Street Kids, Health, and Lots of Questions

by Priya Nalkur, Ed.D.'08

I was five when my parents first took my sister and me to India. They wanted to show me a world very different than the one I knew growing up in Canada. While there, I remember being startled by groups of children, barefoot and dirty, who ran up to us cheerfully but relentlessly asking for money, toys, and food. My mother explained that these children didn’t have homes and didn’t go to school. I think I knew instinctively right then that I was lucky: lucky to have a family who cared about me, lucky to go to school, lucky to be taken care of when I was sick. But why did some kids have these rights while others didn’t?

While too young to understand it at that time, by the time I reached university I’d become much more aware of this disparity in children’s rights around the world. It seemed that no matter where I traveled, there was some level of inequity in children’s access to health and education. Yet while it was clear that these basic rights were not mutually exclusive, it was less obvious which one came first. Did having good health guarantee good education? Or was it the other way around?

I chose an undergraduate degree in health sciences and, after graduating, immediately began graduate school in public health, convinced that health needed to come before education. As I learned how diseases propagate through populations and how health promotion works in diverse communities, the question of education persisted. Repeatedly, I’d read about kids being denied access to school because of their HIV status. Still, other kids were exceeding their educational goals despite poor health and poverty. And very commonly, children who had the lowest rates of disease were engaging in fewer risky behaviors, going to school, and developing inspiring goals for the future. How was education responsible for these trends?

I joined the Harvard Graduate School of Education’s doctoral program to understand how education might be influencing children’s health outcomes. Swiftly my entire view changed. No longer were the people around me talking about disease, clinical trials, and immunization; now they were talking about psychosocial development, prevention, and resilience. The community forced me to broaden my understanding and definition of “education” as I once knew it. “Education” now meant more than schooling, teaching, and learning; it meant empowerment, motivation, achievement, literacy, agency. You could look within a child to understand how she exceeds those educational aspirations even in the face of poor health. You could look within a child to understand how his education helped him practice healthy behaviors. This new perspective changed the way I thought about health, kids, and their futures. It meant that even besides external supports, kids had it in themselves to learn, to be healthy, to achieve. Those once confusing chicken-and-egg questions I asked about health and education no longer mattered; health and education were intimately linked, they fed into each other simultaneously, and this process of gaining health and education could be — and would be — mediated by the child. My health-education question finally found an answer in this community that considered the child an agent in health and educational success.

By the end of my first year, I’d decided on a research project that would throw me into this interdisciplinary world of child development, education, and health. I joined the Child Health and Social Ecology Project in Tanzania at Harvard Medical School and soon developed an offshoot research study that incorporated a psychosocial component. Having a committed interest in adolescents at risk, my dissertation became a study of street children in Tanzania.

Being “in the field” in Tanzania was perhaps the cornerstone of my development as a scholar at HGSE. The foothills of Mount Kilimanjaro, rolling and boundless, are in many ways characteristic of the developing world. Extreme poverty on the one hand counters tremendous natural beauty on the other. Amid this familiar curiosity, I found the street children, who were primarily boys and as young as five, remarkable: Their persistence and savvy seemed misaligned with their vulnerability and risk. Many were AIDS orphans or children whose impoverished families could no longer support them.

Spending time with them, I learned that while many could not read, their math skills were superior; they had learned on their own accord to mentally and quickly compute intricate calculations that gave them the upper hand when bartering and bargaining for money. The gang leaders were impressive, guiding their gang members on how to defend oneself, obtain shelter, and talk to adults. Despite a prevailing local perception of disgust and shame for street children, the boys persisted in developing elaborate organizations of labor, leadership, and care. They shared tasks such as collecting food and money, finding places to sleep, and protecting younger members from rival gangs. They even had their own system of health care, whereby the older children discouraged younger children from abusing drugs, and boys accompanied each other to the hospital when they needed professional care. I frequently saw boys dressing each other’s cuts and wounds with grass, mud, or whatever they could find among the street rubbish. But perhaps more alarming are those health concerns that unfortunately cannot be treated with compassion alone. Though it’s difficult to know how many are actually HIV-positive, their desperation leads to prostitution and numbers are expected to swell considerably. The street children’s motivation to learn came from a motivation — indeed a necessity — to survive, to live, to thrive on these streets without the support of parents and adults. Certainly, separating their desire for good health from their desire to learn was impossible.

During my work with the street children, I came to understand firsthand the challenges of doing ethical research with orphans and vulnerable children. When studying health and education in children, especially in children who don’t have access to either, scrutinizing my own biases and privileges in light of my participants’ situations became paramount.

As I suspected, the street children knew their rights and knew if and when they were being threatened; when I asked them to be part of my study, I was bombarded with questions about what they would gain from participating, how they would be protected if something went wrong, and why this study was so important. For their participation, they requested food, shoes, clothing, and in some cases, school tuition. They felt — and negotiated on the terms — that my dissertation would bring me certain accolades, yet their participation in my study did not guarantee the same return. They wanted to be on a level playing field: If I was to learn from them, then they would gain from me too. Like the first time I saw street children in India, these Tanzanian street children challenged my own assumptions of what it meant to exercise rights, have a family, and be educated and healthy.

After several tiring but exciting months in Tanzania and a bout with malaria, I returned to Cambridge with more questions, but also with more answers. Now in my sixth year of HGSE’s doctoral program, I’ve accumulated an intellectual toolkit that speaks to the not-so-obvious connections between education and health, and importantly, a child’s role, desire, and agency in achieving either. While my time at HGSE took me to Tanzania, I’ve come to appreciate that encountering risk is virtually unavoidable in adolescents’ experiences, no matter where in the world they might be. How they adapt to their contexts, exercise their rights, and eventually trounce those risks to attain their goals for health and education remains my lifelong inquiry.

— Priya Nalkur is an advanced doctoral student in human development and education at the Ed School. She plans to graduate in June 2008 and pursue an academic career in adolescent risk.

About the Article

A version of this article originally appeared in the Summer 2008 issue of Ed., the magazine of the Harvard Graduate School of Education.

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photo by Louise Gubb/Corbis Saba