Category Archives: Paperwork

Embassy Day Update

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!

Embassy Day!

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.

miniature_pool

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.

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.

Getting Closer …

There are so many steps in the adoption process from Kazakhstan that I’m amazed it actually works. As I’ve detailed (below), our “dossier” (now totaling about 250 pages) had to be assembled and translated into Russian. That was no small feat, and took about 3 months time, a good bit of money, and so many trips to the Massachusetts Secretary of State office that they actually took pity on me one trip and apostilled all of my documents while I waited (instead of making me return).

Once the dossier was assembled and translated, it was shipped to the Kazakhstan consulate. It turns out that there are two in the US: one in New York City, and one in Washington D.C. Ours ended up going to NYC and spent a month there before being shipped overseas to the Ministry of Foreign Affairs.

Once approved, it is sent on to the Ministry of Education (MOE). The MOE assigns us to a region (an oblys), and then once a child is available in our oblys, we’re issued a letter of invitation (LOI). You can’t get a visa to travel to Kazakhstan without the LOI. It is forbidden to use other visas’ categories (for example a tourist visa) to enter Kazakhstan for the purpose of adoption. Our agency deals specifically with two regions: the Astana oblys and the Qostanay oblys.

Last week we received word from our adoption coordinator that our dossier had made it to the MFA and should’ve headed to the MOE on August 17th. Once it’s there, our agency’s in-country staff will be able to start asking about our region. We were told that this could take a few weeks, and that it would be not out of the realm of possiblities for us to leave for Kazakhstan towards the end of September or beginning of October.

As you can imagine, with this being only 6-8 weeks away, our first reaction was to nearly throw up. As excited as we are about the adoption, we know that everything that we’ve been through thus far has been the easy part. Sort of like the biological production of a child. For the most part, everything up to the moment of onset of labor is (for many, but not all), fairly uneventful and usually follows a predicable course. That being said, we’ve ramped up our preparations. Over the past weekend we converted what was our guestroom into a baby’s room. Out went the old bed, the cable, all of the old stereo junk that I’ve had since grad school. In came a nice new rug, a new lamp, an antique table from Julie’s grandmother’s house, and a toy chest. The crib and changing table, which had been in the basement in pieces, were assembled in relatively short order. Thank goodness for the Internet, where I was able to find instructions. We’re going to get a bare wood dresser and finish it ourselves. That and some shelves, a video baby monitor, diaper dispoal thing, and some other finishing touches and we’ll be almost ready.

We road-tested a 1 year old child – the daughter of one of my close friends and colleagues – and managed to keep her entertained for 6 hours straight without anyone melting down. Satchel and Milo were intrigued by the new creature and her smell – we take this is a good sign. We also had a chance to spend several hours pushing around a nice baby jogger. This may be the stroller for us.

All in all, pretty exciting. I’ll put up some pictures as things begin to take shape.

One small step for our paperwork …

It’s been about 10 weeks since I’ve written anything, and this is mainly because there hasn’t been much to write about (except for endless navel-gazing and introspection). We just received word today that our paperwork, which has been at the Kazakhstan consulate in New York City (Google Maps satellite view) for the past 3 weeks, has cleared the consulate and is in transit to the Kazakhstan Ministry of Foreign Affairs.

And now … we wait some more. From what I understand, our application will be reviewed by the MFA and then by the Ministry of Education and Science. It is the MES that finds us a child (or children) and issues the invitation letter to travel to Kazakhstan.

Holy Crap! We’re Approved!

approved

I figured that given the glacial pace of the US Government, that our I-171H approval form wouldn’t arrive here for 6-8 weeks. Well, consider me gobsmacked. We got home from work yesterday and found an envelope from the USCIS in the mail with a shiny, new I-797C form entitled, “Notice of Favorable Disposition Concerning Application For Advance Processing of Orphan Petition”.

It also indicates that a copy has also been sent to the American Consulate in Almaty, Kazakhstan, which means that we’ve (virtually) made our first steps into that far-away place.

This notice officially completes our dossier. We heard that we should expect a 2-3 week turnaround time on having everything translated, and then it will be submitted to the Kazakhstan consulate in NYC. From there, the waiting time for an invitation to travel is about 4-8 months. Our adoption coordinator told us that she has seen families travel in as little as 3 months from the time the dossier was submitted, up to 8-9 months. The average time is about 5-6 months.

For us, this means that if the dossier goes out in the next couple of weeks, we could travel as soon as August (holy crap!) or as late as November. In either way, it looks increasingly likely that we’ll have a child by the end of the year (holy crap!).

Biometrics

Biometrics (n): 1. The statistical study of biological phenomena. 2. The measurement of physical characteristics, such as fingerprints, DNA, or retinal patterns, for use in verifying the identity of individuals. 3. A process that takes you to a USCIS (formerly INS) office and makes you wait in line.

It’s been a while since I’ve written anything, and that’s mainly because all I’ve been doing has been gathering, notarizing and Apostilling papers. Trust me when I tell you that it would not make for very compelling reading. That being said, the fact that we’re nearly done gathering all of the papers only 3 months after going to our first orientation meeting means that we’ve made very good time.

Last week we received our “invitation” to come downtown to be fingerprinted at the USCIS (US Citizenship and Immigration Services) office. It’s a good thing that we live in a major metropolitan area. I could only imagine how miserable it must be to have to drive hours to interact with state and federal government offices for all of the papers needed for this process. We managed to make it in, get digitally fingerprinted, and get out in under an hour. It’s a little creepy knowing that our fingerprints are now likely part of some giant government database.

We also managed to get over to the Commonwealth of Massachusetts Secretary of State office to drop off another stack of notarized documents for Apostille certification. I think that the Commonwealth managed to get nearly $300 out of us in the process. FedEx is another beneficiary of the adoption process. Tomorrow I’ll send out this stack of papers and then we wait. We’re waiting for two things, mainly: first for USCIS to process our I-600A form (”Application for Advance Processing of Orphan Petition”). Hopefully this won’t take too long, but it can take as long as 3 months. The USCIS should send us an I-171H form (”Notice of Favorable Determination Concerning Application for Advance Processing of Orphan Petitions”). With this in hand, we’re approved to bring up to two orphan children into the US. While we’re waiting for this, our agency will be having all of our paperwork translated into Russian (I assume).

Once we receive the I-171H, we have that notarized and Apostilled (of course), and then that will complete our dossier. Once the translation is done, the whole thing is sent to Kazakhstan and then we wait some more.

There probably won’t be much to write about here until things move along a little, but I figured now would be just as good a time as any to update our progress.

Paperwork Part Deux

I was pretty proud of us.

We managed to get through the home study and its paperwork in under 6 weeks. I thought we were cruising along. I also thought that when our social worker referred to our dossier she was referring to the paperwork generated from the homestudy.

For those of you not in the know about this adoption thing, the homestudy is a social-worker driven process that evaluates your home and yourselves to determine whether you are fit to adopt a child. It was no small feat. We were told that it can take several months to complete. There’s a goodly amount of paperwork involved including:

  • An application
  • A contract with the home study agency
  • Three notarized letters of reference
  • Acknowledgement of their grievance and appeals procedure
  • Medical insurance information indicating that your carrier will cover your adopted child
  • Notarized medical reports for both of us
  • Criminal record checks
  • Department of Social Service central registry checks
  • A long autobiography statement from each of us, please a lengthy statement from us as a couple
  • Our tax return from last year
  • Acknowledgement of “risk”
  • Assignment of guardianship
  • Acknowledgement that we won’t employ physical discipline and that we don’t own guns
  • Acknowledgement of our “client rights”
  • Copies of our birth certificates and marriage license
  • A “child acceptance sheet” where you indicate what physical ailments or defects you’d be willing to accept
  • An international country agreement where you choose your country
  • Photos of us
  • Photos of the home
  • Three visits with the social worker

I thought that this was all we needed I was wrong.

Libby, the woman who heads up the Kazakhstan program for MAPS e-mailed me the paperwork requirements for the dossier. I almost had a stroke.

Here’s the homework for the month of March:

  1. Two sets of photographs of everyone living in the house, as well as photos of the outside and inside of the home.
  2. The completed home study.
  3. A summary of the completed home study.
  4. Copies of the home study agency license.
  5. Copies of the home study social worker’s license.
  6. Letters from our employers acknowledging that we have jobs and what are salaries are.
  7. Detailed financial information and housing description.
  8. Letters from our banks verifying the contents of our accounts.
  9. Detailed medical reports for each parent.
  10. Copies of the license of the physician providing the medical reports.
  11. Letters from a psychologist attesting to our coping skills.
  12. Copies of the license of the psychologist attesting to our coping skills.
  13. Six certified copies of our marriage license (what are they going to do with six of these ?!)
  14. Statements assigning guardianship in case something happens to us.
  15. Statements accepting assignment of guardianship by the people we designate.
  16. Six copies of our passports.
  17. Letters from our mortgage company confirming ownership of our property.
  18. An adoption placement agreement.
  19. A post-placement requirement agreement.
  20. An acknowledgement of our post-placement obligations.
  21. Registration with the Kazakh consulate.
  22. Clearance from our local police department.
  23. Clearance from the FBI (via fingerprinting).
  24. Approval from the INS.
  25. Power of attorney for the adoption agency’s agent in Kazakhstan.

All of these are done in at least duplicate, each copy notarized, and each notarized copy has to be Apostille certified. I had no idea what this was until this week.  Apparently an Apostille is an acknowledgement that the notary has been designated competent to issue certifications.