Published: September 25th 2010September 25th 2010
Auscultation of the Heart.
Note for the medical folks: Yes, he did eventually pull up the shirt and properly auscultate bell-to-skin.
Today’s big event was the U.S. mandated adoptive medical exam. This is required before leaving the country of origin. Adoptive families who began their application process within the past ~2-3 years are under more stringent requirements for this exam in that they need to start the formal U.S. immunizations schedule before coming back to the U.S. These requirements are part of an international agreement called the Hague Adoption Convention which aims to standardize international adoption and prohibit child trafficking. Thus, families that have currently been waiting >3 yrs (like us) are called “Non-Hague” Families and the rest are simply called “Hague” families.
In any case, the medical exam was at a clinic close by on Shamian Island within walking distance from our hotel. We had been warned it would be a bit on the crowded side. However, for a country with 1.3 billion people, I didn’t expect to find ~1 billion of them in the same clinic at the same time. Or so it seemed.
In short, it was Chaos!
The whole experience recalibrated my view of crowded conditions in medical settings. My pediatric medical office on its worst day of frantic Deep-Winter Swine-Flu Madness
would be a Paragon of Serenity compared to what apparently passes for standard operating procedure on a daily basis in this clinic. May God Bless the staff that has to work in this Chinese clinic! This office serves as a public health travel clinic seeing folks for all types of medical problems including infectious disease. The adoption sub-clinic is just a side note to the busy machine of it’s daily work with local Chinese residents. It's hard for me to imagine though how complicated medical diseases such as tuberculosis much less diabetes, asthma, or heart disease/hypertension could be managed in a medical system like this.
To paint the picture for you, recall a moment in your life when you were packed into a loud standing-room-only mass of indoor humanity, then crank up the temp, add flop-sweat humidity, pump in some beefy odors, ask everybody to fill out forms while getting wrapped up in a tangled mass of overlapping indecipherable lines, then cue the 100 dB “Crying Babies” soundtrack, add a few “Crying Mommies” soundtracks, hang out (aka WAIT) for a few hours, seal the whole thing up with a language barrier, then finally get down to the work of
Mega-Dense Crowded Clinic!
This clinic was a super-busy place!
medical evaluations and immunizations and you’ve got yourself some Good Times at the old pediatric clinic!!!
Despite this, I am glad to report that most everyone got through it with a smile and a good attitude (including us)! Baby Julia was definitely a little shut down and anxious compared to her baseline smiley self but she was still a rock star baby girl with barely a peep of real protest. She was more just quiet and clingy and holding on tight to Mama. (An appropriate response considering the ongoing chaos around her!)
All in all, our time there wasn’t that bad and only lasted a few hours so we can’t complain. It was a valuable experience for several reasons, not the least of which was the horizon-broadening value to my personal understanding of how medical care is dispensed outside of the U.S.
The medical exam itself was cursory and brief by U.S. standards. For example, the audiometric evaluation (hearing screen) consisted of hitting a note on a toy keyboard and squeaking a squeak toy to see if the child would turn her head and look in the direction of the sound. There were 3 stations: ENT, Medical/Surgical
(cardiac/resp/abd), and Vitals (wt/ht/temp). The ENT station exam lasted about 90 seconds but the cardiorespiratory and abdominal exam was a relatively extravagant 4-5 minutes. However this may have been due to the fact that the doctor at that station figured out I was Er Ku Yi Sheng (Physician of the Pediatric Department). I think we may have gotten the extended VIP exam for that station as the folks in front of us had gotten passed through a bit faster than we did.
Julia appropriately protested getting set on the scale (away from Mama) at the weight station (a familiar dynamic to all my friends back at Denver West Pediatrics!). Regardless, we were excited to confirm that she's gained 2 lbs in just the 9 days that we've had her! Nutrition has been a real focus of our time with her so far and she is already filling out from her former thin habitus on Gotcha Day.
Overall, the people working in this clinic were all good folks who clearly cared about the kids coming through the clinic. I can only imagine what stresses they must be under as they are asked to see what I would estimate to
be 100-200 patients per day per provider (an unbelievable patient load by U.S. standards!). And their entire practice population is transient and emotionally traumatized given their newly adopted status. Then they’re additionally dealing with stressed out newly adoptive parents to boot. Many of these parents are first time parents too! Putting it all together makes me realize these medical providers are likely quite skilled despite the cursory exams demanded by their job requirements.
At the very least, the mandatory adoptive medical exam was an instructive and worthwhile experience as it allowed us to check one more critical box off the list and move one day closer to going home with sweet Baby Julia!
Julia quickly bounced back from the clinic experience and we spent the day walking around Shamian Island. She is such
a happy and pleasantly dispositioned baby girl! Everyday she is a more giggly and smiley little person than the day prior, with her true personality now really starting to shine through!
Thinking back to her initial adoptive day 9 days ago, Julia seemed pretty even-keeled and emotionally well-regulated at the time. But now that we are seeing more of her truly vivacious baseline personality,
we look back on that initial day and realize in hindsight that she was really quite traumatized and completely shut down emotionally. For example, we didn’t get any real semblance of a single smile in the first 24 hours. Now she smiles literally thousands of times in a full day!
Ironically, seeing some signs of emotional trauma during the infant’s adoptive transition is reassuring and predicts emotional health and good potential for normal attachment and bonding with her adoptive family. Adopted babies who don’t seem to mind the initial transition from their former setting (foster family or orphanage) to their new adoptive family are concerning for likely having a more difficult time quickly growing down strong stable roots into their Forever Family. So, paradoxically, we are glad to see in hindsight she was a little more traumatized than we initially thought!
In any case, we are still happily sailing along through the process.
Happy to report that Emma completed her first blog post as many of you have already seen. Funny to think of this as a milestone for the youngest generation of American children. It was a fun Father-Daughter process taking her through the basics of
The Med-Surg Station
This station was the most thorough, running about 4-5 minutes and covered cardac, respiratory, and abdominal exams.
digital photography, written composition, and electronic posting.
Tomorrow: A day off with a recreational excursion to the Guangzhou Zoo!
There are more photos below