Health Horizons : SOCIETY : Daniel’s Story : Adopting an infant from a foreign country takes time and money. And when you finally meet the child, it may be at the junction of your greatest joys and your worst fears.

For 18 months, my wife Elizabeth and I had gathered reams of documents, discussed our lives with a social worker and waited anxiously. And now the big day had arrived--June 29, 1991. Bleary-eyed after taking the overnight flight from Miami to Asuncion, Paraguay, we stood in the doorway of our small hotel room waiting for a local lawyer to appear with an 8-month-old baby--our adopted son, Daniel.

Unfortunately, we were about to learn that the world of international adoption is fraught with perils we could never have imagined.

Our lawyer, whom I shall call Hector, soon arrived, flanked by his college-age son, who served as his interpreter. Behind them stood a woman described by our lawyer as “my associate.” In her arms she held Daniel.

Elizabeth sat on the bed and took Daniel on her lap. Choked with emotion, we gazed at him as Hector’s “associate” filled us in on our child’s daily routine.

“He takes four ounces of formula every two hours,” she said, showing a clear command of English. “The foster mother says he has a good temperament and sleeps through the night.”

Yet we looked at the boy and sensed something was wrong. His tiny body sagged limply against Elizabeth; he made no sounds, and no expressions crossed his face. Hector, who often seemed to know more English than he let on, announced that he would pick us up on Tuesday morning for a trip to the courthouse and the signing of our adoption decree by a judge. He smiled and departed, son and associate in tow.

We now took a close, frightening look at Daniel. He resembled not so much a baby as a rag doll. Under layers of clothes and swaddling we found a tiny, pale body. Impassive brown eyes stared blankly, rarely blinking. A circular bald spot spread across the back of his head. Above his forehead, where cranial bones had not yet fused, a quarter-sized piece of flesh sagged, indicating dehydration of his brain tissue. We lay our son carefully on the bed and realized he could not move. With great effort, Daniel managed to roll his head from side to side. He remained eerily silent--no gurgles, no coos, nothing.

Cases such as ours are not unusual. International adoptions have increased greatly over the past few decades. In the United States, about 10,000 children a year now enter the country from abroad as adoptees and make up more than 10% of all adoptions. A decline in the number of healthy domestic infants available for adoption--both black and white--has fueled this trend.

These days, virtually all domestic adoptions of healthy white babies are for those who can afford private lawyers, rather than public adoption agencies, and usually cost at least $20,000. International adoption, with costs usually ranging from $5,000 to $12,000, proves appealing to prospective parents willing to raise a child of a different race or ethnic background.

As we were to learn later, international adoptions overwhelmingly involve children of poverty who often have undisclosed health problems. These ailments, such as malnutrition, ear infections and intestinal viruses, usually vanish with proper nutrition and medical care.

A sense of anguish and confusion set in as I recalled our meetings over the past four months with the case worker at our adoption agency in Washington, D.C. She had recommended an adoption in Paraguay after our two tries at adopting through orphanages in Colombia had failed. “Hector handles one adoption at a time, and his sister-in-law is the foster mother for each baby,” she said proudly. For that security, we gladly paid $1,000 for four months of foster care while Hector handled the preliminary legal intricacies of our adoption.

To top it off, several babies previously adopted by American couples through Hector had all arrived healthy.

Now, in the hotel, which served as an adoption center for many couples like us, Elizabeth looked over the frail, non-responsive infant and voiced a concern I could barely acknowledge. “Do you think he’s brain-damaged?” she asked. “Can we raise a brain-damaged child?”

A jagged burst of air suddenly drew our attention. It came from Daniel, who we now realized had functioning bowels and a raging case of diarrhea. We soon filled the bathtub with hot water to soak his clothes.

We lay sleepless that night, getting up periodically to hold and give Daniel his formula.He finally found his lungs and bleated--he lacked the strength to cry--into the morning.

After a bleary-eyed breakfast, we met several American couples staying in the same hotel with newly adopted infants. Some youngsters seemed in good shape, others looked malnourished, but none displayed evidence of the type of neglect Daniel had suffered.

Daniel’s scrawny state of suspended animation raised immediate concern for his well-being. To our dismay, the local pediatrician sanctioned by the U.S. Embassy to examine babies undergoing international adoption could not see Daniel until Monday.

We retreated to our room and our worst fears. Should we keep this child if he can never lead a normal, or even barely functional, existence? Whatever neglect Daniel had endured, however withdrawn he had become, he retained an alluring face dominated by large, polished brown eyes. I put my arms around Elizabeth and we cried against each other.

Adoption often stirs controversy in countries giving up children to foreigners. An adoption “business” run by local lawyers or those familiar with the judicial system often sprouts suddenly in impoverished nations, and then quickly shuts down with revelations of abuses, real and rumored.

“International adoption, like all adoption, requires a leap of faith, but it is a leap that will generally prove warranted,” says Elizabeth Bartholet, a professor at Harvard Law School who teaches and writes about adoption. A child’s current physical condition typically poses fewer problems to adoptive parents than the lack of medical histories for the child and his or her biological parents, according to Bartholet, the mother of two adopted boys from Peru. For example, adoptive parents often do not know if their child is prone to a particular genetic condition or susceptible to certain diseases.

The next morning an American woman approached me as I held Daniel in the hall outside our room. “He’s beautiful,” she said. I confided my worries to her and she scoffed. “No, this child will be all right. He needs love and attention and food, but he’ll do just fine.”

The woman, who had accompanied her daughter there to adopt a baby, explained that she was a pediatric nurse who had seen many neglected infants bounce back when offered good care.

Her daughter had been residing in the hotel for slightly more than a month with a premature baby unexpectedly brought to her by a local adoption lawyer. The “preemie” arrived the day after a healthy infant placed with the woman’s daughter was retrieved by the birth mother. Several thousand dollars’ worth of hospital care for the premature baby had so far not persuaded the local judge to sign an adoption decree. My perspective on our situation suddenly widened.

That afternoon, we took a taxi to the pediatrician’s office. To our surprise, he had already seen Daniel a couple of times, once with his birth mother and once with the foster mother, who we now confirmed was not Hector’s sister-in-law.

“I don’t call these women foster mothers,” the pediatrician remarked acidly when we asked about Daniel’s foster care. “They usually keep anywhere from three to 30 babies in a room, prop them in cribs and put in a bottle of formula for about 20 minutes at a time. If the baby finishes the bottle, fine; if not, too bad.” That explained Daniel’s bald spot and immobility--he had spent four months on his back in a crib. In that time, he had gained one pound and now weighed 12 1/2 pounds.

A prescription for medicine to treat an intestinal virus had not been filled by the foster mother. And for some reason--possibly because of dislocated hips at birth--a brace had been placed around Daniel’s hips during foster care, but the pediatrician suspected it had not been loosened as Daniel grew, leaving him with limited leg flexibility.

But the pediatrician agreed with the nurse’s diagnosis--Daniel suffered from reversible, fully treatable health problems. “Three or four more weeks of what you call ‘foster care’ and I don’t think he would have made it,” he added.

The question we now faced was not whether we would be able to keep this child, but how fast we cold get him back to the United States for thorough medical care.

Despair at Daniel’s condition turned to anger at our adoption agency and Hector, but we knew we had to follow the central rule of parents adopting internationally: Keep a low profile and don’t alienate any of the lawyers and bureaucrats who hold the fate of your child in their hands.

On the way to the courthouse the next day in Hector’s car, we bent the rule a bit. “How’s the boy?” Hector asked from the driver’s seat. “He’s not in good shape,” Elizabeth responded curtly. She ran down the short list of Daniel’s ills as Hector’s son translated. I held Daniel in my lap and, with an eye on the car’s rear-view mirror, watched Hector’s impassive face take it all in. The rest of the ride proceeded in silence.

Nevertheless, over the next 11 days Hector guided us expertly through the legal and bureaucratic maze of international adoption.

Then, the day before our scheduled departure, Hector announced, “We’ve got a problem at the American Embassy. They have no visa application forms.”

We had presented all our laboriously gathered adoption documents to the U.S. Embassy, but only an official visa application form would allow Daniel--or indeed any Paraguayan citizen--past immigration officials in Miami.

Embassy officials told us they had unexpectedly run out of the vital forms. Check back tomorrow, they suggested; who knows, some of the forms might arrive in a diplomatic pouch from Brazil or Chile.

Elizabeth then called her parents in Virginia with this discouraging news. On his own initiative, her father called the office of John Warner, Virginia’s senior U.S. senator. The following day, about two hours before our flight to Miami was scheduled to leave, an Embassy official called us back. Someone from Warner’s office had called to ask about what was going on, and--wouldn’t you know it--the visa application forms had just come in.

But time was too short. We ended up waiting another two days for the next flight to Miami.

Hector took us to the airport, where he produced a photocopy of a picture of Daniel’s birth mother. She was 16 years old--Hector previously told us she was 20--and gave birth to Daniel out of wedlock. The whereabouts of the biological father were unknown. In the young woman’s Catholic family, giving her illegitimate child up for adoption represented her only choice.

After taking a few days to settle in at home, we sent a letter to our adoption agency detailing what had happened to Daniel and demanding an explanation. The agency director’s reply--which didn’t come until two months later--contained numerous unsatisfactory excuses, but it carried a depressingly clear message between the lines: You’re on your own now; whatever happened in Paraguay is not the agency’s responsibility.

Oblivious to our disappointment with the adoption agency--and to all he had endured during his first eight months--Daniel began to blossom into a healthy, active little boy. Today, he erupts in laughter when we play a frenzied game of chase, and fearlessly climbs over our 70-pound Labrador retriever (who patiently endures the assault).

As the trauma surrounding our adoption experience fades, Elizabeth and I marvel at the ease with which Daniel has fit into our family. Our son was born in another country to biological parents we will never know, but he has come home.

Guidelines on Planning an Adoption

Here are a few guidelines to consider when planning to adopt an infant from another country:

* Deal with established agencies or institutions in the United States and the child’s birth country. Organizations that have information on agencies specializing in international adoption include the International Concerns Committee for Children, 911 Cypress Drive, Boulder, Colo. 80303, and the Joint Council on International Children’s Services, 877 S. Adam, Birmingham, Mich. 48011.

* If possible, adopt through an orphanage in the child’s birth country that has a good record in international adoptions. If you rely on a private lawyer in the birth country, get details about foster-care arrangements and ask your agency if it has recently sent someone to check on the quality of foster care. Also ask for photos of your child to be sent periodically.

* Most Latin American adoptions require parents to travel to the birth country and stay from two days to two months. Make sure you can get to the birth country and initiate adoption proceedings after a minimum of foster or orphanage care.

* Before adopting a particular infant, find out why he or she has been put up for adoption and ask if all efforts have been made to find relatives.

* More information on agencies and services for international adoption can be found in “Are Those Kids Yours?” by Cheri Register (1990, The Free Press, N.Y.).