Just ‘kaz

Apparently, quite a lot …

In this case, a few pictures speak thousands of words!

It is hard for Julie and me to believe that it has been 6 months since we brought Anika to the United States, and even harder to believe that she’s been in our lives for nearly 8 months.  Looking back at this blog, and looking at all of the photos and videos that we have, it is simply astounding how much she has changed.  She’s definitely bigger and stronger.  She has a personality that is truly sparkling.  She has been developing a will of her own, which has been fun to watch.  Most importantly, her constant happiness has not changed.  She still wakes up every morning smiling and happy.

This past weekend represented an extraordinary confluence of events.  First, it was the 6 month mark since we brought Anika home.  Second, it was our 7th wedding anniversary.  Third, it was Julie’s first Mother’s Day.  How can one possibly top all of these events taking place at once?  With an extraordinary reunion, of course.  It turns out that three other children from Anika’s group at the Delphin House live within 30 minutes of us, and so we got everyone together for a celebratory lunch.  Who would have imaginged that four children from an orphanage on the outskirts of Kostanai, Kazakhstan would all come to the same corner of the United States?

Needless-to-say, all of the parents were watching to see whether or not the kids recognized each other.  While we’ll never know how much they remember, I think that we felt that they at least had some sense of familiarity with each other.  By the end of the afternoon they were happily crawling, walking, and running all over the place (and at times, all over each other).  We took a group photo to send back to Dr. Irina an the staff at the DBH so that she can see how Alexei, Aliya, Nora and Anika are all doing.  As you can see for yourselves, they all look great!

Happy Holidays to all from Sam, Julie and Anika! We enjoyed an unusually balmy night and ventured out to see the lights on “The Castle” up on Arborway. Anika was entranced. I’ll probably put up one more post - a recap of the last day in Kazakhstan before we left, and then bring this blog to a close. The plan right now is to take the text and pictures, buff and polish them, and then bind them into a hardcover book for Anika, as it is after all, her story. I’ll be sure to post some parting thoughts for the last entry. Until then, stay warm (especially those in Kostanai, where it’s a nippy -13C).

I had to share these photos, if only because they show the delight with which Anika is adapting to the simple pleasures of life at home. In this case, a teething biscuit.

We survived the big snowstorm here without difficulty. Here are a couple of photos:

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The three of us are absolutely exhausted after being awake for the past 36+ hours.  So until I gather the energy to sum up the events of the past couple of days, I’ll let this one picture say it all.  As you can imagine, we’re happier than words can express.  Thanks for all of your support over the past couple of months.  We are very happy to be home!

Additional pictures of today’s long adventure can be found here:

Anika's Last Day in Kazakhstan

We just got back from the US consulate and we are very happy to announce that we are finally coming home!  It’s hard to believe that we are 48 hours (plus the 11 hour time change) away from the end of this entire process!  We now have all of the documents necessary for Anika to become at US citizen — all she has to do is land in the United States.

The whole consulate process was actually interesting.  It turns out that the US consulate is on the 17th floor of a seventeen story office building that is otherwise non-descript (that is, it looks like all of the other high-rise buildings here in Almaty).  Security to get into the building is just as draconian as it is for getting on a flight.  Maybe a little more.  You can only bring one small container of liquid (e.g., a sippy cup), and you can’t bring in any recording devices, cell phones, etc.  We couldn’t bring in any bags whatsoever.  You go through a magnetometer, and have to check in with your passport.  You’re escorted by armed guard everywhere - to the elevator, from the elevator, down the hall.  The door to the waiting room was like a bank vault door, with two guards at the entrance.  All business is conducted through bulletproof glass windows and microphones, all under the pictures of the smirking Bush, the scowling Cheney, and the sinisterly squinting Condi Rice.  Truth be told, I’d rather see another picture of Nazurbaev.  But I digress.

Apparently all of the adoption interviews are conducted at the same time, so when we arrived, we saw about 6 other babies and their newly adoptive parents.  I chatted briefly with a woman had just adopted a little girl from Kyrgyzistan but had to come to Almaty because we don’t have a consulate in that country.

The whole thing took under an hour.  We filled in a one-page adoption survey where we were asked a number of “customer satisfaction” type questions, such as what agency we used, who our Almaty coordinator was, how much the process cost, how much travel cost, how much other expenses cost, did we have complaints or problems along the way, etc.  Then we went to a window and paid our fee for the visa, and waited to be called for our interview.

The interview was very brief - and more of an informational session than anything.  We were told that all of our paperwork was in order and that there weren’t any problems.  We signed a handful of documents: the I-600 petition, a certificate saying that we’d vaccinate her on our arrival home, and her visa application.  We were given Anika’s Kazakhstani passport with her US immigrant visa, her new Kazakhstani birth certificate, and a number of the original documents from her file.  We were also given a large brown sealed envelope that is to be hand-carried to the immigration office at her point of entry to the US.  We were congratulated by the consular officer and then sent on our way!

We made a stop at the KLM office on our way home and managed to change our flight to Friday morning, meaning that we’ll be back home by Friday evening!  Anika is clearly delighted, as we are.

Tomorrow we’ll get wrapped up - some last minute shopping, packing, and early to bed.  More soon!

Things continue to go well here in Almaty.  We are anxiously awaiting our interview at the US Consulate this afternoon.  According to our Almaty coordinator, Oleg, everything is OK with the paperwork, meaning that if all goes well, we’ll have our walking papers before too long.  I have decided that if there is enough time to make it to the KLM office this afternoon, I’m actually going to see if it is possible to get onto the Thursday morning flight.  Despite the fact that this would mean rushing to get packed up and off to bed in time to wake up at 4:00 am (not a problem for Anika) tomorrow, it would be entirely worth it to get out of this hotel room and into our home.

Truth be told, for what this is, we’re actually very lucky.  The hotel has a restaurant in the basement and the room service isn’t half bad (although you only get an English speaking person on the line about half the time).  The location is also good: close to restaurants and stores.  Plus we have two queen-sized beds, a bathtub (not Anika’s favorite, yet), and a crib with enough room to be able to walk around.  However, as I mentioned before, the tiny fridge, no microwave or teapot, only sporadic internet access (one-time, one hour connection for 700TT), and the fact that Anika still requires 3 naps/day means that we’re stuck in the room for most of the day.  We’ve been working hard to figure out her routine and her cues.  We’ve definitely learned when she’s hungry, and that we had seriously underestimated how much food she could hold for the first couple of days.  Now we know that she needs a substantial breakfast, a mid-morning snack, lunch, a mid-afternoon snack, and a substantial dinner in order to be happy.  We definitely her good mood emerge once her belly is full.

Sleep-wise, we’ve managed to get her to sleep through the night, with occasional late-night arousals.  Last night we got her to sleep around 7:00 and she stayed mostly asleep until about 6am.  Then, to my surprise, she hung out in bed with us for about 45 minutes more before wanting to eat.  I don’t think that’s so bad given that it’s only our 4th day with her.  Figuring out the nap times when we have different things to do during the day is bit more of a challenge.  For example, as I write this, we’re probably going to have to pack her up and leave in about an hour, but despite an hour’s walk around town and some quiet play, she’s standing in her crib pretending to be Galileo as launches every pacifier and toy over the side of the crib while happily babbling away at us.  We’re hoping that she’ll sleep now so that she doesn’t lose it completely when we are traveling to and from the consulate (not that it isn’t entirely entertaining to listen to, and watch her, do all of these things).  As I said, it would be worth it to get home as soon as possible, just so that we can begin to recover from the jet lag and get her on schedule.

She definitely seems to be re-attached to us.  From the way that she’ll sit and stare out our faces as we hold her in the carrier, to the way that she stands at the crib and smiles back at us, and especially the way that she’ll crawl into our arms while we’re playing with her, it seems that she’s truly happy around us.  This doesn’t mean that I think that she’s completely recovered from the separation from the orphanage and her regular caretakers, but I’m a lot less worried about her being comfortable with, and bonded to us as her parents.  As promised, I finally had my hands free enough to get some good pictures of her in all of her glory.

If we don’t leave until Friday, then I’ll go and visit the Almaty Postgraduate Medical Institute tomorrow.  Yesterday I had a fascinating (and unexpectedly long) visit at the Scientific Center of Pediatrics and Children’s Surgery.  The trip was arranged by Dr. Azhar Nugamanova who works for the ZdravPlus project, which is a medical assistance project organized through USAID.  The hospital was outside of Almaty in what looked like a poorer residential district.  I was picked up by a USAID driver and the trip took about 45 minutes.  On arrival, I was greeted by Dr. Alzhan Salpynova, who is one of the hospital’s pediatric gastroenterologists.  She had fairly good command of English, and served as my translator and guide for the trip.  After dropping off my bag and coat in the physician workroom (a very small office with 4 desks and a couple of computers), I was told that the head of the hematology department was busy and was offered a tour of the hospital.  Much to my surprise, the hospital was less modern than I expected, but not surprisingly, I was told that it was “undergoing renovation”, which is what I’ve been told about every other hospital that I’ve visited here.  I was shown a number of wards, including the hematology ward.  In Kazakhstan, the hematologists treat malignancies of the blood and bone marrow (leukemia) as well as non-malignant conditions (aplastic anemia, ITP, hemoglobinopathies, etc.).  This is different than in the US where oncologists treat leukemia.  The ward I was shown was pretty big, and very crowded.  Between the two hematology wards, they had the capability of holding about 40-50 patients - the entire hospital has about 250 beds.  Most of the rooms on the hematology ward were doubles or triples, with beds for the parents along with beds for the children.  There were a small number of laminar-flow isolation rooms.  Interestingly, there was a community dining area, as opposed to the in-room dining that is standard in the US.  I was also shown their activity room which was well-equipped and very crowded.  Outside in the hall I came across a group of boys who were playing with a miniature pool table.  Theirs was the one and only picture that I took (with the boys’ permission) during my time at the hospital since I ended up being busy talking to so many people.

This hospital is one of two pediatric hematology centers in Kazakhstan that is equipped to treat children with leukemia.  As such, children from all over the country, as well as from nearby countries, will come and stay for the duration of their therapy, which can sometimes be many months time.  This facility sees about 80 new diagnoses of leukemia per year, and about 600 new patients per year (all blood disorders combined).  The government covers the cost of both the hospitalization, the medications, and the transportation.  Parents (usually the patient’s mothers) stay in the hospital with their children.  Kids with leukemia who complete their induction therapy and go on to receive outpatient treatment  can be cared for by pediatric hematologists in the larger towns and cities in their home region (oblast).  I asked about the numbers of pediatric hematologists/oncologists in the smaller cities and towns, and was told that while there weren’t enough, there was some available in the larger regions.  With regard to solid tumor patients, I was told that children with solid tumors are cared for at a different hospital in Almaty.

Kids with acute lymphoblastic leukemia (ALL) here are treated according to the German BFM protocol.  When I enquired about survival rates, they told me that their 5 year survival rates were about 70-75%.  For acute myeloid leukemia (AML), their survival rates are only about 50%, but this rate is higher than I expected given the more intense chemotherapy required, and the fact that AML patients are at much higher risk for relapse.  Right now there is no capability for either autologous or allogeneic stem cell transplantation, but I was told they hope to have this capability in the next year or two.  From what I understood, doctors here will often travel to other countries to learn these techniques - for transplant, they will probably go to Israel to learn.

I was subsequently taken to the radiology department where I was introduced to their “CT doctor” and shown the CT scanner (Toshiba).  I was told that in the new hospital building that’s being constructed, they’ll have a new CT scanner (Philips) with a digital imaging system instead of their current film-based system.  They also told me that when this new building opened in 2009, they would also have an MRI machine as well.  From radiology we next went to the neonatal ICU where, pleasantly, conditions were much better than in Kostanai.  There were a number of brand new isolettes and ventilators, and I was told that this hospital had the ability to support premature infants as small as 600 grams.  Surprisingly, I was told that in the near future, Kazakhstan will adhere to WHO guidelines and attempt to resuscitate and save premature infants as young as 22 weeks gestation.  While I didn’t have a chance to see them, the hospital also has wards for gastroenterology, trauma (including burns), general surgery, and two “reanimation” units (ICUs).  Alzhan, my guide, took me to meet her mentor, Dr. Mashkeev, clearly one of the senior doctors in the hospital.  Both doctors are very interested in celiac disease and are looking for any international collaborators to assist with their research and the care of their patients.  They peppered me with questions about celiac disease, which is about as far from pediatric brain tumors as you can go, and as such I felt bad that I had little to tell them about what was available in the US in terms of diagnosis.

Before long, it was time for me to give my talk.  For reasons that remain unclear to me, of the topics that I offered to speak on (based on the previous tumor boards and talks that I’ve given over the past few years), they asked to hear about Langerhans Cell Histiocytosis (LCH), an uncommon disease that is only somewhat like cancer (it’s an interesting disease where a certain type of immune cell proliferates in bone or skin).  I had a chance to describe the current treatment protocol that we use for treating this disease, and despite the fact that this hospital sees only 3-5 cases per year, they seemed very interested based on the half-hour long question and answer session that followed the talk.  From what I gathered, one of the bigger problems here is the limited laboratory capabilities.  While they have CT and ultrasound imaging, doing cytogenetics and immunohistochemistry is a problem due to lack of access to specialized reagents.  Hopefully, when I get back to the US, I’ll be able to dig around and see if there’s any assistance to be offered by companies that make some of the antibodies used for diagnosing this disease in tissue sections.

After the talk, I had a long visit with Dr. Kulyan Omarovna, who is the director of pediatric hematology.  We spoke at length about the treatment modalities available here, the types of diseases they see, and the directions they want to go in the future.  Then, to my surprise, she ended up presenting me data from three very challenging clinical leukemia cases, seeing my opinion.  One of the patients - a 15 year-old girl from the southern region of Kazakhstan who has been impossible to diagnose over the past month of her hospitalization - sounded to me like like she needed a bone marrow biopsy to make a definitive diagnosis.  You can imagine, then, how shocked I was when Dr. Omarovna asked me if I wouldn’t mind doing the biopsy on the patient myself.  She even went so far as to bring me the needles and the anesthesiologist!  Having been previously told that it was not possible for me to see/treat patients here (not that I would’ve minded doing it), I demurred as best I could, and was ultimately saved by the anesthesiologist who told me that since the patient had already eaten, it wouldn’t be possible to anesthetize her until much later.  I sincerely wish that I had better command of Russian, because there clearly is a great deal of need her for additional expertise and assistance with some of the more difficult cases.  Nevertheless, I told detailed notes on all of the cases and told Dr. Omarovna that I would contact the leukemia experts at my program and see if they had any advice to offer, and then relay that information to her by e-mail.

By the time I got out of there, it was nearly 2:30pm and I still had a long car ride back.  By the time I got to the hotel, I’d been gone for 6 hours, meaning that Julie had been single-handedly taking care of everything for that entire time.  When I got to the room, I could tell that she needed some relief.  She must’ve really had her hands full, because I learned later that after ordering room service she inadvertently gave the waiter a 2000TT tip (about $16) instead of a 200TT tip (about $1.50) for her 1000TT lunch.

For the afternoon, we packed Anika into the carrier and took her for a walk, and then fed her and took the post-meal good mood as an opportunity for us to head down to the restaurant for an early dinner.  It’s amazing how quickly we’ve gone from the dinner-reservations-for-8pm couple to the alone-in-the-restaurant-at-6:00pm family in 4 days.  Nonetheless, Anika was in a great mood during dinner, and we both managed to eat a proper meal and have a much-needed drink.  We were happy to eat in the bar area but were moved by the hostess to the main dining room because the bar area because the bar area could be a little cold and was “not good for baby”.  At dinner, we realized that Anika was beginning to understand the concept of gravity as she began to purposefully launch her toys onto the floor with obvious delight.  Afterwards we decided to try the bottle/book/bath/bed routine, leaving out the bottle and the book for now.  She wasn’t particularly thrilled about the bath, but she tolerated it, and once she was fed, washed and changed, she was feeling good and we enjoyed her playfulness and managed to get her to sleep in short order.

As promised, I’ve included some new pictures - she’s still fascinated by the sight of the camera, and so whenever I try to photograph her she stops smiling and playing and instead stares intently at the lens - so I usually get seriously looking shots, but with a little patience I managed to get some good ones.  The next installment will hopefully be stories of packing our suitcases, or even better, will come from Schiphol Airport as we begin to make our way home.

[Author’s note: Because I brought my fancy-shmancy MacBook Pro with me to Almaty, instead of the 4-year-old iBook that we had in Kostanai, I don’t have a modem, which means no in-room dial-up internet for me. There is WiFi in the hotel, but it’s by the hour, and the signal isn’t so great, so I’m posting three days worth of stuff in one magnum opus.]

Somehow, we all managed to get some sleep Sunday night, but by 5:30am Anika was up and ready to go. The timing was a little unfortunate, because we were told by Nikolai that we had an appointment for her medical exam at 10:00am, which meant that we had only 4 hours to get up, showered, fed, some play time, and then a nap in before we left. We knew that it was going to be a long day, and we really wanted to avoid a total meltdown which likely would’ve happened had she not gotten a morning nap. With some creative shift-work, we managed to accomplish all of this, and by 9:30am we were in Nikolai’s van and on our way.

We made a quick stop at a photo store to get an additional passport-sized picture of Anika for the medical examination form - apparently the passport photos that we struggled to get in Kostanai before we left in November, were too big. This time, Anika was much better in the car - after a 36 hour train ride, I can assume that she’s now used to moving vehicles. As a result, she was also much better with getting her picture taken. As opposed to November’s 25 attempts, this time it only took two quick pictures to get a good one.

From the photo store, we traveled through downtown Almaty to the International S.O.S. clinic. I am now quite familiar with this company - having called a couple of weeks ago in an attempt to help out a sick American Kostanai. They run a fairly modern clinic for tourists, ex-pats, and apparently, international adoptions. While sitting in the waiting area we met an extremely nice father-son pair who were there for their immigration exams. The father is a health economist who works for the CDC and lives in Atlanta, and his son is an extremely handsome, and extremely affable young man who goes to college at the University of Waterloo. It was quite amusing to hear this young Kazakhstani man speak English with a very clear Canadian accent. We chatted for a while while being shuttled between different stations. Anika had to have a quick blood test (a rapid HIV test, apparently required by the US government), vital signs (where she comes in at 72cm in length and 9kg fully clothed), and then a brief exam by a physician. It was a strange place for me to have my first experience of being a pediatrician standing by as he watched his child being examined by another physician. By the time she had her exam, it was nearly noon and Anika had had just about enough. She was completely asleep before we arrived home, which we converted in to her afternoon nap.

While she was asleep, I set out into town to pick up some additional supplies, and also to book Anika’s return flight home. We were told, prior to leaving this trip, that the infant airfare would be substantially cheaper if we bought it in Kazakhstan, and so I was hoping at some point to get to the KLM office to make sure that this was the case. You can imagine my pleasant surprise when I inadvertently came across the KLM office while randomly walking the streets. I ended up booking her flight and was very pleased to find that the fare was not the $800 or so that I was quoted in the US, but a rather fair $140! I also took the opportunity to ask that we be seated in the front bulkhead row, where the airline can provide a bassinet that clips on to the wall, potentially freeing our hands for a bit.

On the way home I stopped by at one of the outdoor food stands and ordered up two doner kebab sandwiches, and a container full of something that turned out to be rice, meat and red peppers, making for a very cheap (800TT) lunch for the two of us. By the time I arrived home, Anika was awake and so Julie and I switched off and she enjoyed her sandwich while I provided entertainment. Before long it was nap-time again - in the hopes of keeping her on the same schedule that she was at while in the baby house. This time it took a little more effort - she fussed for about 30 minutes but was asleep in under 10 minutes once I put her into the carrier and walked her around the room.

Oleg swung by the hotel around 3:30pm to help me fill out all of the paperwork needed for our petition to the US Consulate. None of it was particularly difficult, and we were finished in about 20 minutes. Once were were done, Oleg told me that he expected to file the paperwork today, to hear about our appointment time tomorrow, and that if all was in order, we’d have our consulate interview on Wednesday and at that point we’d receive all of Anika’s immigration documents. I asked him if that was all, and he said that yes, once that was done we were free to leave. I told him that our flight was booked for Sunday because we were told to expect an interview at the consulate on Friday. He was a little surprised by this and suggested that we try to change our flights.

This, of course, sounded like a mighty fine idea to me, and so if things go well on Wednesday, then I’m going to make a beeline for the KLM office and attempt to change our flights to Friday, meaning that we’ll be home two days ahead of schedule. It’s a good thing that we purchased the unrestricted and fully changeable tickets. I hope that there are seats available, because as much as we enjoy being here, we really want to start the work of getting Anika acclimated to life in Boston.

The rest of the evening was fairly uneventful: room service for dinner, a little playtime with Anika followed by a moderately long period of fussiness capped off by falling asleep (once again) in the carrier. I’m going to send a letter to the woman who invented this particular brand of carrier to ask her what the secret is, and also to thank her. Julie’s sleeping even as I finish writing this, and I’m going to spend the next couple of hours in the hotel lobby working on two lectures that I’m giving tomorrow. Hopefully tomorrow, since we have no “official business”, I’ll be able to snap some good photos of Anika.

After we got settled in on the plane, the pilot informed the passengers that the flight to Almaty was going to be relatively short, again likely due to the strong tailwind: only 6 hours to travel the 3800 miles. Fortunately, I managed to get several hours of solid and uninterrupted sleep. Unfortunately, Julie didn’t, and this definitely factored into today’s events.

On arrival into Almaty, we herded into the immigration and customs area, were cleared by immigration easily, and went to wait for our bags. Within a few minutes we were approached by an American woman who asked if we were Sam and Julie, and introduced herself as part of a couple returning for their 2nd trip to adopt a child from Almaty. They had read our blog and had recognized us from the airport. We were introduced to another couple who where also here for their 2nd trip (for their second Kazakhstani adoption). While waiting for the bags, we swapped stories and exchanged phone numbers. As opposed to last time, where all of the families that we met were in the very first part of their adoption process and all dealing with the anxieties associated with the legal proceedings, this time it much more relaxing to meet other Americans since we were all further along in the process and as a group had a better understanding of what was going on.

We opted to completely (and legally) ignore customs this time thereby eliminating the horrible harassment that we received on our first trip, and within minutes spotted Nikolai who helped us get through the gauntlet of taxi drivers that lines the only way out of the baggage claim area. By the time we were out of the airport it was about 6am and it was still dark outside. It’s cold here, but no more so than Boston, and here there’s evidence of a recent snow. Because there was absolutely no traffic on the roads, we made it into town in relatively short order. Along the way, Nikolai told us (as best as he could with our limited Russian and his limited English), that there was a lot of snow in Kostanai and as a result, Anika and the head nurse weren’t flying but rather were coming by train. We had heard that the train from Kostanai to Almaty took two days, and so we asked Nikolai when he thought that Anika would arrive. Both of us just about fell over when he told us that she’d be arriving at 9:00 am! We had planned on taking Sunday and most of Monday to recover from the travel, gather up the various supplies that we’d need (diapers, food, stroller, etc.) and be ready to meet her at the airport tomorrow afternoon. Instead, we realized that we had just a few hours to get prepared.

We were at the Hotel Kazzhol by 6:30 and as we were pulling in, so was another van, which just so happened to contain the two other American couples that we had met at the airport. It turns out that not only are all of us staying in the same hotel, but all of us are on the same floor, within 10 doors of each other. We got into our rooms as quickly as possible, unpacked, and cleaned up. Because she had barely slept the entire time we’d been traveling, Julie was desperately in need of a nap, and so I ended up trekking out to the grocery store to stock up on baby items. Despite the gray skies and deserted streets, there was something very comforting about returning to Kazakhstan. It was nice to see familiar sights and feel comfortable in a place that it so obviously foreign to me.

The grocery store was fairly empty making me just about the only customer - this meant that I was asked (in Russian) if I needed help no less than a half-dozen times. Fortunately, I knew enough to be able to make people realize that I could get around just fine. Five thousand tenge later (in diapers, baby wipes, baby food, milk, juice, yogurt, and bottled water), I headed back but was waylaid by the woman making fresh bilinis just outside of the grocery store door. For 200TT, I ended up with a stack of piping hot bilinis just as my empty stomach was starting to make itself heard.

On returning to the hotel, Julie and I made quick work of the bilinis and decided to go out in search of breakfast - we didn’t realize, until we had walked around for 10 minutes - that there was a breakfast buffet included with our room. So we headed downstairs and settled in to enjoy a spread of eggs, various meats, fruit, and of course, instant coffee. I got up to get a second cup of coffee and was returning to the table when I noticed that Julie was no longer there. Not knowing what was going on, I put down my coffee and looked around and wouldn’t you know it - Oleg, Saule (the head nurse) and Anika were standing in the door from the hotel to the restaurant! Hardly the Hallmark-esque reunion scene that I pictured, but who cares!

Anika looked great, if not a little shell-shocked at both of us rushing up to her to say hello. It didn’t take too long for us to realize that she didn’t quite remember us the same way that remembered her. It was quite clear that she was still very attached to the caregivers at the Delphin House (and for good reason). I downed my cup of coffee and stuffed another bilini into my mouth and followed Julie and Saule upstairs. Once back at the the room, we unbundled Anika had a look at her — besides being all hot and sweaty form being bundled - she was also a little fragrant from the long, long train ride. We gave Saule two full suitcases for her return to Kostanai: one containing a bunch of baby clothes for the orphanage, and the other containing a bunch of the medical supplies that we had both gathered over the past month. We’re sending back spinal needles, bone marrow biopsy needles, stethoscopes, another BP cuff, boxes of suture material, children’s vitamins, antibiotics, and assorted surgical supplies. We asked Saule to please give anything that looks like it belongs in an operating room to Dr. Sultan at the Cancer Hospital, while everything else can be kept for the orphanage.

Within about 10 minutes, Saule and Oleg were ready to go. We asked some final questions about her sleeping and feeding schedule, and then it was time to say goodbye. Anika was crying real tears, which made us both appreciate even more the depth of her feelings for the people who have done such a remarkable job of caring for her over the past 8-1/2 months. We have no doubt that she will grieve their loss at the same time that she learns to adjust to us, her new home, and an entirely new environment. It’s quite a challenge for a anyone to have to face, let alone a little baby, but I am confident that she’ll be up to it, and I hope that we’ll do a good job in assisting her.

Once Saule and Oleg left, we realized that all three of us were now completely out of sync, and that it was now time for everyone to start figuring out how to get back on schedule. The day ended up being a blur of very messy feedings, long bouts of consolation, and fragmented sleep. It’s much harder to take care of a baby when you don’t have the comforts of home or even our little apartment in Kostanai. We have no way of boiling water, no microwave, and only a very small refrigerator. Anika had to make the switch from regular hot meals to milk warmed under the hot water tap, and room-temperature baby food. At one point I ended up putting her in the baby carrier (which, by the way, she really seems to enjoy) and walking her around the hotel. I was on my second lap - across the second floor, down the stairs, around the lobby, up the stairs and across the second floor - when I ran into a couple with a little baby also in a baby carrier. It took about two seconds for each of us to realize that we were in the same situation, and before long we were being introduced to Dana and __ and their new baby Tanya. We chatted for a long while, with Anika staring intently at Tanya. it turns out that we saw Dana and her husband on the flight from Almaty to Kostanai way back at the end of September. They ended up adopting from a town outside of Konstanai and had a very, very different experience from ours. They stayed the entire time, meaning that they’ve been here for 9 weeks! Fortunately for them, they didn’t have to endure the separation and then re-orientation, but on the flip side, they sound like they’re really ready to get home.

By 6pm all three of us were fairly exhausted. We broke up the afternoon by taking a walk to a cafe near the supermarket that I visited this morning. Julie’s fatigue got the best of her appetite and so I was left to nibble on her chicken shashlik after filling my stomach with a bowl of lagman and a pot of tea. We also hit the grocery store again for some additional supplies (more bottled water, laundry detergent for hand-washing, and some more juice for Anika). For the most part, Anika was very quiet, watching everything intently as we walked down the streets and walked through the stores.

Once we got home, we decided that it would be best if all of us tried to get some sleep. With some work, we managed to get Anika to sleep in the crib that the hotel provided for the room, and then both of us were asleep by 7:30p. Anika was up once around 10:30p, and then managed to sleep the rest of the night through (if, by “rest of the night through” you mean until 5:30 in the morning).

I apologize for the lack of photos but between everything, my much beloved camera has been relegated to the camera bag in favor of my holding my much beloved little girl.