Sunday, July 11, 2010

Amy Eldridge of LWB Speaks

The BEST adult session at the Chinese Heritage Camp was the talk by Amy Eldridge of Love Without Boundaries.  She spoke about the changing face of Chinese adoption and about the current challenges of orphan care in China.  It was emotional, informative, and fascinating.  I'll try to report it all, but I hope others who were there will add anything I missed.  Amy spoke for almost 2 hours, so I don't think I could possibly remember it all!

Amy first talked about the immense changes in China adoption in the past 10 years.  The landscape has changed considerably from the days when Chinese orphanages were filled with healthy infant girls who had been abandoned because of the government's one child policy and the social preference for boys.  Now, the orphanages are filled with special needs kids, many critically ill.  She reported that 98% of newly abandoned children in China have serious medical needs, which explains why 60% of adoptions in 2010 were special needs adoption.

Why the significant change?  First, she said, there has been a growth in more modern attitudes about girls.  It is really only in the rural areas that the social preference for boys remains.  Ten years ago, 85% of the Chinese population lived in rural areas.  Now, only 50% are rural, 50% urban.  With that urbanization has come more education, the internet, and the like, which has led to more modern attitudes.  Second, there has been growth in the availability of ultrasound technology.  Now, anyone who is pregnant can know the child's sex.  Anyone who carries a girl to term does so knowingly and with every intention of parenting her.  Those who want a boy instead will have an abortion.  Third, domestic adoption in China is growing rapidly.  That's caused in part by the public interest in adoption after all the news reporting about the orphans of the Sichuan earthquake.  And another factor is the increased rate of infertility in China.  One government agency estimates that as many as 40 million couples in China are infertile.  Infertility is skyrocketing because of increased premarital sex without much sex education, causing increased rates of STDs and frequent abortions that might be less than sterile and because of environmental toxins and pollution.  Domestic adoption is preferred by orphanage directors, because domestic adopters pay higher fees than international adopters.  In Guangzhou, domestic adopters pay fees of $15,000 to the orphanage;  in Hefei, the fee is $7,000 for domestic adopters.  Most adoptions are handled on the county or provincial level, even though the CCAA now has a national office of domestic adoption.  Orphanages just don't send the files of healthy infants for international adoption when they can place the child domestically.

So, for these three reasons, there are fewer and fewer healthy infant girls available for international adoption.  And there has been skyrocketing abandonment of special needs children.  One reason for that is the increase in children in China born with birth defects.  Birth defects in China have increased 40% since 2001. It is estimated that 1 in 8 to 10 children born in China have birth defects.  There are a number of theories about why the rate of birth defects is so high in China, but most believe it is environmental exposure -- after all, in a recent list of the 20 "dirtiest" cities in the world, 16 of them were Chinese cities.  In one area of Shaanxi Province, where there is considerable coal production and other environmental hazards, it's reported that the birth defect rate is 85%.

Special needs children get abandoned because of the stigma associated with disabilities and/or because of medical costs.  Extended family, espcially the mother-in-law, will insist that a disabled child be abandoned becasue the child is considered unlucky, a curse on the family.  Children with visible disabilities will be refused education, and when they grow up will have difficulty finding a job. Medical costs can be too high for a family to bear -- there is no health insurance, no free health care in China.  All health care has to be paid for up front.  Even if you're in an accident, you won't be treated until your family shows up to pay the bill first.  There are no emergency rooms in China.  Poor families will abandon their children in the hopes that they will receive health care in the orphanage.  Amy said LWB has to be careful about media reports in China, because if there is a story about them doing medical work in an area there's a sharp spike in the abandonment of special needs kids there.  She also talked about my FAVORITE fund at LWB, the Unity Fund, which provides free life-saving medical treatment so that poor families don't have to abandon a sick child.  I think we all know that adoption is not the solution to the orphan crisis, only preventing children from being orphaned in the first place will solve it.

So how has the increase in special needs abandonment affected orphan care in China?  Think about how overwhelmed nannies might be with a room full of healthy kids to take care of.  Now think how overwhelming it would be with the same nannies with the same training or lack thereof and the same resources taking care of a roomful of special needs kids.  Amy talked about walking into a typical orphanage "baby room" and thinking it should be a hospital ward instead. Nannies will also  have the same fear of "unlucky" disabled children as others in China, and may not want to care for a child with albinism or a visible disability.

Two of the biggest needs, then, are education/training for orphanage staff and financial resources.  LWB does both.  Some of their training is with orphanage directors to help them prepare files on special needs kids to submit for adoption.  They sometimes have to encourage the directors to submit files, since the directors will harbor the belief that no one would want to adopt a child with particular disabilities.  They also help them make the files more appealing, like encouraging them to have the children smiling in their referral picture, something that culturally isn't the norm in China.  Amy related that she told a group of 100 directors in a meeting that it was especially important for the boys to be smiling, since Americans were less willing to adopt boys.   She said the room simply erupted in disbelief.  They absolutely couldn't believe that girls would be preferred to boys! The directors are still more likely to submit files on boys than girls.

The poorest orphanages in China might get from the government only $25 per child per month, and formula could cost $20 per child per month.  Then there is salaries for nannies, power, clothes, other food, and there isn't much left over for medical care.  Those orphanages that haven't done international adoptions don't have loyal parents who are willing to help out;  adoptive parents want to help their child's orphanage.

The CCAA has two initiatives for medical treatment of special needs kids, but both have their limitations.  First is the Tomorrow Plan which provides surgeries for orphans.  They've funded 6,000 cleft surgeries alone since its inception in 2004.  But it takes too long to process applications, so it can't help children who are in immident need for surgeries or other medical treatment.  The plan also designates the hospitals the orphanage must use, and in some areas, the orphanages refuse because they feel the designated hospital is inadequate.  The second program is the Blue Sky Initiative.  China is building mega-orphanages that can house 600 children, and has on-site medical care and therapy.  But there are none in rural areas.  And, in places with such mega-orphanages, they are pulling children out of foster care to return them to the orphanage. Amy says they are watching closely  to see if there are worse outcomes for children no longer in foster care.

Even with these initiatives and with all LWB and other orphan care organizations can do, Amy said that adoption into a loving home does more for a child than anything else.  In China there is a significant stigma about being an orphan.  In many areas, orphans cannot go to school outside the orphanage, and in the areas where they can go, they go to the worst schools.  They won't be admitted into better schools because parents won't pay for their children to go to school and sit next to an orphan.  Companies wouldn't hire an orphan, either, since orphans are considered bad luck.  LWB paid for the schooling for the first orphan in Guangzhou to go to and graduate from college.  She earned a degree in accounting, and couldn't find a job because employers were afraid that she would bring bad luck to the financial bottom line.  She eventually found a job with a foreign company.  Another orphan who graduated teacher's college was hired by LWB because no one else would.

Amy also said that adoptive parents need to be prepared before adopting.  When they have seen disruptions of adoption in China -- where adoptive parents decide not to go through with a special needs adoption even before returning home -- it's usually because they have not been adequately prepared.  She received a call from a family who had switched from the NSN program to the special needs program to adopt a cleft child who had been an LWB child.  LWB had repaired her lip, though her palatte repair needed to be done when she was older. Amy knew the child was perfectly healthy, chubby, interactive -- everything you'd want from a institutionalized child. The dad said to her, "Do you know that when she drinks her bottle, milk comes out of her nose?"  Duh, yes, Amy knew that and the family would have known that if they had read ANYTHING about cleft-affected children. 

Finally, Amy talked about orphanage conditions that adoptive families need  to be aware of, so they can understand some of the issues their children may face. 

First, as to attachment, APs need to be aware that children may have had numerous changes in caretakers.  A child might spend time with birth parents, especially since there's been an increase in older-child abandonment in China. Then the child might spend time with the person who found her, who thought she might keep the baby before the neighbors or extended family said she wouldn't be allowed to.So the child is turned over to the police, who might keep the child for a few days before turning the child over to the orphanage.  The child might be in quarantine for a month at the orphanage who is trying to avoid the spread of HIV or Hep C. Then the child enters the young infant room, and then in a few months to the older infant room, and then the toddler room or foster care.  And the child in foster care may be returned to the orphanage for two weeks before the adoptive parents come.  With a special needs child who might have had hospitalizations and/or surgeries, the child would likely be alone at the hospital through all of this.  The orphanage can't spare the nanny who might have been the primary caregiver, so they might send a groundskeeper to take the child to the hospital and then leave her alone.  In Chinese medicine, there is a great reluctance to give children pain medication, so post-operative time will be painful and scary for a child alone.  All of this affects attachment.

Second, children may have feeding issues.  Overcrowded orphanages don't have the time to hand-feed children, so bottles are propped and often boiling hot.  Solid food is beyond the resources of the orphanage, and most orphanages can't afford meat. Newborns might wait 5-6 hours between feedings.  Infants might wait 12 hours.  There won't be between-meal snacks for toddlers or older children.  Children are often hungry all the time, never feeling full. From this, you can expect aversion to certain food textures, no ability to suck, food hoarding, gorging, no off-switch when eating because no feeling of being full.

Third, children might experience "irrational" fears that aren't so irrational after all.  They would often be alone in the dark at night, with only a skeleton orphanage staff on hand.  There might be bugs and rats in the dark.  Fear of the dark, of thunderstorms, of animals, of bugs, are not irrational fears for these children.  Adoptive parents can't know what their children experienced in the orphanage, so must be understanding of these fears.

Whew!  That's all I remember -- if you were there, and want to add or correct, please comment!  As I said, it was an amazing presentation.  I was happy to meet Amy Eldridge and thank her at the end of her presentation, and she was kind enough to say she loved my blog (brag, brag)!  If you ever have an opportunity to hear Amy speak, run, don't walk, to hear her!


Debberoo said...

Thank you so much for posting this.

Victoria said...

Thank you so much for sharing this information!

Mommy Relcuk said...

Many thanks.

Anonymous said...

As the others said, I am really glad you posted this. However, I don't see this as new news AT ALL! That being said, it is important Amy says it because there are those who will NOT do their own research, who never keep in touch with what is current in China, and instead prefer the stories of old--yes, I said prefer. They will only change their tune when forced by those they see in the know--they have no choice because everyone will know when someone so well known in the community speaks out--tells them "hey, this is the way it is"!

Thank you Amy and thank you Malinda. Only through knowing the current situation can help be given, change be made, stereotypes be broken, and ending outdated adoption practices can begin.


Joy said...

Thanks for sharing this. Do you mind if I post a link to this on my blog?

Amy said...

Wow, that's a lot of information. If it's ok, I would like to share a link to this. Thanks!

Amy Eldridge said...

I do love your blog! Thank you for your kind words about my talk this weekend. I wanted to add a few things to what you wrote, as I think it is very important for people to realize how many resources and effort the Chinese government has put into the issues of child abandonment and orphan care. As I mentioned in my talk, I have the utmost respect for the programs they have implemented, such as the national program to encourage families that girls are great, and their efforts to increase domestic adoption. I just watched another news video today on the Wall Street Journal site about domestic adoption in China, and again the point was made that there is far more demand for domestic adoption in China than available healthy children.

As I mentioned, a recent report in Chinese newspapers said that 40 million couples of child bearing age in China are infertile. There are lots of articles about it if you google, but here is one I’ve read in the past: Now that adoption is much more out in the open in China, I think the domestic adoption rate is going to continue to climb steadily. And with the increase financial ability of families in cities, fees for a healthy baby will continue to climb as well, just as they have in the United States.

Regarding the issue of rising birth defects, there are hundreds of articles in both Chinese and world newspapers. Here are a few with some of the statistics I used in my talk:

My heart really does go out to the aunties in orphanages as they are now trying their best to care for children who now have often critical medical needs, as the population of children in orphanages has changed so substantially in the last few years. There is still a very big stigma surrounding most children with special needs in China, but I am hopeful that this will continue to change with more education. I remind myself all the time that back in the 1950s in the US, many parents who gave birth to children with birth defects were encouraged to institutionalize their children – and look at the difference today! I am sure the same will happen in China as well, again as the world becomes so small through the internet and technology – and as more and more resources are put into children with special needs there. The parents who keep their kids with special needs there will begin demanding services just like parents in the US did. I read a great article one day about a woman who has a child with autism in Beijing and how she ended up starting her own school as there weren’t any resources for her. I think we will see that more and more.

China’s Tomorrow Plan has provided thousands of surgeries to orphaned children with special needs, but now with the increased number of children being abandoned with critical, often emergency medical needs, the need for medical funding for orphaned children is skyrocketing. LWB has had to adapt how we work as well, as now we get calls from orphanages all the time for children who need to be moved to the hospital within 24 hours, such as preemies, kids with anal atresia, kids who have had heart attacks, etc….and so the issue of not being able to have the time to put up a child for sponsorship and take in donations over a month period is very real. Many times we have to move kids immediately, and so that makes an emergency medical fund for children very important. I’m at the limit for one comment post, so I’ll summarize in the next comment!

Amy Eldridge said...

As I mentioned to several people after the talk, the important thing for people to remember is that social issues around the world constantly change. We all know there was a time when there were thousands of healthy baby girls who needed homes from Chinese orphanages. Families from around the world sent in their files to adopt those babies. But with the decreased abandonment of healthy girls along with a marked increase in domestic adoption, the orphanage population has changed dramatically. Now when an orphanage gets in a healthy infant, it is the exception. And then there are many Chinese families in the cities who are willing to adopt a healthy child….so there are truly very few NSN children available for international adoption, except for older children.

The bigger issue is the increased number of children with special needs who need homes. More and more orphanages are willing to make their kids with SNs available to families through the waiting child path, but of course many families don’t feel they could commit to a SN adoption. That is why I believe education is so important, and why families considering Chinese adoption should educate themselves about the different special needs and the treatment required to see if it is a path they could handle. I think the important thing to remember, however, is that for most Americans who hear the label “special needs”, they are thinking of much more severe needs (often including mental retardation) than a lot of the kids waiting for homes today on the shared list. Almost all of the kids in our programs are classified as “special needs”, and they are these amazing, wonderful kids who would bless any family. And of course we need to keep encouraging people to at least consider a boy, as so many boys are never chosen, and they would be the most wonderful sons!

Everyone involved in Chinese orphan care is having to adapt. Orphanages are adapting to a changing population of kids and learning how to submit the files of kids with special needs. The government is adapting by increasing the per child stipend needed to provide for the essential needs of children and by introducing programs like the Blue Sky plan. Adoption agencies are having to adapt now that the NSN program has slowed and having to learn how to counsel parents considering children with medical needs. And charities are having to adapt as immediate access to health care has become such a critical need.

I am very happy for the changing attitudes that I see among so many young adults in China who now say it doesn’t matter at all to them if their child is a boy or a girl. But my heart is still burdened in a tremendous way for all of the children who have medical needs who AT THE MOMENT only have a real chance at a family through international adoption. I hope in the next ten years that we will see a marked increase in the number of Chinese families wanting to adopt through the SN path. But for now, finding families around the world is these kids’ real hope. And so anything that we can do to promote special needs adoption is very important. Even if a family decides they can’t personally take that path, they can continue to let other families know that the special needs program in China is a wonderful way to form a family.

malinda said...

Thanks for chiming in, Amy!

Claudia said...

wow... HUGE amount of information here! Thanks so much for posting. People ask me about the china situation all the time (cos, ya know, Ethiopia and China are SO CLOSE and EXACTLY THE SAME) so this is really helpful.

Antinette said...

Malinda, amazing information, thanks for summarizing it here. Glad to see Amy's comments as well.

I was wondering what you think of agencies here continuing to take on families for nsn adoptions? It seems in light of this information that it's not really ethical. We have friends who are in their fourth year of waiting for a "healthy baby girl" and were just told by their agency that the wait could go to six or seven years! Meanwhile they keep paying fees to update paperwork, homestudies, etc.

Anonymous said...

As usual, excellent summary, Malinda! I was at the presentation and the thing that struck me was the sheer number of SN children in orphanages. I knew the percentage was high, but didn't realize there were SO many children! So, thank you Amy, for sharing all that information and for all the work you do. It was an amazing presentation. I remember when you were first trying to find funds to help that first group of kids with heart defects. What LWB has accomplished is terrific.

As for additions or corrections... I think I remember that the Tomorrow Plan ended in 2007. Also, there was a discussion about whether single parents might be allowed to adopt SN kids, since the need for adoptive parents for SN kids is so high. Amy thought that could be possible in the future. She felt that the CCAA was very concerned about gay parents adopting as single parents, especially when that became very publicly known. I personally think that the CCAA probably realized that was happening for awhile, but as the number of adoptive parent applicants sky rocketed and the number of available children plunged, the restrictions were one way they could stem the flow of demand.
Sue (aka anonymous)

DAC said...

Glad I found your blog. Love it and the article.

*Overflowing* said...

Wow...amazing info. Thank you for sharing this...I'm passing it on!

Is there anyway we can hear Amy's session?

We are so blessed by all that LWB's is doing. Our little guy is waiting in a LWB orphanage so we are forever thankful for their ministry and look forward to helping however we can.

Anonymous said...

I really wish they would lighten up on the requirements for adoption for the SN kids. We don't qualify anymore strictly because I am on an antidepressant because of the long, dark gray midwest winters. We would LOVE to expand our family with a little guy. We were getting ready to submit when the "new" guidelines came through. We were crushed to realize how this was going to affect the SN program - those families who have a heart for the children who are so very vulnerable because of their SN being blocked from providing for children. It would be one thing to know that these children are finding good homes in country - obviously that is the best solution for them. But for them to languish in the orphanage and not receive the medical care they need and the family love to allow them to reach their potential is heartbreaking, especially when the reason they are denied these things are because of rules that regarding issues that do not affect parenting ability.

2 China Sweeties said...

My husband is on anti-depressants, and we came home with our then 8 year old son two years ago. Find an agency that will go to bat for you, get a letter from your Dr. saying it won't affect your parenting, and it helps if you choose an older SN child. Our little guy had a cleft lip and aveolar cleft. He is a delight.

Lesa said...

Malinda, thank you for posting this and thanks to Amy for chiming in.
This is very informative.
After waiting 4 years for our NSN daughter we decided to change to SN and found our sweet little boy who had repaired heart. He is a LWB baby and we are so grateful for the loving care he got.
I'm not sure if he had someone with him while he was in the hospital or not...something I need to ask. He is really good with any medical needs he has to have here in the states. Such a BIG boy!
We also have a 6 year old daughter, who we only waited 6 months for referral! Those were the days. When we brought her home we had several pets. One pet in particular she was not happy with, and tried to pound with a block, was our pet ferret. It made me wonder at the time if she could have been exposed to rats. She was and still is scared of the dark.
Again this is very informative on why things are taking so long for families to receive their referrals.

Amy said...

I appreciate this post. I had some incorrect ideas about the current state of orphans in China which this has corrected. Our daughter is waiting in a SWI that is part of the LWB nutrition program. I am so thankful for LWB work in China. I would also like to link to my blog, with your permission.

Anonymous said...

Very interesting report. Thanks a lot from France. now I really understand what's happen since we adopted in 2005.


Mike and Barb said...

Thank you for this summary. I linked to it on my blog!

Dee said...

Wow, great post. My son has a limb difference, and I belong to a Yahoo group for adoptive parents of limb difference children. About 95% of the kids come from China. Most of the kids are healthy and fine, even though they don't have all 4 limbs. A few require more care, but not many.

I wish more couples would consider adopting a limb difference child. My son [from Kazakhstan] is missing his right hand but he is smart, obedient, very athletic, and just a joy. If I could adopt another child with a limb difference I would do it in a heartbeat. Children with congenital limb differences almost never want prosthetics because they figure out how to do things on their own.

I can only assume the children born in China with limb differences are a result of industrial pollution, which is so sad.

I am sending a link to your post to everyone I know who has adopted from China. Thanks Malinda and Amy!


Amy said...

We just accepted the file of our SN daughter from China today!! This post was so helpful to me. I've bookmarked the blog for future reading as well. Our daughter has a post surgery VSD and the reports we received from the doctors here were very good. Can't believe she could've gone without a family because of her special need. So glad my God intervened! Thanks for the post.

Anonymous said...

This is a really informative post, thank you! It sounds like it was a great talk!

I wonder if using the term "healthy" to describe kids without special needs perpetuates stereotypes about children with special needs and keeps a certain segment of special needs children invisible. There are a lot of special needs a child can have and still be perfectly healthy: birthmarks, albinism, burn scars, limb differences, etc. (For the sake of argument, I won't classify developmental delays as healthy in this comment because some people may think of "healthy" as including intellectual health as well as physical health, and I think it could be legitimately argued either way).

Even if a large portion of orphaned children in China have special needs that involve actual health problems, like cleft palate, heart defects, or anal atresia, there will always be a number that are, for all intents and purposes healthy, but simply look different. I think that referring to the children without special needs as "healthy" to distinguish them from the kids with special needs may do a disservice to these kids whose special need is cosmetic or limb difference related, especially when the audience is prospective adoptive parents, whose attitudes towards disability and cosmetic difference may be being consciously shaped for the first time as they investigate special needs adoption.

I would be interested in others' thoughts on this language issue or any relevant articles if people know of them.

Thank you again for your blog post!

Gretchen & Craig said...

What a wonderful post! Thank you Malinda and Amy!! We adopted our "special" son in 2008. We began with the NSN program in 2006 because we didn't understand the SN program. I agree that agencies need to be much more upfront and informative about SN and let people know how managable many are. If we had been informed in 2006 we would have started out in the SN program, of course we wouldn't have meet our son in 2008, all things work out for the best. He had bilateral cleft lip and palate, lip repaired by China's Tomorrow Plan (?? I think I have that right...) and his palate was repaired once we came home.

We now have our dossier in China to find a new child from the shared list. We are always trying to educate people about the special needs program and to let them know it doesn't mean that these children aren't awesome. I can not imagine our lives without our son.

I would like to post a link to your post because this was an incredible post and I would like others to see that I am not the only one who feels so strongly about advocating for the children.

Thank you!

Anonymous said...

Thank you so much for sharing this information. I've really struggled to understand the changes, and you've helped me how things have changed in China.

Dana@AdoptionJourney said...

Thank you so much. We are just a couple of months away from travelling to adopt a seven year old boy in Beijing.

zororiver | babysitting games said...

Why is the media didn't make this issue up? thanks for sharing

Donna said...

This article is just wonderful, and we'd like to share the information on our blog. Would you mind if we re-posted it there?

Mirjam said...

I saw on the rumor queen blog that there were NSN-children being referred of 3 or 4 months old. I wonder what Amy's take is on that.

Clay said...

To my knowledge the Tomorrow Plan is still used to fund surgeries. Pam in Henan

Anonymous said...

Thank you so much for your blog. I just learned about it and the updated information on Amy's talk was great. We adopted a 2 1/2 year old boy from China in 2008. He has spina bifida. It has been a long road, but I must share that he is a wonderful little guy. He does suffer from attachment difficulties, has had more medical issues than we expected, etc., etc. BUT it has all been worth it. We have not only added to our family and given our biological son a brother, we have changed the life of our son immeasurably. I realized special needs adoption is not for everyone, and it is crucial that prospective APs research the medical conditions with which they feel comfortable, but for us, it has been an incredible journey.

China Dreams said...

What a great article-thanks!

JShannon said...

What a great article! However I find it interesting that Amy said there are no emergency rooms. I'm about to get our Article 5 on a 5 yr old who is reported to have been found in an emergency room bathroom on her day of birth.

snow in september said...

we just got back from a trip to china w/our two teenage chinese daughters. we visited their swi's - one was adopted from an orphanage that now only has sn children. its very different than 11 years ago when it was full of babies. our other daughter came from an orphanage that now has LWB trained nannies - they are doing a wonderful loving work w/the kids there!

Ruth Marie said...

I live in China and work at a special needs foster home. While most of this is true as far as I know the only thing that is not true is that Chinese are NOT allowed to know what sex their child will be. I have Chinese friends that are or where pregnant and they were not allowed to know even if married to an American