What Will Become of Africa’s AIDS Orphans? Part 2

Part 2

''Our little ones think they are going to America like the children in adoption programs,'' Atsede says. She is a small, dignified woman with delicate features and fine hair, who stands ramrod straight and offers a mild smile that trembles between civility and grief; she has seen much death. ''The older ones gradually understand: 'Because we have AIDS, we cannot go to America.''' In fact, though it is not explicitly U.S. policy to exclude H.I.V.-positive adopted children, and these children generally respond rapidly to the onset of medical treatment in America, the immigration paperwork is more complicated, and few families step forward for these youngsters. So the Enat children are not in line for adoption; nor are they receiving medical treatment. ''Medication to fight AIDS is not available,'' says Atsede's husband, Gezahegn, who has the dark, rumpled, bloodshot look of a man who has been up all night; he has wrestled AIDS for a dozen of these small lives already and has had every one of them pulled from his arms. In America last year, thanks to vigorous treatment of infected pregnant women, only 200 H.I.V./AIDS-infected children were born, down from 2,000 in 1994. Most of those babies will live fairly normal lives and survive to adulthood. In Africa, without medications to treat complicating infections, 75 percent of H.I.V.-positive babies will be dead by the age of 2, says Dr. Mark Kline, director of the International Pediatric AIDS Initiative at the Baylor College of Medicine in Houston. Of the remaining 25 percent, he says, very few will reach age 11. Until recently, Enat served as a holding center for children prior to testing. It was not always clear at first whether the children were infected or not. ''We see nice kids, bright futures, then we must test them,'' Atsede says. ''Some get the news that they are negative; then we can refer them to the Children's Commission for assignment to a foreign adoption program. Some will be adopted to America; others, to different countries. But other children test positive. When they first come, we often cannot guess. You'd think it would be the baby of a sibling group who will test positive, but then the results come back and sometimes it is the middle child, so the older child and the baby are transferred out.'' Gezahegn's background was in business and government administration, not medicine; he was reluctant to enter this field. Now he finds it has swallowed his life. Nothing compares in importance with trying to sustain the lives of the ill children in his care. ''We can fight pneumonia and small infections in the children, but that is all,'' he says. ''We are running a hospice program. It is rather hard to see the children dying.'' Still, these stricken children must be counted among the relatively blessed of their generation; the care they receive is the best available. ''The children are happy here,'' Atsede says. ''We celebrate holidays; we give them birthdays; we invite their living relatives to visit them. They know that the children at orphanages with adoption programs are learning English and other languages, so we teach them English here, too, so they don't feel left out. The hotels invite them to swing and climb on their playgrounds. We want them to enjoy life. We want them to see something of life.''

Time for that is often short. ''A child begins by losing weight,'' Gezahegn says. ''Then she develops infections, stops eating, has diarrhea, pain in joints, pain in ears. It can take five months, three months, two months. A child does not talk about it, but she's kind of depressed. One day she is not playing on the playground; she just wants to sit and to be held.''

It has become the life mission of this couple to do more than sit by the deathbeds of small children in pain. They are not participants in the debate among health-care professionals over whether treatment or prevention ought to be the public health priority in Africa, Asia and South America. Their question is simpler: how can they get hold of the triple cocktails that in America now have reduced deaths by AIDS by 76 percent since 1996? By American standards, the cost doesn't sound extravagant. An average figure for pediatric triple-drug therapy in Africa is now $60 to $80 per child per month, and the price is dropping. But without serious commitment of financing from the industrialized world, even these modest costs are unreachable. When Atsede sits down on a chair in the dirt yard under a shade tree for a rare break, the children skitter over to her and lay their heads upon her long cotton skirts or climb up into her arms and nuzzle their faces into her neck. She laughs as her face is dotted with kisses. ''The children call me Abaye, Daddy, and her Emaye, Mommy,'' Gezahegn says. A little girl waits for him, eager to demonstrate for him a trick she has mastered at jump-rope. The music class waits for his attention to show that they have learned a song with synchronized dance steps. Children raise their hands and hop up and down to be chosen by Gezahegn to accompany him in the backfiring van on an errand to town. Until sickness comes, the faces under the bouncing braids of the little girls and the brimmed caps of the boys are round, happy and hopeful. ''Without therapy,'' Kline says, ''as far as we know, all of the children will die.''

Layla House, a shady compound with a paved common area, a baby house, dormitories for boys and for girls, a schoolroom and a kitchen and dining hall, is run by Adoption Advocates International, based in Port Angeles, Wash. A.F.A.A. House, on the outskirts of town, almost buried in flower gardens, is run by Americans for African Adoptions, based in Indianapolis and directed by Cheryl Carter-Shotts. These two are the only American agencies permitted by the Ethiopian government to arrange for adoption of healthy Ethiopian orphans to America. More than 100 children joined new families in the U.S. in 2001. At least a dozen other adoption agencies based in Addis Ababa represent Australia, Canada and seven nations of Western Europe and Scandinavia. It is the first recourse of everyone ethically involved with intercountry adoption to place orphans with relatives, with friends or with families within their home countries; no one imagines or pretends that adoption is a solution to a generation of children orphaned by disease. It is one very small and modest option, a case of families in industrialized nations throwing lifelines to individual children even as their governments fail to commit the money to turn back the epidemic. ''Consider the impact of 'The Diary of Anne Frank' on the world,'' says Mark Rosenberg. ''That was the journal of just one doomed child. Though we are looking at the deaths of millions, the saving of even one life is not trivial.''

In the dusty schoolroom at Layla House, students face forward on wood benches and chant lessons in high voices. It is a relief on this hot day to enter the cool, whitewashed room. The children's faces are soft and hopeful. Most are of elementary-school age, though a few perspiring teenagers tower over the rest with the same earnest, slightly anxious expressions. Their teacher, a young man who has never been to America though it is his fondest wish to go, writes American greetings on the chalkboard. ''How are you?'' he taps out, while pronouncing the words. ''How are you?'' the children repeat. ''I am fine,'' he dabs in chalk. ''I am fine,'' they call back in high voices. ''I am very well,'' he writes. ''I am very well,'' they sing. They roll their R's, giving a high-tone flourish to their ''verys.'' ''I am doing nicely.'' ''I am doing nicely.''

There is no preparation for bad news here, I notice. The working premise is that these children will be chosen by American families for adoption, and their airfare out of Ethiopia paid for by their waiting parents. From the vantage point of this ancient and poor country, this great opportunity would seem to leave no room for complaint and thus no need to prepare a vocabulary of grumbling.

''How are you this evening?'' ''How are you this evening?'' ''I am quite well, thank you.'' ''I am quite well, thank you.'' With the next lesson, the teacher offers many ways to express ''I don't know.'' ''I have no idea,'' the young man is calling over his shoulder. ''I have no I-dea,'' sing the sweet voices, rising up near the end of each phrase. ''I shouldn't think so.'' ''I shouldn't think so.'' ''I don't expect so.'' ''I don't expect so.'' ''Search me.'' ''Search me.'' ''I haven't a clue.'' ''I haven't a clue.'' Through the square uncovered windows, sunlight and dust motes stream onto the pebbly floor. The kids, wearing T-shirts, cutoffs and flip-flops, begin to fidget in expectation of lunchtime. The lessons in Americana do not cease at mealtime. At long wood tables, there are bowls of orange slices and carved-up bread. Though the children would welcome, at every meal, platters of injera used in lieu of silverware -- they are being taught to use American forks and spoons and to maneuver foods like spaghetti and meatballs. ''Please to pass the water,'' a boy booms. ''Thank you very much.'' ''Thank you very much,'' replies his friend, who has passed the pitcher. ''How are you this evening?'' ''I am very well,'' shouts the roly-poly boy. ''How are you this morning?'' ''I have no idea. Please how is your sister?'' ''I haven't a clue. Please to pass the meatball. Thank you very much.'' ''Thank you very much.'' Some of these kids once lived on the street, cried for food, tried to keep alive younger siblings and had few prospects of surviving to adulthood without their birth parents. They now enjoy fantasies that they will wear Walkmans and ride bicycles when they live in America. When asked by the adults in their lives, ''What do you want to be when you grow up?'' no one replies, ''I didn't actually realize I was going to grow up,'' though some must think it. Instead, these boys and girls have learned to reply ''doctor,'' ''teacher,'' ''scientist.'' ''I want to drive a car,'' says a 6-year-old girl named Bethlehem; whether professionally or at her leisure, she doesn't specify. ''I will be an actor!'' cries a boy, ''an actor like Jackie Chan.'' ''I want to ride motorcycles!'' shouts another boy. ''When I grow up, I want to help the elderly people,'' says a merry dimpled 13-year-old girl, Mekdes, cognizant, like many of the young teens, that she is on the receiving end of charity and eager, herself, to be of service. ''I wasn't at all sure what the response of American families would be to our opening an Ethiopian adoption program,'' says Merrily Ripley, director of Adoption Advocates International. Her agency places children from Haiti, China and Thailand with American adoptive families and assists with a program focusing on children orphaned in Sierra Leone. She flies to Ethiopia nearly every other month and occasionally indulges the little girls who beg to fix her long, straight gray hair. On this day, she looks like a cross between someone's hippie grandmother and Bo Derek in ''10,'' with skinny beaded braids dangling over her shoulders. ''Would we be able to find families for African children? Would we be able to manage a children's home half a world away? We never dreamed that Ethiopia would become our most popular program.'' While a couple of the older children have arrived with psychological challenges based on early loss of mother or other relative, the majority began their lives in families as breast-fed, tickled, treasured children. They are like kids in any backyard or school playground in America. Though a round-roofed straw hut in Gondar, Ethiopia, may seem impossibly different from a suburban home outside Cleveland or San Francisco, it is not. Children who have known the love of parents are eager to enjoy it again, and their adjustment to American family life has been rapid.