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



Exceeding Abundantly

Above all that we could ask or think! I have always loved that verse! It makes me catch my breath and sends a thrill through me, "Now unto HIM WHO etc.."
Today is a day that I have been privileged to see the exceeding abundant work of our Father.  We received our I-797 on Saturday late afternoon.  This was thrilling, but concerning timing as we could do nothing that day to certify it and prepare it, yet it had to be done this week due to upcoming US and Chinese holidays, and I couldn't take clinic off at such a last minute to start the process on Monday.  After talking to my clinic supervisor, she graciously helped me get all my patients from Tuesday moved to this Monday or next ;) and scheduled an extra nurse for the increased workload.  So while I saw extra pts, my husband took some time from his work on Monday and did the notary and county clerk and was blessed to get an appointment for us with the Dept of State for Wednesday morning.  Tuesday, with clinic cancelled, I drove the three hours over to our state capitol, first thing in the morning, and despite bad weather, God helped me to get in and out shortly after the government offices opened.  I drove back to our town, picked up our boys, and Daniel drove back from work, and we headed to DC, stopping only to make the requisite copies.  It was bad, bad weather all the way, blinding, driving rain, but in the wee hours of the morning, we made it to Fairfax, VA and gratefully turned in at a hotel. (Thank you, Lord for Priceline and smart phones!)  The next morning we headed to DC, had a pleasant and very quick appt with the DoS, (5 minute turn-around with a smile, how is that for a blessing?) and rushed to the Chinese embassy to turn in our paperwork.  We found that they were telling all people there that there would be no more rush (same day) service, but they were glad to get it done overnight for us. ** For other PAPs, I am not sure if this is a permanent change for personal, urgent/emergent hand delivered documents, as the option is still on the website, but the embassy staff did make it sound like this was a permanent policy change, so I would recommend planning for two days in DC.**
  This was a skewer in our plans, but we knew God had a reason, so since my parents live only 3 hrs from DC, we trucked on up to them.  Needless to say, living 12hrs apart as we do, these grandparents do not get as much time with the little guys as they would like, so this was a very fun surprise for them and us.  We are hoping and praying that my father will be able to accompany us on adoption trip, for so many reasons.  The next day, we headed back to DC, got the documents all looking pretty! and headed to Fed Ex, where I spent an unreasonable amount of time, copying, checking, collating and fine tooth combing, this which was to be our very last package of dossier documents to our agency! Poor Daniel, I think the boys were quite a handful, but I must say they were really troopers for this long crazy trip and only needed to occasionally let off a little very understandable steam now and then.
With that over-nighted to our agency, we got in our car and headed back toward home, watching the weather map that showed a bad looking snow storm was coming.  Most of the afternoon and evening we drove undisturbed, though the weather map declared we were at that very moment being pelted with snow.  God was driving the storm before us. Suddenly, my phone rang. It was CCAI, I answered, curious as to why they would be calling at this late time.  Jaime told me that our critical review was done, "yay!" but "I have some really bad news for you, can you talk now?"  Quickly she told me that all our documents that we had sealed in October had an error in that they were all lacking a date on one of the seals from the embassy.  She noted that this was a very serious error and would require all the documents to be returned to the embassy and a correction requested.  We would not likely make our hoped for goal of DTC before the New Year.   We were at a loss of what to do. D and I both had to be back in town for work and responsibility this morning, and we had already left DC.  J said she was closing up the office, but she would be happy to overnight the documents anywhere I wanted.  D and I did not know what to do. Rapidly we discussed options, but all seemed impossible given the circumstances, only two more intercountry mailings scheduled-and next week was inauguration, MLK...the list of impossibles was too long!
J did not believe that the embassy would be able to do any same day corrections.  Our hearts sank.  We thanked her for the info and hung up, puzzled and heart sick.  It seemed, humanly, that our dossier would now have to wait till after the New Year at minimum and get caught in the piles that build over this long, lovely holiday. Suddenly, I thought of my parents! Perhaps they could take the package (today) to DC. I was upset, "be ye angry and sin not" ran through my head, because "it was too late" J had said she was leaving the office and would not be back till Monday.  Daniel suggested (after I had been upset and tearful for a few minutes) that I should call back, even though the office was closed and see if J was still there.
I did.
She was.
She would.
Of course.
 (thank you, Lord for making me set up a fed ex account back when I thought I didn't really need too.) Then, Daniel began looking to see if we could find a fed ex office near us (somewhere in the boonies as our family would say) to send my father our passport copies, examples of correct sealing etc. We found one. It was closing in 2 minutes. They suggested another. We rushed there and sent off the package and got back on the road, praying. Up till this point the roads had been clear and no traffic, so we were able to do all this running around with no problem.  I called my parents and my father was happy to take on this ticklish task of running to DC and seeking a solution. Thank you, Abba!
The roads stayed clear but the snow on either side increased.  Finally, the traffic ground to a halt. Parked on the interstate, we were grateful that Daniel had filled up the tank at the last fed-ex stop.  We spent most of the night parked for a hour or so, suddenly traffic would start and we would rush on, no sign of the reason of delay, and then again, the traffic would suddenly condense and park for a couple hours.  Finally, we decided, tiredly to try the back roads if we had a chance at an exit...I cannot countenance this decision as having the slightest rationality to it.  If the interstate, which was quite clear could not move...! Daniel had been sleeping, while I watched for movement in the traffic. When it came, I pointed out that according to my phone there was a critical access road that paralleled the interstate. What did he think? We got off.  We looked at our map.  The critical access road looked very small and unlikely to be fully plowed, we were in the mountains.  We opted for some country(state) highways instead. As we drove these roads, I noticed a small dot on the map directly on our proposed route "Highest peak in the state of X" Uh Oh.  Should we turn back?  But the snow was so high, that the only way was forward. Trees were downed everywhere. The road wasn't that bad...and then it was. The plows had passed that way. Brave plow drivers! But they had only plowed their best around the trees that blocked up to 75% of the roadway.  Lots of snow remained.  Creeping along at no more than 15- 20mph we did sharp hair pin turn after hair pin turn slowly ascending the mountain.  The mountain stream on one side had become a raging and furious river tearing trees out and bearing them down (last night was the first time I have seen real waves in a stream!) and the tiny rivulets down the mountain side had become roaring waterfalls that sprayed across the road like fire hydrants.  On the other side the valley dropped down down and in places the edges of the road had given out, crumbling and tumbling down the living storming mountain.  We had to maintain enough speed to not slip and yet I was constantly afraid that we would hurtle either over the cliff  or into the raging waters.  This was all at 2 and 3 and 4 and 5 in the morning.  Finally we reached the peak, and if possible I felt that the road became worse, how I hate hairpins downhill on a good day!  I was so exhausted I could hardly keep my eyes open, but was trying to stay awake to help Daniel.  Thankfully the boys slept peacefully. Daniel is an amazing man.  I have always known that, but watching his nerves of steel last night, his calmness and skill, I am so thankful for him. He threaded around trees on steep grades maintaining the center of the road always alert. We were praying all the way.  When we finally crawled into the tiny town at the base of the mountain, there was no doubt to us that A. We didn't deserve to be all in one piece! and B. That God is very merciful! Our lives are in His hands. There were still lots of windy mountain roads (one is never quite out of the mountains around here) till the interstate, but finally we found a partially plowed grocery store parking lot and were able to sleep for an hour. Then back on the interstate, where the traffic was light, but the car in front of us immediately spun out on black ice.  We decided this time that wisdom was the better part of valor and pulled off at the next exit to rest till the sun had been up for a while.  Eventually we were able to get back on the roads, and though there was still black ice and thick fog, we were able to continue slowly and steadily.  Around 8 my mother called to let us know that they had received the fed-ex packages at 7:40 and my father was heading out to DC.  We made it home safely.  Around 1:50 my father called to say that not only had he made it safely to DC, but that the embassy had, after discussion with him, graciously and willingly corrected the seals on the spot!!!!! He had them all in hand! He was taking them to Fed Ex!  To use an over used expression--MINDBLOWN!! Definitely today, yesterday, all of this is Exceeding abundantly above all that we could ever ask or think!
So at this moment, God willing, our documents are on their way to our agency, and J says (God willing) we should be DTC next Friday!

Here I raise my Ebenezer

Hither by Thy help I've come

 And I know by Thy good pleasure

 Safely I'll arrive at Home