Brooklyn Leitch, MD - Adoption Medicine Clinic May 2020

I chose to do my global health elective in adoption medicine. All patient care was performed as an outpatient and was virtual. Telemedicine had recently been established, so it was interesting to have this added perspective. I took part in clinic 2-3 half days per week. Our patients included new international and domestic adoptees, as well as follow ups. For most of these patients, we performed a medical assessment and screening. For new patients, there was a joint occupational therapy assessment as well. It was a great opportunity to see the kinds of things that Megan asked about and to learn about her recommendations. I also had the chance to speak with her separately and learn more in depth about the goals of OT evaluation and therapy. It was particularly interesting to learn about her work with kids with sensory processing issues. In addition to seeing recent adoptees, we also saw patients who were currently in foster care. Many of our foster care and domestic adoptees were referred to our clinic to be evaluated for fetal alcohol syndrome disorders. Although I knew the basics of FASD, I did not realize the full spectrum of disease and the impact it can have. It was a unique experience to hear about the struggles patients and parents were having and to view them from the perspective of FASD. I learned about counseling families on expectations, and ways to approach their children with a history of FASD, neglect, trauma, and/or multiple transitions.

In addition to clinic, I participated in preadoption counseling and medical reviews. Dr. Eckerle’s counseling sessions with parents starting the adoption process involved going through a list from the agency of medical conditions the parents definitely would not be okay with, would consider, and would definitely be okay with. Not only did I learn about how expectations vary between countries based on their reports, but more broadly it was a chance to reconsider how we explain potential diagnoses to families and their short- and long-term impact. This was reinforced in my reviews and in clinic. In reviews, I would go through the records we were sent (sometimes a lot, sometimes only a few) and interpret them for families. This included summarizing the child’s health history and identifying any areas of concern or consideration, and recommending requests for more information (measurements, developmental skills, labs, imaging, consultation with a specialist, therapies, etc.). It was a new challenge to have to counsel families on the unknowns and possibilities when the child was not right in front of me and I did not or could not have all of the information I would normally have to make decisions and recommendations. Although I did not do my elective internationally in a LMIC, I did get a sense of clinical decision making with less resources. I had to decide what the priority was among the information that I asked families for – what would be of most help and importance – and then give them the best information that I could based on what I had. I also learned a little about other healthcare systems by reviewing their records. As parents continued to send updates as they progressed in their adoption, I was able to learn from previous reviews and see more of the process while answering their questions. When I did face diagnostic challenges, I had time to do research and I was able to consult different specialists and learn from them, too. During my month there were quite a few interesting and rare diagnoses.

When not in clinic or doing preadoption medical reviews, I had education time. Through didactics, I learned more about FASD, unusual medical diagnoses, and other factors impacting adoptees. I watched videos, read articles, and reviewed the presentations of previous residents. One of my biggest learning opportunities was talking to Deb Harder, from Children’s Home (an adoption agency). She has been doing this work for decades, and it was fascinating to learn about the origins of international adoption and how it has changed over the years. I learned so much about both domestic and international adoption and the full process that parents go through. This helped me better appreciate the role of medical reviews, too. In summary, I really enjoyed this elective and would definitely recommend it to other residents. 

Favorite quote: If you don’t like something, change it. If you can’t change it, change your attitude – Maya Angelou. Dream, believe, achieve! 

Favorite travel destination:  Paris

What the world needs more of: Kindness

If you weren't a physician you would be: Honestly, I’ve never had a second career choice…..may be a travel/food blogger.