The Special Traveller: Travelling to Adopt
There are countless reasons why people travel, and I’ve heard them all…to lounge by the ocean, climb a mountain, pray at holy shrines, visit friends and family, conduct business or volunteer their time and skills. But perhaps the most exciting, both for both me and the traveler, is to adopt a child from a completely different country and culture. The commonest destinations for adoptive parents tend to be eastern Europe (Romania, Ukraine), Asia (China, Korea, Vietnam, India) and Latin America (Guatemala, Peru). But, it could be anywhere!
Several factors have led to the upsurge in international adoption, not the least of which are the extremely long waiting times to adopt a child locally. But perhaps the most important is the desire of adoptive parents to be able to provide a loving home and endless opportunity for a child who would never get to experience this in their native country.
Adoptive parents share some of the same health-related anxieties as do all travelers, such as “Do I need any shots?” “Can I drink the water?” “What about malaria?” and “What do I do if I get sick?” The answer to many of these questions can be found by reading this book. But a visit to your local travel clinic is still a good idea.
The shots you may receive will depend upon your particular destination, how long you plan to be there and whether you will be visiting rural areas. At a minimum, you will need to be up to date with your routine inoculations such as tetanus-diphtheria-polio and measles. Protection against hepatitis A and typhoid fever might also be recommended assuming you are traveling to a lesser developed country where the safety of the food and water might be suspect. And don’t forget your Imodium!
Hepatitis B is a very important issue. The first concern is the fact that you might become ill and require medical care that is less than sterile in the middle of China. Added to this is the worry that the baby you adopt might in fact be a carrier of the hepatitis B virus, and hence be infectious to you. As you recall, hepatitis B is transmitted via bodily fluids, and such contact is usually an occupational hazard of parenting! These children may have become infected directly from their mother during pregnancy, or from contaminated needles or blood, that is often commonplace in their country of origin. The bottom line here is that you should be immunized against hepatitis B! Also consider vaccinating siblings and grandparents eagerly waiting at home.
Whether you will need any other vaccines or malaria prophylaxis will depend mainly upon your destination. You should also be aware of the non-infectious risks where you are going, whether it be the buses in Guatemala or the pollution in Beijing. Many excellent organizations now exist to help adoptive parents through every step of their incredible journey.
Having looked after yourself, your concerns should then focus on the soon-to-be your baby. New questions should enter your minds, such as:
- How will I know if my baby / child is healthy?
- What tests should he or she have done when we return home?
- Could the baby be carrying any diseases that might be a risk to friends and family back home?
Ideally, there will be a complete written record of your baby’s and the birth mother’s medical history. This can hopefully answer some of the following questions:
- Is there a family history of any medical problems?
- Were there any problems during pregnancy or surrounding the delivery?
- Did the mother smoke, take any drugs or drink alcohol during pregnancy?
- What inoculations, if any, has the baby received to date?
- What were the results of testing for hepatitis B and HIV, stools for parasites, etc.?
- Has the baby had any medical problems or required hospitalization to date?
- Has he grown well and passed the usual milestones such as smiling or sitting at the appropriate times?
- Under what sort of conditions has he been brought up so far, i.e. living with his birth family, foster care or an orphanage, and what was the quality of caring?
That was ideally! It is quite conceivable that any records will be few and far between, and what is available could even be fraudulent. Certain infections, such as hepatitis B and HIV have a long incubation period, so a negative test when you meet your baby could subsequently become positive in the months ahead. There is no guarantee that the vaccines your baby “received” were actually given, and if they were, the vaccines may not have met our standards. As well, a malnourished child might not respond adequately to immunization. What this usually means is that you will repeat the appropriate tests when you return home, and consider repeating some or all of the vaccinations.
Upon return, your baby should obviously have a medical examination. This need not be on the way home from the airport, but preferably within two weeks of arriving home. Should there be any acute illness, however, it should be attended to immediately. Remember that a child adopted from a malarious country may develop malaria days, weeks or even months after their arrival home. Respiratory infections, diarrhea and skin problems such as scabies and impetigo are common conditions in these children.
Aside from performing a thorough general examination, the doctor should be on the lookout for any sign of growth disturbance (height, weight, head circumference), malnutrition, hearing and visual problems. A developmental assessment is crucial in order to detect signs of past emotional deprivation or abuse. This may require a referral to a specialized facility.
Routine investigations might vary according to the age and origin of the child, but should probably include most of the following:
- CBC (complete blood count, to detect anemia, sickle cell disease and other inherited conditions)
- Chest X-ray
- TB skin test (if negative, repeat in 6 months)
- Stool for culture and sensitivity (to test for bacterial infections such as Salmonella and Shigella)
- Stool for ova and parasites (to detect protozoal infections such as giardiasis, and amebiasis, and helminthic or worm infections)
- VDRL (for syphilis)
- HIV (should be repeated in 6 months if negative)
- Hepatitis B screen (for antigen and antibodies - should be repeated in 6 months if negative)
Any further testing or treatment will depend upon the results of the above assessment.
If it is felt that your child needs to be reimmunized, the exact schedule for those vaccines might depend upon the child’s age and past records. The routine vaccines that will be necessary are DPTP(diphtheria, polio,tetanus, pertussis), MMR (measles, mumps, rubella) and HiB (haemophilus influenza). If there is no evidence of past exposure to hepatitis B, this vaccine should also be given. Newer vaccines against varicella, meningitis and pneumoccocal infections might also be worthwhile.
Just as there are organizations specializing in international adoption, there are also medical clinics across North America that have expertise in assessing your new bundle of joy. He or she might not appreciate all of the probing, prodding and needling, but you will rest easier after it has all been done. Go to the COMEUNITY website listed below to find a clinic near you.
I suppose there are certain health risks involved in adopting a child from a lesser developed country. But if you and your family are properly immunized, and take sensible precautions such as washing your hands after changing a diaper, these are really quite negligible. Some babies may be harboring intestinal worms. These are generally not contagious to others in North America as the life cycle of most worms requires some time spent outside the body in a different home (e.g. in the soil) before they become infectious to others. This is quite unlikely in countries with indoor plumbing and three feet of snow!
For further information on the subject of international adoption, browse through the following websites:
- Children’s Bridge
- Open Arms to International Adoption
- International Adoption for Canadians (information for Americans too!)
Traveling is stressful, and I would assume that traveling to a foreign country to adopt a child must be very stressful. But imagine how it must be for the child. Giant, strange-looking humans staring and making silly faces and noises at you, and then whisking you to a foreign country by airplane, where you receive a multitude of needles. But I am sure that for all parties involved, things get better and better. Good luck!
- Take the appropriate medical precautions for yourself before and during your trip
- Assume that your child will need to be retested and reimmunized when you arrive back home