OVC Support Toolkit  >  Living environments 

Carers

This section looks at issues relating to people who provide care for orphans and other vulnerable children. It looks at who these people are and examines, in particular, the problems of stress and burnout. Other sections look, in general, at environments in which children live and in detail at issues facing older carers and child-headed households.

Key points about carers of orphans and other vulnerable children are:

1. Most orphans and other vulnerable children in developing countries are cared for by family members in the local community. These family members include surviving parents, grandparents, other adults and brothers/sisters. These people are a child's primary care givers.

2. Although men are often identified as a child's formal guardian, the burden of care falls mainly on women.

3. Primary care givers may receive support from a number of sources. These include community-based volunteers, professional staff and traditional healers.

4. Care givers may experience stress for a variety of reasons. In some situations, this stress gradually builds up until a person can no longer cope. Their physical and mental health, personal relationships and standards of care may all suffer. This is referred to as 'burnout'.

Carers of orphans and other vulnerable children

Most orphans and other vulnerable children in developing countries are cared for by family members in the local community. These family members include surviving parents, grandparents, other adults and brothers/sisters. These people are a child's primary care givers.

A study in Uganda showed that orphans received care from a surviving parent in 50% of situations. Other carers were grandparents (35%), aunts/uncles (11%) and brothers/sisters (3%). Most of the brothers and sisters providing care were aged over 18 years but there was one situation where care was being provided by a child under the age of 18 years.

Although many children are cared for by surviving parents, this is not automatically the case when one parent dies. Reasons why this might not be the case include:

• Cultural practices which lead to children being 'inherited' by one side of the family (often the father's) rather than by the surviving parent (usually the mother).
• The surviving parent remarrying and the new partner being unwilling to take on responsibility for the children. This is strongly influenced by cultural norms and practices.
• Better economic prospects for the child with the extended family.
• The surviving parent being unable to care for the children. A common reason for this relates to the parent's need to work.

Although men are often identified as a child's formal guardian, the burden of care falls mainly on women.

Primary care givers may receive support from a number of sources. These include community-based volunteers, professional staff and traditional healers.

Stress and Burnout

Care givers may experience stress for a variety of reasons. In some situations, this stress gradually builds up until a person can no longer cope. Their physical and mental health, personal relationships and standards of care may all suffer. This is referred to as 'burnout'. Primary care givers may experience stress and burnout, as well as volunteers and professional staff.

Signs of stress include:

• Physical symptoms, such as inability to sleep and bowel disturbances.
• Emotional problems including feelings of inadequacy, helplessness and guilt.
• Withdrawing from other people.
• Reduced quality of care.
• Worsening relationships with other people.

Stress is caused by a number of factors including:

• Poverty and its effects, including lack of resources to meet survival needs of both the child and carer. This includes lack of food and medicines.
• Interpersonal and family conflict. This is common within families affected by HIV/AIDS because the virus spreads mainly through sex. This often leads to people being blamed for 'bringing the virus into' the family.
• Isolation and fear for the future.
• Excessive workload.
• Stigma and discrimination relating to HIV/AIDS.
• Excessive personal involvement in issues relating to the child.
• Poor organizational arrangements. This applies particularly to secondary care givers. Issues include lacking a voice in the way things are done, inadequate support and lack of clarity over roles.

Stress and burnout can be managed by developing personal coping mechanisms and organisational strategies. Religious faith may be important as part of personal coping mechanisms. Organisational strategies include:

• Recognising that caring is stressful and that stress and burnout are complex.
• Ways of dealing with problems that carers can not deal with.
• Finding ways of showing that carers are valued.
• Providing carers with training.
• Relieving poverty and ensuring that activities are reliably funded.
• Effective stress management measures including regular time off, realistic workload, team meetings and participation in decision-making.

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