Samoa Adoption

I am currently in the finalization stage of adoption for my 10month old niece who was born in Apia, Samoa. I am a U.S. Citizen now residing in the Territory of American Samoa. My baby is currently with me in American Samoa. After reading all the post previously. I'm quite confused at this point. I was told and i thought that once i contacted a adoption lawyer in apia to do the adoption, and once everything is approved throught the court, etc.... that the adoption is final and my niece would be my daughter. Now i read earlier post that after i go through adoption in Apia, then i would have to do more on the U.S. Side. I have no intenstion of moving back to the States, but the only reason that i might want a Travel Visa for my child is ONLY for medical treatment ONLY! I am for one DO NOT TRUST the Hospital in American Samoa, and so for this i would want my child to be treated off island. What can i do to be able to get a visa for my child or passport for my child to travel only in Medical Emergencies only. PLEASE HELP any suggestions or advise would be greatly appreciated. Sincerely, AnxiouSarah