Tag Archives: orphanage

Piano Plus


We are thrilled to have a piano, which the girls have been so excited about.

We also decided to have a teacher come and give them lessons weekly.

This young lady is special and we hope to get to know her better over time.

Her home is the orphanage.

She was raised by an older woman (not a relative) until she was ten, when she had to go to the orphanage to live.

She graduated from the “orphan boarding school” for our province and now is studying music at a music college in our city.

We want to build a friendship with her and show her God’s love through our family.




Orphanage Update: Internal Fostering


Over the past 6 months the orphanage in our city has made some changes, and we are already seeing the fruit.

Although we visit the orphanage as a team every week, I am often the last to find out about certain things, since I miss the side conversations and snatches of talk that yield useful facts.

All the more stimulus to press on learning Chinese, of course.

We knew they had a few couples fostering children and living on the social welfare campus that houses the orphanage (there are buildings for every age category from cradle to nursing home here), and suddenly there was a promotion on TV and the internet that the orphanage was searching for 20 more couples.

The word was, they had such a positive feedback from the trial of the first 8-10 households that they decided to implement the fostering much more broadly.

A Chinese friend called and inquired about how it worked, since they were considering fostering, and found out that it involved living on site at the orphanage apartments, taking in 3 or 4 children, and feeding them in a family style environment, and keeping them at night, for a modest stipend.

Apparently over 200 people applied for the positions!

We had, around the same time, started a more intensive monitoring of the most underweight children, with monthly weight checks.
The wonderful thing we are noticing is a dramatic improvement in the weights of many of the children in the past couple months, and the same children have nearly all been placed in this fostering setting very recently (in general less than 2 months of fostering).

The kids are being fed 3 square meals prepared by their primary caregivers, then spend mornings and afternoons at the orphanage. now more like a daycare environment for them.

The caregivers pick them up around 3:30 and take them home for the evening and night.

They can play on the playgrounds in the area, they can go for walks around the area, and in general be in a much more home-like environment.

I am convinced this will have a positive impact on their bonding ability as well.

Orphanage Notes July


I have not blogged so much recently about the orphan work, not because nothing is going on (there is, overwhelmingly so), but because I didn’t feel like reliving the roller coaster ride of emotions yet again.

But I think I have sufficiently recovered by exploring green spaces, reading books made out of paper, and distancing myself from unnecessary computer time recently.

Today we went on our weekly pilgrimage to the city orphanage.

We are trying to figure out a strategy to help the large proportion (27%) of <3rd percentile kids in the under 5 building, so the residents reviewed about 7 or 8 weight check follow ups with me.

I saw the 7 month old kid who we brought hydrolyzed formula for last week after they told us they suspected a milk allergy, since the orphanage only has milk based formula.

He had not gained an ounce since April, and now in one week he gained 200 grams!

Will try to recruit more formula for this guy from a group who wants to help specific kids at the orphanage (it’s about $40 for a can he went through in less than a week!)

I was also told he is not being moved to be with the regular kids because of his eczema.

He actually had terrible eczema the first 3 months, then it disappeared (probably when they stopped feeding him milk based formula and he stopped gaining weight).

I think he would thrive if placed with the other kids, where they get a broader diet than formula and rice cereal.

The challenge is always how to communicate effectively with the orphanage doctors.


A volunteer spent a couple hours holding and providing tactile stimulation to another 2 year old.

He especially loved the (new) toothbrush being stroked on his face and arms.

He has a feeding tube and cerebral palsy, and I suspect he does not get very much physical touch on a daily basis.

Our non medical team is finally starting to use the bags of special items that were thought up and made this spring.  Yay!

Change always takes a while for everybody.

I saw a kid who has hand and foot deformities, probably acrorenal syndrome according to my reading tonight.

He had a heart murmur not heard previously and toe walked with one foot.

Normal intelligence and language development.

Many of these defects we see are “once in a career” type diagnoses.

I am opening my congenital syndromes and deformities textbook a lot.  [my kids like to leaf through it when they are looking for something to do].

I checked up on the 2 month old, 3.1 kg kid with Trisomy 21 and a huge heart defect, laying there puffing away, bright-eyed and interested in me.

We saw a perfectly healthy and well-developing 5 month old rolling and cooing on the floor.

The caregivers actually do a very good job with their young charges.

Most of the “regular” kids are in cohorts of 3-4 kids per caregiver, with 3-4 clusters per room.

Recently the orphanage advertised for 20 foster families to come and care for 3-4 kids, apartments near the orphanage provided.  I hear over 200 responded.

They had done a trial with a smaller group of families, and it was so successful they want to expand it to all the typical kids.

So most of the kids spend the day (8a-3p) in a daycare-like setting at the orphanage, then are picked up by their foster moms and taken home for the evening.
I think this is fantastic and a huge step in a positive direction for these kids.

Today we managed to catch one of the moms as she picked up our young patient, and she said she’s only been fostering her for one month.

We were able to discuss a couple of pointers with her about the child, and reassure her that she was doing a fine job.

And our residents are also doing a very fine job.

I’m thrilled to work with them.

And so we persevere, one day, one child at a time.






Adoption Triad…or Tetrad?

Adoption Triad…or Tetrad?

I have been pondering the popular notion of the “Adoption Triad.”

That would refer to the adopted child, the adoptive parent(s), and the birth mother.

This is not an adoption blog, but in my many interactions every week with orphans, foster parents, and orphanage caregivers I am thinking a very significant group is left out of this discussion.

Namely, the persons and  groups caring for the child for that very significant period of time between the birth parent and the adoptive parent.

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I have seen orphanage caregivers cry as the child goes to their waiting forever family.

I have seen foster parents grieve for months or even years after their child has gone to a loving home.

I know of nurses who housed an abandoned infant in the wing of a hospital and split the cost of feeding the child for many months.

I see the orphanage caregiver pouring days, months and years into a child, and often some form of attachment has taken place in some settings.

And I am slowly recognizing that orphanage directors often are stuck between a rock and a hard place when it comes to making decisions on behalf of the children under their wings.

I have also seen plenty of children on the other end, even after arriving to their wonderful new family, grieve what was familiar and yet gone forever.

It is essential that we recognize the many faces involved in orphan care and adoption, and the way each of those helps shape that child into who he or she is today.

It is often easy for us (i.e. me) to prefer to judge those working in suboptimal settings and be angry with the way things are.

I just want to remind the forever family moms and dads (and myself) that every moment somebody cared for your child, fed them, and sheltered them from the elements, they were giving you a gift.

The gift of expanding your child’s capacity to love and receive love, to respond to stimuli in their environment, and the gift of survival.

Even though that period may or may not be suboptimal, the fact is, your child survived to this point.

And that is in part because of the fourth member of the Adoption Triad.

Surprise! Again.


It’s amazing how often there is never a final answer here.

About anything.

YB has been in foster care for 1 1/2 years now, since we “discovered” him languishing at 3 kg when he was 9 months old (he had actually lost weight from when he first arrived at the orphanage).

Now he is a rambunctious 2 year old in the 95th percentile, spreading cheer everywhere he goes.

His loving foster mom has been advocating nonstop for him to be adopted after he made it through the first fragile few months.

His orphanage has continued to say that no Downs syndrome kids can be placed on the special needs list.

We had all really anticipated finding a long term Chinese foster family for him, which would be a pretty good option as well and the most realistic and practical solution.

Then yesterday, on a Sunday of course, the orphanage called our director saying they were ready to let him be adopted now.

We just never know which way the pendulum swings, but are grateful when the door opens for someone to have a forever family.

Living on this end of things, I am increasingly realizing how random some of these decisions seem to be, from a Western perspective.
I know it’s not really random, I just  haven’t passed the class to understand and interpret the data.

Here he is a day or two after release from the orphanage.

And here he is in the last month or so. 

Cuddling a little stuffed animal (read:  attachment going well)

Learning to walk (read:  excellent progression of developmental skills at his own pace)

As satisfied as they come (read:  Chinese are into punk haircuts for little boys)

Hopefully he will be united with his forever family quickly!




Last week was yet another scramble as an orphanage that we visit several times a year offered two children for us to foster, seemingly out of the blue.

As recently as January we had pleaded the case for LXT, who is actually much older than he looks in this photo.



He is about ten years old, although he looks 3 or 4. 

At that time he was not allowed to be fostered.

After the Lunar New Year, he apparently deteriorated and an orphanage caregiver took the initiative (very surprising but good!) to contact the director about him and a new little guy, who talked to someone else who then called our group. 

The end result was that suddenly we were trying to drum up two more foster family caregivers out of the woodwork, through our network of contacts in the city.

This is easier said than done, for several reasons.

1)  We try to identify people interested in fostering ahead of time, so they can have some preparation time, time to learn about common issues, etc.  But they don’t actually respond with a sign of interest until the heat of the moment, in many cases.

2)   The general realities of fostering, including the great uncertainties of how long will we have the child,  is the child adoptable and will my family adjust to the child coming or leaving sometime in the future, are enough to dissuade many from jumping into this wild river. 

3)  We often have no clue about the child’s actual health situation until we lay eyes on them, at the time of pick up.  Even then the workup and available information is often marginal. 

4)  Even if we know the child’s state of health and functional level at the orphanage, it is not an accurate indicator of how the child will do in a home setting.  Although we are optimistic that many will do well, some have very severe neurological disabilities.  It is not easy to predict who will be extremely resilient and who will need lots of labor of love. 

Anyway, back to the story.

We did manage to line up two households who have been willing to take the children for at least the first month. 

Two women who both have fostered before: 

The American woman fostered a little guy until he was adopted by her parents in the US!

The Chinese woman is still fostering an older girl who uses a wheelchair and has cerebral palsy. 

They are both on my list of people I admire.   

In the first couple weeks we should have a more realistic assessment of the children’s ongoing needs and can give a clearer picture (hopefully!) to the long term families who are yet to be identified!

It is truly amazing.

Despite local factors (most of which I have no clue about) which dampen the orphanage’s willingness for children to be fostered, we get these surprises placed in our laps!

And as I well know, even a surprise addition to the family is still an indescribable joy.


Bread and Butter Pediatrics


Twice a month I am the teaching attending for the medical team which goes to the local orphanage weekly.

Today I went for the first time since before the serial blast of holidays that started with Christmas.

First I went with our staff nurse and pediatric assistant to the “newcomer’s wing” and sick clinic.

We had a 7 month preemie with positional plagiocephaly, with a misshapen skull from always preferring the same position.

The easiest suggestions was to move his dangly toy to the right side of his bed.

The nanny was not so keen on taking down the bumper pad to let him see what was going on around him, so we had to leave that up.

Really, the best suggestion for him is to go to the regular kids section in the other building where he will spend much more time out of his crib, and we tried to make a case for that with the house doctor later.

Another 2 month old had pretty significant seborrheic dermatitis of the scalp and eczema of the face and chest.  We discussed vaseline, which is my personal preference for the eczema, and oil to soften the scalp plaques.

A baby who had repair of omphalocele shortly after birth was finally beginning to gain weight, a little bit.

A newcomer, 3 weeks old, had been diagnosed with pneumonia and treated in the hospital.  I heard a small heart murmur, and we mentioned that to the house doc as well.

We looked at some kids who have had some skin rashes for about 3 months, and I suspect it was scabies.  Discussed different treatments and their availability here.  And the lovely treatment of bedding, etc.

In the regular wing we saw a 3 year old boy with congenital clubfoot, who is actually walking pretty well on his own uncorrected curved feet.   He also had a pretty significant speech delay, and we recommended a hearing test.

Then there were two more kids with growth well below the 3rd percentile, including an 18 month preemie who is actually progressing in milestones.

Two kids were gone by the time I went with the resident, and I was happy to hear they had gone to their foster home for the evening and night.

All in all, a palette of teaching opportunities, and thoughts to ponder.

Will the thin crib bumper truly keep a baby in if they are trying to crawl out of a crib that’s too small for them?

What is the scabies resistance incidence here?

Is there anyone in town who can do the Ponsetti clubfoot braces, or is the only local option surgery?  I have seen plenty of kids with surgical scars from the repairs.

Need to think about how we could organize a hearing screening day for a bunch of kids.  It’s one of those tests that very rarely gets done, yet could make a huge difference for many.

We discussed the fact that there are many fewer kids in the orphanage this year under 3, and especially under age 1.  Even compared to two or three years ago.

When I asked the residents and nurse why, they shrugged and mentioned these thoughts.

Perhaps the one child policy?  (That was enacted almost 30 years ago).

Perhaps more people these days keep their children instead of abandoning them.

How do the abortion trends compare?

And are the numbers of children with disabilities who stay with their families, climbing?
Are some of the babies getting adopted domestically and we just don’t know about it?

Hmm.  Will sleep on it.