Title: Rules of Engagement
Author: Dr. Alla Gordina
Date: 7.9.2008

MEDCAL ASPECTS OF ADOPTIONS FROM RUSSIA:
RULES OF ENGAGEMENT

A. BEFORE VISITING THE ORPHANAGE

General Rules

1. Educate yourself

2. Familiarize yourself with normal child’s development

3. Familiarize yourself with Russian laws and regulations regarding international adoption

4. Have a support person

5. Do not expect others to guess what you want/need to know

6. Do not expect the orphanage to volunteer information

7. Be ready to openly discuss any concerns

8. Allow yourself to be emotional and adjust your plans accordingly

9. Unless you are ready to say “yes”, try not to attach to the child

10. Be ready to say “No”

11. Have someone who is emotionally divorced from YOUR adoption process

12. Do not expect somebody else (visiting physician, facilitator, etc) to collect all the information, which you will need in order to make this - the most important - decision of your life. At the end of the day YOU will be making this decision based on all the information YOU were able to collect.

Consider Bringing with You (see the observation charts)

1. Age appropriate toys (developmental age vs. calendar)

2. Musical toys (gentle!)

3. Balloons, inflatable toys, bubbles

4. Books, stickers, crayons, paper

5. Puzzles

6. Cheerios, raisins, juice

7. Comfort foods for yourself

8. Alternative evaluation tools
   
   

B. INTERVIEW (see “Availability and Reliability of Records” and “Additional Information About Child’s Development”)

General Rules

1. Take notes as detailed and as legible as possible, don’t expect to remember or decipher the details.

2. Write down all and any information given by the orphanage – official and unofficial

3. Have a list of questions and stick to it

4. Ask questions and question the answers

5. Re-phrase questions in necessary, break them into parts, repeat them until you will be satisfied

6. Make sure that there is no gaps in the information (timeline, development, health)

7. Don’t be afraid to ask “stupid” questions

8. Ask orphanage director to write down the things that you can not spell (medications, diagnoses, and so on)

9. Don’t trust any promises to provide written information later (today, tomorrow, after adoption)

10. Request documents in Russian

11. Don’t let anybody to rush you through the interview. If a doctor is talking too fast, ask him/her to slow down, so you would be able to take detailed notes.

Questions to Ask

1. Any information about family (parents, siblings), pregnancy and labor, early development, etc.

2. What vaccinations have been administered to the child and when?  If any vaccinations are missing - expect BCG (tuberculosis) at 4-6 days of life, and maybe Hepatitis B. If not - why hasn’t the baby received them? 

3. What types of tests have been done and when? What were the results? If any positives - ask for actual reports 

4. When was the baby/child transferred to the orphanage?

5. Any social service/court reports available? 

6. What was the condition of the child at the time he arrived in the orphanage?

7. How is the child developing?  How does he/she compare with other children in the orphanage?

8. Was the baby hospitalized after arriving in the orphanage?  Why? Has he had any surgeries? For what reasons? Ask for the discharge summaries from those hospitalizations

9. Is the baby sick right now? If so, what type of illness and what is he being medicated with?

10. Is the baby acting as usual today?

11. What is the baby’s schedule? Is now his/her time to sleep (eat, etc.)?

12. Has the baby recently undergone a painful procedure? What type?

13. Ask for as many sets of measurements as possible, including the most recent ones and re-measure yourself.

C. SEEING THE CHILD

1. Take notes

2. Ask questions and question the answers

3. Ask permission for everything and be prepared to bend the rules

4. Call your child by his/her real nickname (i.e. Sasha or Shurik vs. Alexander)

5. Make sure that pictures and/or videos are taken

6. “Corner” your space

7. DO NOT OVERWHELM YOUR CHILD

8. Observe!!!! – the most important. Let the baby to get used to you.

9. Don’t overdo with toys.

10. Ask for permission to feed, undress, or change clothing (beware of layers, uncomfortable/ unfamiliar clothing and shoes)

11. Ask for the caregiver to be with you initially or even feed the baby with you watching

12. Place baby on the flat surface on his/her stomach (floor, table, chair, your lap). 

13. Let older child to play and choose the activities

D. PICTURES AND VIDEOS

Theory (way before your trip)

1. Pictures vs. videos

2. Camera vs. camcorder

3. Internet vs. regular mail

4. Quality vs. quantity (length)

5. Image size vs. quality vs. ease of transmission

Practice (while waiting for your trip)

1. Taking pictures 

2. Taking videos

3. Using (actually – not using) flash (for pictures of the body, skin, documents)

4. Using your equipment (don’t forget spare batteries and memory)

5. Transferring data (make sure to save everything frequently, don’t forget USB cables and memory card reader, create a blog and/or on-line album)

6. Selecting the best material

Action (during your trip)

1. Face – front (not smiling) and ¾ view

2. Head – profile, preferably without bows or hats

3. Body – the least clothing the better

4. Interaction with subjects and objects

E. YOUR REPORT

1. Consider contacting your IA physician while you are still in the region, not after coming home

2. Use wide-ruled loose paper and extra-fine black marker

3. Number all pages, put you name, child’s name and region on all pages

4. Do not expect to re-write you notes

5. Provide the detailed record of all developments, facts, as well as of any non-official information– the probability is that you will regret if you would not do it

6. Note differences in opinions, discrepancies and your concerns

7. Write down your detailed questions for the IA physician

8. If not sure of Internet connection – draw a sketch for your fax

9. CC all your e-mails and faxes to the contact person home – this way they will be able to forward information if any problems with transmission will occur.