The Story Behind The Photo: Celebrating Progress

At first glance, there may seem to be nothing out of the ordinary in this photo of babies resting in their cribs in an orphanage in China. But if you could step inside this room, inside this moment 20 years ago, you would notice something not quite right. You would not hear a single sound. It would be as silent as the photo you see now on your screen. 

On her first visit to China in 1997, Holt’s senior director of adoption services, Susie Doig, holds a child awaiting adoption in orphanage care.

In December 1995, I began my career in adoption working in Holt’s newly formed China program, helping families adopt baby girls living halfway around the world. In the early 1990s, Holt and many other U.S. agencies became aware of the urgent need to find families for children in China, and quickly put the staff and infrastructure in place to start meeting this need. Orphanages in China were overflowing with infant girls — girls unable to remain in their birth families because of China’s one-child policy and the society’s longstanding need for a male child to ensure a family’s long-term wellbeing.

While I understood on an intellectual level that a great need existed, it wasn’t until 1997, when I took my first trip to China, that I came face-to-face with that need. During my stay in a rural province in China, I was able to visit some of the children waiting to be adopted. It was truly a trip of a lifetime, but one moment in particular stands out from all the others.

Holt’s in-country staff person, Xiao Xiao, had taken me to visit a Holt foster family recently charged with caring for a child from the local orphanage. It was obvious that this foster mom was incredibly nurturing and caring, and instantly made it her life’s mission to nurse this little one-and-a-half-year-old girl back to health. Most of us picture a one-and-a-half-year-old and think of a busy little toddler engaging in playful interactions with adults, taking her first steps and exploring the environment around her.

But those weren’t possibilities for this little girl yet.

Instead of celebrating important firsts or helping this child learn how to feed herself or speak her first words, this foster mom’s mission was to teach this little girl how to swallow. At 18 months old, she had never been given the opportunity to develop her throat muscles or the coordination needed to successfully move food from her mouth to her stomach on her own. Tears welled in my eyes as the foster mom gestured to explain how each and every time she put congee or formula in this child’s mouth, she had to massage her throat muscles to help her train her body to learn the basic skill of swallowing. This little girl wasn’t toddling around or repeating consonant and vowel combinations like most children her age. Instead, she sat docilely in her foster mother’s arms and made little grunting noises, almost animal-like in tone, as if she had been left on her own to discover her vocal cords and what exactly she was supposed to do with them.

Gone is the silence in rooms full of babies, waiting for their next meal but knowing that crying or fussing will not bring it sooner. Cribs have been replaced with beds for toddlers and older children. Some care centers have special baby units for medically fragile infants, including incubators to care for the most fragile during their first days and weeks of life.

My mind could not grasp what circumstances had led to this little girl being at square-one after a year and a half of life. I just could not comprehend what circumstances could have led to this reality for this child.

Xiao Xiao patiently explained to me that the country’s orphanages were simply overwhelmed, and sometimes just two or three nannies were responsible for caring for a roomful of 30 or 40 newborn infants. These “ayis” — caregivers — struggled just to keep these children alive, and adopted shortcuts like cutting the tops off the nipples on bottles so formula or congee could flow more easily into babies’ mouths and stomachs — unwittingly bypassing the normal suck reflex and eye contact that is a critical part of infant feeding. Very few toddlers or older kids were in care, due to high infant mortality rates. There simply weren’t enough resources available to treat common childhood illnesses, to personalize care for children whose health or development fell below normal standards, or to tend to anything other than the babies’ most basic physical needs in an attempt to keep them alive.

Flash forward to 2016, and Holt staff traveling to China for the first time today encounter an entirely different scene when they arrive in country.

More than a decade of unprecedented economic growth, paired with a central adoption authority that is internationally recognized for its well-organized, smooth-running and transparent system has resulted in tens of thousands of children being adopted. As a result, child caring institutions are almost unrecognizable from the social welfare institutions of the 1990s. Many orphanages now have updated facilities or new social welfare buildings, in part because of the mandatory donations adoptive parents pay to cover the cost of care for their child prior to adoption.

But what’s even more remarkable than the buildings is what’s taking place inside them.

Gone is the silence in rooms full of babies, waiting for their next meal but knowing that crying or fussing will not bring it sooner. Cribs have been replaced with beds for toddlers and older children. Some care centers have special baby units for medically fragile infants, including incubators to care for the most fragile during their first days and weeks of life. Other institutions have physical therapy rooms bustling with staff and volunteers who are busy encouraging children with cerebral palsy and limb differences to use the equipment at hand to walk, run and jump. You might see older children attending school or learning a vocational trade like sewing or knitting. In some cases, orphanages also serve as a community resource center for kids, where children come for learning opportunities or services during the day and then return to foster families in the afternoon to take part in household activities and live their day-to-day life as part of a family.

Like many public institutions in the U.S., some care centers in China have more resources than others and some still need extra support to be able to provide the same level of care and stimulation to children. We still encounter isolated orphanages that need better models of childcare practice. But when we do, our staff in China is able to draw on Holt’s strong reputation and relationships to help strengthen the quality of care that the children receive.

Today, healthy infants coming into care no longer wait to be matched with a family half-way across the world, but have adoptive families in their own communities coming forward to welcome them as their daughters and sons. Because of the increase in resources and improvement in the overall level of care and services available to children, it is no longer just the youngest and the healthiest who have the chance to know the love and belonging of a family. For older children and children with special needs, the possibility of being adopted didn’t really exist the first time my feet touched Chinese soil. Two decades of international adoptions later, increased resources and a commitment to finding families for traditionally “hard-to-place kids” have allowed a new generation of vulnerable Chinese children to know the love and belonging of a family.

That’s progress worth celebrating this National Adoption Month.

Susie Doig | Senior Director of Adoption Services

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