The Head of the Aghia Sofia Children’s Hospital Social Services talks about the children stranded in paediatric hospitals, the training of health experts to deal with abuse, and the heavy toll of austerity on welfare.
What happens when a child showing signs of any type of abuse arrives at the hospital?
If a child has been subjected to abuse that cannot be dealt with, then the child might be brought to the hospital. There, it is up to the attending paediatrician to diagnose whether the child has been abused or not. If abuse is detected, the paediatrician informs us and is obligated to inform the Public Prosecutor for Minors, with whom we are in constant contact. The paediatrician reports their findings to the Public prosecutor and the child is admitted to the hospital. This can even be done over the phone with the public prosecutor giving a verbal order that the child should be admitted. We inform the parent or the uncle or aunt who has brought the child to the hospital, and the admission is made discreetly. In other words, we say that the child has an issue that necessitates a hospital stay for monitoring.
The following day or, if the admission is made in the morning, that same day, they inform the hospital’s social services, and we proceed with the necessary actions. We meet the parents, meet the people accompanying the child, looking after the child, and try to obtain background and records to ascertain what is going on. The child psychiatry clinic is also informed provided a Public Prosecutor’s order has been issued, and then the team of the University Child Psychiatry clinic takes over. They are experts in the field, child psychiatrists, psychologists, social workers and other specialists at the hospital such as speech and occupational therapists. These specialized psychologists have the scientific tools to diagnose whether there has been abuse.
What is the legal procedure from that point onwards?
We notify, and the Public Prosecutor decides whether a forensic examination is called for, which is usually the case when there are findings or indications present. If the relative arriving at the hospital is reluctant to report the incident to the police, then there is a problem. We inform the relative that they must go to the police station and notify them, and the relative goes to the police and informs them who inflicted the abuse if it is known. The police Division for Minors of the General Police Directorate of Attica (GADA) arrive immediately and carry out an investigation, in other words, contact the abuser and take them to make a statement about what has happened. If the offence has been committed, the accused is brought before a court within twenty-four hours of the arrest, and then the whole legal procedure begins.
What we want is to prevent the abuser from coming to the hospital and being near the child. That is very difficult because we need to inform the Public Prosecutor and the Public Prosecutor decides whether to issue such a ban. Recently, this has started happening more properly, meaning that public prosecutors often come to the hospital and realize what is going on. You can’t have a child that has been abused and have the offender present and everyone commenting on what a lovely person the abuser is. Because inside the hospital, the abuser will not show any signs of what has been happening. However, as a hospital, our job is not to prosecute. Our job is to help the perpetrator too, to refer them to a unit for adults to deal with their own issues. There have been times when a mother or father who has abused their child goes on to receive treatment once the police have intervened.
Where do the abuse reports you receive originate?
In recent years, abuse generally gets reported through the helpline of The Smile of the Child. Certainly, The Smile of the Child is right to do its job the way it does, but this matter should fall within state services. It is like an epidemic, so to speak, which concerns public health, isn’t it? If I am not well and I am a dangerous mother, should not the state address the issues I am facing? Should not the state have addressed it years before I, before anyone, ends up abusing their child?
Most children arrive here in The Smile of the Child vehicles following a request by the police. The Smile of the Child receives reports from neighbours, siblings, the children themselves and then it notifies the police. The police call for a psychologist or social worker, who goes to the police station and then transports the child to the hospital. But has the Public Prosecutor been previously notified during this process? On weekends, only the police are involved because none of us can contact the public prosecutor.
So most of your cases come through The Smile of the Child helpline. Do you also get incidents from the National Centre for Social Solidarity (EKKA) 1107 helpline?
Yes, of course, they also refer instances to us. But EKKA is under the radar, it is a state organization, and it does not make announcements on television. The EKKA helpline is not well known, but it is effective and has instant access to family accommodation to protect the child and the parent – the non-abusive parent. Because the other parent rightly or wrongly…
How many incidents do the ‘Paidon’ Children’s Hospital social services handle?
There has been a sharp rise. In 2016, there were 125 public prosecutor orders for abuse or neglect, 178 incidents in 2017 and 221 in the first eleven months of 2018. It’s not a massive increase but, let me tell you, we are becoming more desensitized. In the past, when a child was admitted, it would become the centre of our world. You can’t imagine the lengths we would go to in order to ensure the child recovered, not just physically but psychologically too. What would become of the child? We called relatives, talked to them, looked into who would care for the child… It was a huge deal, in other words. Now seven children are admitted within the same one hour, there’s only so much we can do.
How much staff are employed by the hospital’s social services?
There are eight of us in total. Six from the Child Psychiatry clinic and two here. Currently, we have a third person here, but she is on secondment and will be returning to Thessaloniki. A staff of two is meagre and people come knocking on our door whenever they feel like. They do not threaten us, but when someone comes wanting a solution to their problem, they become aggressive. In the past, it never got to the point where we had to call the police.
What do you attribute this change to?
A lack of time. Working with instances of abuse is a delicate process, you need to have sessions with the child, someone else must see them again, the nurses need to care for them, their feet. Very often, children are admitted to the hospital having spent several days away from home, they need comprehensive care. When you are dealing with 62 admissions by order of the Public Prosecutor, you tell me, is that possible?
Is it abuse or the number of reported incidents that are on the rise?
My view is that it is both. The state is somewhat more alert, and citizens report incidents more easily too. And there is a staff shortage. For example, the police department or the public prosecutor issues an order for accommodation, medical examination and child psychiatric evaluation. Psychiatric evaluation is not a case of “hello, how are you?” and then you are done. You need to give the children toys during the session and, using the tools, assess where they have been abused, what your prognosis is, whether the child can return home or not. Who will show an interest in looking after the child? They might turn up in a month. To what extent can the staff fulfil that role? What I mean is the child is admitted, needs care, but the staff can’t dedicate all their time to the three children who might be wreaking havoc in the department.
We had a case of a young child with lice on their eyelids, but a different “kind” of lice and it caused great consternation here. In the end, it was not a case of neglect, probably something caught on a bus. The grandparents would look after the children, they would get on the bus with the baby, possibly some people who were not clean had sat there before, the grandfather sat on the seat, went to the house, hugged the child and so on. We counselled them, we met with them, we investigated what was going on at home, the grandparents were kept away. Maybe the grandfather had dementia, maybe he was not to blame, maybe he had an issue; you need to investigate all this, but the investigation cannot be rushed, you need to gain the other person’s trust.
Child protection, however, as a principle, belongs to social workers. We do not make home visits; the public prosecutor of the area where a family resides orders the home visits and an investigation into the child’s living conditions. Because if a child has fractures or something caused by an electric shock or anything else, it could be a result of the conditions they live in. We have had child patients who had spent months living without electricity or running water. That is a form of indirect neglect, isn’t it? The rehabilitation lasted six months, during which these children were accommodated at the hospital. Can you imagine the irritation of the doctors and nurses? To have “healthy” parents and children occupy beds that were needed for the hospitalization of children requiring medical care? Well, at least they recovered. The family are actually doing well, but they were very cooperative, certain circumstances were present that helped. We were pressured by associations, they paid off the electricity bills, cleaned the house, an uncle painted the house, they got pots and pans, the father received treatment because he was an alcoholic, in other words, a number of things came together, and it all went well. But not all incidents work out this way…
Are doctors trained on how to recognize signs of abuse?
Look, the training is a requirement for paediatricians, including those working in the outpatient clinics. They have seen many, many incidents. In the past, we had the institute of child health which dealt with abuse, inside the hospital. It was a programme initiated by Doxiades, the minister who used to be a paediatrician here. As an extension of the institute, he founded a medical-educational centre in Mets to address psychological issues. The institute itself has moved away from the hospital and provides training to all specialists.
A study on abuse was carried out by a nurse at this hospital too. Mr Anagnostopoulos, who is the director and the first child psychiatry professor at the hospital, was one of the first to address child abuse along with Ms Xeni Dimitriou, who is at the Supreme Court now. There is a hospital protocol drafted by the Child Psychiatry clinic, but it deals with child psychiatry procedure as well as several things similar to what I previously mentioned. For example, the child is admitted to a paediatric clinic. The paediatrician present, the nurse, must care for the child, the paediatrician must examine the child and make a diagnosis. If a forensic medical exam is needed, we notify the public prosecutor, and they request the examination. All hospital personnel may have access to this protocol.
Have they read it?
That is a different matter. Moreover, abuse is a shocking situation, you can’t keep calm. Will you remember everything you must do on the spot? Of course, there is a chain of supervision for each shift, X supervises Y and Z. So if you are Z, you will ask X what you should do. Things do not get missed. They just have a great many children to attend to and with a father yelling, needing help and the other parent outside shouting “what are you doing in there?” and causing havoc, threatening to alert the press, to do this and that, it’s not an easy job. There should be another kind of record-keeping at the community level. The municipalities should know their citizens, where they move to, when they move. To have preventive care. If a woman is an addict and falls pregnant, who cares for her? Is she receiving treatment for her addiction (which is also a huge issue as you know)? Does the mother suffer a from mental disability, is she vulnerable, does she have enough money to get by? Does she not? Has she been checked?
Babies arrive at the hospital without any previous checks, and you don’t know where to start. Moreover, the financial crisis has affected the Greek population to such an extent that comprehensive prenatal testing is absent, as well as other things possibly. For the first time since 2011, we have parents arriving here and saying, “I cannot look after my child, I would like the state to assume responsibility for it”.
Do you receive incidents from all over Greece?
The whole of Greece. If Patras decides to send an abuse case here, the child arrives here. When there is a Public Prosecutor’s order, you cannot decline, it is prohibited.
Do the children who are hospitalized long-term have atypical development?
They are mostly children with some developmental issues whose families in the past would not have said: “I will leave them in a child protection unit”. There would have been a grandmother or a grandfather to care for those children. Children arrive here in various ways. They could even arrive from a private maternity clinic. The child may have stayed there, had surgeries, treatment and whatever else is needed, and the parents see they cannot cope, and they leave the child at the “Paidon” Children’s Hospital. The child enters an intensive care unit, the parents say they cannot look after the child on a 24-hour basis, and they leave. That raises another issue: we are not equipped with interim care units for those children.
How do you deal with that issue?
The “With Family” programme allowing foster care has been running for the past two years. Before that, the children would be sent to the “Mitera” Hospital, and they would arrange for foster care. We usually prefer kinship foster care where a relation cares for the child. We had a case of a woman with substance withdrawal syndrome, the father had other issues, and we tracked down her sister. She came to the hospital, we persuaded her, and the child was placed in kinship foster care with her, which was the best possible outcome. The child did not go to “Mitera”, the Public Prosecutor of her region assigned the placement, and she now comes for follow-ups. That was a good outcome, but the child stayed at this hospital for eight months. The child was admitted as a newborn and left aged eight to nine months.
Recently, a social media post that went viral claimed that there is a child at the hospital who has lived here for three years.
A child who has been living at the hospital for thirteen years is about to leave. That is a great achievement. This child has done very well. The child lived with the father until the age of six, in and out of this hospital, but spending most of the time here. The child had a serious metabolic problem, which is now a simple issue, it has been addressed, you adjust the diet, and it resolves the issue. The mother got tired, had another family, other children. The father was disgruntled and used to cause conflict with the nursing staff and the doctors; he now lives abroad. When the child was six, parental responsibility was terminated by Public Prosecutor’s order, and the child has been living here during the seven years that followed.
What are the repercussions of this kind of long-term hospitalisation?
The children do not want to leave and cannot easily adjust elsewhere. The hospital is a protected environment, a nurse is always around, someone to talk to. The nurses love the children, but a child could take your injections, endanger medical care… You can’t always stay calm, faced with such incidents you might snap “go away”. The child cannot handle hearing that. Then the nurse supervisor will reprimand you, “What did you do? Why is this medicine bottle broken? I can’t order it from the pharmacy now.” So, the stay of some children is not an easy matter, children whose abuse has caused a disorder and have to be good inside a hospital twenty-four hours a day. We have teachers, we have a school, teachers come to give lessons, in other words, this is a well-organized hospital, it is not disorganized. But a hospital is not suited to deal with every kind of issue. It is not supposed to be.
Do you know of any instances where the child was immediately placed in foster care?
Well, foster care has only just started. In the past, the child had to go to another body which would then handle foster care, to Mitera, to Agios Andreas, within the framework of state services. On the island of Rhodes, foster care runs very smoothly, but we must note that the municipality there is efficient and wealthy, so things happen more easily. Have children come back after their army service and told us how nice the institution that they stayed in was? I will never forget a boy at the Hatzikonsta Foundation (a neglect incident), who had come there and then found a job and was very happy. It does not always go wrong.
Do the municipalities refer incidents to you?
Yes. If the abuse and or neglect is verified by civil servants, it makes matters easier. The incident is brought directly here, and there have been instances of children arriving accompanied by the social workers of their area, and the admission is made with documentation provided by a public prosecutor. They come to visit the child the following day, and the days after that, they tell us about the family, they have a good idea of what is happening. So you allow whoever is close to the child to be with the child, it could be a grandmother, it could be an aunt who has been prepared, that is why I maintain that it is good for municipalities to know their citizens.
So they should become more involved, with more personnel, more training…
Yes, and not come here. Let me give you an example: a homeless pregnant woman and her child suffering from scabies. We gave them a room to deal with the illness. They used to sleep outside a school, so she picked a mattress from the trash and contracted scabies. At this hospital, we also assisted the adult mother. She had never been to a gynaecologist. It was not easy to make the appointments, call the hospital, make the appointments and ask her to go but keep the child here because the mother was afraid that we might take the child away, that we were doing it on purpose. In the end, she went to “Mitera”, to the space allocated to parturient women, because our Municipality had told us that there was a programme providing flats, which would have been perfect. But the programme was not running yet, and she would have gone into labour here. Ultimately, she did give birth here and was transported to the “Alexandra” Hospital by ambulance. Then we allocated “exclusive” nurses to the child… the manager now places “exclusive” nurses to care for difficult children.