A Just Walk (run, hike, etc…)

"…to the Rock that is higher…"

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This will make your day!

??????????????????????????????? Many of you remember JB – one of the precious abandoned children I had the privilege of caring for in China. I’m so happy to tell you that a couple weeks ago he was finally adopted and went to America with his Forever Family!

He was about 5 months old and only 8 lbs when I managed to place him in emergency foster care back in July 2009 (here is my original post and here is another post about him). He has been cared for by the same family these four years. Of course JB’s adoption is bittersweet for them as they have considered him one of their own for so long.

It has been so encouraging to witness his growth and development over the years I lived in China and to continue to follow his amazing progress after I left has been a blessing.  The photo at left is at his going away celebration.

Please do continue to lift up JB as he makes the transition to a new family and a new place as well as for his ongoing health care needs. As you think of JB, however, please remember to lift up all the other abandoned children, many with profound physical and mental disabilities who continue to languish in institutions in China and around the world.

JB with his foster mom of four years

JB with his foster mom of four years


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Orphan Awareness Month

I’ve been quite busy these last couple of months in the States, so today I get a 2-for-1 on the blogging about this important issue. Here is what I’ve just posted on the Relentless site. If you get both, no need to read this one.

November is Orphan Awareness month. You will no doubt see many posts by friends about orphans, adoption, fostering, etc. There are many perspectives on this topic but I will present just one here – one related to the just care of these vulnerable children.

First, a clarification: many “orphans” around the world aren’t technically orphans at all. They are children who have been abandoned for one reason or another. Sometimes the children have a disability and the parents either do not want to have a disabled child, or are overwhelmed with the burden of caring for the child. Sometimes divorce, poverty, imprisonment and other factors contribute to the child’s abandonment. I’m not demonizing these parents, I’m just stating what is true in many places.

It is not that we are not aware of orphans and the issues involved in the care of them, but I think we need to reflect on our awareness of our approach to caring for orphans. One approach has been “orphan tourism” or “voluntourism” From the the Child Safe Network:

“Many people come to Cambodia with the intention of donating their time to volunteering at an orphanage or other child-related organizations. Like orphanage tourism, this can develop into a lucrative business which can endanger the proper care of children rendering them more vulnerable to abuse and exploitation. Unregulated volunteering in all its aspects is harmful to children.”

Here is a real story from a colleague in Thailand:

A colleague of mine who works in a children’s home had a trusted friend in her church invite her to bring the children to a fun day of activities with other children. When they arrived, all the children were separated and placed in 20 different vans with tourists from different parts of the world. The children’s home staff were not allowed to be with the children. This was a group of tourists who had paid a lot of money to the leader of this group to allow them to spend a day with children at an elephant show, etc. However, since my colleague and the staff could not accompany the children, she demanded that the children be returned to her and they went back home.

The leader of the tour  group was angry. Some of the leaders of other children’s homes and the tourists were upset, and did not understand.  Some of the other leaders wanted to know why the children in my colleague’s group kept covering their faces when people were taking photos of them. Well done, kids! Nothing bad happened, and nothing bad was intended, but the procedure of the “fun day” presented all kinds of risks to the children.

Children have a right to privacy, even if they are “wards of the State” and their care is funded by foundations based in foreign countries. Children also have a right to be protected. Some well-intentioned volunteers can inflict unintentional harm on children. Some volunteers appear to be well-intentioned but have nothing but harm intended for children. Proper child protection policies properly enforced will protect children, as well as protect those serving children.

You will find much more information about why children are not tourist attractions at the Child Safe Network. Here are some Child Safe Traveler Tips. You will be interested to see this documentary on “Cambodia’s Orphan Business“.

Do you have any other reflections or questions or comments about this? Perhaps you have a story to share  – please do!

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Moldova, At a Glance

A glance, it seems, is pretty much all I got in the nine days I was there. Even so, there is much more to say than I can fit into a single blog post – but I will try!

Eric Weiner, in  his book “The Geography of Bliss”, claims that Moldova has the world’s most unhappy people. Another article states it this way: “Landlocked between Romania and the Ukraine, Moldovans lack a solid sense of identity, pride of nation and hope for the future. That, along with grinding poverty, help explain why as many as one-quarter of all Moldovans live and work abroad, sending back the remittances that keep this country afloat.” I will add that this sentiment was corroborated by my Moldovan friends. The Moldovan emigration may keep people going back home, but it represents a brain drain of epic proportions. Moreover, it is really hard for people to want to invest and develop in a place where everyone’s dream is to leave.

Church workers harvesting corn for the elder home picnic for lunch

This trip was different than most I’ve taken in that it was purely a vision trip. I was invited by a businessman colleague who is interested in integrated holistic development in Moldova – health being one component of that approach. We met with MANY many leaders, pastors, and organizations addressing various issues and needs in the city and countryside.

The human trafficking situation in Moldova is dire. Because of poverty and the myriad other “push” factors, Moldovans are at great risk of being trafficked (for sex and labor), and many many are. There aren’t any hard and fast figures to post, but it is known as one of the major source countries to Europe, the Middle East, and beyond. There isn’t much of a “red-light” district in Chisinau, the capital. As one Moldovan (who runs an after care facility and a trafficking prevention program) put it, “Why would the men pay for sex when there are many women in bars willing to give it for free?”

Look at this guy! I know that the junior high students take him seriously when he discusses sexual violence!

One of these organizations, Beginning of Life, also has a robust trafficking prevention program, with access to all the schools in Chisinau for teaching on subjects such as sexual abuse, rape, domestic violence, etc. Check out their website – I don’t have to write it all here!

From what I could see, there are two aftercare shelters for trafficked women run by NGOs, and I was able to spend time at both. There is one shelter for minor girls that is run by the government, and possibly other government shelters for women as well – will have to look into this on the next trip.

In 2001, there were 12,000 children registered as living in “orphanages”, a.k.a government institutions for children with “special needs” or from families who are unable or unwilling to care for them. Some are children “left behind”: their parents have gone somewhere to work and no family is left (or willing) to care for them. Only a few of these have significant special mental or physical needs and they are put into separate institutions. Most of the children come from environments of abuse or neglect, and have minor mental or emotional or learning problems. Due to pressure for European Union “readiness”, there is a push for de-institutionalization of at least half of the children cared for by the government. While living in one of these “boarding schools” is wrought with problems, simply dumping children on the streets is not exactly a good solution. Many organizations are currently working with children within these institutions, as well as providing “transitional care” for children over 16 years old – when they “age out” of the institutions, but are not ready to be fully integrated to society. These young people  have the greatest risk for being trafficked.

I took my medical kit, but there seemed to be no acute interest in having me do any medical evaluations on anyone. I thought it was strange, but I suppose the medical system and attitude toward medical care is different.

There is some amazing work going on in Moldova – but it seems

Highlights of  the week include:

  • Meeting a kindred spirit in a new Moldovan friend: a single woman physician involved in full-time ministry.
  • Getting lost in a Moldovan forest and how I found my way back! This story is good for it’s own post.
  • Vineyards are EV.VER.RY.WHERE! Got handed a bag of grapes fresh off the vine by friendly harvesters. Another time, gleaning grapes with a local pastor as we walked through a vineyard post harvest.
  • A visit with a countryside pastor who is doing amazing work mobilizing his church to care for the “left-behind” elderly in the surrounding villages.
  • Invitations to return to provide more in-depth training on health issues to the human trafficking aftercare and prevention work being done on the ground. Anyone want to join me? Let me know!

A harvester gave me a pair of snips and invited me to take my own cut! Fresh grapes - never better! But since Moldova has the highest alcohol consumption in the world, Christians are sensitive to alcoholism and I never got to try the fermented fruit. No matter - these were so delicious!

The Orthodox Church casts a dark shadow over Moldovan society


ZX and JB updates!

So many of you have been asking about these little guys and I’m so happy to have been able to see both of them soon after I got back. They are both doing well! For those of you new to these guys, you can check out JB’s backstory here and here. You can learn more about ZX’s story here and here.

ZX is now back living with his foster family in a town a couple hours outside of Shenyang. That is where he had been living for two years prior to being transported to the Shenyang Institution for his bleeding problem. About April, he was sent back to live with his foster family as they had determined his bleed risk to be less. I don’t really know how they made this determination as they had not been checking any blood tests – I suppose that he stopped bleeding so much and they let him back. Thank you God!

Last week we made our monthly visit to this village to do health checks on the kids and I requested ZX to be there. He wasn’t exactly chummy with me, and I don’t blame him. I had left him there in that place and didn’t come back. He is still pale and bruised and has evidence of a bleed into his eye indicating that his platelets and blood counts are still low, but he is clinically stable (no major bleeding). He also seems to be doing much better now that he is back with his family. YAY!

Naah! I think it is more fun to see the world THIS way!

JB has improved SO MUCH during the time that I was gone. He can almost sit by himself unsupported, but does really well in his high chair for eating and playing! It appears that he can now see objects as he follows them around his field of vision, but I don’t know what his visual acuity is. He brings so much joy to all around him. The good news is that a forever family has been found for him! So now begins the long, drawn-out, confusing and convoluted process of adopting from China. Please be lifting up that situation.

Henri Nouwen, who as you know spent the latter years of his life as a pastor to severely developmentally disabled people, wrote “When I know that I am chosen, I know that I have been seen as a special person.” And then, “We are God’s chosen ones, even when our world does not choose us.” How beautiful is that?! The world certainly would not choose people like JB or ZX, but they are chosen none-the-less. The world does not have the last say! Now that is good news indeed!

What Up?!


JB is on deck!

Do you remember JB, a little orphan we helped get out of the orphanage nearly 2 years ago? See the “Meet JB” post to refresh your memory. Jason and Christa have been JB’s foster parents all this time and they have been actively searching for a foster family for him. Now, it seems to be coming to the 11th hour for him to be able to be placed in a forever family. Please read what they have written below. Feel free to get in touch with me regarding JB.

On July 29th, 2009 we got an email from a pediatrician friend who volunteers at an orphanage in the Chinese city we live in. There was a child there who was failing to thrive.  He was 5 months old and only about 7 pounds. Each week his health seemed to be getting worse. Our friend had been petitioning with the orphanage for weeks to allow her to find a foster family to take care of him. They finally said yes and she sent an email trying to find a family. She said that if no one fosters him he’ll almost for sure not make it and even if a family takes care of him it might be a hospice situation. We felt burdened to take this little boy into our home.

We are thankful to God that it was not a hospice situation! With proper feeding and the loving environment of a home, Jian Bei (JB) quickly gained weight and showed obvious physical improvement. He was born with glaucoma, cataracts, and clouded retina. We were able to get surgery for him and his sight has been gradually improving.

After JB had shown significant physical improvement, a Christian organization (that set us up with the contract with the orphanage) requested the orphanage to fill out forms so he could be adopted.  Many children are never given the opportunity to be adopted, some just because of a physical condition that is deemed undesirable.  The orphanage amazingly asked us to help them in finding a family for JB. We said we would love to help find a family and the orphanage started the first steps in the adoption process for JB.  There have been many people praying for a family to adopt JB. There have been some families that expressed some interest, but no one has committed to adopt him. After many months of not hearing anything just last week the orphanage called and said that we should have the family that wants to adopt JB fill out the application form now. The person who’s been petition for JB to have adoption papers these many months said that if we don’t take advantage of this opportunity, JB may not have a chance to be adopted in the future.

From among the people who have already been praying for him and from among the people who are just now learning about him, we are praying to find a Godly forever family for this precious little boy.  He turned 2 in March. He has some special needs as he has hydrocephalus, development delays, and limited sight.   If you or somebody you know would be interested in adopting JB, please contact us ASAP.  Please pass this on to those you know. Help us find a forever family for JB. 

For the joy all peoples,

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On The Road Again

Lately I’ve been traveling (A LOT!) to different parts of China. Just over a week after getting back from Thailand, I spent a few days in a city in central China to visit a project that reaches out to vulnerable women in the entertainment business. I am not at liberty to say where or the name of the organization because security in there is particularly tight. Nearly all of them have been to prison (due to suspicion of their activities as followers) at least once, but they faithfully continue, and what they are doing in the face of adversity is remarkable – and growing! It was such a privilege and an honor to work with a group of people who have sacrificed so much to love the unlovable. I have never have I been asked to risk or sacrifice so much in my work or to defend my faith. Some of the staff had been trafficked themselves and are now reaching out and helping to get others out of slavery. I was able to go over some basics of reproductive health as well as give an overview of some of the common mental health disorders that they see. I also spent quite a bit of time with some of them in one-on-one sessions discussing anything from insomnia, issues in rearing children and child behavior, and other medical issues. Every minute of time there was a blessing. Remember to ask me about it if I get to share with you in person.

Ma Chi and Rachel examine a baby

Less than a week after that trip, I left for a 10-day trip to SE China to help facilitate and develop Pediatric work with a family medicine training program in Macau. Three of us (two pediatricians and a resident) traveled from our program in Shenyang, and one pediatrician came all the way from Texas to participate. The family med doc and one of the residents came from the Hope Macau program. Six women traveled by van to several places in Guangdong province visiting various places that serve abandoned children in China.

a few of the orphans practice CPR on their toys after watching the adult's do their training! (photo credit: Nancy Y.)

Like anything in China, a wide variety of situations exist among these types of places. A couple places we visited were at government child welfare institutions that had various levels of cooperation with foreigners to help in the daily care and education of the children. Other places were foreign-run foster homes that care for children outside of the institution. Our visits involved a combination of evaluating children with acute as well as chronic health needs, teaching the local physicians about the problems we diagnosed, and training the staff and nannies in basic CPR and other techniques in caring for special needs children.

For example, I diagnosed a child with Apert syndrome, and Turner syndrome, and a colleague diagnosed another with Bloom syndrome. We gave an overview of these syndromes, what the doctors need to check for soon, as well as some anticipatory guidance. Every child was reviewed with one the local physicians regarding their specific care – be it a congenital heart defect, Down Syndrome, or one of the many other problems often seen. We also gave some recommendations for general care of all the children, such as hearing screens and dental care. Whether or not they follow up on any of these recommendations is anyone’s guess, but it seems like they were more invested than at other places I’ve visted.

Generally speaking, many of the doctors assigned to child welfare institutions (if any are assigned at all) are not specifically pediatricians (a few are), and learn about the problems of these children through on-the-job training. Some I have encountered are very eager to learn about pediatric medicine, and some are not teachable at all and just want to keep their low-risk government job. A medical problem is a (if not THE MOST) common reason why a child in China is abandoned, therefore equipping physicians in caring for special needs children is a big need here.

in the square oppoite the Macau Cathedral - one of my favorite places to sit and rest a bit in the midst of a busy city

Before the pediatric road trip I spent a couple of days meeting with organizations that outreach to and care for vulnerable women in Macau. The situation for women in the “entertainment business” Macau is quite different than on the mainland – it is a bit more “open” and “less illegal” and the rule is conveniently ambiguous. Also, mainlanders still need to ask permission to travel to Macau and then can stay only two weeks. Therefore, the temporary service people have a very rapid turn-over. They return over and over again, but not always to the same place. However, it is somewhat difficult to explain well in a blog because I still have to be sensitive in reporting on the situation and who is doing something about it. “Conveniently ambiguous” means that the rules can bend far one way or another – in one’s favor or not – so I’m going to err on the side of providing less information here. Suffice to say that because of the different situation there, the girls, and the outreach to them needs to be creative and adaptive.

Since I had last visited, one particular outreach group has started a clinic for the women! It was good  to check in on how things are truly going, encourage the physician and give input in to how best the non-medical people may maximize their impact through health counseling and follow up. I also visited a Sister of the Good Shepherds, an order that is dedicated to serving women in difficulty. As you can guess, this also includes women who have been trafficked in the entertainment business. She was a delight to speak with and since she had been there for over 20 years, I learned quite a bit about life and work there!

Always, the travel is not glamorous, it is not easy, and can be fraught with frustration. However, at the end of a trip, no matter how exhausted I am, I come away with blessings – gifted more than I have given for sure.

potty brigade!


ZX’s saga continues

We still waiting? I've got a snack, it's all good.

The next morning, Zhi Xian slept soundly for nine hours, I managed to get him cleaned up, fed, and dressed on time to get to the hospital by 8:30am. We decided to go to the biggest hospital; the one with the best reputation, the place that we were sure could and would help us. Not so much. We went from clinic to clinic, doctor to doctor, (waiting in between of course) each one telling us we need to go somewhere else (usually to a place we had already been). Basically, no health professional was willing to take responsibility for care – we got the circular runaround, topped with a few snarky attitudes. My assistant broke into tears. After trying so hard, caring so much, this very young physician was faced with cold hard reality that people can be so cruel.  Even though this is an orphan with a disability and a serious disease – or perhaps because of the fact, people would rather not bother.

Exasperated, we headed to the fourth hospital in two days. Although we encountered the same system of waiting, we found hospital staff who were at least civil, if not kind. The junior doctors on the ward were kind and helpful, and I had access to the chief physician as well. We were given admission papers, but we still had to wait 5 hours for a bed. A Chinese colleague contacted a friend of hers (who also fosters a developmentally-challenged orphan) who would be willing to help (for a fee) stay with Zhi Xian during his hospital stay. She is an angel!

Up until now, through taking him home, the IVs, the toilet visits, I had become his caretaker, and so happy to be with him; but figuring out how to live in the hospital for a few days was something to which I wasn’t looking forward. I have to admit that I welcomed the relief that the Chinese ayi (and her friends) gave me. She knows the hospital routine, how to get stuff, she knows the Chinese way of course .

The next morning, when I went back to the hospital, Zhi Xian saw me and immediately looked away as if he didn’t want to see me. I had left him there and he didn’t like it and he let me know it. With some tickling and a couple mandarin oranges, he soon forgot his grudge and gave me only smiles. During my visit that morning, he got his bone marrow biopsy. While I wasn’t allowed to be present for the procedure, I was relieved to be there waiting for him to come back. He takes it all pretty well, but looks a bit bewildered about the whole situation. Poor guy!

From here, the plan for his care becomes a mess of communication, phone calls, hedging, guessing, optimizing and bargaining. Because he is an orphan, all hospital stays, medicines, and procedures must be approved by the orphanage. Because they are not paying for it, more care is likely to be approved, but not necessarily – as I’m about to find out.

After the biopsy, while waiting for the results (which could take days), I wanted to take him out of the hospital to avoid exposure to bad germs. No one is willing to transfuse him with blood or platelets (I guess one has to be nearly dead before they’ll do that), and there is no other treatment at the moment (unless you count the IV vitamin C), so why not go to someone’s home and rest? No can do. Either he stays in the hospital to wait on the results or gets discharged to the orphanage. I vote for hospital, where he can be watched and cared for more carefully.

The following day (Friday) was an all-day working retreat for our faculty. Late in the afternoon I got a call from my assistant that the biopsy results came back “consistent with aplastic anemia” and his hemoglobin level had dropped another couple of points to 6.3. I, along with my Chinese colleague, tried calling the chief doctor to get their treatment plan. No answer.  It is the weekend – we need their plan to make our plan to inform the orphanage for their approval. We just may be able to get him to a home – even if only for a few days! No answer, no answer. The two of us leave the faculty meeting a bit early to have a look at the biopsy results ourselves, to try to sort this out with the junior doctor, and perhaps get in touch with the chief doctor.

Several hours later, the biopsy report cannot be found, the chief isn’t answering his phone, and the welfare institute tells us we are wasting our time and money on this kid. Thank you for getting a diagnosis for him, but they’ll take it from here. Fortunately, they don’t want him back from the hospital right away as they would still want to hear the plan from the chief doctor. So the guy gets another night in the hospital.

Saturday morning, we finally get a meeting with the chief as he does his rounds. He suggests another bone marrow biopsy from another site on Monday to absolutely confirm the diagnosis, and then start immuno-suppressive therapy for the aplastic anemia, but using drugs that I’m not familiar with nor am I comfortable with using them on in an unsupervised environment. My opinion ends up being moot because the orphanage balks at this plan and wants him back. Because it is the weekend and it is not a convenient time, we can have him until Monday. In a real home for the weekend!

Zhi Xian and I in the hospital

Instead of my house, however, he went to the home of a dear family with other children who can help play and care for him, and who would foster him in a heartbeat. They will care for him until Monday when my team will return him to the orphanage. When I went to visit on Sunday he seemed to be having a blast messing up their house, and the family was loving it! I won’t be taking him back to the orphanage, though. He continues to hang his head and look away when he sees me putting on my coat to leave, and he still gives me a hard time when I return. I don’t want to insult him or be party to turning him back to the institution.

He is not a candidate for long-term foster care, according to the official, because of his risk for bleeding. I won’t go into their reasons (bogus, in my opinion), or point out other children with blood disorders who have suffered under their “watchful” care. It is unlikely we’ll find the root cause of his disease, and it unlikely that he’ll get treatment for it. Moreover, Zhi Xian won’t be going back to his foster home in the village, and he won’t be allowed to be cared for by a family here in town.

Experiences like this bond me in a way with the Chinese people. I am always aware of injustices here, and regularly care and advocate for orphans and other patients. But this guy invaded my heart and it became a much more personal fight. This is not the outcome for which I was hoping, and I’m frustrated and sad, but it isn’t over yet. Minds and hearts can change, and we can always pray and hope for his healing and his well-being. I’ll still be able to see him and check up on him on my visits to the institution. Who knows? Perhaps we’ll be able to get him out yet.