Our humble medical team made our first foray into the world of China’s migrant children last week.
In China the household registration system prevents children who are not living in their “registered district” (i.e. parents’ hometown) often have limited access to health care benefits as well as public education options.
In China, people moving away from their place of registration are considered migrants even though the term is referring to Chinese citizens, not foreigners.
In fact, these construction workers, restaurant staff, and manual laborers might as well be foreigners, in many cases.
Their health insurance (limited though it may be) is often invalid outside their local area, and their children may not be able to go to health stations for free vaccines. They may need to pay more money to enroll their children in a public school, if they even are permitted to attend without a local registered address.
Many kids end up living with their aging grandparents, often unprotected from predators in their villages, and seeing their parents at the Lunar New Year if they’re lucky, when the entire country boards a train to go somewhere far away and clogs the travel arteries around the nation for 2-3 weeks.
Recent updates to the previously strict anti-migration laws are allowing the possibility of children living with their hard-working parents, albeit in difficult conditions, in more urban areas.
So what does this mean for us here in our 9+ million city in NE China that you’ve never heard of if you don’t live in China?
Another Chinese NGO has been doing wonderful things in our city with some of the in-between children who have come in from the countryside to live with their parents, and we were invited to partner with them in addressing health issues.
We visited two preschool-kindergartens on opposite ends of the city, driving down small bumpy alleys past halfway-done modern highrises on one side of the road and demolition rubble on the other.
In between is a rapidly shrinking zone of small one story homes, fruit trees and corn on the cobs drying everywhere.
We entered the first school to a group of about 45 fairly subdued 2-5 year olds.
They lined up quietly and waited for their turn with one of the doctors, a few cried but most were fairly unemotional.
My new friend Jiang the NGO worker told me that these particular children are living with both parents (if only one parent were working in a site, the child would like stay behind in the village with grandparents), they are fed two meals a day at the school and are picked up around 6-7 pm after the parents get off work.
At the second school, which had less than 20 students, I was told that some of the children would stay all night at the school (also the director’s home) for days at a time if the parents were gone.
The children at school #2 were a lively bunch, with one kid whispering English words to me non stop, and the youngest, a little 2 year old, playing peekaboo.
Two girls gave an impromptu recital of a number of songs/poems they had memorized and others chimed in as able.
We found a few things of medical significance, and plan on coming back to do fluoride varnish treatments and oral hygiene teaching.
As is not unusual in so many of my rural clinic experiences, children in the poorest, most outlying areas starved in every other way often have terrible oral health with numerous cavities.
It seems like even if real food is scarce, there are always pennies available to buy candy.
When we went to Cambodia this was rampant, with the dentist on the team commenting that he would term it an oral disease epidemic, and was pulling out horribly abscessed teeth right and left on preschoolers.
Then there is the problem of the compassionate volunteers who add fuel to the fire and send mixed signals, so while the doctors and dentists are preaching “no sugar” on the inside, the rest of the team is passing out candy on the outside.
As an aside, if you are involved in short term teams, please leave the candy behind and pass out stickers, little toys or books instead to be a part of the solution instead of the problem.
The best part of the day was the wonderful book distribution, funded by a local business who gave us a large donation recently.
Even this gave me another eye-opening moment.
As a huge Reach Out and Read proponent in my US clinic days, I was thrilled to see the kids paging through books, looking at pictures, and jubilantly shrieking at the stacks of books being passed out.
I asked my NGO friend whether the parents could be encouraged to read aloud with their kids in the evenings, for maximum impact in the social, emotional and academic realm.
She told me that they were worried that with the cold winter looming, that anything flammable would likely end up being used as heating fuel at some point so the plan was to leave the books at the school so teachers and volunteers could read with the children.
I mentioned this to my young colleagues, who all said, “oh no, they wouldn’t burn books.”
I don’t know who’s right: the NGO worker or my urbanite co-workers.