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So, A Childless Couple Walks Into a Children’s Hospital…

No, we didn’t take Duke there for his annual checkup. Monday was our initial intake meeting with Dr. Alice Rothman at the Vanderbilt International Adoption Clinic. We already counted ourselves blessed to be right around the corner from one of the country’s top pediatric health care hospitals, and that was before we learned of the clinic dedicated solely to the care of internationally adopted children.

Dr. Rothman has a general pediatric practice with Vanderbilt, but she dedicates one day a week to running the International Adoption Clinic out of the hospital. The clinic serves to guide adopting parents through the process of reviewing pre-adoption medical files to preparing them for travel abroad and finally to examining the children upon first arriving home. Being located in the hospital gives the clinic access to every specialist imaginable to help review the pre-adoption medical files and weigh in if necessary. This is unprecedented in the adoption world.

I’d like to back up a tad and explain just what I mean by ‘pre-adoption medical file’. It sounds so clinical, but in reality this file is how we will “meet” our child for the first time.

Each month, the CCCWA (China Center for Children's Welfare and Adoption) releases a shared list of special needs children to all of the placing agencies around the world. Our placing agency, Holt, will work feverishly on that day to place holds on specific children they feel would be a good match for one of their families in process. This hold is temporary (in the range of 24-48 hours temporary!) so that if a match is not accepted the child can be released back into the list for referral to another waiting family. Matches are made based primarily on a medical conditions checklist that each family is required to complete earlier in their process. The number of children on the list, the volume of waiting families, and the types of medical conditions contained in the list are what dictate the likelihood of a family receiving a match in any given month.

If we are lucky enough to receive a match that month, Holt will call us and provide a general description of the child before we agree to review the full medical file. They will essentially just tell us the age of the child and what her primary special need is (for example, cleft lip/palate or atrial/ventricular septal defect). If we feel comfortable with the general description, Holt will email the file to us and we will get to lay eyes on our daughter for the first time. My heart is pounding out of my chest just writing about this.

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The file will contain any available medical information and usually one small (often black and white) headshot of the child. The file will be written in Mandarin, but roughly translated into English. Sometimes the medical files are quite recent, other times they are several months old. Sometimes they will contain additional developmental information, other times they have been written so early in the child’s life that there is not much to even report. Either way, we have been prepared by both of our agencies to brace for a little ambiguity here.

Since the hold period is so quick, our time to accept the referral is equally swift. We will have somewhere in the range of 24 hours review the file and make our decision. That’s where the International Adoption Clinic comes in. Upon our meeting today, we were officially entered into the clinic’s system and flagged as waiting for a match. They will essentially be anticipating our call at any time and are prepared to review the file with us at a moment’s notice. The purpose of the clinic is not at all to offer an opinion, but rather to provide clarity and factual observations about the medical file from a professional standpoint to help us make the most informed decision possible.

Dr. Rothman knows to look for signs that things might not all be as presented or that a possible underlying condition is hiding in some unusually low measurements. She has seen enough of these files and children before to spot things that we would not even know to look for. She is now aware of our comfort level and will bring to our attention anything that might make this child better suited to be placed with another loving family. She is confident, patient, beyond knowledgeable, and we know that we are in the best hands possible for this circumstance.

In addition to talking through the process for contacting the clinic once we get the big call, we spent the rest of the hour with Dr. Rothman asking anything and everything we could think of. What is your opinion of the medical conditions we have selected on our checklist? Do you see many surprises from these conditions? Is Vanderbilt equipped to care for these conditions? How do you identify possible underlying conditions? Are the files you see from China pretty accurate to the child once you are able to examine them in person? How can you review a heart condition from a flat black and white image? What other delays and issues do you see across these children? What state of health can we expect her to be in when we are in China? How do we treat her medically while we’re in China? How do we treat ourselves medically while we’re in China? Can you arm us with the meds she might need for the probable scabies, lice, worms, and giardia? Where can you point us for more information so we stop asking you questions?

It was a lot to take in, and she gave us a lot to think about. We left with a folder of materials, several pages of notes, orders for travel vaccines, and some open decisions to make about our medical conditions checklist. It was an invaluable hour that will hopefully make us more calm, collected, prepared, and rational on the big referral day. Oh who am I kidding, we’re going to be a blubbering happy mess.

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