Editor's Note: In 1998, Dr. Jane Aronson, adoption medicine specialist and Director of International Pediatric Health Services in New York City, traveled to Russia to learn more about orphanages and pediatric care, and to check up on one particular little girl, Anna. Read Dr. Aronson’s account of her trip below and watch AC360° at 10pm ET tonight to hear her thoughts on the adopted boy who was sent back to Russia alone.
Dr. Jane Aronson
Director of International Pediatric Health Services
January 24, 1998
It's hard to believe that I really traveled to Russia 4 months ago. As a pediatrician specializing in international adoption, I wanted to visit orphanages in Russia and learn more about the medical care of children in Russia. When I talk about my visit to Moscow and Saratov, I get passionate about every adventure. Even 90 degree temperatures did not seem to bother me. The mosquitoes kept me from sleeping comfortably, but I love telling everyone about my 20 mosquito bites in Moscow. In case you're interested, there are no screens in Russia.
My great grandmother, Rose, was born in Chernigov in Ukraine in the mid-1800's. My grandfather, Abe, was born in Skritsk, a small Jewish ghetto about 500 miles north of Odessa at the turn of the century. I felt as if I had something in common with all the Russians whom I met. I wanted to tell them about my heritage and they were truly interested in my family origins. People acknowledged me as Russian.
Saratov, a small city of 1 million people about 500 miles southwest of Moscow along the Volga River was our first destination. The orphanage in Saratov was shabby and old, but as we entered the infant and toddler living areas, the light from the large windows filled the room. There were very few staff caring for the children, but they appeared to be friendly and kind. This orphanage was occupied by 80 to 100 children with a staff of five; there was one director and a full time doctor. I met with the doctor and the director and after the initial "stranger anxiety" we amiably discussed the medical needs of the orphanage. I made a list of their requests and explained that we would work very hard to bring them medical supplies on subsequent trips to Saratov. They were very appreciative, but I really don't think they thought we would ever return.
The caretakers were holding the babies while they were being fed, but there was silence throughout the feeding process. Bottles were propped in the baby hospital in Saratov so I was happy to see that these children were being fed while held. The babies were dressed in very threadbare clothes without diapers. After many hours in the orphanage, we observed the infrequency of the changing of soiled clothes. Children were lying in urine drenched garments for hours and when the clothes were finally changed I could see the painfully damaged, red, inflamed skin.
One infant had a gauze bandage wrapped around his ankle which had obviously dressed a wound. Unfortunately, over time the gauze had been soaked with urine and it had shrunk and tightened around the ankle, cutting off the circulation. A few more days of this tourniquet effect could have easily threatened the entire foot!
We spent a lot of time outside in the playground with the pre-school kiddies. They were dressed in old and dirty clothes. There were no toys in the playground and the little wooden playhouses were deteriorating and unsafe. An old piece of wood with nails was the favorite toy for a 3 year old boy. Rusty nails and splinters were everywhere. The children were quiet and depressed . As we observed them playing together, we heard no verbal interactions. Two elderly ladies sat on a bench in the playground interacting with a few of the children who we were told, had just been abandoned by their parents; the children clung to the ladies, but there was minimal conversation.
Not speaking Russian made me think that it would be difficult for me to communicate with the children; I felt foolish as I spoke in English, but I found that holding the children close and massaging their backs was better than any conversation. They were hungry for physical contact and they nestled easily against my body. I still feel their vulnerability.
They stared at my camera, but there were no smiles. These enlarged photos fill my home. These are the faces that surround me. Each face looks back at me as I eat at my dining room table. I remember the summer of 1997 in Saratov when I made sweet little friends. I yearn for them and I hope that they are no longer there, but I know that many of these children are trapped in a hopeless bureaucratic maze.
The toddler rooms were depressing. The infants vigilantly cruised along large pens. Their faces were empty and distant. The silence of the room, after the initial cries of fear when we first entered the room, was distressing. The children rocked back and forth actively engaged in self-stimulation in order to pass the long hours of boredom. Even with touching and closeness, they did not trust enough to smile or connect with us. I had a passion for one toddler who was very Asian in appearance. Her name was Ria and she was a hardy little girl; she has since been adopted by an American family. Her medical report was filled with the usual horrifying diagnoses including a rare heart problem which were obviously not true. I examined her and found her to be in the pink of health.
My most incredibly touching moments in Russia were spent in an orphanage in Moscow. Orphanage #23 is an infant orphanage about 1 hour from the center of the city. It was my last working day in Russia and it was the hottest day of the trip. It must have been well into the 90's and between the traffic and the heat, I thought that I was going to pass out. Our guide stopped several times to ask strangers for directions. The orphanage was well hidden behind locked gates in a setting of low income high rise apartment buildings. When we arrived, we were greeted by Irina, the nurse who is the director of the orphanage. She welcomed us with overwhelming warmth and kindness as if we were old friends.
My mission was quite unique. I had been contacted by a family living in South Carolina. They were adopting an almost one year old little girl from Orphanage #23 in Moscow. They wanted to know if I would examine their little girl, Anna. I had no connection with this orphanage and it was not part of my itinerary, but I told the mother that I would investigate the possibility of doing this for her when I reached Russia. When I arrived, I asked the Russian facilitator who had arranged for my visit, if she could contact the orphanage and see if we could get permission to visit Anna. Days went by and there were lots of unanswered phone calls and the probability of the visit did not look promising. The director was evidently out of town.
On the morning of our last day, I was informed that the director had returned and would allow me to visit. She immediately took me to see Anna. The rooms of the orphanage were bright and colorfully decorated. The cribs were clean and the children were dressed beautifully. Even children who were obviously severely disabled, were clean and clothed as if they were going for an outing. The children were in the playground in their underpants playing actively in prefabricated plastic modules that had been donated by a group of Italian families who had adopted children from this orphanage. The caretakers were playing with the children and there were lots of smiles, giggles, and conversations.
I was given ample time to examine, video, and photograph Anna. She was happy and obviously very well cared for by the staff.. She actually had a diaper on with a cloth rag that was washed and dried and replaced inside the diaper so that the diaper could act like plastic pants. The babies were fed formula in this orphanage which is rare in Russia. Most orphanage children eat Kefir (cold yogurt) which is unpleasant tasting and provides limited nutrition. Many of the children in this orphanage were handicapped kids. I stopped counting the children with Down syndrome after a while. They were loved and developing to their potential because Irina had arranged for a physical therapist to work with the kids from their earliest moments in the orphanage. She even had a music room with an infant stimulation box.
Irina gave us an honest appraisal of the philosophical approaches to handicapped children in Russia. She told us that handicapped children usually end up dying young in most orphanages because they cannot get the services that they need. It is a triage system. She requests that handicapped kids be placed in her orphanage and she takes pride in her ability to care for these children successfully. I left Orphanage #23 with bitter sweet thoughts. Obviously some orphanages are capable of providing a decent environment for relinquished infants and children and other orphanages are not.
I could not wait to return to Moscow to speak to Anna's prospective parents. As I spoke with Anna's mother that very afternoon, I cried with joy and told her that Anna was healthy and happy. She was adopted in January, and she is thriving in her new home in South Carolina.
During my visit to Russia I had the opportunity to lecture at a seminar for orphanage staff in Saratov. Press conferences in Saratov and in Moscow allowed me to express my recommendations for improving the health of children in orphanages. A visit to Filatov Children's Hospital in Moscow with a special tour of the Neonatal Intensive Care Unit with its director, Dr. Everstova, really taught me about children's medical care in Russia.
Since returning to the U.S., I have been actively involved with FRUA and families traveling to Russia to adopt children in an effort to provide needed medical supplies for orphans. We mail a box of supplies to the family just before they leave for Russia and then they deliver the medical supplies to orphanages. It is working!
We obviously have a long way to go, but we are all working together to make the lives of orphans around the world better. I look forward to returning to Russia this year to develop educational programs for staff in orphanages, to organize research programs, and to develop an international health fellowship to promote better health care in orphanages.