Trauma response interview George Rogu M.d.
What is your background and training?

The medical school that I attended was the University Medicine at Bucharest Romania. After the completion of medical school, I pursued Pediatric residency training at Albert Einstein College of medicine, Montefiore Medical Center. Since graduating from Montefiore Medical Center, I have been practicing general pediatric medicine in a private medical practice located on Long Island, New York called Reichman, Brown, and Kaplan M.D. P.C.,
I have admitting privileges at Good Samaritan Medical Center, South Side Hospital and St. Catherine of Siena. It is from within my general pediatric practice that I had created the web site Adoptiondoctors.com, The International Adoption Private Practice. I am a member of the JCICS (Joint Council) and I am a Fellow of the American Academy of Pediatrics as well as being a member in the AAP section on International Adoption and Foster Care.
I am also on the board of Medical Advisor for AAETS.

• I know that as a General Pediatrician you keep quite busy. Could you tell me about the various other roles and positions that you currently hold?
  No matter where are or what you do, children indeed do keep you very busy. I am currently a senior partner for a general Pediatric Private Practice located in Commack, Long Island, NY named Reichman, Brown, Kaplan M.D.P.C., phone number being 631-499-4114. It is from within this office where I provide general pediatric care to the local community children, and scores of others adopted from all over the world. Through Adoptiondoctors.com “The International Adoption Private Practice”, my associates and I provide Pre-Adoption Medical Evaluation and educational support service for parents of Domestic and International adoption, more on this later. My associates and I are also medical correspondents and advisors to various adoption related websites. The focus of adoptiondoctors.com is to provide a centralized and authoritative Internet presence where families could turn to in order to obtain medical information pertaining to Domestic and Internationally adopted children. The Internet is full of great information and with that misinformation. When a parent googles a certain topic,. Who knows what you will find. An authoritative website created by physicians was long overdue.

• How did you first become involved in International Adoption Medicine?
  Being a general pediatrician, my daily routine allows me to meet people form all walks of life. Over the years I was fortunate enough to me many adoptive parents in the process of adopting a child from a foreign country. These children would come from came from eastern European countries such as Russia, Romania, Moldavia, and sometimes from China, Korea, Columbia. Many times the families would approach me being their general pediatrician and ask me to look at the child’s medical records and sometimes videotape. I remember my first International Adoption Evaluation. It was a case of a little Russian child that I was asked to perform shortly after finishing my pediatric residency.  The case came into the office as a routine consultation. Generally, these consultations are more for the families to meet their new pediatrician In the case of little 12 month old Andre, it was a case where I the physician was to evaluate the medical records and video tape and educate the pre adopted family in terms of risk of adoption. Now being fresh and residency, I was not aware that this was one of the many roles of being a general pediatrician.  I went to my senior physician and asked him if  “as pediatrician’s do we look at foreign medical reports and videotapes and consult with the parents?” his response to me was, “ just be a doctor, look at the report, look at the video and tell the mother what you see” do not tell them to adopt or not to adopt the child, just educate them.  With education and knowledge that I provided to this family, they subsequently became empowered to make their own informed decision.
  In Adoption Medicine, the primary role of a pediatrician is to explain the medical jargon, answer any questions, and to help alleviate any stress that the adoption process has created.
  Now I took these words of wisdom and proceeded as instructed, “ just be a doctor” I did just that.
  I went back to consultation room and started to speak with my new potential adoptive family. Andre’s mother was excited and scared that same time. She had been trying to have a biological family for many years, but due to circumstances beyond their control that was not a possibility. Failed attempts at infertility treatments and numerous visits to the doctor’s office made having a biological child not an option. After many years of disappointment and skyrocketing doctors bills, they decided on International adoption from Russia.  Andre’s mother went on to explain is great detail the entire adoption process to me. I was astonished as to how stressful and complicated the process can be.
  From the bureaucratic point of view, to the emotional turmoil, she described the adoption process as a row coaster ride that feels like it will never end. Today she was ecstatic because she finally received her referral and pretty soon that roller coaster ride will stop.
  As she was telling me her story, a tear of joy came from her eye as she told me about her video of little Andre. Now it was time for me to “be a doctor”.  I looked over the Russian medical report and became dumbfounded as to what I was reading. On the report I found words that when translated in to English have devastating meanings to them. I found words like Perinatal Encephalopaty, Cerebral Anoxia, Developmental Delay and Pyramidal Insufficiency. These words made me “the Doctor” highly concerned. My doctor thinking was telling me that this child was devastated beyond repair and more than likely would carry a diagnosis of cerebral palsy. With all these terrible words I thought I was would potentially wheelchair bound.
  My dilemma now was how to tell Andre’s mother who was so happy about her new referral that according to the medical report has child is more than likely brain damaged.
  In order to buy some time and figure out how I was going to break the news I decided to look at the video and then comment. I presumed that the video would show a little emaciated infant that would not be walking, little interaction, drooling on itself.
  After turning on the video, I was shocked.  Andre was walking running climbing the stairs. His speech was a delayed, but certainly he was not the child that I read about on the medical report.
  I went over everything with Andre’s mother and I explained about the quandary that I was in.
  The report described a  brain damaged child yet  the video tape showed a relatively healthy child with some delays secondary to be in institutionalized.
  Andres mother said to me,” don’t worry I too was scared after reading the report but after looking at the video tape all of my concerns were lessened”  “ I know that Andre is meant to be mine and I thank you for alleviating the great deal of stress from my mind” “I thank you for taking the time to look at the documents and video” Since both the doctor and the parent had similar vies about the same topic, we must be right.
  I am happy to report that I have been following Andre for many years and that he is doing stupendously. He is in mainstream elementary school, 4 th grade, he has a family, many friends and a life that he would not have been possible if he had remained in the orphanages of Russia. in Russia.
• How the to come to develop adoptiondoctors.com?
  My web site is the cumulation of my two talents in life. I wanted to create an Internet presence where parents can go to obtain reputable information about children that were internationally adopted. the Internet is a wonderful place for obtaining almost any type of information required.  The Internet can also be a terrible place because it is not regulated by any entity.  Hence there is a lot of Miss Information and personal opinions on the net. with this in mind, I created adoptiondoctors.com It here that professionals from the adoption world provide medical information for parents to read.  On the web site we have created the “Ask the IA doctor? Section” it is here that parents can post their medical concerns and one of our professionals will answer the question in general terms and and expand on this topic to provide a detailed column written in language that families can understand.  From this idea we have also expanded the concept to include a section on psychological concerns with in the adoption process, this section is managed by the president of the academy of dramatic stress Dr. Mark Lerner.  We also have a section it deals primarily with issues pertaining to social work.  Here we talk about the home studies, school years and the adopted child. This section is managed by a Leslie Zindulka. in order to make our web site more interactive, we have taken our ideas one step further, we need the medical E-Zine called adoption doctors Rx. every month be published a number of articles from our designated domains and deliver them to the email box of our subscribers.  On their web sites with also created a section of adoption resources, medical archives, and consultation services for pre-adoption evaluations. in the past, only people who lived on long island and came to my office were able to have the pre adoption evaluation with me. now with the intranet, I received consultation requests from from all over the United States.  Our service can be accessed by anyone who has a computer and a telephone.  Soon we will be launched in a new phase of our service geared for parents who travel overseas and wants to have the comfort of knowing that they have access to a medical professional from the United States.  Presently we keep contact with families while overseas be an email and telephone.  We will be enabling video teleconferencing through the Internet within the next couple of months.
• Are there an increasing number of children being adopted today?The inability to have a biological child is the prime motivating factor in adoption. Infertility is where the most common reasons why families adopt. in one study, more than 80% of those adopting independently or through an agency in responded that the inability to handle biological child was the main reason when they choose to adopt is estimated that eleven to 24% of couples who experienced difficulty conceding were carrying a pregnancy to term pursued adoption.  The number of reductions have fluctuated overtime and generally for clarity of societal and economic reasons.  For instance, adoption skyrocketed from a low of 50,000 a in 1944 two as high as 175,000 in 1970.  In1992 there were almost 127,000 annual adoption is in the U.S. in 1997 a public opinion benchmark survey found that 58% of Americans know someone who has been adopted, has adopted child or has relinquished the child for adoption. to a variety of adoption types.

Domestic adoption is the adoption of a child who resides in the U.S. either through the public health welfare system or private adoption
A) foster care adoption:  Is the adoption of a child within the state child welfare system of for whom the reunification with the birth parents is not possible for reasons of child safety.  Children may be adopted by the foster parents, relatives or adult home they have no prior relationship.

1. B) private and options can be arranged you through an agency or through an and adoption. In a private agency adoption, children are placed through a nonprofit hall for profit agency that has licensed by the state. In independent adoption, in children are placed directly with about that parents by birth parents or with the help of a facilitator or attorney.
2. C) international adoption is adoption of children from other countries by U.S. citizens these adoption as a usually arranged through adoption agencies. Adoption as a file as the broad or in the United States depending on the laws or of the country when the child resided. a large number of children adopted internationally are less than five years old or how a majority of those adopted from foster care a more than five years old.

International adoption in the U.S. is usually prompted by warm, poverty and social upheaval.  U.S. citizens target adopted children from other countries in large numbers after World War II.  Many of these children were European and Japanese war orphans.  Any additional adoption this followed after the Korean in Vietnam war.  Warren its aftermath I’m not the only factors that lead to international adoption.  Desperate poverty and social upheaval had been critical factors in the adoption of children from Latin America and the former Soviet Union and eastern Europe over the last 20 years.  In China, government population can call policies have contributed to the abandonment of interim kernels and over crowded orphanages. Between 1971 and  2001, U.S. citizens have adopted over a quarter million children internationally.  Into national of actions have more than doubled in the last eleven years and a number of girls out number the boys that are adopted. China and Russia have replaced south Korea as the primary countries from which U.S. citizens adopt.
In 2001, 95% of internationally adopted children came from 20 countries ( China, Russia, south Korean, Guatemala, Romania, Vietnam Vietnam, Ukraine, India, Cambodia, Kazakstan,, Columbia, Philippines, Haiti, Ethiopia, Poland, Thailand, Mexico, Jamaica, Molova)
In recent years in recent years international adoptions have exceeded 20,000 children per year.

• What do you do to address the dramatic stress in the adoptive family unit?
  While children that have lived in orphan ages without the comfort of parents and families certainly has a significant amount of traumatic stress, the family issues of traumatic stress begin even before the word adoption comes into play.  Families that seek to adopted child have been through great deal of psychological and emotional turmoil.  Their stress begins when they discover that’s they will not be able to  conceive biological child.  In fertility treatments, medications, and many physician visits all are part of the beginnings of dramatic stress in the adopted family unit.  In international adoption this dramatic stress is compounded by the fact of the unknown medical conditions of the potentially adopted child.  When the family receives a referral, the report is laden with medical terminology that is difficult to interpret actively person quite intimidating. the family also receives a video of their child and with this information, the parents are supposed to make an informed decision to adopt these child.  This medical information can create a great deal of unnecessary stress for these parents. I created adoption doctors.com in order that to create a centralized Internet presence that is reliable with families can submit them medical documents and videos for the adoption physician to evaluate.
  Our job is not to pick-out children for adoption, we try to forensically dissect the entire medical report and video tape and explain everything tube the pre adoptive parents.  We translate the medical terminology into layman terminology.  We try to help families understands the underlying risk factors that this child could have, and if the medical diagnoses prove to be true we try to explain what is in-store medically for this child and their family. During our consultation we also provide advice for international travel with the child’s and how to prepare the child for the transition between the orphan age in life with a new family. I find my work to spread across a wide array of professional fields.  Sometimes I find myself acting as a forensic detective, counselor, educator, and lastly  as a physician. when the family receives a referral package the emotions they usually the same.  This is a moment of great joy and happiness for these parents because they are one step closer to completing the family unit.  Parents have described as a motion and something similar to giving birth to what child.  After the read the medical report especially a Russian one, e emotions of doom and gloom set in. because of words like perinatal encephalopathy, minimal brain dysfunction, and pyramidal insufficiency suddenly these parents are worried and concerned that their newly adopted child will not be normal.
  I have found that traumatic stress in the adopted family is even more intense in families that have to except a referral blindly. a blind referral is one in which a family must travel overseas and only then will they meet there potential a adopted child.  Traumatic stress is intensified because of factors such as the unknown medical condition of the child, lack of communication with the medical professional from the united states, and just from issues of international travel. adoption doctors.com has tried to diminish the blind referral dramatic stress I always being available through the Internet for our families that are overseas.  We can communicate with them via email and we now can’t even provided pre adoption medical evaluations of their children while they are overseas. parents can of email documents for doctors, upload video footage that they have taken via the Internet and its own our web site will be able to videoconference in real time.  Videoconferencing while still in the early stages of technology will help physician to evaluate the child.  After performing a production evaluations, I have had many parents thank me equal as I took the time to evaluate everything and explain everything to them.  With the knowledge that they obtained from me, I have empowered them to make an educated decision on whether to adopt or refuse a particular referral.  International adoption is a leap of faith, I feel that they should be a calculated leap of faith.
• We see that on adoptiondoctors.com you have established a multidisciplinary approached to dealing with all aspects of adoption process from medicine to law. What other disciplines are represented in your organizations?
  What makes our web-site service truly unique is the fact that we have numerous professionals available to respond to questions posted by adoptive parents. Our primary discipline is obviously pediatric medicine. We have including myself four general pediatricians on the advisory board, a psychologist, social worker and a lawyer. All disciplines have their own forum and deal with all aspects of the adoption process for both International and domestic. Everyone in our organization participates in seminars provided to agencies and organizations. I find that by using the multi-modal approach, all aspects of the adoption process can be covered all in one venue. The one thing that we are not is an adoption agency, we do not place children for adoption. We are an educational organization.
• Do you have any thoughts about the impact of the Tsunami and children who could potentially be adopted?
  The recent tragedy affecting so many people in Asia has spurred the worldwide concern about the orphans of this from the Tsunami. because of the magnitude of the devastation , and the inconceivable death toll the reality is an many of the children in these regions would be left with the family to take care them. Although there many of us with a strong desire to help these children, is imperative that all means of reuniting these children with their biological parents and or family members first be exhausted.  As in any country it must be first established that at child is truly an orphan.  The chaos around that devastated areas may have caused these children to be lost from the parents. countries must work to locate extended families if no parent remains and placed them accordingly. it’s all means are exhausted and the child’s does not have a permanent and loving home in which to leave them than and only then should international adoption be entertained.  Some countries affected  by the disaster may have established some programs for adoption, each individual country has its own criteria.  Ethical adoption practices require that for a child to be considered legally eligible for adoption the child must be relinquished or abandoned.  The midi aftermath of the disaster, a country’s government may be in disarray and no resources may be deployed on projects ensuring the day today survival of its citizens such as maintaining order, caring for the injured and bearing the dead.  The courts another deal entities usually are not functioning during these events and international adoption cannot proceed in such an environment.
• To a significant amount of internationally adopted children exhibit at symptoms of post from any stress disorder?
  
  All types of early childhood trauma such as parental loss, physical or sexual abuse and or neglect will put these young children at increased risk for post dramatic stress disorder. Many years ago when orphan ages old eastern European countries were nothing more than warehouses for abandoned children, many of these children’s ended up suffering from later mental disorders, depression, emotional disorders and post dramatic stress.  Over the years through time and experience, people I’ve come to realize that children are very susceptible at a very young age and they do not do well if there socially and physically neglected . the orphan ages of today are better equipped and staffed than they were even as little as ten years ago.  They now have a low caregiver two child ratio, the living environment is colorful and stimulating and to children are encouraged to play with toys, hear music, and interact with as many people as possible throughout the daily routine. experience shows that warehousing of children can only have devastating results.  Many of the older post institutionalized children that were neglected for many years will exhibit a similar symptoms of PSTD. In children this is manifested by, intense emotional reactions, sleep problems, learning difficulties, memory disturbances dissociation, aggression again self and others have psychosomatic reactions.  Chronically, these children will exhibit detachment, dissociative episodes sadness and feeling of hopelessness unfortunately this condition those under recognize post adoption. he aging which that from her peers is critical the earlier that dramatic experience a more permanent devastation.  I am pleased to report that internationally adopted children of today because of worldwide education  are doing far better today than if they were warehouse in an institution in the early 80’s.
• Have you believe the academy to contribute to the field of adoption stress?

As I mentioned earlier traumatic stress in adoption is not limited just to the child, encompasses the entire adopted family unit.  The stress begins as early as when a couple discovers that they are infertile, it progress through the multiple infertility treatments, adopted process, fear of the unknown medical condition of the child, and it continues throughout the rest of the life of the adopted child and the family unit. the American academy of experts   in a traumatic stress is a multidisciplinary organization with old specialties represented a major advantage at this organization has is that is that it is dedicated to increase in the awareness of traumatic stress and ultimately improving the quality of intervention.  By creating an organization at his multidisciplinary  in nature dealing  with a similar condition it it facilitates a dialog between all disciplines. By increasing awareness of dramatic stress, doctors, lawyers, psychologist, social workers, adoption agencies, clergy, medical directors can all deal with their particular facet of this entity and a combined result should be added treatments for survivors of traumatic stress.
 

• Any final thought on Adoption for our reader’s?

I have heard many people say that been international adoption is a leap of faith.  People that adopt a child other kindest and most loving and most vulnerable people have ever met.  Sometimes the desire to adopt the child a so great that one may become temporarily blinded to reality of the situation.  And my personal opinion while at international adoption is indeed a leap of faith, with education, and knowledge provided by the staff of adoption doctors.com the decision to except an international adoption can be a calculated leap of faith.