BUCHAREST, ROMANIA -- It will be a better new year for a lucky few thousand of Romania's estimated 100,000 abandoned and orphaned children:
At the state-run Orphanage No. 1 in the Moldavian city of Ias, for example, once severely malnourished children now are at normal weight after more food, increased adult affection and medical attention, part of a plan by an American pediatrician to link state-run children's homes with Romanian medical and nursing schools.
In Transylvania, one cold and leaky children's home has been taken under the wing of a German village, which dispatched its plumbers, carpenters and electricians along with a vanload of copper pipes and wires, relief workers said.
And at the state-run Gradinari House for the Deficient and Incurable, an hour's drive from Bucharest, children will soon be moved to a new, prefabricated dormitory with modern plumbing and heating provided by a French aid agency.
But for most of the children and teenagers who live in the state-run homes and hospitals of Romania, this will be a cold winter, little different from the ones before.
Many of the country's 800 or more orphanages and children's homes still lack heating systems that function, so some children "will surely die of cold" this winter, a Western doctor said last month. That is little different than in past years, when annual mortality rates of 40 percent were not unusual at the worst of the institutions, which were crowded because of the anti-contraceptive policies of dictator Nicolae Ceausescu.
The new Romanian government has been overwhelmed in the last year by a huge outpouring of humanitarian aid and has been unable to distribute it effectively, relief workers said.
Poor coordination and impractical donations mean that sinks, washing machines and clothes dryers often go unused because there is no one to install them or because they are too modern for most orphanages' decrepit wiring and plumbing. Relief workers report that truckloads of secondhand mattresses sit unused because there is no equipment to cut and restitch them.
No longer tied by law to their jobs, many orphanage employees have abandoned their low-paying work, leaving already understaffed institutions further bereft. Boxes of winter clothes go unopened while children are still clothed in heavy, urine-soaked cotton jumpsuits, fed out of slop buckets and showered in black, cold water.
Some improvements have created new problems.
In the pediatric AIDS wards at hospitals in Bucharest and the Black Sea city of Constanta, withered infants appear to be dying of AIDS. But they are actually only HIV-positive, and in fact are dying of malnutrition and dehydration, the latter exacerbated by improved heating, Western doctors said. The dehydration is effectively untreatable because the hospitals often have no rehydration supplies.
Perhaps the most sobering news from the homes is relief workers' growing understanding of how deeply many children have been scarred by life in Ceausescu's warehouses for the unwanted.
Last year, photographs of emaciated, scabrous children rocking monotonously in rusted iron cribs brought hundreds of volunteers -- many of them nurses from Europe, the United States and Canada -- to Romania to try to stimulate the children.
But there is a growing realization that rehabilitation for many children will be a much longer and more painstaking process than a few months of cribside therapy.
"You have to unlayer these children like an onion," said Dr. Barbara Bascom, an American pediatrician and child-development specialist now working in several orphanages in Romania. "Some of them will demand the services of a whole institute to sort out how that child is functioning. Many of these children need expert therapy before you can provide stimulation or even get them to accept touch."
Bascom and other experts say that short-term care offered by temporary volunteers may do more harm than good, and they now recommend a minimum year-long commitment by volunteers. Health workers also are more aware of the strong emotional bonds that have formed between many of the children in state homes -- for example, between a blind child who can feed himself and a seeing child who cannot.
They worry that continued bad publicity about the orphanages could prompt the Romanian government to close the homes, severing the only human contact that some children have ever had.
Foreign relief officials also say that revival of the orphanages will require close attention to the needs of underpaid and untrained orphanage attendants, some of whom have such hard lives and poor self-esteem that rejection by a withdrawn or balky child can be enough to push them into an abusive temper.
Prime Minister Petre Roman recently admonished Romanians, especially orphanage workers, for an attitude of "indifference" toward the children.
Last month, a Romanian health official said he thought it would take at least five years to build responsible and competent staffs in state homes.
The Swiss Red Cross is one of several agencies working to train orphanage staffs. Its officials, Bascom and other specialists say that many of the mostly female workers and managers are eager to do a better job, and that small improvements in their own circumstances -- a small box of cosmetics, for example -- can make a big difference in the women's spirits.
That attention also would work on a related problem, that of resentment in some villages of the special care and toys lavished on children in state homes while local children receive nothing.
Bascom also has found a hunger for information and training among Romanian doctors and nurses. "There are many talented doctors and nurses here, desperate for education and information," she said. "This is not an undeveloped country. It is just extremely hard hit."
Her program, funded by the California-based charity World Vision, aims to improve care at eight state-run children's homes by linking them with university medical and nursing schools. Teams of Western specialists will be brought in to diagnose and treat ailments such as malnutrition, AIDS and cerebral palsy.
A related program run by Bascom's husband, Dr. James Bascom, will try to upgrade medical school libraries that have spent 40 years in isolation from Western medical science, and try to establish links between the Romanian and American medical communities.
Romanians and Western diplomats and health care workers also are troubled by the growth in recent months of a so-called baby market, created by foreign couples who started arriving in Romania in large numbers last year, hoping to adopt healthy children.
At least 1,000 children have been adopted since the revolution in December 1989. Frazzled prospective parents from Western Europe, Canada and the United States have become a familiar sight at orphanages, where they scour the wards for healthy prospects, and at provincial courthouses, where they conduct urgent negotiations with biological parents and grandparents, lawyers and magistrates for the agreements necessary to take the babies out of Romania.
The "baby stampede" has given an opening to unscrupulous lawyers and created a black market for infants and toddlers. As the number of newborns entering state homes has fallen due to increased availability of abortion and contraceptives, Romania's new adoption industry has now reached beyond orphanages and into impoverished villages, where unwed mothers and their parents are visited by eager, moneyed foreigners.
The last Pan Am flight out of Bucharest before Christmas was crowded with more than two dozen Canadian and American women carrying newly adopted babies in brightly colored snowsuits and blankets. Most of the children presumably will go to vastly better lives than their biological parents could have provided, but the exodus has led to some soul-searching.
"We sell our children too easily," one Romanian journalist wrote last month in a Bucharest weekly.
Western relief workers and diplomats are concerned about reports of baby-shopping. One American doctor was visited last month by a weeping Romanian physician, who said her unwed patient had been induced to sign away her child while still groggy from childbirth.
Bascom is worried that some prospective parents, although well intentioned, may come to Romania with "rescue fantasies" and be ill-prepared for the difficulties that can come with adopting a 2-year-old who may be functioning at an 8-month-old's level.
"They leave here thinking that as soon as they get the child home in his own room, with toys and home cooking, everything will be fine. But these children can have deep scars. They may accelerate in their development, then plateau for a long time," Bascom said.
In the year since its revolution, Romania has been deluged with material aid -- clothing, medicine and "mountains" of toys, doctors said. Relief officials in Bucharest now say the children's crisis is changing from an emergency to a situation requiring long-term relief work.
While continuing supplies of some materials are still greatly needed -- medicine, disposable syringes, "mountains of socks" and disposable or cotton diapers that don't require safety pins -- the biggest need in the months and years ahead will be for clinical expertise and support.
That, too, will require careful monitoring, relief officials caution. Even now, the sheer volume of humanitarian aid has outstripped the ability of Romanian officials to distinguish what is sound from what is experimental and even false.
"The country is very vulnerable," said Bascom. "The situation is a natural one to attract charlatans."
Among last year's visitors who turned out to be something other than what they claimed were a Briton who persuaded a Bucharest hospital to use an unknown and highly experimental treatment on AIDS babies, and a European "orthodontist" who relief workers say turned out to have no credentials at all.