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Out of curiosity I asked two co-workers who are immigrants from the Ukraine (one recent, one about 10 years ago) if they knew the answer to this question. Although they both admitted to knowing nothing about the adoption system in the Ukraine, they both agreed that they would be shocked if paying "extra" didn't result in a healthy referral. According to my Ukrainian co-workers, just about everything in the Ukraine - from medical care, to college admissions, to being excused from mandatory military service - works on an unspoken system of bribes.