The Staff at the Rainbow Unit in Mongolia Never Give Up on a Child, and It Shows

By Paul Kim, Assistant Program Director for Northeast Asia

Full of anticipation and wondering if the children would remember me, I opened the door and peeked around the corner.

It had been several months since I last visited the “Rainbow Unit,” Holt International’s special baby care unit in Mongolia, but as I walked into the bright room, the children all turned around and ran up in one happy gaggle of smiling faces. They had been sitting with one of the nannies, learning about animals from large, colorful books that Holt had helped provide.

“Awah, awah, awah,” they exclaimed pointing to me, as they ran up to get hugged and proudly show me their books. Several mischievous tikes grasped my wrist and started pushing buttons on my watch. They had learned to light up the dial the last time, and the novelty had obviously not diminished. Some waited patiently to get a hug, while others dove right in.

I asked one of the staff what awah meant. “It means ‘daddy,’” she said with an expectant look, and a grin. “What do you think of that?”

“It feels wonderful.” My answer echoed what I felt in my heart, because the children’s joy and energy was so different from earlier conditions. As I ran around the room, joining the children in their play, I recalled faces that were no longer among the happy children I saw. I especially recalled one remarkable child.

Her name, Altaa, meant “golden pearl” in Mongolian. Born in June 1999, her entry into the world was a special miracle in itself. Of her birth parents, we know very little, but we might imagine that her mother, like so many mothers of the children in this unit, was young, unmarried, and away from her extended family.

Successive extreme winters had wiped out roughly a quarter of all livestock, forcing many people to abandon their nomadic lives and seek work in the cities. Separated from their extended families and communities, the traditional safety nets and supports were lost. In the nomadic communities, if parents were unable to care for their child, another member of that community would automatically take that child in and raise him or her as their own. Children were not viewed as “belonging” to the parents but were a shared responsibility to be cared for by all. But life in the cities offered no such relief for many who had tried to survive there.

The young mother’s health was grave, so much so that the doctor recommended termination of her pregnancy to save her life. And so a decision was made, but remarkably the procedure failed, and at 27 weeks, a child was born, premature, weighing 2.4 pounds. Shortly afterwards, her mother disappeared, perhaps to ensure that her child would be cared for by others as she could not.

On the sixth day of her life, Altaa was brought to the premature unit of the Infant Sanatorium, but doctors held little hope that she would live.

The building undistinguished from the outside, you could pass by it and have no idea of the miracles occurring inside the warm and clean Infant Sanatorium. Though resources are limited, the staff work hard to meet the needs of the children in their care. The “preemie” unit of the Infant Sanatorium is not much different from the other parts of the facility. Despite having just one incubator and little specialized equipment, it has a remarkably high survival rate.

The staff at the Infant Sanatorium never give up on a child, even if others view the situation as hopeless. They ask birth mothers to hold and feed premature infants for the first critical days or weeks. When mother and child are sufficiently recovered, birth mothers can then rejoin their families.

When Altaa came into care, she had no birth mother to care for her, but the staff asked one of the other birth mothers to help this additional child.

For a month, Altaa was held and nursed by a woman she may never know. Soon Altaa began to get stronger, and contrary to some expectations, she lived.

Seventeen months later, in October 2000, Altaa’s life changed again. Holt International sent Dr. Becca Brandt—a pediatrician and Holt board member—to establish a special baby care unit at the institution.

Holt representatives first met with Mongolian officials in 1997 and began exploring ways to collaborate on behalf of homeless children in that nation. Holt agreed to improve the care of orphaned children with the goal of finding permanent, loving families for them. Holt’s first objective was to improve the health and development of the children living in the institution. While the childcare staff were providing nutritious food and a clean and safe environment, Holt found ways to improve the overall well-being of the children.

Dr. Brandt noticed that the units, especially for the older children, were much too quiet. The day areas for the children, while warm, clean, and well-lighted, lacked any activity. There were few toys and not much play interaction with the childcare staff. The children sat rather passively in an essentially empty room. The staff had been trained on the Soviet institutional model that placed little importance on stimulation for the children.

To change this, Dr. Brandt held seminars for the physicians and nannies on the value of play, interaction, and talking to the children. She found the staff eager to learn. Though it took reinforcement, the staff took this training to heart, and steadily improvements occurred. Holt and Holt friends provided toys, books, and new clothing. Focus Teams renovated play areas and built a playground for the children.

Holt also provided nutritional support for the children. The children’s diet while high in carbohydrates, fats, and protein—reflecting the traditional Mongolian diet—lacked fruits and vegetables. These often had to be imported, and the cost was prohibitively high for the limited budget. Infants received primarily cow’s milk, which may be adequate for the healthy children but could not provide essential supplements needed by those children coming into care malnourished and anemic. In addition, some of the children’s digestive systems could not easily handle the milk, and thus their recovery was compromised.

Holt provides funding to purchase fresh fruits and vegetables, specialized infant formulas, multivitamins, and iron supplements for the children. Holt also subsidized the hiring of a nutritionist to oversee the proper diets for the children. The children now enjoy the benefits of a balanced and varied diet, and have realized greatly improved health and vitality.

Medical care has also been improved. Pediatricians on staff are the primary providers of medical care for the children. However, some children need specialized medicines, tests, and treatments not normally available at the facility. Holt provides funding for this supplemental care. In addition, generous Holt supporters have donated medical supplies and equipment.One difficulty of working in Mongolia is the availability or prohibitive cost of certain supplies or equipment. Despite this, Holt has worked hard to ensure that the children receive the best possible care under the circumstances. Holt also provides training and current healthcare information to the staff. As a result of the improvements in diet, activity, and medical care, the rate of illnesses in the units dropped by over 50 percent during the first year.

And so Altaa enjoyed a world characterized by health and enthusiastic play. As the nannies talked with the children, encouraging them to play and become involved in daily activities, the children’s personalities began to manifest themselves. They became much more active and vocal.

Altaa’s confidence began to grow, and she would happily place herself in the middle of the activity, smiling and laughing and having a great time just being a child. She played with toys, looked at books, and wrapped herself in the comfort of caring people. She grew into a beautiful young child—healthy, vibrant, and starting to babble and hum. She loved one particular game. When asked “Where is your nose… eye… mouth, etc.?” she would point to it, giggling with delight, proud to prove that she understood.

Improvements in the children’s health were obvious to all, especially to the Mongolian families coming to the institution interested in adopting a child. Whenever possible Holt tries to keep children with their birth parents, but if that is not feasible, Holt tries to find adoptive families in the children’s country of birth. If that is not possible, Holt finds adoptive families in the United States.

For Altaa, the first option was not possible. But in the summer of 2001, almost exactly two years from the day she came to the Infant Sanatorium, a Mongolian family visited the Rainbow Unit and noticed a bright, healthy, and beautiful little girl, and they chose her to become their child. For Altaa and everyone involved in her life, this was an especially poignant success. She began life with the odds stacked against her living, but she not only lived, she received the greatest chance of all, a life with a family of her very own.

During 2001, Holt reunited seven children with their birth families and placed 18 children with families in Mongolia, and one child with a family in the United States, all from the special baby care unit.

Back to my most recent visit to the Rainbow Unit… it was lunch time. As I helped gather the children to their places at the tables, I remembered the last time that I saw Altaa, one year earlier. I was helping the staff feed the children their dinner. Altaa was sitting at a table next to the window, where we had been playing her favorite game. Her attention turned to something outside, and she pointed off toward the waning sunset.

I looked out to see if I could spot what she was seeing. She looked at me, then back outside, babbling, trying to make me understand. She may have seen a bird, a passing person, or maybe a car. I never did know what. Two months later, I received the wonderful news that she had a family, and I was joyous but a bit sad that I would probably never see her again.

I thought back to that last night, and I like to think that maybe in her own special way, she had known that her future was not in an institution. That her life was out there, and that was what she had been trying to tell me.