Orphans in China
Before I traveled to China with the World Wide Orphan Foundation, I thought I understood the hardship of orphanage life. I had grown up with the story of my grandfather who became an orphan at the age of 9 days. In 1902, he was bundled up on the doorstep of an elderly woman in Brooklyn. He was one of many children from New York City who was shipped out west on "orphan trains" at the turn of the century. In Montana and Missouri, he was adopted by several families who treated him more like a farm hand and less like a child. From these stories, I thought I understood the hardship of orphanage life.
The Calculus of Orphans in China
China, from the moment we stepped off the airplane, was a world of contradictions. On the one hand, there were tall skyscrapers and fancy new apartment buildings under construction; on the other hand, there were the stench of back alleyways and people so poor that they set up their homes on the abandoned floors of parking garages where we could see them dressing in the morning from our hotel window.
I traveled with two other Americans, both mothers of girls adopted from China. From them, I learned the calculus of orphans in China. The vast majority are girls, abandoned because they are thought to be less desirable. Girls will not make money or be able to provide for their parents in their old age. The ones who go to the orphanages are the lucky ones with a chance at a beautiful life with a family in America or Europe. Many girls in China simply disappear, perhaps drowned in a rice paddy or smothered with a blanket in a quiet home in the countryside. The boys who go to the orphanages are usually sick, disabled or with obvious malformations. The families who leave these children are rural and poor. They leave them in crowded areas, train stations or shopping areas. Rumor has it that they wait for a kindly stranger to come pick up the newborn baby (usually less than a week old) and then dart away.
It is illegal to abandon children in China and children who are truly orphaned in China go to live with relatives. This means that most children in Chinese orphanages are abandoned anonymously and nothing is known of their background. Were their mothers drug or alcohol abusers? Do genetic disorders run in their family? No one really knows.
Each day I learned more about orphans in China. I saw the picture of the daughter of one of my travel companions before she was adopted. Maren was dressed in a pink and yellow wool turtleneck sweater with a matching pink and yellow hat, all this despite the fact that she came from one of the warmest southern provinces. Her mother, Maureen, explained to me that many of the children were dressed to cover as much skin as possible and hide unsightly rashes from prospective parents. Maureen recalled how floppy her daughters were when she picked them up the first time, their muscles wasted through disuse.
I did not fully understand until we bumped into an adoption group from Canada at the Forbidden City with their newly adopted babies. I saw how their arms and legs hung from the baby carriers like skin and fat without any bones. These were not the vigorous eight-month-olds that I saw in my pediatric clinic in New York City kicking their legs merrily at any opportunity as if they were practicing the squat-to-stand maneuver that would soon astound their parents.
It was difficult to gain access to the Nanjing Orphanage, and we were lucky to be granted a day there to tour the facility and conduct our workshop on safe vaccination and preventing the transmission of infectious diseases. From outside, the building was large and modern. "Only five years old," we were told as we stood in the lobby greeted by a tall woman in a nurse's hat and white coat. We knew before we went to the orphanage that we would only see the best of the best. There had been reports of human rights violations by foreigners visiting orphanages in China several years earlier and the government did not want any more negative reports leaked to the press.
Still, I was overwhelmed as a pediatrician by what I saw. There were children with heart disease, cleft lips and palates, clubfeet, terrible skin diseases, and children wasting away because they could not take enough food by mouth to nourish them. I could imagine the reasons why these children's parents had abandoned them. The parents were poor and they hoped that their sick child would receive the care she needed at the orphanage. Perhaps they were ashamed by their child's clubfeet or misshapen ears, and they did not want anyone in their village to know that they had given birth to this monster.
As we went from room to room, it was clear that each one of the four hundred children in the Nanjing orphanage had a hidden past. In each room, there seemed to be so many ghosts. Many of these children would never be adopted. The sick ones were considered unfit for foreign adoption, and many Chinese families could not afford to raise a child with so many special needs. They would go on to be the paralyzed and blind beggars that you saw at the local street market.
The Nanjing orphanage was trying to change the situation of these unadoptable children. They had started a program with a community in the local countryside to place disabled children with foster families. We traveled to a Yangtze River town outside of Nanjing to meet with several foster mothers and their children. One was the mother of a two-year-old girl with cerebral palsy who eagerly showed us the boxy homemade contraption she had designed to help her daughter in her slow progress toward standing alone and walking.
We learned that there are no physical therapists in China. The difficult work of strengthening young bodies weakened by disuse and disease was left to parents and orphanage workers. Orphanage workers, who were assigned one to four or five children even for the youngest children, never had the time to do intensive physical therapy. Ironically, the foster child, despite her cerebral palsy, seemed stronger than some of the healthy children at the orphanage. From the way the children looked up to their mothers and tugged at their pants legs, I could see that they were benefiting in more than one way from the individual attention of a foster mother. All of the four hundred children at Nanjing Orphanage needed this one-to-one interaction, but only some would be lucky enough to find it.
The mission of our trip to China was to teach the orphanage staff and foster families about preventing the transmission of infectious diseases between the children in their care. This seemed at first like a simple task, but became much more complex when we learned some of the obstacles we faced. We had to think about how our recommendations could be adapted to all circumstances. Some orphanages do not have running water or soap, much less bleach or latex gloves. Many orphanages were still sterilizing needles by boiling or reusing syringes, even if they were using new needles for each child. Vaccines were often stored improperly or used after their expiration date. Children only sometimes received vaccinations in a timely fashion, but they frequently received injections of antibiotics that they did not need. These practices unnecessarily put them at risk of getting many different kinds of infectious diseases. We made some progress, but there is still a lot of work to be done.
The day after I returned from China I went back to work in the pediatric intensive care unit at New York Presbyterian Hospital. Now I found that this world seemed impossibly clean, well equipped and technologically advanced. This type of facility would be beyond the wildest imagination of the people I met in China. In our hospital, we do three to five surgeries per day to correct birth defects of the heart. What haunted me now was a little four-year-old boy with blue lips and a blue tongue who I had met in a room full of dancing orphans. From my first glimpse at him, I knew that his blood flowed the wrong way through his heart. In China his disease was a death sentence, but in our hospital three children a day were cured of the same problem. The Worldwide Orphan Foundation is taking the many small steps that it takes to begin to address these types of injustice.
Who Are the Orphan Rangers?
Orphan Rangers are university students and healthcare professionals who live and work in orphanages for up to one year in China, Southeast Asia, Russia, and Latin America. They study the epidemiology of infection, developmental delays, sensory integration dysfunction, and other medical problems common to orphans.
The preparatory educational and clinical training for Orphan Rangers begins on site in the United States at the International Pediatric Health Services of New York in Manhattan under the supervision of Dr. Jane Aronson, adoption medicine specialist and executive medical director of the Worldwide Orphans Foundation.
About Angels in Medicine
Angels in Medicine is a volunteer site dedicated to the humanitarians, heroes, angels, and bodhisattvas of medicine. The site features physicians, nurses, physician assistants and other healthcare workers and volunteers who reach people without the resources or opportunities for quality care, such as teens, the poor, the incarcerated, the elderly, or those living in poor or war-torn regions. Read their stories at www.medangel.org.