. . . and a child shall lead them

Riley's International Adoption Clinic provides a passport to parents seeking to send their children on a healthier journey through life.

In June 1999 Michael and Deborah Martin returned home from Russia with love. Daniel.

For the Newburgh, Ind., couple, the homecoming marked the end of a lengthy adoption process negotiating the mind-boggling maze of two countries' bureaucracies. For ten-month-old Daniel, it meant the end of an uncertain future in an orphanage in Ekaterinburg, a large city near the Ural Mountains. For the Martin family, which also includes preschooler Mikelle, one of the first priorities was a thorough medical evaluation to determine if Daniel had any undetected health problems or special needs. Evansville pediatrician Deborah Goldman, MD, '76, suggested the International Adoption Clinic at Riley Hospital for Children. The clinic was established to be a comprehensive medical resource for Hoosier families adopting children overseas as well as to be a consultative service to the primary care physicians who treat them. Operated through Riley's Pediatric Infectious Diseases Section, the clinic was a necessary response to a growing challenge, says IAC Director James H. Conway, MD.

U.S. adoptions - of children from Russia, the People's Republic of China, Vietnam, and throughout Southeast Asia and Latin America - have spiraled to an estimated 10,000 each year. Dr. Conway notes that more than sixty children have visited the clinic since it opened more than a year ago. Two clinics are held each month, with staff evaluating four to six patients each session.

"In most cases, children are seen first by their family physicians for a brief evaluation of potential acute conditions," says Dr. Conway. "Most children come to our clinic after they have had a few weeks to adjust to their new homes and surroundings."

Parents are encouraged to send in advance all available medical records, in any language, and expert interpreters help detect suspect or erroneous information. Children receive extensive examinations with particular attention paid to infections, immunization history, nutrition and neurodevelopment. Lab tests and X-rays are performed as needed, and a treatment plan and immunization schedule is developed for the primary care providers to implement.

"Because of environmental and socioeconomic conditions, children in certain countries are at particular risk for health problems that are unusual or virtually nonexistent in the United States," says Dr. Conway, assistant clinical professor of pediatrics at IUSM. "For example, the rates of tuberculosis among internationally adopted children are fifty to one-hundred-fifty times greater than for children born in our country. Also, we know that internationally adopted children frequently are found to be nutritionally deficient and developmentally delayed. The upside is that if properly diagnosed and treated, catch-up growth generally occurs the first year after arrival."

"Daniel weighed only fourteen pounds when we brought him home," recalls Deborah Martin, "and we were concerned why he hadn't experienced a growth spurt." His records indicated that he had been inoculated against TB, yet testing revealed he had been exposed to the disease. Daniel's weight has since increased, thanks to a combination of antibiotics and a much improved diet developed as a collaborative effort between the International Adoption Clinic and the family's primary care provider.

Not all adopted children have medical problems, however. Shortly after their return to Indianapolis, Dave and Anne Okerson visited the Riley clinic with their new children, Emily Thi and Michael Lee. The diagnosis? No medical problems were noted and both children were pronounced healthy.

Beaming with pride, love and unabashed amusement, the Okersons watch as Emily and Michael explore the wonders of a pad of yellow Post-it® Notes. Two weeks before, the new siblings were christened at the Okersons' church on southside Indianapolis. Two months before, the children were unrelated and living in an orphanage near Hanoi.

Unable to have biological children, the Okersons ruled out domestic adoption because of the legal possibility of a biological parent reneging on a contract or later suing for custody. They also wanted to adopt more than one child, which is the maximum in some countries such as China. After careful investigation of international adoption agencies, they chose Vietnam, which permits adoption of two children simultaneously.

Late last January, the Okersons were on their way to Hanoi to adopt Emily and Michael and celebrate the beginning of their new family. "There were two caregivers for every child at the orphanage - an unusual arrangement for any orphanage anywhere," says Dave Okerson, an executive with Inland Paperboard and Packaging, Inc. "You could see the love in their faces and hear it in their words, even though we couldn't understood a word they were saying without an interpreter."

Back in the states, the Okersons found a similar level of caring at the IU clinic. "The people at the clinic were thorough and professional in their clinical duties, and they answered all of our questions," says Anne Okerson, a special education teacher. "More important to us, too, is that the staff spent time just observing and playing with the children."

Dr. Conway has some equally compelling praise for families who adopt children overseas. "What impresses me most about these parents is that they're not only pursuing adoptions to bring children to the United States, which in many cases means saving their lives. They're doing it with the understanding that parenting is a lifelong process and a day-to-day commitment to children, particularly those with serious and long-term health problems."

Deborah and Michael Martin can vouch for that continuing commitment; they've just returned from Volgagrad, Russia, with their newest family member, Kayla.

For more information about the International Adoption Clinic, call the Pediatric Infectious Diseases Office at 317-274-7260.