Clinic Helps Parents Who Adopt Foreign Children

by Jean Hopfensperger, Star Tribune

August 26, 2003

The little girl on the videotape wore a frilly blue dress, a white hair ribbon and a forlorn expression.

Dr. Dana Johnson froze a frame of the video, which he was watching in his office, and examined the sad eyes and the mouth of the pretty girl in a Russian orphanage.

"I think I'll tell the parents that her motor skills are fine but that she may have fetal alcohol syndrome," said Johnson, referring to the prospective couple who are considering adopting her.

"I want the family to understand the risks," he said. "We know that adopted kids who are alcohol-exposed can do well, but they do present challenges."

This adoption screening is among hundreds performed each year at the International Adoption Clinic in Minneapolis.

Adoptive parents from all over the country know of this unusual clinic and its services.

Parents, both before the possible adoption and afterward, send videotapes, photographs and medical records -- and later their children -- to the clinic founded by Johnson and three other clinic staff members.

Considered a relatively low-profile operation in the Twin Cities, the clinic has a national reputation as one of the few places that not only deal with the quirky medical problems linked to foreign adoption but also conduct research on them and provide training to parents, adoption agencies and health care professionals.

It was the first clinic in the nation to specialize in this field.

"Dr. Johnson and Dr. Margaret Hostetter [a clinic founder] are considered the father and mother of international adoption reviews," said Deborah McFadden, president of the International Children's Alliance adoption agency in Maryland and a former official in the U.S. Department of Health and Human Services.

"Here I sit in Maryland, and we refer all our families to Minnesota," McFadden said. "It's not just that they're medical doctors. They've traveled to orphanages in many countries too. I tell our families, 'There are other clinics out there. But if you want the best, go there.' "

The clinic, started in 1986, is in the Fairview-University Medical Center at the University of Minnesota. Staff members say that Minnesota was a logical location because it has the highest number of foreign adoptions per capita in the nation.

A clinic visit

On a recent morning, three parents and their adopted children sat in examination rooms at the clinic. The children included a frail baby girl from China, a sturdy baby boy from Russia, and three older Russian boys adopted last year.

The Russian boys -- ages 3, 4 and 7 -- roamed around one room while their mother, Michelle Molitor of Buffalo, talked with Sandy Iverson, a nurse practitioner and clinic founder.

Molitor said the boys were generally adjusting well to their new lives with parents, a house, birthday parties, new friends and school. But the youngest son still has some problems, no doubt stemming from his time in the orphanage. He could not walk, talk or chew when he arrived.

Iverson jotted down notes and performed a physical examination on the little boy who wore big glasses. A doctor had already examined him for neurological problems. And a physical therapist would arrive soon to check his motor skills.

"This kid has made astounding progress," Iverson said, watching the boy walk across the room. "We [the doctor, therapist and Iverson] will be back in a minute to talk about a plan for him."

Having a plan of action, having someplace to turn to, has been a godsend, said Molitor, who with her husband, Paul, doubled their family size with the boys' adoption.

The couple relied on the clinic at every step of the adoption process. When they traveled to Russia to meet their new sons, they took along an information packet from the clinic. Michelle Molitor used the information to measure the boys' head circumferences, for example, and examine their faces for signs of fetal alcohol syndrome.

The couple also brought the clinic's e-mail address, in case they had any questions. And when the family arrived home, the kids had check-ups at the clinic.

"We're in America, and we don't have institutions anymore," Michelle Molitor said. "There isn't a book on this . . . This is a large enough facility that they can meet your concerns. If they don't know the answer, they find someone who does."

The next stop for Iverson was a quiet room where baby Adam sat comfortably in the arms of his new mother, Alisa Jesse of Minneapolis. Adam had landed in Minnesota two weeks earlier.

"We think he's doing great," Jesse told Iverson. "I want to make sure we're right."

Iverson asked about the boy's medical history, his Minnesota family, how he was adapting. As Jesse answered the questions, a physical therapist walked into the room with a bucket full of toys -- cups, balls, a mirror.

Adam sat on the floor and peered into the mirror, crawled toward a ball and pulled on a set of beads placed around his neck.

"There's nothing floppy about this guy!" Susan Jackson, the occupational therapist, told Jesse. "He's got good strength. He can cruise. He squats beautifully."

Emotional strength is another issue, however. Iverson told Jesse that her job now was to get Adam attached to her and her family. That meant spending a lot of time with him, keeping a predictable routine and limiting his contacts outside the immediate family.

Attachment issues, or bonding, have emerged as serious matters for children who have lived in institutions, Iverson said. Normally, babies develop a sense of trust and security by having their needs met for such things as food, rest and love. That trust and security are the foundation for everything from learning to personal relationships.

"A child in an orphanage who doesn't have his basic needs met . . . after a while doesn't reach out to other people," Iverson said. "He becomes inward. They never learn to trust."

These same issues are faced by Minnesota children who have bounced from foster care to foster care, Johnson said.

Gauge of world affairs

The clinic, in many ways, is a barometer of international strife and socioeconomic conditions. The boxes of videos and medical records tucked under the desks of staff come from South Korea, Vietnam, China, Kazakhstan, Albania, Colombia and elsewhere.

The children's journey to Minnesota varies by country. In China, babies who are abandoned typically are left with a favorite blanket in a public place, such as a police station, staff members said. They're sent to an orphanage. In South Korea, children are often left in the hospital by their impoverished mothers and then live in foster homes.

The children still trapped in orphanages are a growing focus of clinic research. For example, Kathryn Dole, a clinic founder who also is the lead occupational therapist for the Minneapolis Public Schools, recently returned from a trip to several Chinese orphanages. These orphanages were equipped with preschools, donated by a California foundation. The clinic is measuring the effects on the kids.

The clinic also joined forces with a British charity that is moving Romanian teenagers out of orphanages and into group homes. The clinic is evaluating the boys' progress.

The clinic is also training staff members at the medical school and the orphanage in Veronish, Russia, about the special needs of children reared in institutions.

"The more time you spend overseas, the more tapes you look at here, the more you want to help those poor kids over there," Iverson said.

In fact, some of Iverson's most heartbreaking moments came while visiting Romanian orphanages.

"You'd see 12-year-olds the size of 6-year-old kids, there was such profound growth failure," Iverson said. "Some were severely abused, had minimal speech, even if they were older. There were 10-year-olds rocking in cribs."

And when Romanian kids started showing up at the clinic, many came with horrible histories. Iverson remembers a baby who would not drink from a bottle, who had burns in his mouth, from being fed boiling drinks.

"Those are the saddest cases," she said. "They make you cry in the clinic.

"The happiest times are when kids make remarkable comebacks. That's the joy, to realize what amazing families these kids come into. They'd basically do anything for these kids. You don't get a job too often where you get to work with these kinds of parents."

Jean Hopfensperger is at hopfen@startribune.com.

Source: http://www.startribune.com/stories/462/4061528.html

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