Health of Panama Children

A quick rundown of health issues....... 1. lice - BIG TIME DENIAL (by nuns) of problem..... although they do treat the children, it was OUT OF CONTROL when I was there (I treated the children EVERY time I went).... and they were convinced that cutting the children's hair was the answer (old wive's tale). Panamanian culture is rich with "old wive's tales" and superstitions (someday I'll tell you about the theory of ironing after touching water - or is it BEFORE touching water - either way, it's the silliest thing...... they also believe you DO not take your baby OUT OF THE HOUSE for 40 something days..... AND.... they still give the EVIL EYE.... yes, THE evil eye - my friend got it while we were shopping with her infant daughter (adopted) at a mall there). 2. INTESTINAL PARASITES - recently found out a friend's adopted son, now 7 years old, has had them the ENTIRE TIME, unknown to any of them. While in Panama, 2 adoptive families I knew of said their children tested positive. My daughter did not test positive, however, I am now - after all this time - taking her back in for another test due to continuing intestinal problems. She still seems "bloated", and she should be growing more. 3. MALNUTRTION - I don't care if they're nuns, or not..... the kids struggle to get proper nutrition!!!!!!!!!!!!!!!!!! Not only was my daughter malnourished (at the LARGEST and most respected orphanage in Panama), but she was also anemic and had crusty, infected sores (from numerous bug bites - bed bugs are rampant) all over her scalp and body. 4. UPPER RESPIRATORY INFECTIONS - my daugher had one until she was permanently out of the orphanage. It cleared up quickly, but she had bowel problems for quite some time (change of diet, etc). DON'T LET THIS SCARE YOU......... clearly, these are all TREATABLE AILMENTS.......... but bring lice treatments with you when you go to Panama...... bring basic pediatric medicines (tylenol, cold/flu stuff, aveeno, benadryl lotion/hydrocortison lotion, bug repellant). Don't let the agencies tell you any different...... just DON'T tell them you're going there prepared in the first place, so that it's not an issue.... it insults the Panamanians to bring up lice.... the nuns would "pooh pooh" me when I treated the kids. ~kim p.

If you're adopting older children (toddlers/school age/etc)..... Keep in mind..... If they are toilet trained, they are NOT used to using lots of toilet paper (if any). They were toilet trained COLD TURKEY, too. ALSO.... they are taught to put the toilet paper in a can next to the toilet (vs. FLUSHING it)..... I found this out the hard way - I took a bunch of young girls home with me....... and a few days later, I saw the BIGGEST PILE OF DISGUSTING toilet paper stuffed behind our toilet!!!!! I had forgotten about the "do not flush rule" at the orphanage..... They were SO thrilled, though, when I told them they COULD flush at our house............ it was like Christmas to them! LOL! Also..... hiding food might be an issue for your adopted child..... Sometimes they'll keep chunks of food under their tongue overnight or for an entire day (survival mode)... or they may hide food in their room, under furniture, etc. THEY MAY ALSO SHOVEL FOOD IN LIKE THEY'RE NEVER GOING TO SEE FOOD AGAIN...... so help them to slow down, and assure them they will get fed regularly........ On Sundays at my daughter's orphanage, they only had 2 meals. THIS issue took a while to resolve with my daughter (who was nearly 3 at the time).... but it DOES GO AWAY...... I promise.. ~kim p.

... are highly treatable. Some conditions, such as lice and upper respiratory infections, are the sorts of things that go around even in American day care centers and schools, not just orphanages -- any place where kids are together and may share toys, clothing, etc. Don't blame the nuns for not taking lice seriously. Even in some prosperous countries, schools do not routinely exclude kids with active lice infestations; they consider the problem no more serious than a cold. Americans just happen to be very fussy when it comes to bugs. And the nuns may not want to spend precious resources on a minor condition, when they need the money for basics such as food, medicine for serious conditions, and so on. Some conditions, including malnutrition, are related simply to having not enough money, caregivers, and other resources. Let's face it. The countries from which Americans adopt are not generally prosperous, and orphanages may be woefully underfunded by the government. Private funding may also be very limited. But do recognize that even well-nourished children in some countries will be smaller than their American counterparts. Don't automatically think "malnutrition" if a child is in the 5th percentile on an American growth chart; try to find growth charts based on kids from the country from which you are adopting. My daughter, age eight, has been consistently in the fifth percentile for weight on the American growth charts, probably because she is Southern Chinese; she is as healthy as can be. Some conditions may be endemic in the population at large; remember that the countries from which Americans adopt are usually poor, with limited health care resources, inadequate water supplies, and so on. As an example, the incidence of intestinal parasites may be great in a country with an antiquated water system. Frankly, I would not worry about any of these conditions, unless the child has been seriously debilitated by them. (As an example, very VERY severe malnutrition could have a lasting effect, but you are unlikely to encounter this.) They are certainly not special needs. Your pediatrician will be able to recommend a good lice treatment; you may even be able to bring it with you when you travel and use it while still in-country, if needed. I would suggest that you also travel with a prescription scabies remedy, such as Elimite cream, if your pediatrician permits; there are a couple of schools of thought on traveling with prescription medications. Scabies, a mite that burrows under the skin, is even more prevalent than lice in some orphanages. It itches like crazy and is highly contagious. Many new adoptive parents have caught it from their children. It isn't very harmful, though a person could get a bacterial skin infection by scratching with dirty nails. Some pediatricians will prescribe an antibiotic for you to use while traveling, if you suspect that your child has bronchitis or an ear infection. Others will not, since the average layperson can't distinguish between a bacterial condition treatable by antibiotics and a viral condition, which cannot; the average layperson also won't have appropriate devices for looking into the ears. If your doctor does not prescribe any other treatments, and your child has nasal congestion or a heavy cough, you can always sit with him/her in a steamy bathroom, which will help. You can also feed warm liquids, such as chicken broth, if your child eats table foods. Saline nose drops (non-medicated) and use of a nasal aspirator can be helpful, too. Over the counter cough and cold medicines aren't terribly effective, and may make a child "hyper"; however, a little Benadryl may be a bit helpful for a drippy cold, and may be sedating enough to reduce the fussiness caused by a respiratory infection. As to parasites, whenever you bring a child home from a foreign country, you should do a 3-sample stool test for ova and parasites; you are very likely to find something like Ascaris (roundworms). Unfortunately, you may also find roundworms in your child's diaper before you get the test done, and they are truly gross; the good news, however, is that you can get rid of them easily. You may also want to test for Giardia, a problem caused by a protozoan, which is extremely common in internationally adopted kids. If your child has stomach pains, consider testing for Helicobacter pylori, which can cause an ulcer. If your child has diarrhea or vomiting from an unknown cause, including parasites, the one thing you will need to do while traveling is to keep the child from becoming dehydrated. I would suggest that you take with you packets of an oral rehydration powder, such as KaoElectrolyte, that you can mix with boiled or bottled water. Pedialyte, a liquid oral rehydration product is great, but don't bother carrying heavy bottles, since the powder works as well. In a pinch, you can even make your own oral rehydration powder, using table salt, sugar, and pure water; just find out the amounts in advance. Some children simply won't drink oral rehydration products; my daughter was one of them. While you don't want to give a lot of sugary products if your child has diarrhea, you CAN use flat Coca-Cola if your toddler or older child has been vomiting; that's what my pediatrician recommends. It actually helps quiet the vomiting, while providing needed fluids. Do NOT use Diet Coke. To make the Coke flat, either leave an open can out for a while, or simply stir out the bubbles with a spoon. If your child has really severe diarrhea or vomiting that lasts a long time, and if he/she won't drink enough, you will need to take your child to a health care facility, where fluids can be given intravenously. Simple malnutrition will disappear once a child's intake of nutritious food increases. In some cases, the doctor will recommend supplementing with Pediasure, for extra calories as well as nutrients, or with pediatric vitamins. Some children could have rickets, which is a deficiency of vitamin D, calcium, and/or phosphate, and which can weaken the bones. Mild rickets can usually be overcome with a diet rich in things like dairy products, as well as with exposure to natural sunlight. Be aware that some children may be malnourished due to problems such as lactose intolerance or texture aversion. Lactose intolerance means that you may have to switch from a milk-based formula to a soy-based one, if you have a baby. Older kids may be able to be given lactase-treated cows' milk, but may have to eliminate other dairy products. Some children will have feeding disorders, such as texture aversion, that contribute to malnutrition. In texture aversion, the child does not want to make the change from a liquid diet to solid foods. Children's hospitals often have feeding disorders programs, that can provide a multidisciplinary approach to identifying and treating problems that may cause a child to limit his/her intake. While all of the mentioned items are generally mild conditions, any adoptive parent SHOULD become aware of the more serious things that have been found in adopted children. As an example, Hepatitis B is endemic in the population of many countries, particularly poor countries where Americans often adopt. While it is transmitted in the U.S. mainly through sexual contact or the use of illegal intravenous drugs, it is often passed from mother to baby during the birth process, in foreign countries. Although most countries test adoptable children for Hep. B and don't refer children known to be carriers to parents who want a healthy child, the fact is that foreign testing may not be good, and that there may be some children who come home and are found to be positive. Many people with Hep. B can live normal lives. However, you should know that if your child is a carrier, he/she could be at increased risk of liver diseases, such as liver cancer and cirrhosis of the liver. He/she is also able to transmit Hep. B to others through bodily fluids, and will have to be taught about "universal precautions", safe sex, and so on. Caregivers should be immunized, and should be taught about universal precautions in any case. Since you won't know for sure about your child's Hep. B status until you arrive home, it makes sense to be immunized before travel and to be careful when changing diapers, dealing with nosebleeds, and so on. In countries where alcohol consumption is common, fetal alcohol syndrome may be found in babies and children whose birthmothers drank during pregnancy. This condition predisposes children to behavior and learning problems. A trained physician may be able to identify at risk children, in the absence of good family history information, by looking at the facial features in the referral photo or video. Attachment disorders are a distinct possibility in children who have gone through abandonment or institutionalization. These disorders can range from mild to extremely severe. Most children are pretty resilient, and cope reasonably well with disruptions in their lives. Therapy is available for children with mild disorders. In extremely severe cases, however, the child can become a threat to animals or other children and may not be able to be cared for at home. Older children may have been subjected to physical or sexual abuse, either in their birth families or in institutions. These abuses may leave lasting scars on the psyche. Families need to know what resources are available in their community if they suspect that their child may have been abused. Children in institutions may develop a variety of "survival" mechanisms that don't work well once they are in adoptive homes. Food hoarding is one; the parent may find that the child takes food from the cupboard or the dinner table and hides it where it may not be found until it starts to stink, and must reassure the child that he/she will not experience hunger in his/her new home. Stealing non-food items may also occur, as the child continues habits that may have formed as he/she tried to provide for himself/herself and birth family members. It is a good idea to choose a pediatrician who will take a call from you while you are overseas, if you have a question about your child's symptoms. You may also want to find out, in advance, about good health care resources in your country of choice, in case you really need to seek professional help. Consider getting insurance that will cover the cost if you or your child has to get medical care while abroad, or if you or your child has to be transferred to the U.S. or another country for treatment of a serious problem. It is certainly important to find resources in your community, which you will be able to call on if your child turns out to have either a physical or a mental health problem.

I want to quickly respond to something the previous post (which is excellent, by the way) stated: And the nuns may not want to spend precious resources on a minor condition, when they need the money for basics such as food, medicine for serious conditions, and so on.Ӕ Thats an excellent point Җ and perhaps it applies to some of the orphanages in Panama. However, I spent 3 years being at the disposal, 24-7, of the staff (nuns, cooks, etc) of the orphanage where my daughter lived ݖ the largest, government supported & privately supported institution in Panama. Whatever they asked of me, Id do҅.. I mopped, served food, cleaned bathrooms, bathed new arrivalsӔ, fed infants (which, sadly, usually meant propping up bottles, and TRYING, in vain, to give as much attention to each one as they ate it was almost futile at times), etc etc ֖ they called me at all hours when they needed extra help as well. In a perfect world, yes, the nuns would put more serious issues at the top of the priority chain, however, that was not what I experienced. It doesnt mean the nuns and staff didnҒt flood the children with love and attention! Many times, however, it was a bit of anarchyӔ when the head nun made decisions the rest of the staff disagreed with, or could do nothing aboutŅ lots of gossip, which used to give me a few chuckles (just didnŒt expect that at first). At one point during my volunteering, I was pulled aside by one of the workers (a former resident of the orphanage who adored our daughter, and took specialӔ care of her for us), and warned that there were 2 cases of hepatitis, and that the nuns were NOT telling visitors or volunteers for fear of losing the much needed help. Subsequently, we learned that we had also been unknowingly exposed to AIDS babies (which, the only fear there was the fact that we handled dirty diapers, and while feeding babies, they would, of course, spit up, etc). The nuns didnt tell us about that either҅ we all had to be tested. We quickly learned to be vigilant. As volunteers, our goal was to help with the small stuffӔ: Lice, body sores, hygiene (tooth brushing, bathing, etc). One person I volunteered with got her behind chewed out for giving baths to the children before bedtime - they were filthy from playing with some goats out in the courtyard. AnywayŅ. She was nearly BANNED from the place, but we worked it out in the end. I got my hands slappedӔ for passing out clothes donations to the older girls that had come from my church back in the States. When I asked one of the older girls what I had done to tick off one of the supervising nuns (not the friendliest gal to begin with), instead of explaining, she secretly took me up to this shed behind the office that was FLOOR TO CEILING donations of clothing, toys, etc that were NEVER passed out to the children, but were instead being sold. Apparently, my handing out the donations directly was a no-no. Anyway.. things just run differently there. WHO KNOWS WHY. But as adoptive parents, IŒm sure everyone at this board has spent MANY A DAY learning all about conditions such as fetal alcohol syndrome, attachment disorder, and serious medical problems (deformations, congenital defects, etc), be it physical, emotional, or mental. My intent in discussing the more obviousӔ superficial medical conditions was basically to prepare adoptive parents to be ready for the small stuffӔ.. the treatable thingsŅ. And to reassure them that itŒs temporary but. ItŒs going to be uglyӔ at first. Head lice, common world wide (of course), is not something that is affordably treated at most orphanages, although they do try with home madeӔ remedies (to include shaving the childrens hair off). Unfortunately, as was my daughterҒs case, it had gotten so out of control and so neglected that the itching lead to infected sores. The bed bugs left bites as well that often became infected (dirty hands scratching the bites open). As a volunteer I would be dumbfounded as to why the oodles of bottles of hand soap, medicines, lice treatments, dish soap, and laundry soap (a hot commodity for the orphanage) had disappeared after only just bringing it to themօŅ and it was discouraging for us to see that the staff wouldnt heed our advice, and wash their hands in between changing diapers and feeding the children. Clearly, there are ғseedy issues within the orphanagesԅ.. AGAIN. That doesnŒt mean the kids arent loved and attended to emotionally҅.. however, I felt that the neglect of the obvious medical/health needs was detrimental to their mental and emotional well beingŅ.. so it could often be very discouraging and felt like we were running through quick sand. We had medical professionals from the American hospital visit the orphanage to help urge the staff to pay close attention to sanitation issues we also tried to educate the staff and nuns on F.A.S., attachment disorder, etcŅ.. but they did NOT believe in these conditions. at all. IŒm not kidding. They looked at us like we were nuts. Anyway, to be prepared for the less serious medical needs of your newly adopted child, will only make things easier and less stressful for everyone. Bring decongestant, lice treatment, Neosporin, benadryl, etc WITH YOU if/when you go to Panama so that youre not attempting to locate these things at the last minute - itҒs just a friendly tip from someone whos been there/done that! As for the bigger, more serious medical/health issues Җ I assume your agencies wont direct you down that road unless you specifically requested children with medical needs Җ if that fits your description, then I can say from my experience that the worst cases I personally witnessed were injuries from severe abuse (one child was in a full body cast every bone broken), fire injuries (an infant had been set on fire by it֒s drug addicted mother), physical deformations (almost all were mild that I saw a friend adopted a baby boy with an ear malformation and a hole in his heart), I didnŒt see as many children with F.A.S. as I would have expected, but I felt that attachment disorder was very common. OurӔ orphanage had a handful of children with mild retardation, but for the most part, I was under the impression that children with severe mental disabilities were placed elsewhere perhaps a home equipped to give special care to those children. We did have one special little girl that my church supported (with a special wheelchair and therapeutic devices)Ņ. However.. she was not deemed adoptable. IŒm not sure why. I felt that Panamanian children were pretty darn toughӔ considering what they go through at times (poverty, malnutrition, etc). Much healthier, in my opinion, than children found in impoverished Eastern blocӔ or far EastӔ countries. I also want to add that some children were more READILY AVAILABLE FOR ADOPTION that had minor health conditions. orphanages tend to look at those cases with dollar signs, and will help do what they can to push those cases through the adoption network so that they can get the medical care they need. I wouldnŒt hesitate to ask your agencies about thisŅ PS: The previous writer makes an excellent point re: sexual abuse. It is definitely an issue (as with most places in the world).

I appreciate all of your first hand comments. Please note that I was not referring specifically to conditions in Panama or any specific orphanage in Panama. I was giving my perceptions of issues arising in the general population of internationally adopted children. You make a good point about diversion of donations. While some orphanage directors and staff are 100% committed to the children they serve, and use donations appropriately, there is no question that corruption and greed can and do exist. I would imagine that folks in any country could point to a situation in which Director X bought himself a new car or Director Y requested donations of air conditioners that were then given to relatives or sold, with the proceeds going into her pocket. You have to understand, of course, that working in an orphanage is not a particularly high-prestige or high-salary job. The best and the brightest often do not wind up in such positions, unless they just happen to be saintly people. I suspect that one reason for such ills as sexual abuse of institutionalized kids is that orphanages must often scrape the bottom of the barrel to get staff. No one is going to do an exhaustive reference check, if someone is willing to accept a job that involves long hours and a lot of dirty work. That person could well be a pedophile or, at the very least, an embezzler. And even if a person is not a pervert or an accomplished thief when he/she starts work, the temptation to do wrong may be nurtured by an environment of lax supervision, inadequate salary, and so on. Why not take that washing machine or that box of pharmaceuticals? No one will notice, and I make too little money. Why not turn a blind eye to the fact that sexual activity between staff and residents is occurring? Raising a fuss could get higher-ups involved and could put my job in jeopardy. Etc. While one might hope that people with a religious vocation would be less inclined to wrongdoing than others, the fact is that they are as human as the rest of us. They may also be more inclined to "protect their own." We have seen the issue most dramatically in recent revelations about sexual abuse by Catholic priests in the U.S., but my guess is that every religion, as well as atheism, has had its share of wrongdoers at one time or another. In addition, a person who becomes an orphanage director may not have had any management training. Even the most well-intentioned person, thrust into the position of director of a large orphanage, could do a lousy job without a good understanding of personnel management, financial management, medical issues, fundraising, and so on. A head nun could make bad decisions by virtue of ignorance, a tradition-rooted failure to communicate with staff, and so on, even if she happened to be a very decent person. People go to graduate school in the U.S. to learn how to run hospitals and educational institutions. The head nun may or may not have ever gone to college, may or may not have had previous opportunities to run anything. Staff may also be fairly ignorant. Often the product of the local culture, they may believe local myths -- that babies will get chilled unless so bundled up that they can't move, even in summer, for example, or that AIDS is a plague visited by God on homosexuals -- not a disease of viral origin that can be passed by heterosexually promiscuous men to their wives and by the wives to their babies. They may be resistant to "outsiders" who teach them a different set of beliefs and practices. As an example, if your mother didn't wash her hands after changing a baby's diaper, and all your siblings are alive and well, why in the world should you believe the "nonsense" spouted by foreign doctors about handwashing being the best infection control mechanism? Especially if you know next to nothing about bacteria and viruses. Staff may well be overworked, or sometimes not inclined to do a reasonable amount of work. They may also be concerned about how their performance will be viewed by others. It has been found that children in some orphanages are not allowed to play with donated toys, even when the toys have not been diverted to places outside the orphanage. Sometimes it's because they will have to be cleaned, put away, and so on. Sometimes, of course, it's because staff want foreign visitors to see neat shelves of clean, attractive toys and so they leave them on the shelves so that they do not get "spoiled." Orphanage directors may be political appointees, in some countries. In such cases, the directors know that keeping their job means being politically orthodox. For a long time, the "party line" in China was that AIDS did not exist there to any significant extent. Today, it is known that China has plenty of AIDS cases, and that one reason is a government-sanctioned blood-buying program that existed in certain provinces. But if you ran an orphanage in the past, you probably wouldn't have admitted that any of the kids were HIV-positive, even if you knew for sure. Of course, you probably wouldn't have known for sure, since AIDS testing was not done. By the way, I volunteered at a children's hospital in the U.S. for four years, before I adopted. The custom in children's hospitals is NOT to tell volunteers the kids' diagnoses. There is a belief that the privacy of the children would be violated, and also that some volunteers might discriminate against some patients, such as those with HIV. All volunteers are expected to practice "universal precautions" as if everyone had HIV or Hepatitis B -- things like careful handwashing, using gloves for diaper changes, covering open sores, and so on. Volunteers are also expected to pay heed to signs regarding isolation cases -- for example, that they must follow a contact or respiratory isolation protocol, which may involve a gown or a mask, or that they should not come into the room if they are pregnant. Most of the volunteers DID figure out or were told who had AIDS, of course. I spent a lot of time holding and caring for two little girls, children of drug abusing mothers, before they died of AIDS at age two. One of them was a biter, and I DEFINITELY had to be careful about her! You are certainly right that parents need to know not to be shocked by the "small stuff" they encounter when they meet their child. Instead of seeing the child of their dreams, all too many parents WILL see a kid with green slime coming out of his/her nose, a nasty cough, scabies lesions, a diaper full of diarrhea, a nasty diaper rash, and a bellybutton caked with dirt. They do have to be aware that things like external bugs, internal parasites, respiratory infections, eczema, decayed baby teeth, fungal infections in the diaper area, etc. are commonplace and not terribly worrisome. The child of their dreams may emerge only after these conditions are treated appropriately. And they do need to talk with a knowledgeable pediatrician about what things should be treated while the family is overseas and what should be palliated until the child can be seen by an American doctor. I would add that parents also need to know not to be shocked if they encounter a child who is wildly hostile to them OR totally shut down emotionally. Many parents go to the orphanage with a fantasy image of their child and a fantasy that their child will instantly snuggle against their shoulder, smile, and fall blissfully asleep. In fact, that just doesn't happen in many, many cases. Wild hostility is normal and, surprisingly, a good sign. The toddler who runs for the door, who screams "Ayi" ("Auntie" in Chinese) as his caregiver attempts to leave, or who just cries the whole first night, is showing that he has bonded to someone in the past, and will probably be able to bond to his new parents, over time. It is heartbreaking to watch the child who reacts with hostility -- I remember the wild and woolly handover of a 3.5 year old Chinese child to her new Mom, which I saw when I was at my daughter's orphanage. But within days, that child will usually come to recognize the virtues of having a Mom and/or a Dad, and may become so intensely bonded that the parent can't go to the bathroom without carrying a small person along. The little Chinese girl bonded so strongly to her new Mom and Grandma within two or three days that she would scream and rock like a mentally ill person if anyone else approached, fearing that these other people would take her from her new family. I was prepared for wild hostility when I met my 18.5 mo. old daughter. I was NOT prepared, however, for what she actually was like. She was like a little zombie -- no crying, no smiling, no curiosity, nothing. If I stood her up, she took a few steps. If I sat her down, she stayed sitting. If I put her into her crib, she would shut her eyes and try to sleep. She showed no signs of speaking, or even understanding, Mandarin or the local dialect. I was scared blue. Was this child autistic? Mentally ill? Mentally retarded? I must confess, mortified, that I gave thought to rejecting this child and asking for another placement. She seemed so damaged. However, I decided to accept the placement because I just couldn't believe that God would have taken me all the way to China to throw me a curve ball. And I'm so, so glad that I did. For after three days, it became clear that I had been seeing grief and shock. My daughter's depression lifted, and I found that I had the most huggy/kissy/smiley kid imaginable, and one who loved having a Mom and being adopted. She also turned out to be such a curious child that she managed to pitch headlong into the empty bathtub while exploring our hotel room -- and, yes, she cried. Within a week, she was saying "hi" and "bye-bye" in English! Today, I have a child who is totally healthy, performing well above grade level academically in a tough private school, loving and empathic, and very calm and balanced. I subsequently learned that emotional shutdown is common in newly adopted children. It's often a way of responding to overstimulation -- too much new stuff thrown at them, all at once. It's also a way of dealing with intense emotion -- huge sadness at the loss of everything familiar. But I fear that many prospective parents still aren't prepared for it, and could possibly reject utterly wonderful children because of it. There is also a myth of "instantaneous bonding" on the parents' part. You know, just as the child is expected to nestle on the parent's shoulder, the parent expects to be overwhelmed with a feeling of love and to cry, "My son! My son!" In fact, just as the child is likely to be wildly hostile or emotionally shut down, the parent may well react with a feeling like, "I came all the way to Russia -- for THIS?" Parents need to know that this, too, is perfectly normal -- that there is nothing wrong with them and that their child is not necessarily the wrong one for them. You have to remember that the parents are under quite a lot of stress. They may still be harboring sadness about their infertility. They may have had lots of warnings from relatives and friends about adoption. They may have traveled halfway around the world, and may be terribly jet lagged. They are likely to be in a place where they don't speak the language. They may have picked up a tummy bug from unfamiliar food and drink, or a respiratory bug from the recirculated air on the airplane. They may not have slept well from excitement and anticipation. They may have built up huge expectations about their new child. And in that stressed-out condition, they have been handed a child who may be smaller than expected, lacking in muscle tone, obviously ill with minor bugs, dirty and stinky, wearing mismatched clothing and a terrible haircut, and totally unhappy about having new parents. Why in the world should they expect to bond instantaneously? It is totally reasonable that they should think, "What the Hell have I done?" The fact is that almost all new parents will bond to their children, just as almost all children will bond to their new parents. It just isn't likely to happen instantly. It may take a day, a week, or maybe longer for the initial bonding to occur. And real attachment will take much longer. Attachment grows over long periods of time together -- years, in fact. The love I feel for my daughter now, and she has just turned eight years old, is much, much deeper than the love I felt for her when she turned age two. We have grown together and shared so much. I must say, however, that I don't share your optimism about the pre-adoption training that prospective parents get, with regard to serious medical issues. You state that the folks on this board have spent "many a day" learning about serious issues such as attachment disorders and FAS, and maybe this is the case. I believe, however, that many prospective parents are still either failing to do their homework or forming an unrealistically rosy picture of children from a country in their minds. When I look on boards like this, I see many parents seeking out the quickest, cheapest possible homestudy. Some social workers call it the "drive-by" homestudy. I also see many agencies and social workers who offer these quick and cheap homestudies. The agencies and social workers are NOT doing anyone any favors. The main goal of a homestudy should be to prepare prospective parents for the challenges of adoption. Parent preparation is NOT a quick process. It cannot be done in a single homestudy visit, or over the phone. And it must address not only medical issues, but also issues such as dealing with transracial adoption, dealing with grief over the loss of birthparents, and so on. It is NOT unreasonable for an agency to require pre-adoption classes or several counseling sessions with a social worker; in fact, parents should welcome such preparation. I also see parents choosing facilitators and agencies who do very, very little to ensure that a placement is appropriate. They often accept at face value some rather preposterous health claims by these facilitators and agencies, and fail to check references carefully. Placement agencies have an obligation to provide families with any and all information that is available on a child, and to use a certain degree of care in making a match. Yet all too many do very little, and foster the notion that "all" children available from certain countries are healthy. To do this is to create the conditions that spawn adoption disruptions/dissolutions, which are harmful to children and painful for parents. These same conditions can also spawn lawsuits. Yes, little information on a child may be available in some countries, particularly where most of the children have come into the system through abandonment. In those cases, agencies have the responsibility to remind parents that they will get very little information, or very little reliable information, and that adopting a child with an unknown history involves a fair degree of risk. Again, however, that subject is often avoided. If you want confirmation, call some of the adoption medicine doctors. Ask Dana Johnson, M.D., or Jerri Jenista, M.D., or any of the good folks who helped make adoption medicine a recognized subspecialty of the American Academy of Pediatrics about parent preparation and agency responsibility. Be prepared to get an earful about what families DON'T know about internationally adopted kids and their physical/mental/emotional health. And be prepared to get an earful about how some facilitators and agencies mislead parents or fail to inform them about their children's health status. Ah well, I guess I've said enough. I am very eager to see adoption from Panama "take off." There are certainly enough children in need of permanent loving families, who won't be adopted within their own country. And there are certainly families who desperately want children and would welcome a child from a Latin American country. I worry, however, that some prospective parents are choosing Panama at this time, without understanding that newer programs carry higher risks than more established ones. The parent who is looking for a "sure thing" should probably consider a country like Korea, which has been placing children with American families for over 50 years and which has a very stable and well-organized adoption system. Only parents who are comfortable with the added risk of a newer program should consider pursuing a Panamanian adoption -- and they should definitely check out agencies and facilitators very carefully, in terms of their expertise, familiarity with the country's laws and customs, and so on. Sharon

Sharon, You bring a very realistic picture to international adoption---one that raises the hairs on the back of my neck! I'm curious...what is your affiliation with Panama adoption? Are you one of the many families who have switched from Guatemala during the moratorium and thought Panama would be the quick, easy solution? (Many are now finding that that is NOT the case!) Or are you a medical professional who has seen/treated internationally adopted children? (You sound "experienced"!) Rebecca

... no, I am not adopting from Panama. I'm not sure if I can adopt again from anywhere, much as I'd like to do so, as I'm 58 and single, which means that I have to be thinking about preparing for my own old age and my daughter's future educational needs, as well as contemplating the costs of raising two kids, thinking about guardians if I should pass away or become incapacitated, etc. I am the former Executive Director of a well-known advocacy organization, focused on promoting ethical intercountry adoptions. Although I am no longer affiliated with the organization, I continue to monitor the international adoption scene carefully. I have followed with great interest and concern the developments in Guatemala and the decision of some families to bail out and turn to Panama, as well as other countries. While involved in that organization, I was privileged to work with some of the finest international adoption professionals in the country. They represented agencies large and small from around the U.S. I was also privileged to meet and listen to many of the leading adoption medicine professionals in the country present their findings about the health of internationally adopted children. They taught me a great deal. Sharon

Dear Sharon, You said: "I have followed with great interest and concern the developments in Guatemala and the decision of some families to bail out and turn to Panama, as well as other countries." Because you have been following the situation in Guatemala closely (and are much more familiar with the Hague treaty than any of us likely are), would you mind sharing your concerns about families switching to Panama at this time? Many posters on this Panama board are still hanging in with Guatemala, but ready to switch to Panama should the situation get even more tense and uncertain. Do you have any advice for those families? (Sorry this question is off topic for this thread.) Thanks, Rebecca

... I didn't really mean to cause you alarm. International adoption can be a wonderful experience, IF you go into it well prepared and work with professionals committed to the highest ethical standards. About 20,000 children from overseas are adopted annually by Americans. The vast majority of these adoptions work out extremely well. There are only minor glitches, if any. There are predictable fees. The children have the health status that the parents expected. And so on. Yes, there are horror stories -- stories about greedy facilitators and orphanage directors, stories about children who are so damaged that they kill the family cat and try to molest their siblings, and more. But you have to realize that scandal sells papers. For every family that reports a terrible experience, there are many, many more who come home with the children of their dreams. Orphanages and impermanent foster care settings, however good, are not optimal for children. In countries where domestic adoption is not customary, adoption by overseas families is the best hope for children in need of permanent, loving families. I would urge you to pursue your plans to adopt. As the delighted Mom of a wonderful daughter, whom I adopted in May, 1997, I can tell you that adoption can make your dreams, and a child's dreams, come true.

International adoption works best for families who can live with some degree of uncertainty. Sovereign nations have the right to make their own laws and policies regarding child welfare and adoption. They have the right to change these laws and policies from time to time, in what they believe to be the best interests of children and their birth families, without the approval of people in other countries. The U.S. cannot dictate to these countries how they should proceed, even if many people want to adopt there or don't feel that the new laws and policies are good ones. As a result, some countries may change their laws and policies during the time when families are in the process of international adoption. The changes may deprive some families of the ability to adopt from those countries. In other cases, the changes may lengthen the adoption process. At times, the laws and policies will require clarification through the judicial system or simply with experience, and families may go through a period of being uncertain as to whether they will be able to finalize adoptions. The Guatemalan situation is one in which there remains some uncertainty. I must say that I support the Hague Convention overall. It is a treaty that aims to protect children and birthparents, and that advocates for intercountry adoption as superior to institutional and foster care, for children who cannot find permanent homes in their own country. However, I also know that some countries have not done a good job of implementing the treaty, and that the net effect has been to limit the ability of parentless children to find forever families. I don't know whether the Hague would have been implemented well in Guatemala. Implementation is a complex matter. Here in the U.S., we passed legislation allowing the implementation back in 2000, but we are still in the process of finalizing the supporting regulations, and probably won't implement it fully for some time. And it remains to be seen whether we do a good job of carrying out both the intent and the specifics of the Hague, once it is implemented. Individual families will have to make their own decisions about whether to stay the course in Guatemala, in hopes that things will work out in their favor, or whether to bail out and pursue adoption from another country. I would advise families considering adoption from Guatemala to consult with experienced and ethical adoption professionals, as they make their decisions. These people are in day to day contact with both Americans from the State Department and BCIS/INS and key Guatemalan leaders, and are in the best position to assess the changing situation and its implications. Some of these people post regularly on Guatemalan listservs and bulletin boards. Others work less publicly, though no less actively, and can be reached through their agencies. Families can also read the communications of responsible advocacy organizations like the Joint Council on International Children's Services (JCICS), which monitors the adoption situation in various countries. JCICS has a 25+ year history of advocating for ethical intercountry adoption, and has worked to help families caught up in difficult situations in Cambodia, Vietnam, and elsewhere. I would also advise families to search their own hearts. If their goal is to adopt a Guatemalan child, they might well want to stay the course a little longer, in the hopes that they will be able to fulfill their dreams. If they are not particularly wedded to the notion of a Guatemalan child, but simply want to be parents, they may want to, at the very least, consider other options. If they are very risk-averse, they may want to switch to a country with a history of great stability, such as Korea, which has been placing children with Americans for over 50 years. If they are open to a little more uncertainty, they may want to pursue adoption from a country like Panama, but should work ONLY with the most reputable and conservative of agencies. It's pretty hard to go wrong when adopting from a country with a long-established, stable adoption system. But it's all too easy to go wrong when going with a very new program, unless you work with an organization that tells you the unvarnished truth about the risks and that can minimize the risks because it simply will not work in a country without doing its homework carefully. In my own case, my dossier went to China in April, 1996. At that time, referrals were coming in 2-3 MONTHS. Unfortunately, one month later, China announced a major reorganization of its adoption system. My paperwork was in a Ministry that, under the reorganization, was no longer authorized to process dossiers and assign children. It took until September, 1996 until China resolved the issue of whether the old Ministry would be allowed to finish processing those dossiers it already had. The answer was "no" -- but it took until October until my dossier was moved to the Ministry that was now in charge of all dossier processing. At that point, no one knew how long the new Ministry would take to give referrals, since it had doubled its workload. No one knew, in addition, whether the new Ministry would make some changes in policies and procedures that could affect whether I got a referral that I could accept. This was of special concern in my case, as I was over 50 at the time. I am also single. Some families decided to give up on China and attempt to adopt elsewhere, particularly in Korea and Vietnam. Some became parents before I did. After listening to many adoption professionals, however, I decided to wait. This turned out to be the right decision for me. In May, 1997, 13 months after my dossier went to China, I became the Mom of Zeng Chufang, now Rebecca Joy Chufang K------. She was 18 months old then, and has just turned eight years old now. She is truly the child of my dreams, and I feel so blessed to have her. The bottom line is that there WAS a child out there who needed me. I had to wait, and the wait was agonizing. I faced uncertainty, and I sometimes felt that the uncertainty would drive me insane. But today, I am a Mom, and when I watch my daughter emerge from school with her loaded backpack, or laugh with a sleepover buddy, or sleep with her arms full of stuffed animals, the wait and the uncertainty seem like nothing. Sharon

Excellent comments, Sharon....... All things I said emphatically to adoptive parents IN Panama (all military families) at our adoption briefings........ It's difficult to explain to them that the overwhelming urge to believe that "God just brought this child to them" (after a visit to an orphange, where a particular child became "clingy" and desperate to be with them) could very well be something not quite so "rosie"....... I felt HORRIBLY guilty raining on parades, and I touched on the subject as delicately as possible...... But, the truth be known...... toddlers who, literally, crawl into their laps, wrapping their arms around adult's necks, refusing to let go after JUST being introduced is just not normal toddler behavior. Our daughter was different --- she was the one who stood in the corner when visitors came, turning her back to them, and using her peripheral vision to scope out what was happening. When visitors would offer her candy or a toy, she would refuse - basically turning her nose in the air as if to say, "I don't need YOU to give me ANYTHING...... I won't reduce MYSELF to begging...... I've GOT a mom." *She lived with her birth mom from birth to age 2.... slept in the same bed......... etc. Her birthmom, however, was 12 when she became pregnant and 13 when she gave birth. She was ILL prepared, after her own life of abuse (serious physical, emotional, mental abuse from her father and abandonment by her own mother) to raise a baby when she was a baby herself. Regardless of the horrible care my daughter received from her birth mother, she had one "central" care giver, which is - of course - essential to avoiding attachment disorder... so it worked in her favor. But she kicked into survival mode at the orphanage, and was in total control of her little life - a hard habit to break. Unfortunately, our daughter did have issues with things such as hiding food, regressing (she began having accidents although completely potty trained), silence, "killer" stares (enough to make you boil inside, and groping for ways to ignore it and not be affected... ha), and all out sneakiness. The food issues went away quickly....... potty training came back, but we had to re-train her (no biggie though)........ the stares still remain, along with her need to ALWAYS BE RIGHT (because being wrong would imply that she is imperfect and "defective" - I bet you know what I'm talking about! eh? :) Very difficult to get her through this)...... until about 2 years ago (my daughter just turned 9), if she had an injury, you wouldn't know it. Most kids would scream in agony if they cut off the tip of their finger........... NOT MY DAUGHTER. She silently tried to fix it in the bathroom (age 5) on her own, holding the tip back on....... until my father and I found her. Lots of tears, lots of blood (yuck)...... but not a WORD........... :o( The ER doctor was also an adoptive parent, and knew exactly what was going on w/Juliana (my daughter)....... she was extremely helpful, gave us lots of advice, etc. Shortly after that, Juliana fell on a metal bunkbed frame, and put her teeth through her face (a "through and through").... NOT ONE WORD..... not a scream....... nothing. Again, she tried to fix the problem herself in the bathroom until she realized she couldn't get the bleeding to stop. I cried all the way to the pharmacy to buy the steri-strips (doc's advice by phone) at the thought that my daughter couldn't turn to us when she was in pain. *sigh.................... it's been a long road. Now, it's a big fuss over every bump and every scrape due to good advice from that ER doctor........... now we hand Juli the box of bandaides and neosporin and tell her to "go to town", at her delight. What does remain now is a bit of sneakiness........ and an extrovert who is comfortable talking to ANY stranger - so we contend with safety issues. You hit the nail on the head about low pay, bad working conditions, etc - that was my daughter's orphanage EXACTLY (and it's still the same there now)... excellent point. You're also right about adoptive parents needing to be very scrupulous. I have a good friend adopting from Panama - and I can't tell you how many times I've said, "adoption is like a marriage... it's for life...... so no guilt for being selective about who you adopt." I've mentioned here, at this website, countless times to ASK FOR VIDEO of the prospective child - video of the child interracting with other children, adults, caregivers, and VISITORS (if possible)....... this, of course, applies to toddlers and older children. As for infants...... well...... those were the ones I could immediately determine if attachment issues were at hand. Babies would be screaming to be held..... you'd hold them... and they'd become stiff... unable to handle the contact, even though it's what they were crying for. It broke my heart. I URGE anyone adopting ANYWHERE to try to visit the children FIRST.... and if possible, play THE BIGGEST ROLE IN SELECTING A CHILD. It is sooooooooooooo important. I've loved your posts..... great info, Sharon. How long did your adoption take, by the way? What agencies would you suggest in Korea??? Just curious! ~kim *I'm presently living in Okinawa - I see adoption meetings advertised all the time and am curious if it's for Korea, China, Thailand, etc........ :)

Hi All, I am in the process of adopting from Ecuador. Our child has lived in an orphanage all his life (now 2.5 yrs). We have seen a homemade video (2 hrs) of the orphanage and Ecuador. The orphanage seems very well staffed and clean. We have spoke with numerous others who have adopted from this orphanage and they concur. We will be receiving a video next week of our child. Is there anything in particular we should look for? Any testing we should specifically ask for? He will have a developmental assesment done by a psychologist there. He appears (by monthly Dr reports) to be healthy and nothing other than a few colds. You both sound very knowledgable of orphanages and would appreciate your input and opinions. Thanks! Marsha

As to Korea, it is the only country currently open for adoption where families must use an agency that is licensed in their jurisdiction and has a contract with the Korean authorities, unless they wish to adopt a child with significant special needs. As a result, people in some states have one or, at most, two agencies to choose from. There are, I believe, a few states with no agencies authorized to place children from Korea. Korea has chosen to contract with only a few agencies, and these agencies tend to be long-established and highly reputable. It is pretty hard to go wrong with any of them. As it happens, the agency through which I adopted my daughter from China -- Adoption Service Information Agency (ASIA) -- got its start as a Korean adoption agency, and still is best known for its Korea program. It is conservative, ethical, and committed to good service to children and families. The agency head is Korean and well-connected in that country. U.S. agencies authorized to place children from Korea must work with one of four social welfare organizations in that country. ASIA works with Eastern Child Welfare. Besides doing adoptions, the agencies generally assist their Korean social welfare organization with projects for the children who are unlikely to be adopted, as a result of age or severe disability. Regarding my adoption, it felt like the gestation period of an elephant; however, compared to the long waits experienced by China parents currently, it wasn't so bad. Here's the rough outline: 1. I first began to consider adoption in 1993. However, I could not proceed at that time, as I was dealing with issues concerning elderly parents. I did, however, take a preadoption class sponsored by a parent support organization and begin doing volunteer work at a local children's hospital, to "reality test" my thoughts about parenting. I continued my volunteering until the night before I left for China to complete my adoption. 2. My stepfather passed away in 1994, and my mother passed away in 1995. After taking some time to grieve and take care of matters neglected during my involvement with my parents' last years, I began the process of agency selection. Although I had become acquainted with the agency I subsequently chose to use during my pre-adoption class, I met with a number of other agencies, as well, during this phase. 3. My homestudy and INS clearance were begun in late 1995. 4. On Thanksgiving day, 1995, I was called away from my Thanksgiving dinner to meet with the head of the adoption unit at the Ministry of Justice, where my dossier would eventually be sent. She happened to be visiting agencies in the U.S. at the time, and spent the holiday with the head of my agency, who organized a small reception for the agency's China parents on short notice. I was allowed to make a gentle and respectful statement about my desire to adopt and the hope that China would grant me a young child, although I was 50. 5. My dossier went to the Ministry of Justice on April 10, 1996. At that time, referrals were coming in 8-12 WEEKS, and travel was occurring about 6 weeks later. I fully expected to be a Mom by the end of the summer, though there were still uncertainties about whether my request for a young child would be honored. Some agencies felt that people over 50 would be granted only a child over age three, but this was not actually China's policy at the time; it made decisions on a case by case basis. 6. China's reorganization was announced in May, 1996. The Ministry of Justice, where my dossier was sitting, was put out of the referral process. All dossiers had to go to what is now the China Center for Adoption Affairs, which was already processing some dossiers. China felt that it was important to centralize adoption processing in one Ministry, for consistency and the ability to exercise tight control of the process. 7. There was some hope that China would allow the Ministry to complete dossiers already in process. It took until September, 1996 for the Chinese government to decide that the Ministry of Justice could not process dossiers received before the reorganization. 8. The dossiers actually didn't get logged in at the new Ministry until October, 1996. At that point, no one knew exactly what the timetable for referrals would be. With a double caseload, the CCAA might have difficulty keeping turnaround time short. Also, there was a feeling that the Ministry's policies with regard to matching children to families might differ from those of Justice. Some agencies advised families to consider switching to other countries, if they could not tolerate the uncertainties. I briefly considered Vietnam, but decided that my heart knew where my child was, and that was in China. 9. On January 30, 1997 -- four days into a new job -- I got "the call". Even my agency was astounded. Li Weilin was exactly 13 months old that day -- truly a young child! I began to shop like crazy and to prepare for travel. 10. Just when I was expecting to get a call that travel approval had been received, I got a call of a very different sort. China had sent my agency a fax, indicating that the referral of Li Weilin had to be withdrawn. When the CCAA had informed the province of the match, so that travel arrangements could be made, the province told the CCAA that the child had already been adopted domestically. It appears that, frustrated with reorganization-caused delays, the orphanage and provincial authorities had begun seeking local homes for the children, and failed to notify Beijing that adoptions had, in fact, occurred. Suffice it to say, I was devastated. I felt as if I'd had a miscarriage. 11. A new referral was sent immediately. I was grieving so heartily, however, that I could not look at it for several days. Even then, I found myself being critical of it, out of grief. Zeng Chufang was two months older than Li Weilin. She was crying in her picture and didn't look as good. Her name was odd (although it meant "clear and beautiful"). And so on. But I knew that I wanted to parent, and accepted the referral. The CCAA had rushed through the referral so I could travel with my group, which meant that I got very, very little information; basically, all I knew was a height and weight, the fact that she had ten teeth, and that China considered her healthy. 12. My group and I left for China on April 29, 1997. We spent a few days in Hong Kong, resting up from jet lag, before going to adopt our children. There were eight families in the group; five families, including mine, were going to Xiamen in Fujian province. The other three were going to two cities in Guangdong province. 13. On Monday, May 5, 1997, Zeng Chufang was placed into my arms at the Xiamen Social Welfare Institute. That afternoon, the adoption was finalized. My group and I then had to wait until the next Friday to leave Xiamen for Guangzhou; it takes China about five to seven days to process paperwork after an adoption, and to issue the child's birth certificate, adoption decree, abandonment certificate, and Chinese passport. We toured and spent lots of time bonding with our new children. 14. We received our paperwork on Friday, May 9, 1997, and left the next day for Guangzhou. Sunday, May 11, was Mother's Day, and I celebrated my first Mother's Day as a Mom there. 15. On Monday and Tuesday (May 12 and 13), we had our children's visa photos and medical exams done and went to our interviews at the U.S. Consulate. Since our paperwork was in order, we were told to come back the next afternoon (May 14), after 3 p.m., to get the visas. We did so, then caught the last flight of the day to Hong Kong. 16. After a very brief overnight in Hong Kong -- I was up all night because my daughter had a bad stomachache -- we headed for the airport and our long, long flight home. My daughter threw up all over me just before I boarded the plane, but I was an experienced Mom by then and had extra clothes for both of us in the carryon bag. 17. Korean Air was great. The flight from Hong Kong to Seoul and then on to Los Angeles was uneventful. Unfortunately, I was switching to United in LA, and my flight was cancelled. I had to wait hours for another flight, which was packed to the walls and staffed by the surliest flight attendants ever. I arrived in Washington DC around midnight, having not slept for two nights. It was a heck of a way to begin parenthood, but we've had smooth sailing ever since. Sharon

Wow!!!!!!!!!! What a WONDERFUL story!!!!!!!!!!!!!! I'm anxious to know what life was like w/your new daughter after arriving in the States... and what it's like now (how old is she now?)..... Please continue!!! Everyone here seems to be experiencing delays and stalled paperwork...... but I want to assure everyone that, regardless of how long it takes, it is worth it. And as I've stated before.... I've only ever known of ONE adoption that did not proceed...... and I knew of at least a dozen that did..... Some were speedy..... some weren't. NO TWO CASES ARE GOING TO BE ALIKE!!!! EVEN WITHIN THE SAME AGENCY!!! I urge all those here to avoid comparing their individual adoption processes to one another....... If one person is receiving a referral before someone else whose paperwork was in earlier....... most likely that is because the requests are DIFFERENT!!!! The DNA wants to make referrals that "match" the prospective adoptive parents to the adoptee. EVERYONE'S case is going to be different in the end. Some judges require certain steps that others do not.... Out of everyone who adopted at the same time as we did.... NOT ONE FRIEND HAD THE SAME PROCESS WE HAD, OR THAT ANY OTHER PERSON HAD. So take a deep breath... and HAVE FAITH that your adoption WILL HAPPEN.... I REALLY and TRULY want to see your adoptions succeed!!!!!!!!! These children deserve to have parents and loving families!!!!!!! At this point - if you guys compare your adoptions to that of those adopting in China, Korea, Ukraine, etc...... you will be hard pressed to find someone whose adoption is going speedy fast........ from what I see, they're all dragging on for over a year. Ours took a looooooooooooong time (we began in early 1997 and finished in Sept 1999)... and we were there! That didn't make one iota of difference except that we were less effected by the delays and slow progress....... heck... it took a lone time to get a drink at a restaurant.... we didn't expect too much!! LOL!! HANG IN THERE EVERYONE.................. O.k.? Sharon - thanks for your story!!!!!!! Please continue!!!! I would love to know how things are now............ ~kim p.

Congrats on the progress of your adoption!!! Our daughter was 2 1/2 when we first "met" her, and began taking her home for week-ends...... it's a GREAT age to adopt!!!! KUDOS on receiving a video...... THIS IS HOW I WISH ALL ADOPTIONS operated! Sharon will probably be the best "expert" to ask about this stuff..... she's got LOTS of info!! From my perspective.... Try to have a video made, if possible, that includes the child's interaction with: 1. Other adults (strangers, for the most part- to see if they are skeptical, or extraordinarily friendly and "physical" w/the adult). 2. Other children 3. TOYS of various developmental levels (can the child easily manipulate/operate toys that are beneath their developmental stage? How do they interract with toys that are age appropriate? Are they more interested in destroying the toy, or using it as it's intended? How well do they do with toys above their developmental level? Etc).... 4. Facial features - I'm sure Sharon would know WAY more about this.... but for those of us volunteering at my daughter's orphanage, we knew which children most likely had F.A.S. by their unusual facial features/ears/eyes/etc). 5. How does the child respond when the visiting adult leaves? (Freaking out and becoming hysterical is the issue). REMEMBER....... none of this implies that a child who has a few abnormal behaviors ISN'T WORTHY of adopting or of consideration!!! My daughter did some PRETTY STRANGE THINGS (and still has a few remaining issues)...... AND ALL OF MORE SERIOUS ISSUES WERE RECOVERABLE. It's about being PREPARED, not about wanting "perfection"..... I'm afraid that sometimes my suggestions come across that way. So, I just want to clarify..... Get all the info you can so that there are no surprises. You wouldn't marry someone without knowing everything possible beforehand, right? You'll have to tell us about the Ecuador process....... how long has it taken to get to this point? You must be soooooooo excited........... HAVE YOU READ: TELL ME AGAIN ABOUT THE NIGHT I WAS BORN... by Jamie Lee Curtis????? My daughter's favorite book....... our favorite line: Tell me again about how something so small could make you smile so big..... I cry. It is THE BEST BOOK about adoption (IMHO)..... BEST OF LUCK TO YOU.......... ~kim p.