In Uganda, Fostering a World Without Adoption

Groups across the East African country are working to build systems of “alternative care” for children living outside their families. But do these efforts stand a chance next to the business of international adoption?

Fellows 2016

By Kathryn Joyce

September 06, 2016

Also published by Medium

In 2011, a young Ugandan woman I’ll call Evelyn learned she was HIV-positive when she was six months pregnant. Her husband’s family blamed her for the diagnosis, and declared they would find him a new wife. Newly alone and vulnerable, Evelyn was at a loss when she learned her newborn son “Joshua” was positive as well. So Evelyn listened closely when a nurse at the hospital said she knew a place where Joshua could receive treatment: a nearby “baby’s home,” or orphanage, that also offered free medical care.

For months after his birth, the nurse urged Evelyn to take Joshua to the home. When Joshua was around a year old, Evelyn finally relented, but called back the next day, saying she missed him. The staff at the home told her it was too late — that Joshua was going to be taken out of the country by a foreign white couple.

Evelyn (who asked not to use her name for safety reasons) was told minimal information about the white family being proposed — just that they were Americans who already had daughters and wanted a son. She was told variously that she’d be allowed to see Joshua every two years, or perhaps every five years, or maybe that she’d be flown to the United States to visit him. The word adoption, she told me, wasn’t used.

Despite the ambiguity of the plan, Evelyn agreed. She didn’t know how she’d support herself, and white families from abroad had a reputation for taking good care of Ugandan children.

When Evelyn visited Joshua at the home — the visits were never officially condoned, but she argued her way into visiting more than a dozen times — she saw staff rushing to wash and dress him; she began to suspect that he wasn’t being well cared for. When he had been there for around four months, the home called her and told her to come: Joshua wasn’t well. She arrived to find him lying naked on a mat, evidently ill. Evelyn asked to take him to a doctor, but the staff said they didn’t have authorization for her to reclaim him, and that she’d have to return to ask a supervisor. Three days in a row Evelyn returned to ask, but the supervisor was never in. She went to the hospital where she’d delivered to ask them to intervene, but said she received no support.

The baby’s home was located in Uganda’s sugar-farming country, along the road between the capital city of Kampala and Jinja, the picturesque source of the Nile. At the time, Jinja was poised to become a hub of orphanages supplying Ugandan children for international adoptions.

Three-year-old Kevin with 13-year-old Jackie at the spot where she found him after he was dropped off by his kidnappers. He was missing for three weeks and finally found his family with Reunite’s help.

That year, adoptions in Ethiopia — at the time, the country sending the second-highest number of children for adoption in the U.S., including more than 2,500 in 2010 alone — had entered a government-imposed slowdown. Authorities in the East African country sought to investigate widespread claims of irregular adoption practices and the recruitment of children from poor, rural families. Amid the slowdown in Ethiopia and the closure of adoption programs elsewhere, adoption agencies began to look to other countries. Uganda, which has plentiful connections to the U.S. — particularly to U.S. evangelical groups, at a time when many evangelicals were embracing adoption as a social cause — was near the top of the list.

In many other circumstances, Evelyn’s relationship with her son would have likely ended at the baby’s home. Discouraged by the orphanage’s obstruction, and lacking the resources to demand her rights, she might have walked away. The American family proposed by the home would have adopted, and they would have been assured that they were helping an abandoned orphan. But this time, things happened differently.

In the U.S., the prospective adoptive parents — a Christian couple from California in their early 30s, Emily and Matt Knudsen — had grown suspicious. They’d come across story after story of unethical international adoptions and had decided to pursue a special needs adoption, in the hopes that children with medical needs like HIV were more legitimately in need of a new home.

“We made that clear with our agency,” said Emily. “I said, ‘I don’t want to bring a child home unless that child has no other options.’”

But they began to notice red flags: they had received three referrals for children in short order, and when they asked questions about the children being offered, their agency representatives grew hostile and defensive. When they reached out to other adoptive families working with the agency (“Thank goodness for social networking,” Emily said), they found that others shared their concerns about both the U.S. agency and their Ugandan adoption attorney.

In early 2012, they decided to find someone to help them investigate. They learned of a Welsh couple living in Uganda, Mark and Keren Riley, who were working on “alternative care”: a term used in the international child welfare field to discuss options other than placing vulnerable children in institutions, from which some are adopted but where most linger for years. At the time, Mark was working with UNICEF and Uganda’s Ministry of Gender, Labour, and Social Development to help draft a set of child welfare guidelines. Keren had recently started an ad hoc organization, Reunite, to reintegrate children living in orphanages with their families.

The Knudsens asked Keren to help. Armed with adoption paperwork that included Evelyn’s name and a photo of her and Joshua, a Ugandan investigator hired by Reunite tracked Evelyn’s family down on a small island in Lake Victoria. Within days, Evelyn met Keren in Kampala and explained how the baby’s home had refused to return her son. Keren recalled that Evelyn said she’d stopped eating in protest and would starve herself to death if she lost him.

That week, Keren went with Evelyn and a small group of others to the orphanage, informing staff at the gate that Joshua’s mother wanted him back. The orphanage staff refused to answer their questions, and the party left, saying they’d come back in a week’s time to pick Joshua up. When they returned, they brought a child protection police officer from Jinja, but orphanage staff still wouldn’t let them in. In a video Keren recorded at the scene, she slipped through the orphanage gates while the police officer was negotiating entry, walked up to a locked building where a number of the orphanage children were being kept, and asked through the window if a baby named Joshua was inside.

The ordeal went on for several more days after this “raid.” Orphanage officials demanded that Evelyn get her estranged husband’s permission to reclaim Joshua, and they turned her away when she brought her husband’s sister instead. But eventually, the involvement of the police and a persistent foreigner seemed to convince the staff to give in. Five months after being sent to the baby’s home, Joshua was returned. In a video Keren filmed of their reunion, Evelyn knelt before him, weeping and asking his forgiveness, saying she hadn’t known what she was agreeing to.

Four years later, when I went with Keren to meet Evelyn in the rural community she lives in now — a small, subsistence-farming village where starchy matoke plants and coffee trees flourish — she remembered the feast she’d prepared to welcome Joshua home. She had placed an entire enormous tilapia on a platter before the child, even though he was too young and too sick to eat it.

The Knudsens, for their part, continued to help. After pulling out of the adoption — forfeiting the roughly $10,000 they’d already paid — they helped relocate Evelyn and Joshua to a new home where orphanage workers couldn’t find her, and committed to help fund Joshua’s education. It was a hard choice, Emily remembered. The family had had Joshua’s picture on their refrigerator for months, and when Emily and Matt told their daughters the adoption was off, they were heartbroken.

Sitting on a mat on the floor of her two-room brick home — its front room bursting with the three-piece sofa set that many Ugandan families, no matter how poor, seem to own — Evelyn asked Keren about her son’s benefactors, as Joshua, now six, strong and in school, played in the next room. She inquired after the Knudsens’ new baby, and whether Keren could bring her computer on her next visit so they could Skype; she wanted to know whether Joshua would ever have a chance to meet “the other family that has looked after him.”

In Evelyn’s questions, and the nuances of her relationship with the U.S. family, there’s a glimpse of one possible roadmap for life after the era of widespread international adoption ends — one that recognizes the often-invisible family members and communities that surround so-called orphans, and the capacity of poorer nations to find their own way forward.

Keren Riley (center) with Helena at her son’s foster home before Helena and Samuel returned to Tanzania.

“Ididn’t come here as a missionary in the traditional sense,” says Keren Riley. In fact she’s not a missionary at all. But it’s a pointed statement in an African country where foreign Christians have played a significant role: most notoriously through support for Uganda’s harsh anti-LGBT laws, but also through promoting international adoption, as U.S. Christian leaderspresented adoption as the ideal marriage of evangelical charity and theology.

But Keren, herself a devout Christian, represents both an evolution in the Christian approach to “orphans” as well as a broader movement towards reforming the longstanding boom-and-bust cycle of international adoption.

Keren’s revelation came in 2011 while she was volunteering in a Kampala baby’s home, where she grew so attached to one young boy that she considered adopting him, only to later realize that he had family members listed in his orphanage file, and a father prepared to take him back.

Five years after resettling that boy, Reunite has returned 15 children living in orphanages to their parents; prevented 12 international adoptions (usually because the prospective adoptive parents came to suspect they were unethical); brought home three children whose parents said they were kidnapped; and worked with a handful of mothers in a Kampala-area psychiatric hospital to either resettle with their families or find alternative, local arrangements for their children. With just two part-time employees in addition to Keren’s full-time, unpaid labor, Reunite has no offices or institutional resources, and pays its drivers and social workers on a case-by-case basis with donations solicited on social media.

In Kampala, I met some of the families Reunite has worked with.

There was Jackie, a charismatic 24-year-old hairdresser who nearly lost her twin daughters. Their father, a married man, refused to recognize them, and an aggressive orphanage worker hectored Jackie that she and her children would starve if she tried to care for them on her own. Through a joint effort by Reunite’s social workers and local law enforcement and government officials, Jackie retrieved the twins from the orphanage and got on her feet with a small business loan from Reunite to open a hair salon.

There was “Josephine,” a single mother who was estranged from her family and eking out a living for herself, her son, and daughter by selling passion fruit juice from a Kampala street stand. As with many families living paycheck to paycheck, a series of small setbacks — a zoning change that compelled her to move her stand, her juice refrigerator breaking — tipped her into crisis. Following the advice of a local community leader, she put her children in an orphanage, from which they were eventually offered for adoption to an American couple. When the American couple met Josephine in court, however, and saw her children rush to her side, they realized the family bond was too strong to justify completing their adoption. They contacted Reunite, which provided Josephine with money for school tuition and a pile of high-quality used clothing (collected by Keren from local ex-pats) that she could sell in Kampala’s thriving second-hand clothing market. Through that small investment, within six months Josephine was able to buy a new refrigerator and restart her juice business, eventually expanding to a food staples store.

Harriet with her grandchildren, Patricia and Brian.

And there was Harriet, a 53-year-old grandmother caring for five of her grandchildren, including two whom Reunite helped resettle after they’d been placed in an orphanage. Harriet had wanted the children back when they’d first been put in the orphanage, following domestic disputes between their mother and father, but hadn’t had the money to travel there from her home outside Kampala. Reunite helped her buy bedding and mattresses for the children and committed to paying their school fees — a major factor in many Ugandan parents relinquishing children.

John Kasule, a 78-year-old social worker who works with Reunite on a part-time basis, said that in his years working in orphanages, he saw many cases where children were taken to orphanages because of relatively small problems like these: parents who couldn’t afford to send their children to school, or who dropped children off after personal conflicts — particularly after holidays, when family celebrations turned into quarrels.

The amount of money that it’s taken Reunite to bring these children home — tallied in the hundreds of dollars, rather than the average $30,000–40,000 most international adoptions cost — underscores common complaints about international adoption: that as a means of caring for poor and vulnerable children, it’s both inefficient and marked by deep power imbalances between the world’s haves and have-nots. And during a time when international adoption is undergoing a massive sea change — international adoptions aredown by more than 75 percent since 2004, as many countries have closed their doors and many agencies have subsequently gone out of business — family preservation stands to become an important part of developing nations’ child welfare systems.

Three-year-old Kevin with the woman who sheltered him while he was missing for three weeks (left) and his mother (right).

The Rileys’ involvement in Uganda predates the founding of Reunite. Mark Riley first came to Uganda as a young man in 2001. His father was a minister in Wales, and his church had a connection with a Ugandan organization that worked with street children. Mark found himself distressed that so many former street kids — abandoned children and runaways living by themselves in cities, often getting by selling small wares, like bananas or gum, car-to-car — wound up in institutions, growing up without the family connections vital for children’s emotional and cognitive development.

It was at a Ugandan children’s home that Mark met a four-year-old boy he became close to. Four years later, when Mark returned with Keren, the boy was still in the orphanage. Though they searched extensively for his family, too much time had passed and the trail had gone cold.

The couple adopted the boy, and for five years lived with him in Wales, before returning to Uganda in 2010. Mark, still haunted by his visits to children’s homes, drafted a concept paper on the possibility of creating a foster care program in Uganda, similar to the systems that exist in richer, Western nations, which for the most part discontinued the use of orphanages decades ago. It was a potentially transformative plan.

By comparison, the U.S. child welfare system, while still marked by deep systemic problems, is intended to serve as a temporary, emergency response for families in crisis, with the primary goal of reunifying families after they’ve become more stable.

In 2011, Mark’s work drew the attention of UNICEF, which for years has been working to deinstitutionalize children living in orphanages, and he was hired as their Alternative Care Consultant for Uganda, working closely with the country’s Ministry of Gender. Together, they began to assess how they might help the country transition from an orphanage-based system of child welfare to something more closely in line with contemporary social work best practices. The collaboration ultimately led to the creation of Alternative Care Initiatives-Uganda (ACI).

They started with a baseline study of how many orphanages, both formal and informal, were operating in Uganda. At the time, there wasn’t an accurate count of how many such facilities existed. They suspected there might be 50 — Uganda is, after all, a country of only 38 million people — but instead identified 420 operational homes around the country (and likely hundreds more unregistered facilities). They also found that at least 85 percent of children living in those homes had at least one living parent. And they witnessed the individual repercussions of that trend, like mothers arriving at the ministry offices saying that they didn’t know where their children had been taken, or grandparents complaining that their grandchildren were adopted against the family’s wishes.

While ACI was forming, international adoption began to pick up. It wasn’t a huge program: in 2013 there were only 276 official adoptions from the country. But that number represented a four-fold growth since 2010 — something many attributed to U.S. adoptive parents flocking to Uganda after Ethiopia’s program slowed down.

And increasingly, there was a problem with how the adoptions were taking place, through a technical loophole. Uganda’s legal process for approving international adoption was intentionally onerous, requiring most applicants to reside within the country for three years and serve as a child’s foster parent, before they could apply to formally adopt. Instead of complying with this rule, numerous Western adoptive parents began coming into the country, obtaining legal guardianship of a child — a custody order that, unlike adoption, does not permanently terminate biological parents’ rights — and then leaving the country to complete the adoption at home.

Caroline Bankusha, the current Alternative Care Coordinator at ACI, worked for years as a probation social and welfare officer, which in Uganda means a social worker who applies to the court for “care orders”: legal documents that determine where individual children living outside their families should be placed. In theory, that meant that probation officers recommended where children should be placed. But during the early 2010s, Bankusha said, adoption lawyers frequently came to her office asking her to draft social welfare reports for particular children, regardless of whether she’d worked on their cases, recommending they be adopted. Sometimes the lawyers came with money — as much as a probation officer’s monthly salary. Once, she claimed, a junior colleague of Peter Nyombi — the country’s former attorney general, who worked on numerous international adoptions — brought her a file with a thick envelope tucked into its first pages. (She said she turned him away. In an email response, Nyombi indicated he didn’t have enough information to answer the specific allegation but generally dismissed claims like these. “This is not the first time that wild allegations have been made against our firm,” he wrote, noting previous negative media coverage in the Ugandan press.)

As a result, Bankusha said, probation officers often did not perform the background checks they were supposed to carry out, and children who might not have been eligible for adoption under Ugandan law were cleared for guardianship arrangements, and then whisked away. Sometimes parents were incorrectly declared dead, and sometimes, as in one 2013 case that made international news, parents assisted in the deception.

Helena and her son Samuel at the foster home.

2013, ACI proposed a new policy for Uganda, the Alternative Care Framework, drafted primarily by Mark Riley. The framework heavily prioritized family preservation and reunification, as well as kinship or foster care — all with an aim to reunite children with their parents whenever possible. The plan made room for domestic and international adoption but warned that, “When the last options are used it should ring alarm bells that the earlier and much preferred responses are failing and need more investment.”

A few traditional orphanages rose to the challenge, shifting from adoption to family reintegration. But elsewhere, there was resistance. Many organizations saw that it would be a struggle to maintain their funding because, as Mark put it, “It’s much easier to find sponsors for kids in an orphanage than to get money for social workers.”

Local adoptions bring in no income either, since by law (under Uganda’s 1997 Children Act), no one can charge Ugandan adoptive parents to take in a child. By comparison, outsourcing the solution through international adoption is both easy and remunerative.

That’s why ACI’s position has been that, although they’re not opposed to international adoption on principle — having a child raised in a family, even if outside their culture, is still better than leaving them in an orphanage for years — they see it as having an intrinsically distorting effect on the child welfare landscape. When one child-care option brings in money, and the other costs, it’s easy to see which will win.

This year, however, that old balance has changed. In March, the Ugandan parliament passed a bill amending the 1997 Children Act that will effectivelyclose the loophole through which so many international adoptions have been approved: the legal guardianship provision which allowed many adoptive parents to skirt Uganda’s three-year residency requirement. Although it’s unclear how many adoptions have taken place under the guardianship provision, a 2014 joint government-UNICEF study found that, in one sample of 100 completed domestic and international adoptions, nearly two-thirds had used legal guardianship to sidestep the country’s adoption regulations.

In late May, Ugandan President Yoweri Museveni signed the bill into law, to be enacted June 2. Going forward, foreigners will have to reside in Uganda for a year before applying to adopt, and courts are only supposed to approve international adoptions as a “last option” when children are found to have no known relatives, nor locally available foster or adoptive parents.

Minister Bernard Atiku, the parliamentarian who introduced the legislation, said that aside from lawmakers’ frustration with the unknown number of legal guardianship adoptions, the law was intended to address Uganda’s need for a broader system of child welfare.

“We’ve had a National Council of Children with no staffing, no funds,” he said. “So the children’s homes took over the role of the state.” Limiting the role that children’s homes and adoption can play, he said, will help Uganda create a system more on par with international standards.

Predictably, there were some protests. Peter Nyombi, the former attorney general who has facilitated a number of international adoptions, warned that curtailing international adoption would lead to growing numbers of children languishing in orphanages. Members of U.S. adoption communities worried online that this would spell the end of Ugandan adoption.

But Freda Luzinda, the country director of the nonprofit Child Advocacy Africa (and a former employee of the U.S. embassy in Kampala who worked on processing adoption visas), wrote in support of the law, predicting that limiting international adoptions would have immediate effects. “Let the people who are giving up their children know that they are giving them up for adoption in Uganda [and not abroad],” she wrote. “I promise you that child abandonment and parental consents to adoption will be halved…. Let every middle and upper class Ugandan take on at least one unrelated child and adopt them. You will see orphanages empty because orphanage directors have no motivation to ‘make more’ children available for Ugandan adopters.”

But if Uganda is to move away from the orphanage-adoption model, something else must take its place. In Western countries, that usually means foster care, local adoption and, more broadly — albeit imperfectly — the apparatus of the state helping support vulnerable families. International adoption advocates have long argued that such programs aren’t replicable in developing nations: that people are too poor already to take on additional children, that stigma prevents local families from caring for strangers’ offspring, and that any kids who are taken in are at risk of being treated more as indentured servants than as members of the family.

Groups like Reunite are trying to address this as well. In addition to her work in orphanages, Keren Riley has started helping another group of vulnerable women: the patients of Butabika National Mental Hospital, on the outskirts of Kampala. Since a chance encounter in 2014 with a vulnerable woman suffering mental health problems, Keren has worked closely with several patients from Butabika, helping contact extended relatives for some so that they might be transitioned home. But one case that she’s worked on this year has brought together both arms of her advocacy work.

Helena and Samuel at the foster home.

Helena, a 19-year-old woman from Tanzania, came to Butabika after a series of encounters with local police in Kampala that left them concerned about her wellbeing. Helena for the most part seemed healthy, but her train of thought led repeatedly to a number of recurring delusions, like that she wasn’t from Tanzania, but Greece; or that her real father was a prominent Ugandan pastor. She spoke of a traumatic past — that she’d fled Tanzania because people were trying to kill her — that was hard to confirm, but which continued to frighten her. (Initially staff at Butabika told Keren that Helena suffered from schizophrenia: a condition that experts say is often greatly over-diagnosed in African patients who may instead suffer from less severe illnesses like depression or PTSD.) Helena hadn’t come to Uganda alone: she’d arrived with her son, “Samuel,” now three years old. When Helena was committed to Butabika in early 2016, Samuel was at first put in an orphanage. Keren helped Helena obtain permission from the hospital to visit her son there, but a week later, the orphanage told them to stop visiting, as Samuel cried every time his mother left.

Keren managed to convince Samuel’s social worker, Jackie, to try something new: rather than keep the boy in the orphanage, they would enroll him in a pilot foster care program. Samuel wouldn’t have to live in an orphanage and Helena would be allowed to visit and maintain a bond with her son, in the hopes that, with treatment, she’d one day be able to care for him again. Reunite would handle the expenses associated with driving Helena and a social worker out for their weekly visits.

Jackie agreed, and the boy was placed in what seemed like an ideal foster family: a retired couple in their late 50s and early 60s, Moses Ssentongo and Mary Seriuliiko, who lived in a large, middle-class home in an idyllic rural village. When we arrived one weekday for a visit, Mary, a bubbly and kind 56-year-old grandmother, met us in her front yard, which was dotted with pecking chickens. Samuel had been holding Mary’s hand, but when he spotted Helena he pointed and exclaimed. Helena waited silently until Samuel walked to her, raising his arms to be picked up.

For two hours, she stayed and played, while Mary, a former nurse, bustled in the kitchen and Moses, a former civil servant with a playful manner, explained how they’d been recruited as foster parents. They’d raised their own four children, and now had six grandchildren, and were well-liked in their community. One day, a man from a nonprofit, CALM Africa, approached him to say they appreciated his home environment and wanted to give him a responsibility: to take in one child. CALM Africa would help them with schooling and medical expenses, and would check in frequently.

“We accepted, both of us,” Moses said, “because almost all of our grandchildren are of his size.” In addition to his native Luganda, Moses also happened to speak Swahili, Samuel’s mother tongue, which helped ease the transition. Nodding to the boy darting around the house, he continued, “Now he’s feeling at home.” After watching Moses and Mary’s success with the child, other family members and neighbors have asked about fostering themselves.

That’s exactly what Joseph Luganda, the 36-year-old program manager of CALM Africa, hoped to see. For 10 years, the NGO had been working with children and families in Ugandan communities, largely focusing on education and advocacy. More recently, they’d become involved in alternative care, working with local teams of volunteers to identify good potential foster parents whom CALM Africa can then approach and train for short- or long-term placements.

“In my opinion, when training our foster families, we’re taking them back to traditional ways,” said Luganda. “In our tradition, a child belongs to a community, where neighbors help take care of the child. That tradition started to fade because people moved to urban areas, coming from different communities, and didn’t know each other. But we put it back in their mind — that it’s in our culture.”

It’s also an answer to the unspoken challenge that foster care can’t work in an African context.

“We do have deep ignorance about foster care in Uganda,” Luganda concedes. Often prospective families ask who will provide them with money or food. CALM Africa tries to avoid setting up an expectation of payment for foster parents — something that’s part of the government-run U.S. system — by instead offering practical help: bedding and some food at the initial stages only, and ongoing support for school fees and medical care. “We’re going back to our tradition, when you take care of a child that isn’t yours, and where matters like food remain a family obligation.”

“Andrew” and his wife “Cisy” (all names have been changed for privacy reasons) decided to foster three children left behind at a closing orphanage where Cisy had worked for many years. Cisy had seen all three children arrive at the orphanage as babies and grow up. Frank (left), 16, is deaf and autistic. Esther (center), 15, lived with other foster parents from age six to nine, but was returned to the orphanage. Sara (second from right), 14, was diagnosed with autism when she was one year old.

“They thought it was a myth,” Luganda said, meaning the idea that average Ugandans will step up to foster, “but many are now saying it’s practical.”

CALM Africa has done the same thing that Keren Riley set out to do with Reunite: it’s demonstrated that alternatives to institutions and international adoption can work in Uganda. But also like Reunite, CALM Africa’s foster care program, however successful, still feels impossibly small. As of April 2016, Luganda said CALM Africa was working with just seven foster families in two communities. He estimated that there were perhaps 12 other organizations across Uganda also doing foster care, and that currently there were probably fewer than 60 foster families in the entire country. By contrast, the Ugandan government conservatively estimates that nearly 60,000 children reside in the country’s orphanages.

One of CALM Africa’s fellow foster care initiatives is the Child’s i Foundation, a U.K. charity operating as a nonprofit in Uganda that promotes adoption and foster care. In a familiar story, Child’s i’s founder, Lucy Buck, originally came to Uganda to establish a baby’s home, only to realize Uganda didn’t need any more orphanages. Part of the group’s work today, which is jointly funded by the Ugandan government and USAID, is sensitizing the community to the problems that arise from widespread institutionalization of children, explained Interim Director of Operations Chris Muwanguzi. Sometimes they host training days for prospective adoptive parents, explaining the transformative effects that moving a child from an orphanage to a family setting can have, and helping nervous families learn how to talk about adoption to their friends and family. Sometimes they go to communities and pass a doll from one person to the next, asking the participants to imagine what happens to a baby if it spends one year in this orphanage, one year in another. Following this demonstration, Muwanguzi recalled, one orphanage director admitted she’d never before heard about the developmental harm of raising children in institutions and vowed to do something else. It gives him hope that education will lead to broader community involvement in formal systems of alternative care.

Along with groups Muwanguzi considers partners, like CALM Africa, Reunite, and ACI — “We’re all singing from the same hymn sheet,” Muwanguzi said — Child’s i supports the relatively new official process of Alternative Care Panels. In these panels, social workers report to the Ministry of Gender on numerous cases: of children in institutional care, parents trying to get them back, and other parents hoping to foster or adopt.

At times, it seems to be working. Child’s i currently has a backlog of some 30 Ugandan families hoping to adopt, and Muwanguzi said they receive at least two new inquiries per week. A recruitment event this August drew around 10 prospective adoptive families. And around the country, signs of a growing Ugandan middle class — billboards advertising insurance companies and pregnant women smiling in party dresses; office workers walking past ubiquitous furniture stores dressed in modern suits — hint at the economic development that in other countries helped end the reliance on international adoption.

At other times, it still seems challenging. As we rode back from Helena’s visit with Samuel, the social worker assigned to his case, Jackie, said that foster care was a nice idea, but not one she’s likely to try again. Who, she asked, would pay for the transportation to and from the hospital, or stop at the grocery store to pick up food gifts for the foster family, in the vast majority of cases that Reunite isn’t involved in? What social workers would have the time to invest in this sort of resource-intensive work when they’re juggling multiple cases? And as anyone familiar with problems in Western foster care knows, these are issues that persist in even the richest nations.

Muwanguzi acknowledges that the process of building a social work force equal to the task of addressing children’s individual needs is likely more than a decade out. To that end, Child’s i hosts social work interns from Makerere University, helping introduce them to the more just, but far more laborious, case-by-case approach of figuring out what families need in order to bring their children home, or to find another home when that’s not possible. In August, the Hague-based International Institute of Social Studies hosted a two-week training seminar in Kampala for child protection specialists from six East African nations. Led by Mark Riley and U.S. anthropologist Kristen Cheney, the training was meant to introduce alumni to the concept of alternative care.

On the larger scale, for now, orphanages remain the path of considerably less resistance. But if that sounds discouraging, it’s worth considering the longer backstory of the child welfare movement in the U.S., where less than 100 years ago it was common practice to deal with poor or putatively parentless children by putting them on “orphan trains” bound for the frontier and offer them for adoption at depot stops along the way. The evolution from that model to today’s modern (and still troubled) child protection system, has taken longer in the U.S. than the transformations currently underway in Uganda.

On a late Sunday afternoon in early August, Keren returned to Butabika hospital with Reunite’s part-time investigator, “Andrew,” a retired police detective. After six months in treatment, Helena was being discharged, and that evening was picking up her son, Samuel, from his foster parents’ home.

Helena, her son and his foster parents Moses and Mary

Lucid and happy, Helena was quiet as she got into Keren’s car. The next day she’d be traveling with Keren, Andrew, and Samuel to resettle in Tanzania. Her application to stay in Uganda as a refugee had not been approved, and she’d instead be making a new life for herself and Samuel in a seaside village near some relatives, where she hoped to eventually establish a small business selling prepared foods. But before that challenge came a bittersweet goodbye.

When we arrived at Moses and Mary’s house, their front porch was crowded with relatives. Moses’s sister-in-law, the wife of his preacher brother, laughingly ululated at our arrival. Samuel spotted Helena and ran to hug her legs as she walked carefully, balancing a cake Keren had brought.

The family members — more than 20 of them — crowded into the living room, sitting on couches, the arms of chairs, and the floor. A cake was placed on a central table, alongside several liters of soda (the appearance of which sparked applause and a joking “Praise the lord!”). From speakers attached to a computer in the back room, an eclectic mix of American soft rock ballads, 1940s standards, and African pop played low.

But while the family celebrated, Moses and Mary were subdued. The jovial grandmother — who had vamped as she modeled her finest traditional outfits on an early visit — instead stayed mostly in the back room, frequently disappearing to her bedroom and emerging with watery eyes. The usually playful Moses was instead sadly formal, presenting Helena with a rectangular baptism card that marked the day Samuel had been admitted into the family’s church and given the family’s clan name. Sitting beside Helena, he told her she must always feel at home in his house, because she was now his daughter, as Samuel was his grandson. He’d even put them in his book, he said repeatedly, adding their names to the family Bible.

To Keren, Moses expressed more concern, wanting to know what would happen to Helena and Samuel in Tanzania. With a meek hopefulness, he suggested that perhaps Samuel should stay with them a while longer — just until he was 10 or 15 years old. At Moses’ request, the family pastor, Reverend Henry, came in, and after introductions — Moses presenting Helena as “our daughter, the mother of our grandson” — it became apparent that the reverend was there to determine whether or not to give his blessing to Reunite’s plan.

The room fell silent as Keren explained the support systems she’d help Helena build in Tanzania: connections to family and local healthcare providers so that Helena could stay well and create an income, initial support from Reunite, and ongoing communication through Whatsapp. Although the foster family was obviously sad to lose him, Keren said gently, Samuel had a mother who loved him and who deserved the chance to raise him.

Speeches followed: from a CALM Africa representative who praised the foster family and encouraged everyone to consider following their lead; from Moses, thanking CALM Africa; from Helena, thanking him and Mary. Rev. Henry led the room in prayer — “that the child be loved by his community and mother as he has been loved here” — and then in song, “This Is the Day the Lord Made.” There was dinner and cake — cut with expert symmetry by Helena, already dreaming about her future food stand — then pictures and ultimately, in keeping with Ugandan reserve, muted goodbyes on the bumpy, red-dirt road outside the house.

The following morning, Keren, Andrew, Helena and Samuel would all board a bus for the long, cross-border journey. But that night, Helena and her son stayed by themselves in a downtown hotel, just down the street from the Kampala police station where they’d first been separated, in a small but clean and modern room, where it was easy to imagine a future open and unknown.

Kathryn Joyce reported on religion in Uganda on a fellowship with the International Reporting Project (IRP).