All those acronyms!

Last fall getting the dossier organized..

I'm a doctor.

I think in acronyms. 

 For instance, if you come to me complaining of chest pain and belly pain after eating, I may write the following in my note: "*49 yo ow wf co CP  w/+RUQ abd pain, w/o LE, no DOE, no SOB, no diaphoresis, no radiation, no fh CAD. no tob, no EtOH, sh unremarkable.  PMH neg for CAD, CVD, MI (STEMI, nonSTEMI), DM, HTN, CKD. ho burning sensation on back of tongue, Exam: A&Ox3, PERRLA, EOMI, ENT-MMM; CVS-RRR, S1S2, no M/R/G; Lungs CTAB; Abd: NABS, ttp epigastric &RUQ, no r/g. CMP normal, -trop, normal CK-MB, H&H normal. Normal diff.  Will wu w/ ekg, etc but given hx atypical, strong post-prandial assoc. will eval for GERD, PUD, BE, GB dz will obtain RUQ US, trial PPI Rx (NKDA). May need further w/u with EGD, ERCP and/or  MRCP. D/W pt DDx, S&S to call, when to come in, when to call 911, pt VU & A. FU in x days."  *(any similarity to persons living or dead is purely coincidental.)

:)

Okay, I admit that note is a little over the top as I wouldn't order all those tests immediately :)  but truthfully the acronym part is often not far from reality! While my made-up note uses standard acronyms, what about some regional, speciality-specific notes?  I acknowledge, I have spent a lot of time on hospital rounds trying to decipher a CT surgeons notes (there it goes again!)

 I realized the adoption community (especially country specific communities) have whole lexicons of acronyms, and when I am talking, sometimes I forget and start talking about TAs and SFs and 797s and...you get the picture! Perhaps I have already left you in the dust sometime when you kindly asked "So how is the adoption going?" 

So here you go, some basic acronym's and a smattering of jargon :)

• PAP--Pre-adoptive parents
• AP-Adoptive parents
• HS--home study, a 20-40 pg report by a licensed social worker detailing you and your family.  Based on background checks, interviews, home inspections, financial reports, references, and every personal document that describe you!
• Dossier--Not an acronym, but a collection of many, many documents including the home study that are notarized and certified up to 4 times before they are ready for China.
• MCC--a list of medical conditions given to your adoption agency detailing the medical conditions you feel prepared to and willing to handle in a child available for adoption
• NSN--non-special needs--A child with no known long term medical problems/disease or conditions
• SN--Special needs child: This could be a child with anything from mild easily correctable problems to severe syndromes or potentially life-threatening conditions.  It also includes children who are healthy, but older (often male) and have less chance of getting adopted. SN is further divided in the China adoption community to SF and LID-only.
• WC--Waiting child--same as above.
• SF--Special Focus.  SF children are children with more severe or complicated medical needs or issues, children who have been on the "Shared list" for >60 days with no family inquiring about them, and children whose age makes them less likely to be adopted. *The shared list is a list of children available for adoption released by the CCCWA that the CCCWA has not specifically assigned to adoption agencies who are working in China.  Because of the severe needs of these children and the lower rates of adoption among them, China will accept applications to adopt these children from families at any stage in the process. However, you still have to complete all the paperwork before you can bring them home :)
• LID-only--Children with medical needs available for adoption who have been deemed to have minor, more correctable medical conditions, usually much younger/infants.  Per the CCCWA, one cannot apply to adopt such a child until all paperwork is completed
• CCCWA--China Center for Children's Welfare and Adoption, sometimes referred to as the CCCA, this is the central government agency that oversees all adoptions from China.  China and the US are both signatories of the Hague Adoption Convention, which aims to protect children from trafficking, innapropriate adoptions and other concerns.
• LOI--Letter of intent.  This is a letter you write and send to the CCCWA when you have recieved a child referral and want to pursue adopting that child.  In the case of WC/SN adoption it needs to detail their medical condition and the future plan of treatment.  It tells how you will care for the child and educate him, love him and never abandon him. In the case of SF children it is accompanied by financial statements, background info, and photos of your family.
• PA--Prior Approval--a PA is a special letter from the CCCWA stating that they will process your application in an expedited fashion for this specific child. Basically, that based on the information they received in the LOI and supporting documents they will plan on you adopting that child, and he is no longer available to any other family, provided you complete your dossier in a set period of time and all of it supports their original decision.
• I800A--A form submitted to USCIS (immigration) to determine whether you are suitable as candidate to adopt internationally from a Hague treat nation, and specifically, what country, what age range, how many children and whether the children can have special needs and if so, what severity for which your family is approved. Approval is based on your home study, background checks etc.
• I-797C--The document from USCIS that says they have approved your I-800A. It is usually the very last document you need to send your dossier to China
• DTC--Dossier to China--A moment to be celebrated
• LID--Log in date, the official date the CCCWA logged in your dossier.
• LOA--Letter of acceptance--Baby, you're ours!!! Also known as the LOC or LSC. This is the official seal of approval on your adoption...but wait...it's not done yet...
• I-800 and 1864w--Filed with the NBC (national benefits center)  this is the application to allow your specific child(ren) to immigrate to the USA, it cannot be filed until you have your LOA!
• NVC letter--National Visa Center letter, comes after your I800 is approved (also know as the I800PA, only here it means "provisionally approved")
• DS 230--what you actually file to get their visas, this is delived to the US consulate in China.
• Article 5--What the US consulate gives you when your DS 230 is delivered. It means you are good to go from the US side--your kids will become US citizens in China (if both parents travel to complete the adoption)
• TA--TRAVEL APPROVAL... your invitation from the CCCWA to come and pick up your children!

So, we are LID, and waiting and praying for LOA...



Please, Lord, please let my brothers come home soon



The "Whys" (a very brief and short version...)

Sometimes (okay, lets be honest, most of the time!) when people hear we are adopting they look at me like I am crazy...I can just see the thoughts racing through their brains: "Did I hear correctly, did the mom standing at my counter with the double stroller just say 'we are adopting two toddlers'???"  Then I get the "oh! You mean you are adopting these two!" (pointing to my stroller), I:  "oh, no, they are not home yet! we are adopting internationally, these are my two other sons!" :)  (and I go off and chortle to myself, all the while contemplating that indeed, they are right...I am probably stark raving mad...)
I'd like to give a little background to why we are adopting,  and as I'm obviously no great blogger ;) here is an excerpt from an email we sent to family

"First then, our reasons for adopting. Probably the core reason is that the Bible makes it clear that God has a special love for orphans. We do want to be passionate about the same things our Father is passionate about. Of course, the Lord is passionate about many things, but a love for children is something specifically that God had been working in our lives. We have wanted to adopt for a very long time (long before we were married). We know that we love children very much and we wanted to make a home for a child who would not otherwise have a family. When the Lord moved us to our current location, he put us with a lot of other Christians who are passionate about adoption. That brought the desire back to the surface and got us to researching it in more detail. We found out that in many ways right now is an ideal time to adopt for our family. Some of those are:

• Big Brother and Little Man are young, this will give them a chance to grow up with their adopted brothers as a natural part of the family.
• We have a tremendous number of resources to help us right now, with many families around us who have adopted and friends who are adoptees.
• In international adoption, there are lots of rules about how many children you are allowed to have when adopting, how much money you must be earning, age of parents, length of marriage, etc. We are in what may be a narrow window to meet these requirements.

But why China? We first researched foster care adoption here in the US, but due to the nature of foster care adoption, we felt it was not appropriate for us while we have small children already in the home. We then looked into domestic infant adoption, but realized that there are many loving families who are eager to adopt a healthy baby from the US, and we knew we wanted to adopt a child who had little chance of a family. So then we began researching international adoption. Conservative estimates of the need show that there are over 130 million orphans across the world (see UNICEF's report 2008). However, in many countries there are also legitimate concerns about child trafficking or unethical adoption practices. After serious research, it appears that China has both a significant need among their orphans who have medical and or special needs and the government is working hard to avoid child trafficking. In addition, we have many, many Chinese friends, which has given us a love for the Chinese and their culture. I (doctormommy) grew up among the Chinese, and consider it to be a home culture.
After settling on China, we then began to research in more detail the specific needs of the orphans there. We found out that some 90% of all prospective adoptive parents are only willing to accept a healthy baby girl. Others have opened their hearts to accept a girl with special needs, but the boys with special needs are statistically the least likely to be adopted (any country, any agency!) and are left with little hope of ever having a family. God leads each family differently, but again our goal was to seek out the children who needed help most, and we love little boys! So we pursued adopting a boy with special needs.

We should insert a note here about the adoption agency we are working with, as some of you have expressed concerns about stories you have heard about unscrupulous agencies. We researched agencies carefully as well. We found that Chinese Children Adoption International (CCAI) is consistently rated the highest among adoptive parents. The Chinese government also rates them as the number one agency working with Chinese orphans. CCAI also works hard to care for and provide opportunities for children who will never be adopted. Finally, CCAI, has the among the lowest fees of any agency (their fees are also published up front and they do not add any hidden fees later), this is because they are genuinely committed to finding families for orphans, not just skimming money from parents.

So in April of this year we began the application process. Our agreement was signed, paid for and accepted on July 10th along with a list of special needs (Medical conditions) we were willing to accept. At that point, we got started on compiling our adoption dossier (a huge collection of legal documents) and applying for our home study (we had been able to do a little of this prior to approval). The general process for special needs adoptions is the preliminary application, followed by home study and dossier, and after all of that is done, a family begins to wait for a child match. We were told that a child match generally took between six months to two years. Imagine our surprise then, when on Friday, July 27th we received a call from CCAI! They had a 15 month old child who had been up for adoption since he was a couple months old. However, we were the first family who had listed his need as one we would be able to consider. We spent the weekend researching Little Lion's  file and praying about him. Our agency would have given us more time, but we were confident that the Lord intended this precious boy for us. We called the agency on Monday, and a week after we sent in our letter of intent, We received pre-approval!
Before CCAI had called us, we had been looking at another child on their list that we thought would be a good fit for our family. After accepting Little Lion, we still couldn't get Little Monkey off our hearts. After considering and praying about him, we asked to see his file on Sept 7th. We reviewed his file very carefully and consulted with many physicians and other adoptive families. We spent another week praying about Little Monkey and seeking advice. We came to the conclusion that while we know adopting two children at once is a tremendous amount of work, and while Little Monkey's needs appear to be very extensive, we believe that he too is our son and that the Lord has called us lay down our lives and our comfort to extend His love to these two precious boys. We received pre-approval for Little Monkey, 8 days after our letter of intent"
For us it has been a whirlwind...as a physician who has cared for many children in the foster system, I originally thought years ago that this was where we would find our children, and maybe someday it will be! What a big change then to go to adopting internationally "one infant" to "hmm, make that two toddlers!"  However, for us this is the exact right place we need to be now, and we feel so honored and privileged to be pursuing adopting these amazing little boys! 
PS: What about those bloggy names??? Well, our dear nanny dubbed the 4 boys, and so far they have stuck...we will see as they grow! 

Chuāngkǒu làzhú

Chuangkou lazhu: literally "window candle" a sign of welcome home, a light that says "come in, there is warmth, there is shelter". But for us it also says, "we'll keep the light burning till you get home!"  This is a peek in our window where the light shines till our sons get home.