South Africa has the highest rate of Fetal Alcohol Syndrome in the world. It's the most common preventable form of mental retardation. But, a deep-rooted history in South Africa's wine industry is making it difficult to turn this problem around.
Eleven-year-old Tisha Lourens is one of the lucky ones. Today she is the focus of attention of her large, adopted family, as she explains what is in store this week at school. The atmosphere is warm and light-hearted.
But this child's life started out much different, as her mother Vivien explains.
"When we had just gotten her we were told, that this is a fail-to-thrive baby. She's been abandoned by her mother. And, don't hold out much hope for her living," she said.
Tisha was born with Fetal Alcohol Syndrome, one of many children born into this area of South Africa where the wine industry dominates. Most experts agree that it was the Dop System, the practice of paying part of farm workers' wages with free cups of wine, that laid the foundation for alcoholism taking deep root in the region.
The area's history of alcoholism goes as far back as the 17th Century. Jan van Riebeeck, the Dutch explorer responsible for the settlement at the Cape of Good Hope in the mid-17th century, was the first to introduce European winemaking to the southern tip of Africa.
In his diaries, van Riebeeck wrote about educating a group of Angolan slave children. He wrote, "To animate their lessons and to make them really hear the Christian prayers, each slave should be given a small glass of brandy and two inches of tobacco."
Though the practice was limited in 1928 and outlawed it in 1961, it continued to endure on wine and fruit farms well into the 1990s.
"I think the Dop System generally engendered a drinking habit and drinking became an acceptable social norm particularly over weekends," explained Professor Denis Viljoen. "Even though now less than 5 percent of the farms in the Western and Northern Cape provinces practice the Dop System. So, it's largely, ineffective now but the actual drinking practices stem from the long history of the Dop system being prevalent in those areas."
Professor Denis Viljoen is head of Human Genetics at Wits University in Johannesburg. He was one of the first to record the number of children born with Fetal Alcohol Syndrome. Three studies, one in 1997, 1999 and 2001, were recorded in a small rural town of about 60,000 in the Western Cape.
"What we found was the rate of Fetal Alcohol Syndrome was about 45 per 1,000 school entry children, in the first study. About 70 per 1,000 in the second study. And it may be as high, and we are still evaluating some of the data, it may be as high as 85 per 1,000 in the third study," he said.
Though one of the biggest challenges lies in the fact that the culture of drinking is deeply embedded, Dr. Viljoen says it's the stigma of alcoholism that also needs addressing in order to break the cycle from generation to generation.
Sophia Warner agrees. She heads the group Pebbles here in Stellenbosch, which works with pre-schools to train teachers and parents how to deal with their children with special needs.
"We are not medically trained to diagnose children and having spoken to various specialists in the field, they seem reluctant to actually diagnose these children as Fetal Alcohol Syndrome, because of the stigma, because of the labeling," explained Ms. Warner. "So, Pebbles, our vision is to provide training for children with special needs, included those affected by alcohol. So, we get the Fetal Alcohol children in the umbrella of special needs without just identifying those kids."
Meanwhile, children such as Tisha Lourens have an uncertain road ahead, having already been born to a generation damaged by their birth mother's alcoholism.
The abnormalities of Fetal Alcohol Syndrome children include low birth weight, facial deformities, and mental retardation. There also appears to be an association with impulsive behavior, anxiousness, and an inability to understand the consequences of their actions.
"Her biggest challenge is her academics, now," explained Vivien. "Her social skills are very good. But, she can't do even the basic math. And she has trouble with reading. She memorizes words but she can't read them. She cannot pick out like 'and' and 'the.' She has a terrific problem with those. But she'll recognize 'LOOK' because of the two 'O' as the eyes. "
"I found them in TV," Tisha interrupted.
"Yes, you saw them on TV didn't you? Because you are very clever," Vivien responded. "But she is going into a new class because the teacher is going to keep on with her reading and we will keep on with her reading as well."
Both Vivien and her husband Peter say that their biggest worry right now is Tisha's inability to retain information. Though she knows, for example, to stay close by them in a crowded shopping center in a split second she may forget and wander off.
"She has no consequences. She doesn't know right from wrong. Which is a problem," added Vivien.
Dr. Viljoen says that the key to helping break the generations of this syndrome lies in the destigmatizing of the disease by the medical fraternity. He says the new generation of doctors is finally starting to turn this around by treating alcoholism as a disease rather than a vice.