Children's Hospitals Today - Spring 2018 - 16

FEATURE / ADOPTION MEDICINE

16

A resource for parents

Changing to meet changing needs

When Eckerle was adopted in 1977, her parents didn't receive
any information about her. But times have changed. Now,
families have a lot of information to sift through and decipher as they are making decisions about adopting. For example, Eckerle says adoption agencies give adopting parents
"giant checklists" of medical conditions an adoptee could
have and ask them which ones they feel they could handle.
One list, Eckerle recalls, had 117 different conditions.
"There's just no way to Google that," she says. "One part
of my job is to go through and help parents pare down
what their expectations are and what they really feel they
could be open to in terms of medical and emotional needs
for a child."
Since Eckerle began her career in adoption medicine a decade ago, she has seen a significant increase in adoptees with
medical needs. "When I started this work, I would say half the
kids we saw were
fairly healthy," says
Eckerle. "We always
consider adoption
A CLOSER LOOK
to be a type of speTop 5 sending
cial need because
they've had transicountries in 2016
tions-and someIn 2016, U.S. citizens adopted 5,372
times loss of birth
children from other countries. That
number has been ticking down every
home, country and
year since international adoptions
family. So there's
in the U.S. peaked at 22,884 in 2004.
trauma involved.
This is a 76 percent drop over 12
But these days, alyears. Changes in laws, process and
most 100 percent of
funding are a driver for the decrease.
these children have
some sort of medi1 China
cal special need."
2 Democratic Republic of Congo
These
needs
range
widely.
It
3 Ukraine
could mean the
4 South Korea
child is missing
fingers or needs
5 Bulgaria
a bone marrow
transplant. It could
Source: U.S. Department of State
mean fetal alcohol
syndrome or cleft
lip and cleft palate.
Or it could mean a condition so grave that the child will never live independently, or live a full life span. This rise in the
number of international adoptees with medical issues can
be attributed, at least in part, to an increase in the number
of in-country adoptions where healthy children are adopted
first, Eckerle says, leaving children with medical issues and
special needs available for adoption overseas.

Over the years, the number of international adoptions has
dropped for reasons ranging from country politics and adoption processes to child trafficking concerns. As these numbers fell, many adoption medicine clinics closed. Eckerle and
her team began seeing patients and families from as far away
as Washington, D.C., Los Angeles, and even Ireland.
But with this drop in international adoptions came a rise
in domestic adoptees and foster children, and Eckerle seized
the opportunity to help. She and her team expanded their
work with families on domestic and foster-care adoptions,
and she changed the University of Minnesota clinic's name
from the International Adoption Clinic to the Adoption
Medicine Clinic in light of the shift. These domestic adoptees and foster kids-children who face many of the same
issues as international adoptees-now constitute about
half of Eckerle's caseload.
"It's an incredibly underserved population," says Eckerle,
who adds that many in this population are on medical assistance, and reimbursement is "disastrously low," creating
a challenge for clinics that serve them. "We have fundraisers every year, because we lose money on every patient we
see," Eckerle says.
In addition to fundraising, as well as reimbursements
and out-of-pocket payments from families on some services,
Eckerle and her team are in talks with the state of Minnesota
about ways they can work together to help this population of
children and families. "We are excited about the future," she
says. "But right now, one of our biggest issues is trying to figure out how to stay alive, so we can continue to see these kids."

CHILDREN'S HOSPITAL S TODAY Spring 2018

The first call
Brooke Waller and her husband, Doug, discussed the possibility of adoption on their first date. Then in Uganda, on
their five-year wedding anniversary, she said they both
had the same feeling: "I think we have kids here in Africa,"
Waller recalls.
And they did. In the years following, Brooke and Doug adopted Henry, Teddy, Joseph and Rose from Africa-four kids
who are now all under the age of seven. All along the way,
the family had the help of the International Adoption Center
(IAC) at Cincinnati Children's Hospital Medical Center. "When
you're adding to your family, everything is overwhelming,"
says Waller. "And this center is one spot where my husband
and I can say ... this runs smoothly."
The Wallers worked with the team at the IAC pre-adoption-including helping them prepare for their travel to
Africa to bring their children to the United States-and postadoption, with evaluations of the kids once home. There was
one day in particular, Waller remembers, that made all the
difference in the world.



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Children's Hospitals Today - Spring 2018 - Intro
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