Changing My Medical Practice to Make Room for A Vision, February 26th, 2011
After more than 20 years of running a primary care pediatric practice for children adopted from abroad, I've decided to change my practice. I'm not stepping away from being a doctor -- a dream of mine since I was 3 years old, but I am removing the daily pediatric care of sick visits and well check-ups, to concentrate solely on adoption related issues for parents and children and my foundation work. I agonized for months over making this decision and will deeply miss not following the kids' development long term as I have for 20 years. This practice change will allow me to focus on the specialty aspects of adoption, and will free up time for me to grow my organization, Worldwide Orphans Foundation (WWO).
The letters notifying parents that I would no longer see their children for sick visits and well child check-ups went out on February 15, 2011. Now there's no turning back on my decision to not be the purveyor of friendly medical advice about runny noses, coughs, fever, broken arms, belly aches, sore throats, rashes and the mysteries of a child just "not himself".
I will now devote my thoughts to attachment, depression, behavioral issues, learning disabilities, attention deficit disorder, post traumatic stress, and other developmental issues that are often the complications of no pre-natal care and institutionalization for children adopted from abroad. And I will help parents figure out what country to adopt from and how to prepare for parenting and see the newly adopted child for just that one initial visit when they first arrive.
Since opening my solo practice in July 2000 in New York City which has a large population of adopting parents, the practice thrived and grew. I worked 100 hours per week to keep up with the needs of the practice. I was on call 24/7 and handled phone calls and e-mails from traveling parents from countries all over the world, day and night. I evaluated over 10,000 kids in this practice and enjoyed seeing myself as "the Stork". I helped people decide where to go to adopt and then saw the newly adopted child for their initial visit on arrival to the US. Those who were local and even from surrounding states often continued to see me for yearly check-ups and I have known hundreds of children over 20 years of practice which includes kids I saw from my Long Island adoption practice.
And I learned so much about every pediatric specialty. I had to know endocrinology in case a child had precocious puberty which appears to be more common in adopted children. I had to know cardiology because lots of kids were diagnosed with heart disease in the pre-adoption documents from Russia and there are special needs children from China with real heart lesions needing surgical repair in the US. I had to know the possible genetics of children who were missing ears, toes, fingers, and who had dysmorphic facial features. Knowing how alcohol might change the face of a child and being able to talk about the possible effects of alcohol even when there were no classic facial features was a daily function of the practice. I stepped up to study every day and learned more medicine and development than I could have ever learned from a textbook. I developed close alliances with specialists at many medical centers to learn their specialty, and I taught them about adoption so that they could help adoptive families with sensitivity and respect.
I learned about the geopolitics of the world and the idiosyncratic cultural differences of sending countries became my continuing medical education. In each country where there was adoption, I scrutinized their medical textbooks and had research articles in other languages translated for me in order to understand the medical context and the child. That was the most exciting part of the field of adoption medicine. There was little to no research on orphans in textbooks, so I learned from parents, adoption agencies, social workers and physicians living in countries around the world. Then, I started to travel abroad to visit orphanages after feeling like a fake just pontificating about orphans from my living room or office. I became obsessed with orphanage life and traveled widely with like-minded professionals . Medical missions to countries like Romania, Bulgaria, El Salvador, China, Russia were a regular part of my personal medical education to further my expertise in orphans.
I spoke at parent adoption meetings and conferences and did clinical research of my patient population. I reported my thoughts and findings to colleagues and we began to formalize adoption medicine as a specialty and organized a yearly medical institute which still exists today. We shared and learned from one another on an adoption listserv. And we created an official section for the American Academy of Pediatrics, "Section on Adoption and Foster Care", to further best practice and education on this specialty.
I then had a vision -- in 1997 to be exact -- to create a foundation that would learn about the medical and psychological issues of orphans and create programs to help children who were institutionalized. That is how Worldwide Orphans Foundation started on Sept. 11, 1997. Now 13 years later, the organization is unrecognizable to even me: a $5 million operating budget; a dozen employees in my hometown, Maplewood, New Jersey; and hundreds of employees who are nationals in five countries.
Since 1997, WWO has implemented innovative programs serving orphans and vulnerable (OVC) children in 14 countries. WWO is on the cutting edge of de-institutionalization and strategically implements programs focused on community building and capacity building in all countries. In just 13 years, we have gone from discovering the complex issues of orphans in orphanages to creating models and interventions to help orphans come out of institutions. We are now side by side with larger child advocacy organizations around the world having learned how destructive and dangerous institutional living is for young children, determined to change how orphans are viewed. We are declaring that children living in orphanages is a holocaust and a tragedy of monumental proportion; the secret destruction of millions of young lives because of extreme poverty, AIDS, malaria, tuberculosis, overpopulation, war and conflict, natural disasters, and the subsequent disintegration of family life must end.
I am leaving primary care pediatric medicine to pursue a larger calling, to help a lost generation of children living without families in desperate settings. It will be my last best job and one child at a time, I will work to understand the cultural differences from country to country and I will identify the best models to move children out of orphanages and back into their communities and hopefully into permanent families. I will work with thousands of other dreamers, like myself, all over the world to find solutions to this formidable, but necessary task.
So I will still be a doctor, but I have carved out the time now to be a strategic planner, a CEO, a fundraiser, a policy person – and a visionary. I'm excited about this new journey.