
Aside from the stress of poverty and loneliness, adolescents separated from their parents face an increased risk for nearly every major emotional and health challenge facing teens at this transitional stage of development: suicide, sexual harassment, sexually transmitted diseases, teen pregnancy, pornography, depression and more.
“It’s a difficult time in a child’s life for them to be without the guidance, love and support of their parents. We understand that you can’t fully replace what a parent can offer, but we work with health officials, grandparents, teachers and other local community leaders to be as supportive of the children as possible,” Ms. Davis says of the origins of GHA’s “Left-Behind Children” program, which began in 2011 and is being expanded.
The program started with the goal of improving the health and lives of 11- to 15-year-old students, and the nonprofit was brought in by heavy-hitting partners in the Chinese government, including the Jiangsu Province Health and Family Planning Commission, the provincial arm of the national organization, and the Nanjing International Training Center, which trains local and foreign government agencies about family-planning and health practices. They would provide the community inroads and cultural knowhow, while Global Health Action would provide program management expertise and training.
Government leaders wanted to attack the issue at the source, so they selected a pilot community that illustrates well the paradoxes of China’s economic success. Funing County, a rural area of northern Jiangsu about a four-hour drive from Nanjing, has been an ironic victim of its proximity to the powerhouse economies of Nanjing and Shanghai. In the impoverished Lupu township, about one-third of the adult workforce – some 16,000 people – had left for the cities. That’s where the work began in one primary school and one middle school.
Defining the Problem
Huang Sen, who handles the project for the Nanjing International Training Center, said children don’t want for food or education like they did in the old days, but they are left lonely and adrift at an uncertain time in their lives.
“There are so many sad stories,” he said. Many kids wanted to give up school and go to the cities with their parents, while others felt a sense of anger and wanted to retaliate against them, Mr. Huang told Global Atlanta during a 2013 interview in Nanjing.
How did he know? Early on in the project, Chinese partners surveyed the students directly about their biggest challenges. The 138-question survey, developed with psychologists, mixed basic informational questions with other queries focused on gauging their understanding of puberty and reproductive health issues, Mr. Huang said.
What emerged was a clear picture of just how much the students were missing without their full families, especially on sex education.
“Sometimes, when an issue arose, they just had no one to talk to,” Mr. Huang said. Some girls didn’t have anyone to explain their first menstruation, for instance.
With feedback on 99 common concerns voiced by the students, Ms. Davis and GHA helped develop a comprehensive adolescent health and life skills handbook. It covers much more than a sex-education manual, including such practical topics as how to prevent burns and put out a kitchen fire, what to do in case of a mudslide, how to tell your father about the health risks of smoking, how to prevent drowning in nearby rice ponds, how to talk to your teacher and much more.
“It’s really meant to be a very practical guide for the children, but also for their families and their teachers,” Ms. Davis said.
Ms. Davis said GHA is helping train teachers to encourage the students to use the handbook in school and at home. To encourage participation and identify the students’ concerns and private questions, they used a suggestion-box technique where each student anonymously had to include one question or something new they’d learned.
At the same time, the program attacked the challenges from a variety of other angles. To keep them better connected, GHA raised money to outfit a communication room with two computers to be used at set times for private video chats between students and their faraway parents. GHA also provided input on the “Hand in Hand” program in which local college students return to their hometown for events to serve as role models and mentors for the children.
With caring teachers as the linchpins, Ms. Davis said the program is starting to show anecdotal success, and the Chinese partner organizations are undertaking a full evaluation to ensure that outcomes like increased focus and knowledge, reduced psychological stress and improved academic performance will stick.
“I’m very positive about the changes that we’ve seen occur,” Ms. Davis said, crediting the teachers GHA has been able to train from Lupu township, as well as leaders from the Funing Family Planning Commission, who she said have worked tirelessly to improve the childrens’ lives.
“They’re invested in this area and they’re invested in these children,” she said.
Multiplying the Solution
Now the challenge is to scale up the program, multiplying the solution to more townships in rural Jiangsu and and beyond, and perhaps develop it into a national model. That’s what’s being discussed now as GHA hammers out a working arrangement for 2015 that calls for expansion into seven new counties.
A national model is not out of the question given the attention the program has received. It ran on the September 2013 cover of “Population News”, a national professional publication with a circulation of 500,000. Now, organizations in Beijing are funding the official publication of the handbooks.
This is a testament to the value of collaboration with the right partners to tackle major health challenges, Ms. Davis said.
“China is a huge country, and this issue with the left-behind children is so big and so complex, but with the strong partnerships that we have in China, GHA and our partners have been able to develop and implement a program at a relatively small level in a way that can serve as a model to be replicated many times over,” she said. “The impact can be large out of something that in the scope of China seems small.”
The ripple effects have also multiplied at home as Americans have learned about the work.
A high-school student in New York is helping raise $2,000 so students living at one of the pilot schools can have solar water heaters installed for their showers.
After Ms. Davis gave a talk at the Westminster School in Atlanta in January, students in its service learning course decided to take on the task of raising funds for 1,200 nail and hygiene kits. Global Health Action itself will also work with its Chinese partners to help fund eyeglasses for 230 students found to be in need after performing tests through the program on 780 students.
Ms. Davis foresees the work going on well into the future.
“We see health as far more than the absence of illness and disease.”
For more information visit: www.globalhealthaction.org.
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