2015 Competition Winner

Street Smarts:

Stories of struggle, survival, and resilience from street children in western Kenya

by Paula Braitstein and Lonnie Embleton (for affiliations see below)

 

Rooted in the process of competition and natural selection, our differences are the basis for evolution happening all around us. Competition, the drive to survive and breed, random selection, these are elements that move us forward as a species. Humanity is full of inequities and inequalities that arise from or result in competition, by gender, race, and socioeconomic status, to name a few. In the here and now of being human, we live with and are confronted by profound inequities and i nequalities every day. Take for example the case of Eldoret, the capital of Uasin Gishu County in western Kenya. One of Kenya’s fastest growing urban centers, Eldoret is home to Moi University, one of Kenya’s largest and best-reputed universities, Kenya’s second referral hospital, Moi Teaching and Referral Hospital, and a rich agricultural environment. Rapidly rising and reshaping the urban landscape, big new buildings are going up by the day, with little thought given to the accompanying infrastructure needed, like waste disposal, sanitation, or parking. Amidst these new structures and thriving educational and agricultural sectors, are vast urban inequalities and inequities. Weaving throughout the city’s haphazard built environment are squalid and sometimes fetid neighborhoods, where temporary structures line the streets made of iron sheets, scrounged wood and other materials in a maze of muddy lanes paved with garbage. Pigs, chickens, cows, dogs, children, and very many people alike are trying to survive.

Invisible to the eyes of many of the city’s dwellers but who inhabit the city’s corners and shadows nonetheless, are children. Many children are born on the streets; many children die on the streets. There are estimated to be millions of them around the world– certainly hundreds in Eldoret. Many of those in low- and middle-income settings are orphans or children from alcoholic and abusive families. The majority are seeking a better life than the one at home – poverty and abuse are the two primary reasons why children are on the street in low- and middle-income settings. In ragged clothes, clutching to bottles filled with a sticky yellow substance tucked into their sleeves (shoe glue, for sniffing), they laugh, argue, work, play, and struggle to survive. They are highly marginalized, stigmatized, and neglected. Their very presence on the street is a testament to the inequalities that produced them, particularly poverty and the inequality of women in Kenyan society. As traditional sociocultural structures have eroded in many parts of sub-Saharan Africa due to HIV/AIDS, civil conflict, and abject poverty, so has the African proverb ‘it takes a village to raise a child’. As the traditional safety net drifts away, children and youth who have fallen through the net become increasingly entangled in the complex subculture of street life with no place else to turn. Faced with extreme violence, poor physical and mental health, and human rights violations, they are subject to profound deprivation, violence and exploitation. Yet, they are still children and are surprisingly resilient in the face of circumstances over which they have little or no control. The lives of street children are intricate stories of inequality, with the causes and consequences rooted in complex social, cultural, political, and economic systems. They are also stories of hope, resilience, and the will to survive in the face of severe adversity.

This compelling book will use children’s narratives and photo essays to guide the reader through their journeys from home to the streets. They will be put into context of the Universal Charter of Children’s Rights, the scientific literature, and anecdotes and vignettes. Intertwined with children’s narratives of their journey to – and sometimes off M the street, we will help the reader to understand their accounts within the social, cultural, political and economic circumstances that affect and contribute to children’s street-involvement. The chapters will identify possible mechanisms for beginning to stem the flow of children to the streets, and ways to help them once they are there. Over the course of several years, we have worked and lived with the street youth community in Eldoret as scientists, community workers, and personally. Using our experiences, the literature, and the prospective permission of five to eight former or active street youth, we will take the reader into the lives of street children to describe the inequalities that led to them becoming street-involved, those they were faced with on the street, and how they are able to live with and overcome them. Street youth in resource-constrained settings are a major public issue but are generally poorly understood and mostly ignored by the public and policy makers. This book will help people to better understand this complex vulnerable population, their potential, and the big picture issues that produce them. Through the voices of the youth and their photographs taken through various innovative health promotion initiativeswe will identify opportunities for programs, policies, and other interventions to better respond to the needs and human rights of street children in low-income settings.

 

Chapter Outline

Forward

A heartfelt forward by a UNICEF ambassador will set the stage for the reader and the need to change the situation that leads to children falling through the cracks of society.

 

Chapter 1: Who are street children?

“My senses were overcome by the clanging of hammers on metal, voices shouting at each other in a rhythmic Swahili, the organized chaos of people working, and an intense mix of the smell of the earth, perspiration, and trash. Passing through the jua kali, a rich red dust blew up the back alley as we walked through an array of items being created by metal workers. We proceeded down the dirt roadway, surrounded by heaps of recycling materials being sold by women in checkered aprons negotiating loudly with purchasers, and neatly stacked freshly painted colorful metal school boxes. My guide and I arrive at an intersection of two dirt roads looking onto the Sosiani river and a network of pathways that lead to a slum called Kipkaren. ‘We are here, this is Mangula’ the outreach worker tells me and guides me to underneath the footbridge and rivers edge, kids and youth in tattered clothing emerge to greet him in excitement, darting out from every direction and suddenly becoming strikingly visible. They are curious about the visitor their ‘teacher’ has brought to their ‘base’. All at once they engage in conversation, with curious smiles and shouts….” (Author Reflection, Lonnie Embleton, 2010)

The average age of street children in Eldoret or elsewhere in low-income settings is not really known, but we can estimate from research that on average they are about ten to 13 years old, with boys tending to be younger than girls. Many youth eventually transition to adult homelessness. Street children in low-income settings are mostly male (~75%)and often have been on or connected to the streets for several years. Street girls, even those in their teens, often have babies or young children, sometimes they live with them on the street or leave them with family or friends; other times they are abandoned at birth and left on the street or in the hospital. In some cases the babies are murdered. We are in the final stages of conducting a systematic review and meta-analysis on the causes of children going to the street globally. This chapter will present These data, which we aspire to have published in a reputable peer-reviewed journal by the time of book preparation. The data suggest that in low- and middle- income settings, poverty is the main driver of children to the street following by abuse and neglect. In high- and very high-income settings, family conflict is the leading cause, followed by abuse, and psychosocial issues. This chapter will introduce a group of up to eight street youth, male and female, who have been or are in street circumstances. Through these introductions the youth will tell their story of what brought them to the streets. Each account will be intertwined with findings from the authors’ systematic review, other research including our own, and anecdotal experiences. The youths’ stories will unfold chapter to chapter throughout the book providing a very personal perspective to the issues. Children’s personal accounts and the authors’ findings will be situated within the global economic and political context and the interconnectedness of these circumstances that drive inequities and social determinants of health that lead to street-involvement. Overall this chapter will provide the reader with a broad overview of what we know about street children and youth internationally, focused on children in low- to middle- income countries but comparing and contrasting with homeless youth in high-income settings.

 

Chapter 2: Initiation to the streets

‘‘My mother has a problem. My father was a polygamist and when he died my mother had to be on her own. She resulted into taking alcohol, wasn’t feeding us or taking care of our needs. We were suffering a lot. I heard people talk of a place called Town and street children. One day I met the street children and I followed them to the market where we ate so many bananas until I was satisfied. In the process they were sniffing glue so I made up my mind to stay in town’’ (Street Girl”)

This chapter follows up on the children’s introductions and their reasons for becoming street- involved. It begins to bring the reader deeper into each child’s story by transitioning from when they left home to their first encounter with street life. It will demonstrate the diversity and range of pathways to the street, from those children that were working part-time on the streets to provide an economic contribution to their family, to those that escape abusive family situations, and those that migrate from rural pastoral communities to urban cities in search for a better life. Children’s narratives will describe what it is like to find themselves on the streets, how they establish relationships with other girls and boys in similar situations and what happens with they join a street gang. The authors will explore this newfound identity from their in-depth qualitative work investigating initiation into street communities in western Kenya. Uncovering initiation rituals that new children and youth undergo to become part of a dedicated group on the street, the authors investigate the differences for boys and girls and the disparities that exist between genders. Boys often undergo physical abuse and are required to prove their strength, while girls suffer extreme sexual-based violence. The use of volatile substances, such as sniffing glue, becomes a prominent component of acceptance and belonging to the street culture and their dynamic social networks. Indeed being accepted into a gang or group on the street is key to survival, so the initiation rites in spite of their violence, are in fact an adaptive response to the circumstances facing children when they arrive on the street. Some of them are intended to screen out children who don’t really need to be there. This chapter will use the personal stories of the children in conjunction with the qualitative research now under review and in progress to help readers understand initiation practices into the street as a core component of adaptation and survival.

 

Chapter 3: Social Networks & Street Culture

“They smear you with ‘bamba nyeusi’ soot from a burnt tire. They smear you with that and that now makes you part of them… After smearing you with the ashes, you can go to the river and wash or just walk around… It is like taking an oath so that you become a member of that base, so that they know you are one of them” (Street Boy)

Children and youth in street circumstances form complex social networks and establish an identity and sense of a belonging within street gangs. This chapter explores the social hierarchy and subculture of street life in Eldoret, along with the interrelationship with societal and cultural norms. Children’s accounts will explain the network of street gangs and how their leadership functions, and the ways in which the social networks and culture on the street are both protective of them, but also highly threatening to them. Research by group has revealed that the social networks formed on the street are critical to the survival and resilience of street children, and largely replace social networks typically formed within a family. This chapter will explore these issues, and have the narratives describe to the reader the importance of friendship and social support on the street. Through this we will begin to identify opportunities for enhancing resilience and positive coping for street-connected youth using social networks and street culture as the basis.

 

Chapter 4: Gender Inequities – On vaginas and vegetables

“The girls are usually called ‘mboga ya jeshi’ which means that a street girl is a wife to any street boy. So if a girl has a boyfriend, it doesn’t mean that she will be his girlfriend forever. You will even find a boy organizing for her girlfriend to go at his friend’s place and have sex with him because he knows that he wants to spend the night with another girl. They can even decide that they should test a girl as a group by all of them having sex with one girl as a group where they queue so that when one finishes another one comes on” (Street Girl) (unpublished work)

Immense and often disturbing inequities exist between girls and boys on the street. While these inequities are visible in every chapter, this chapter will plunge deep into the distinct differences and difficulties faced specifically by girls on the streets.  Girls’ narratives will be the primary component of this chapter, with analysis of these inequalities in relation to the social and cultural context. Particular attention will be paid to violence against girls and women, their participation in survival sex, and unequal opportunities in a patriarchal society using feminist theory to frame the discussion. This chapter will propose ways in which to empower and protect girls in street situations and reduce the inequities girls face.

 

Chapter 5: Substance use

“A new person can stay for one month in town without sniffing the glue after which they crave, taste and begin using it. The journey of addiction starts off…’’ (Street Girl)

Substance use forms an integral component of street life; it provides a sense of belonging and identity and acts as a coping mechanism. Usually children can be found sniffing volatile solvents such as glue and gasoline. Unfortunately this substance use also destroys the brain and other organs, inhibiting rehabilitation and reintegration of children and causing a series of other physical and mental problems. The authors have produced a body of knowledge on the topic of street children and substance use through a systematic review and primary research. In conjunction with our scientific findings, children’s narratives will explore their initiation into using substances and an account of why they use glue and other mind-altering drugs on the street. We will focus particularly on volatile substance use including what volatile substances are, how they affect the body, and the difficulties with mitigating this type of substance use. Internationally in low- to middle-income countries, 60% of children and youth connected to the streets report having ever used drugs. Volatile substances are the primary intoxicants (47%) being used, due to their affordability, widespread legal availability and unrestricted sales to minors. Children’s photographs taken as part of a substance use intervention implemented by the authors will complement the children’s accounts of substance use and provide a provocative visual of children’s substance use on the streets. In conclusion, this chapter will explore the potential for interventions to mitigate substance use and reduce harms associated with drug use on the streets, as well international drug policy implications.

 

Chapter 6: Sexual and Reproductive Health

“Once you join the street you will automatically start having sex and even if you are 5 years you will start with the young children then when you reach the age of 8 years, you just start feeling that you can even do it with older people and they will now start buying you some alcohol so that you can have sex with them. They just confuse the girl and have sex with her. On the street, people don’t marry because they are age mates because you can even find an old person marrying a young one.” (Street Girl)

The commencement of children and youth’s street- involvement is intimately linked with their sexual debut and inability to remain celibate due to peer and other pressures. As sex plays an integral role in street life, we will hear from both boys and girls on the different ways sex functions in their lives. Adolescents on the streets may be particularly at-risk of horizontal HIV transmission, and the girls at high risk of transmitting HIV to their babies. The distribution of HIV infection in this population is unequal, with 15% of females compared to <6% among males being HIV infected. Indeed the prevalence of HIV in this population is several times higher than the background adolescent population at 6%, and HIV is a leading cause of death among them. In general sexually transmitted infections (STI’s) are very prevalent in this community, and sexual violence is part of the grim reality for both boys and girls, but especially for the girls. Pregnancy is viewed by street youth as a positive outcome because their “husbands or boyfriends” expect it, and girls will be beaten if they don’t get pregnant. Becoming pregnant may also be a way of expressing hope for the future. At the same time illegal or self-induced abortions are common, and babies are sometimes abandoned or killed. The options and choices for street youth are limited by their need to survive and conform to the norms and expectations of the social and sexual networks in which they live. Girls particularly have little or no choice if they want to survive and their situation is deeply, sadly, emblematic of the inequalities between the genders in broader public society. Interventions targeted towards the sexual and reproductive health of street children and youth need to be carefully designed and implemented to support choice, respect of their human rights, and offering of alternatives. Through children’s narrative accounts intertwined with the author’s quantitative and qualitative research, we will discuss sexual and reproductive health issues and possible opportunities for intervention around gender-based violence on the streets, the complex issues surrounding pregnancy, and the interplay of the need to survive and sexual and reproductive health.

 

Chapter 7: Physical and Mental Health Issues

“There are diseases like HIV, you can sleep with a girl and you don’t know her status but she knows she is infected. But she won’t tell you, you will just see your body weakening and even if you ask her she won’t admit that she infected you.” (Street Boy)

Relatively little is known about the physical or mental health of street youth. Data in specific regions and for specific diseases are particularly rare but suggest that the daily struggle for survival and the need to survive put youth at higher risk of infectious diseases (including HIV, hepatitis C, other STI’s), psychiatric disease, and perhaps also growth and nutrition. Vast areas of health that may disproportionately affect street children in childhood or later on as adults have not been investigated, including chronic diseases and cognitive deficits. Our group has uncovered some very interesting findings about the physical and mental health of street youth. Their nutritional status, for example in comparison to orphaned and separated children living in peri-urban and rural households in the same region tells a very interesting story. In a cohort of nearly 3000 orphaned and separated children including 100 street youth, only 10% of street youth were normal height for their age compared to 26% of orphans living in extended family environments and 40% of orphaned children in institutions. Yet 99% of them reported having an adequate diet, compared to 92% of children in extended family environments and 95% of children in institutions. Most interestingly 70% of street youth in our study had a normal body mass index (BMI) for their age, compared to 63% and 66% of orphans in extended families and institutions respectively. These data suggest two very important things. First, stunting (i.e. height for age) does not occur overnight but over months and years and is not easily reversed. The street youth in this study are apparently coming from highly food insecure environments supporting the data suggesting that poverty is the main driver of children to the streets in a place like Eldoret. Two, their weight is relatively normal for their height and age. Once on the streets, street children scrounge in the garbage, eat leftovers and handouts from restaurants and hotels. Children, like many orphans, who are socioeconomically deprived eat the same basic diet every day – ‘ugali’, the local maize staple, with greens and perhaps sometimes beans or lentils. Meat is usually in the form of chicken and usually only for holidays like Christmas if at all. It is likely that street children are eating a varied diet of different fruit and vegetables, meats, and carbohydrates, and may on balance eat more calories than either of the other two categories of children. This chapter will help the reader to appreciate the issues and opportunities for nutrition intervention for children connected to the street.

Our research has also uncovered some important aspects of the mental health of street youth, aspects that will be explored in more depth in conversations with our interviewees. In the same cohort study for example, street youth in our study were more than twice as likely as orphaned children living in institutions to be diagnosed with post-traumatic stress disorder (PTSD). This is perhaps not surprising given their lives before and on the streets. Yet nearly half of street youth reported having a positive future outlook or optimism about the future (work in progress). This suggests resilience among them and the possibility of helping them to use their positive future outlook to help them transition off the streets. This research also points to an acute need for mental health counseling for street youth both as a means of supporting them and helping them with reintegration into society.

 

Chapter 8: Protection and Criminalization: Blaming the victim

“There are some of us who don’t sleep at night so that they watch over others as they sleep. There are also others called soldiers who inform us when the police come because the police usually come to beat us and I don’t know why.” (Street Boy) (unpublished research)

In Eldoret, as in many places in Africa, the response by the government is to arrest and detain children living on the streets. Strategies frequently involve street sweeps conducted by police with unnecessary violence resulting in children being placed in overcrowded detention centers or repatriating them to unsafe care environments. Chased and beaten when arrested, they are detained in Juvenile Detention, which at last count had 282 children in a facility designed for 75. Girls and boys housed together, and young children (<10 years) with older ones. A court date sometimes is set and the parents or guardians if they show up are fined more money than they surely can afford. If they don’t show up the children are sometimes dropped at their last known address without a risk assessment being conducted in advanced, sometimes dropped off at the county line wherever it happens to be, and sometimes the child is just released back onto the street. It is a vicious cycle where the children, as so often happens, pay the highest price for the uninformed policies. On the streets there are Good Samaritans, guards of shops sometimes, or shop owners, who look out for street children. Unfortunately there are also those who view street children as akin to vermin and have them beaten up if they are ‘loitering’ or sleeping. A restaurant popular with locals in Eldoret has a guard who for years carries – and uses – his ‘kiboko’ (literally, hippopotamus, meaning a long leather whip) on street children if they come near the restaurant or appear to be bothering prospective or actual clients. Police brutality against them is common. This chapter will use narratives, qualitative research and information from UNICEF documents including the Universal Charter of Children’s Rights to describe the problems of protection and criminalization of street children and point to policies and charters through which their rights and lives are supposed to be protected.

Chapter 9: Prevention, Rehabilitation & Reintegration

“Enroll them for some form of training and when they get a good education and job it will make their life better. Such a child will leave the streets and help rehabilitate other street children. He or she can take the street child to school and in future that child will also help others on the street.’’ (Street Girl)

This chapter will use the narratives of the participants together with information from the scientific and program literature together with our own experiences to discuss issues related to prevention, rehabilitation, and reintegration. We will specifically discuss anti-poverty initiatives such as conditional and unconditional cash transfers, free public education, and programs targeting single mothers. Rehabilitation and reintegration aspects to be presented and discussed will include many of the issues already touched on in previous chapters such as substance abuse, post-traumatic stress, and will address the needs and challenges for street children and youth in learning to live within a scheduled and structured environment.

 

Chapter 10: Conclusions and Recommendations

This chapter will summarize the key points raised by emphasizing modifiable areas for intervention and highlighting the adaptive and resilient elements that street children intrinsically exhibit. We will make detailed recommendations, and use the narratives from participants and photos from our photo-documentary work that illustrate how with the right resources and approaches, the filthy and high street child can transition into the beautiful and bright young person they were meant to be. We will have a section on getting involved for those interested in working with or supporting street youth. This chapter will require a comprehensive search of the grey literature and the Internet to identify resources and organizations at global and country that target or work with street children.

 

Author Information

Paula Braitstein is a Canadian PhD epidemiologist who has been working with homeless and street- involved youth populations in North America and sub-Saharan Africa since 1990. Today she holds a Canadian Institutes of Health Research (CIHR) Chair of Applied Public Health, and is Associate Professor of Epidemiology at the Dalla Lana School of Public Health at the University of Toronto (Canada) and Visiting Professor of Medicine at Moi University in Eldoret, Kenya, where she lives full-time.
Lonnie Embleton, MPH, is a Canadian public health researcher who has been working with Dr. Braitstein on scientific projects and issues related to street youth for the past five years. Ms. Embleton currently lives in Toronto.