Adopting Orphans Abroad
By Mary Ann Littell

illions of children around the world face a future without hope. Some 150 million lack parental care, and are either orphaned or abandoned. Countless children languish in orphanages worldwide. These are often grim places, overcrowded and understaffed.

Many of these orphans are malnourished and suffer from chronic illness. Some are HIV-positive. Their faces reflect their sad circumstances in a life without loving families or basic material necessities.

American families are seeking to adopt abroad in ever-increasing numbers. However, too many children are left behind. Jane Aronson, DO, known as the Orphan Doctor, is an advocate for all these children. The physician’s goal is improving living conditions for orphans in their native countries, as well as helping adoptive families cope with the health and developmental challenges these children face. She runs a busy New York City practice entirely devoted to adopted children, and also serves as a consultant to anxious families contemplating overseas adoption.

“One of the first questions families ask me is, ‘Where should I adopt from?’” she says. “It’s a hard question to answer. There’s so much need everywhere.”

The physician, a 1986 graduate of UMDNJ-School of Osteopathic Medicine (SOM), is an adoptive parent herself, of 51/2 year old Benjamin, who came here from Vietnam in 2000, and Desalegn (called Desi), 71/2, from Ethiopia, who joined Aronson’s family two years ago. So she’s personally as well as professionally involved in this complex, frustrating, and ultimately rewarding process.

In the past 10 years, the number of foreign adoptions in the U.S. has doubled. Last year, 22,700 children were adopted from overseas, 7,900 of them from China. Almost half were from Russia, Guatemala and South Korea. Aronson is one of a small group of physicians across the country helping adoptive parents navigate the many pitfalls of overseas adoption.

When a child is referred for adoption, abstracts from his or her medical chart are sent to families. Medical information is quite comprehensive from some countries, but sketchy at best from others. Aronson reviews the records, seeking clues to the child’s health. She factors in any diagnoses or hospitalizations, immunization records, measurements of growth, and information on language and social development.

She also reviews photographs and videos, looking for health problems. For example, a close-up of a child’s face may indicate signs of fetal alcohol syndrome, which is prevalent in eastern Europe and Russia.

Jane Aronson, DO, with her adopted boys: Benjamin, 5, looking over his mother's shoulder, and Desi, 7, playing with a red balloon, as well as Gypsy, the family pet.

She never advises a family to adopt or not to adopt. Instead, she classifies adoptions as “average risk,” “mild risk,” “moderate risk” or “severe risk.”

“The majority of children in these institutions are developmentally delayed, and they often require early intervention services,” says Aronson. And she should know: Over the past 11 years, she’s personally examined more than 4,000 children adopted from abroad.

It’s not unusual for Aronson to receive phone calls from concerned parents-to-be in China, eastern Europe, Russia, Latin America or other far-off places. They’ve gone to pick up their child, and now they’re concerned that he or she refuses to eat, won’t make eye contact, or rocks back and forth endlessly. In most instances, the physician is able to reassure them. “The good news is that these kids are incredibly resilient,” she says. “They’re survivors. Most of their problems can be overcome with early intervention, good nutrition and a loving family.”

Aronson, who is an infectious disease specialist by training, also does post-adoption evaluations. She screens for infectious diseases, including hepatitis A, B and C, HIV, tuberculosis, syphilis, and other illnesses, and tests for rickets, anemia, and lead levels. “To practice this type of medicine, you need to know about a lot of things, including endocrinology, genetics, and orthopaedics,” she states. “You have to know about cardiology and how to read CAT scans. Academically and intellectually, this work is very challenging. That’s one of the reasons it’s so rewarding.”

In many cases, Aronson becomes the primary care provider for the children she evaluates. She says it’s extremely gratifying to watch her patients grow and thrive with their new families.

Aronson has traveled the world to personally observe orphanages, learn about orphan health issues and seek ways to improve the children’s health. While she’s seen some horrific conditions, she prefers to focus on the positive. The project most important to her right now is the Worldwide Orphans Foundation (WWO). She started the foundation in September 1997 with the Orphan Rangers, volunteers who travel overseas to live and work in orphanages.

“Now we’re at the point where we’re able to send a lot of people abroad to do this work,” she explains. “Some of the volunteers are graduate or medical students. Others are occupational therapists, speech therapists, or nurses — people with a knowledge of healthcare. Their mission is twofold: to look at conditions and find ways to improve care.”

Orphan Rangers research and document conditions in orphanages. They assess children’s development, care for sick babies and play with children starved for attention. Their observations inform the international adoption community and the medical profession about the challenges facing orphans and adopted children.
Aronson has been featured in numerous articles in People and New York magazines, The New York Times, Newsday, and other publications. In December 2005, NBC Nightly News profiled her in their weekly series, “Making a Difference.”

The reporter, describing her as “a force of nature,” recounted how she raised $800,000 for her foundation in a single night. One of her benefactors is the actress Angelina Jolie, an adoptive mother of two: a little boy from Cambodia and an Ethiopian baby girl who was treated by Aronson for a salmonella infection shortly after arriving in the U.S. The two have become friends and their children play together. The foundation’s other supporters include individual donors and pharmaceutical companies.

WWO is involved in several projects overseas. In May 2004, a team of American experts in pediatric HIV/AIDS traveled to Vietnam to train 26 Vietnamese physicians, nurses and other healthcare professionals at the Tam Binh 2 orphanage in Ho Chi Minh City. This orphanage is specifically for children with HIV-infection. The team cares for 100 HIV-infected children at Tam Binh 2 and two other orphanages.

In April 2005, WWO held Ethiopia’s first training conference on pediatric HIV/AIDS at the AHOPE Orphanage in Addis Ababa. The foundation currently cares for 150 HIV-infected children in Addis Ababa through Barlow House, its freestanding outpatient pediatric HIV/AIDS clinic. In addition, volunteers monitor and administer HIV medications to orphans from many orphanages in that city. There are currently 250,000 children in Ethiopia infected with HIV/AIDS (a figure believed by many to be an underestimate), and 13 million HIV-positive adults.

Aronson is in the process of setting up a formal rotation for SOM students to work overseas as Orphan Rangers for a semester. They’ll be able to select the rotation as an elective. “This is an invaluable experience for a medical student — for anyone.”

At work she counsels groups of prospective parents about what to expect, and advises social workers, psychologists and teachers about developmental, behavior and learning issues. She also does workshops at schools for teachers and families.
On the home front, Aronson says her sons have adjusted well to their American environment. Desi, who was adopted as an older child, has memories of his former life and family. Ben, on the other hand, was a baby when he left Hanoi. The two boys are very close and protective of one another, despite their cultural and racial differences.

“These adoptions take a lot of work and a lot of preparation, particularly with racially different children,” says Aronson. “But I highly recommend it, I promote it and I sell it as loudly as I can. It’s so worth it.”