Our Stories :: In the News :: "Doctor in a Global Village", from Newsday

By Sylvia Adcock, Staff Writer, Newsday

The waiting room looks like the one outside any pediatrician's office. A battered play kitchen with plastic toast that pops up, a toy airplane waiting to take off. Children with stuffy noses. Wide-eyed babies in strollers. And of course, anxious parents. But the chatter here at Dr. Jane Aronson's office is different. "Where is she from?" one mother will ask another, as they compare notes on their long journeys to parenthood. "What agency did you use?" And, "How old was she when you got her?" These families were formed not in the delivery room but in hotel rooms half a world away. These are children who were adopted from overseas, who have been in orphanages or in foster care, often in poverty-stricken countries. They arrive with little or no information about what kinds of infections they may have been exposed to or what kind of prenatal care they received. Many have rickets, a calcium and vitamin D deficiency that causes weak bones and muscles, from drinking watered-down formula. Some are anemic. Some have developmental delays that come from lying in a crib all day with no one to pick them up or play with them. And almost all of them will need a battery of blood tests to rule out diseases that most Long Island parents never need concern themselves with-such as hepatitis-B, HIV, tuberculosis and syphilis.

In some ways, the parents in the waiting room are Aronson's patients, too. When the phone rings in her Manhattan apartment or her Mineola office, it's often a new mom or dad calling from overseas. One morning last month, a couple in China called because they were concerned that the 18-month-old they were adopting wouldn't make eye contact. "She's grieving," Aronson said, explaining that children who have been in foster care must mourn the loss of their foster mother. When Aronson hears the baby is eating, she's enthusiastic. "She loves Cheerios? Fabulous!"

Now, after years of counseling and sometimes consoling parents, after years of taking care of other people's children, Aronson is about to become a mother at the age of 48. This summer, she will travel to Vietnam to adopt a baby boy. On May 14, she left a message on her mom's answering machine in Florida: "Next year, you can call and wish me a Happy Mother's Day." Her trip to Vietnam to bring home her son will be the latest of many journeys.

In the past five years, Aronson has traveled to Russia, Guatemala, China, Bulgaria, Romania and El Salvador, visiting orphanages and studying health care systems. In an orphanage in Saratov, about 500 miles southwest of Moscow, she said she saw a playground filled with quiet children, no toys and a 3-year-old boy playing with an old wooden board and nails. She gave seminars there to staff members on how to interact and play with the children to help them develop normally. In Bulgaria, she had a standard developmental screening test translated into Bulgarian; she taught the staff at an orphanage to use it to keep track of the children's growth and milestones. Learning about their lives and the culture of their homelands helps Aronson understand the children that come through her office.

Like 10-month-old Mario, a butterball at 21 pounds with a swatch of black hair and smile that stops traffic. One afternoon in May, he was busy charming everyone in the exam room as Aronson doled out standard new-parent advice to Ellen and Paul Casciotta, who adopted Mario from Guatemala. Keep the poison-control number on the fridge. No raisins, no peanuts. Childproof the house. And as Mario tried to pick up a Cheerio with his fingers, she explained that he may have some mild developmental delays. He may not crawl or walk as quickly as other kids; he may have trouble picking up a Cheerio with his fingers. But he'll catch up. "I have not seen a baby from Guatemala that was not a few months delayed," Aronson told the Casciottas, who live in East Hampton. "It's the style of childcare. They hold them and feed them but they don't let them do anything adventurous." During Mario's first two months of life, he was in a foster home with too many children and an overwhelmed foster mother. At a time when infants need to steadily gain weight, Mario didn't grow. It was only when he changed foster homes that he plumped up. "That's an important part of his past," Aronson said. "The most important thing it tells you is that if a baby isn't getting any attention, he can't grow."

Much of Aronson's time is not spent in the exam room, where a map of China holds pushpins to mark the towns where the Chinese children she treats were born. Across the hall in an office lined with photographs of children she met in a Russian orphanage, she reviews the medical records, photographs and, in many cases, videos of children who are referred for adoption. She's looking for signs of problems that might make the adoption a high-risk one, such as signs of fetal alcohol syndrome. Sometimes, she has to tell a couple that the child they've already become attached to could be at risk for severe disabilities. "It's hard. I'm making a judgment about a child, putting them in a category where they may not get adopted. And I feel guilty," Aronson said. "People say, 'What should I do?' I don't do that . . . I don't tell people whether to adopt a kid or not. I leave that to the families. There are some people who are more ready for risks than others."

But always, she is optimistic about the resiliency of children. And about the instincts of parents. When Meg D'Ariano and her husband were about to travel to China in late 1998, they had already received a tiny picture of Li Pei, the little girl they were about to adopt. But shortly before they left, they got word from their adoption agency that Li Pei was very ill. At only 15 pounds at 21 months, she was not thriving. The Chinese officials wanted to know if the couple still wanted to meet her-or if they wanted another baby instead. "My heart was in my throat," said D'Ariano, who lives in Manhasset. "I picked up the phone and called Jane and she said, 'Come over.'" Aronson told the couple to look into the little girl's eyes and trust their instincts. Weeks later, in a hotel room in China, D'Ariano and her husband saw a spark. "There was an instant connection," D'Ariano said. Li Pei, now Lilly D'Ariano, has just turned 3, weighs a healthy 35 pounds and is a bundle of energy.

As demand for adoptions went up and children became available to Americans in Eastern Europe and China in the early 1990s, international adoption exploded in the United States. When the explosion began, Aronson was finishing a one-year fellowship in pediatric infectious diseases at Columbia-Presbyterian Medical Center in Manhattan and was about to start working at a pediatric AIDS clinic at Jacobi Medical Center in the Bronx. At the time, only two clinics in the country had physicians who specialized in the medical needs of children adopted internationally. Aronson started getting phone calls. "People were calling medical centers where there were departments of pediatric infectious diseases. I took a lot of those calls," she said. "Someone would say, 'My child was adopted from India, and he has all kinds of parasites. My pediatrician doesn't know anything about parasites. Who do I talk to?' " Quickly, she developed a reputation, not just as a doctor who could answer the questions but as a doctor who gave out her home phone number. In 1992, she came to Winthrop-University Hospital in Mineola as chief of pediatric infectious diseases, and soon opened International Adoption Medical Consultation Services, practicing with other pediatric specialists at Winthrop. At the time, her practice was one of a handful of such specialties nationwide; today about 30 physicians around the country concentrate on international adoption. The American Academy of Pediatrics is planning to create a section on international adoption next year.

Aronson's path to medical school was circuitous. Growing up in Valley Stream, she always has wanted to be a doctor and remembers that dream as one of her earliest memories. But dreams don't always come true easily. After graduating from Valley Stream North High, where she was senior class president, Aronson moved to Manhattan at age 17. She went to Hunter College and worked as a bartender, carpenter and photographer. She came from a family of physicians, and in some ways that made her decisions more difficult. Would she simply be doing what was expected of her? It was the '60s. "I wanted to own my choices," she said. Instead of pursuing medicine, she became a teacher. She taught autistic and emotionally disturbed children at Sagamore Children's Center in Melville, then taught science and math at several private schools in Manhattan, coaching cross-country and women's basketball along the way. But in her late 20s, Aronson finally decided she was ready. She signed up for a course to prepare for the medical school admission test, spent a year studying and entered medical school at the age of 31. She chose pediatrics as a specialty and added infectious diseases, following in the footsteps of her father's brother, an infectious diseases specialist who worked for the Armed Forces Institute of Pathology. Aronson's Uncle Joe had spent years studying the efficacy of tuberculosis vaccines among American Indians. He died in Suriname studying leprosy.

As a child, Aronson said she always thought she would have children. She never saw herself pregnant but imagined that she might adopt. But years of medical school, residencies and 24-hour-a-day on-call schedules were not kind to such a dream. And a long-term relationship with a partner who didn't want to have children helped Aronson to suppress her feelings. And yet the longing was always there. "I struggled morning, noon and night," she said. "Years went by. Each day, I was in pain. Was it my destiny to have children or to take care of other people's children?" Then, one day last June, after her long-term relationship had ended, Aronson was having dinner with a friend who asked why she didn't have kids. She gave the usual answer. But her friend didn't buy it. "That doesn't sound right," she said. The conversation spurred Aronson to confront the subject in a way that she hadn't before.

One year later, she is expecting news from her adoption agency any day now about the baby boy she will adopt. She plans to name him Ben, keeping his Vietnamese name as a middle name. She has a new, two-bedroom apartment on the East Side. She hasn't fixed up the nursery yet-"It's bad luck, if you're Jewish,"-but she has lined up a nanny, obtained with the help of an e-mail list of families who have adopted from China. Aronson also will give up a Manhattan-to-Mineola commute on the Long Island Rail Road. This summer, she will move her practice to Manhattan, with an office near her apartment to make working outside the home more compatible with motherhood. New parents usually are anxious. Aronson said she thinks the parents she sees have a different level of anxiety than most. They are older and "further away from that undaunted, reflexive approach to child care," she said. "They've seen things happen. And many have been longing for a child for a significant amount of time." Now, she is about to count herself among their ranks. And a woman who exudes confidence on every level has doubts. "As a doctor, I know what to do to take care of a baby," she said. "But will I be a good parent?" Her journey to parenthood has been different than most. Like the parents she sees in her office, she will be undergoing a kind of labor in a foreign land. But her questions are the same ones all new parents ask themselves. "Will I be organized enough?" she said. "Will I be accepting of my child? Will I make the same mistakes my parents made? Will I have the stamina I need?" Her journey is about to begin. To wish her well, the parents whose children she has treated in Mineola made her a book filled with crayon drawings, handwritten messages and photographs of their smiling children, children from around the world. The advice from one mother to the doctor who is about to become one is simple: "Remember to giggle a lot. Be there-express your love-hug trees together . . .Children are miraculous!"

'Orphan Rangers' in Search of Facts

FOUR YEARS AGO, Jane Aronson dreamed of a kind of Peace Corps dedicated to working with children in orphanages around the world. As a pediatrician devoted to treating children adopted internationally, she wanted to help the children who didn't get adopted and learn more about the lives of the children who come to the United States. In 1997, she formed the Worldwide Orphan Foundation to send what she calls "orphan rangers" overseas. The next year, she sent her first ranger to live and work in three orphanages in a remote part of Russia. Lydia Stickney, now in a pre-med program at Harvard, became a part of the daily life at the institutions where she worked, feeding, diapering and playing with babies. She also administered a standard developmental screening test to see how many of the children were speaking later than usual or had physical delays, and kept records of her assessments. She found that one orphanage, in Votkinsk, had done a much better job than others in helping children grow and develop normally.

"The students go in there and they not only research, they're role-modeling," Aronson said, adding that the other members of the orphanage staff see the student playing with the children and speaking to them and learn that interaction is important for the children to grow and develop. Aronson said she has three criteria in selecting the college students she sends overseas: They must speak the language, respect the culture and have an affection for children. She pays for the trips from private donations to the foundation, a private, nonprofit organization she founded, and from her own pocketbook. The summers abroad are not expensive, she said, only costing a few thousand dollars, because the students live on a shoestring and often stay with host families. Another orphan ranger spent a summer in St. Petersburg and Borovici in Russia, studying children's delays in speaking, and their problems bonding with the people taking care of them. This summer, a student will travel to Ecuador. Another will spend time in Russia later this year. The information helps Aronson understand the children. "I didn't just want to make assumptions about their lives," she said.

For more information about the Orphan Rangers, visit the Worldwide Orphans Foundation section of this site.

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