Early lessons in life and death

Cotlands looks, at first glance, like any other nursery school. Children clamber over a jungle gym; others splash paint over sheets of paper stuck to the wall. Bigger children pore over colouring books under the watchful gaze of a teacher.

But if one of those children were to fall off the jungle gym and scrape a knee or an elbow, drawing blood, the response of both children and teachers would reveal that this is no ordinary nursery school. It is attached to a home for abandoned, abused and HIV-positive children, and 22 of the 89 pupils at the Cotlands créche and nursery school are from this sanctuary. In another wing is South Africa’s first paediatric hospice.

Contact with infected blood is one of the few ways in which the HIVirus can be transmitted by children. So if anyone starts bleeding, the children know not to touch the wound but instantly to summon a teacher. ‘We drill into the kids that they must not touch each others’ blood and we encourage them to tell us if they see other kids bleeding,” says principal Crystal Smit. ‘If anything, we are over-cautious.”

The teacher or classroom assistant tending the child will don

rubber gloves and disinfect the wound and swathe it in bandages or plasters to prevent the blood from spreading. Bleach must be poured over any spilt blood. These are the ‘universal precautions”, a set of guidelines taught to everyone who comes into contact with Cotlands children.

Cotlands began in 1936 as a home for unmarried mothers. Situated in one of Johannesburg’s southern suburbs, it has evolved into one of the most effective non-profit organisations caring for children affected by HIV/Aids. The sanctuary houses 42 children up to the age of six; the hospice takes 20 children from birth to the age of nine who are terminally ill with Aids.

The hospice has a high turnover, with an average of a death a week. As well as catering for children from the sanctuary, it also takes in children from communities badly affected by HIV, where Cotlands runs home-based care schemes.

The school was started to cater for Cotlands children, but later opened its doors to kids from the local community. Very few of the children from outside Cotlands are HIV-positive, but for safety’s sake and to avoid discrimination, staff treat all children as if they were.

It is a sensible precaution for any school to take, given South Africa’s high incidence of HIV, and some parents send their kids there because, paradoxically, they know they will be protected from the virus. Some parents do not disclose the fact that their children are HIV-positive because of the stigma that is attached to the disease. Others may not know whether they are or not.

Smit and her team had to evolve their own workbook to explain HIV/Aids and the universal precautions to young children because there was nothing else available. They tested a homemade version in the classroom for a year before coming up with a draft they were satisfied with. They then had to find sponsorship to print it. But so effective is it that the school now distributes it to schools all over Johannesburg and holds workshops for teachers on how to use it.

Now they are developing a second workbook – on death and dying. ‘We have anything from four to five deaths a year in the nursery school,” says Smit. ‘We have to prepare our children for death and we could not find any existing material.”

Her attempts to prepare the children for what they should not have to face, at least to such a degree, has led her into a profound study of death and what happens after it. Because the children come from a variety of religious backgrounds – Christianity, Islam and traditional religions – there are no pat answers to their questions about what happens to a child after he or she dies. ‘Children are very literal. You can’t say you’ve lost someone because they think they can be found.

‘We don’t want to scare the children, so we agonise over every word we use. But the kids here are much stronger than those from other schools because they have to deal with so much more. Other children ask for what they want; these kids ask much deeper questions.”

In the meantime, the children are told they go to heaven, but are encouraged to make up their own versions. Invariably it features a McDonald’s, a favourite toy and friends from Cotlands who have already died.

‘The kids know when one of their classmates is getting ill because they go to the hospice,” says Smit. ‘We prepare them, let them say goodbye – the sick child to the classmates and the classmates to the sick child.

‘We often ask the child whether he or she wants to go to the hospice or stay in the dormitory. Sometimes they want to stay in the dormitory because they are used to it and they will be with their friends. And the older children have come to the conclusion that when a child goes to the hospice they will not be coming back, as they are going to die.

‘We tell the children when the child has died and let them talk through their feelings and do role plays. We have a memorial service with a photograph of the child, his or her favourite toy and some of the pictures they drew in class. Each child will place a flower in the memorial corner and say goodbye to their classmate. The children need closure to eliminate any fears they might have about death – and so do the teachers.”

Adds Smit, ‘We sometimes get angry that not enough is being done to stop this virus. You learn to love these little things and then you have to start all over again, loving another child who will die.”

The Aids children tend to be smaller than their healthy classmates, she says. ‘We have found that the HIV-positive child is at least two to three years behind in their developmental milestones.” They are low on energy and tend to fall asleep in class. They are prone to skin rashes and ear infections.

She says grouping HIV-positive and -negative children together means they learn from each other. ‘If the school took only HIV-positive children, it would mean they would only be exposed to sick children.”

Despite the pain and difficulties, Smit says, ‘I couldn’t see myself working in an ordinary school. The Aids kids teach you so much about both life and death. They’ve got such fighting spirit. They don’t give up easily.”

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