Deciding to leave their Dallas home and jobs as emergency physicians to live with their adopted son in the Democratic Republic of the Congo (DRC) was not easy, but Andy Kahn, MD, FACEP, and Amy Kahn, MD, FACEP, are pleased with their decision.

The couple, who already had three biological daughters, felt a Biblical calling to care for an orphan, Dr. Andy Kahn said. “We wanted our faith to be reflected in our lives,” he said. They were also influenced, among others, by the medical director of the emergency department where they worked at Baylor Medical Center at Garland, who had adopted a son abroad.

International adoption comes with many challenges. “There is a lot of paperwork involved,” Dr. Kahn said. “You must fill out many documents to allow for a background check, financial screening, and review of your home. A doctor must write a letter stating that parents are in good physical and mental health. Some countries require you to make multiple visits or spend significant time there.” The cost can range from $15,000 to $30,000.¹

But the couple faced one final hurdle, one they continue to battle, when they learned that they couldn’t bring their now 2-year-old son, Daniel, home because the DRC requires that children leaving their country must have an exit letter. In September 2013, the DRC suspended the issuance of such letters after the Kahns had been matched with their son.

“The government initially stated they were concerned about the treatment of children once they left the Congo,” Dr. Kahn said. “Later, they stated the need to reform their adoption process before children could leave.”

It was difficult for the Kahns to know that their son was growing older without knowing them, even though he was being cared for by a foster mother who they paid. “He was not learning English, and we felt we needed to move there because there was no end in sight to the exit letter suspension,” said Dr. Kahn, who met Daniel once in 2014. “We were his legal parents according to Congolese law, so we were in a difficult position, being ethically and financially responsible for him but not allowed to have him leave the DRC.”

Although the couple highly valued their jobs, they wanted to do what was right for the hospital’s emergency department. Not knowing how long they would be gone, they made the difficult decision to ask the medical director to replace them so their colleagues would not be stretched thin covering their shifts indefinitely.

Departure Date Moves Up

When President Barack Obama asked the DRC’s president, Joseph Kabila, for a timely solution to the pending adoptions, the Kahns decided to leave a month earlier than intended, at the beginning of April, in the hope that they would be ready to take Daniel out of the Congo as soon as the exit letter suspension was officially over.

“Our medical director, fellow physicians, physician assistants, and nurse practitioners were all so supportive and covered our remaining shifts,” Dr. Kahn said. “We are hoping to return soon so that we can … say thank you in person.”

Despite overwhelming support, the Kahns had many concerns about making the move. “We had enough savings to support ourselves for a year without an income, but it was risky to give up jobs we loved so much because we didn’t know if we could get them back,” said Dr. Kahn, who noted that his wife worked at Baylor Medical Center part-time and had been the department’s physician scheduler since 2009.

The Kahn family on a hike in the Lola ya Bonobo nature preserve in Democratic Republic of the Congo.

Diseases and health care were concerns, as well. Anyone entering the Congo must have proof of getting the yellow fever vaccine. It is important to wear insect repellent to avoid malaria because it is transmitted from mosquito bites. “We take Malarone daily to prevent malaria,” Dr. Kahn said. “Our son has had diarrhea, and his stool studies were positive for Giardia, so he is now taking metronidazole.”

The family’s health insurance covers everyone, including Daniel, while in the Congo. “We invested in medical evacuation insurance in case of an emergency,” said Dr. Kahn, noting its affordability. “The health care in the DRC is not at the level of the United States, but there are a few places here that are very impressive.”

Of course, adapting to living in a new country was another challenge. “I was afraid my daughters [ages 7, 5, and 5] could get sick and not have the same health care options we are accustomed to in Dallas,” Dr. Kahn said.

But the family is adjusting well, and each day is getting better. The girls already attended a school and are now getting home-schooled.

Easing a Difficult Transition

Dr. Kahn believes that being employed as an emergency physician made the move to Africa possible. “There may not be a full-time position available as soon as we return, but at some point, I assume something will open up. The nice thing about emergency medicine is that you can pick up shifts at various locations. I could always do some locum tenens work while I wait for our emergency department to have space for us again.”

According to Dr. Kahn, there are 500 other American families in their same situation, but most people cannot quit their jobs and relocate. “Many dads are staying home to work and raise their biological kids, while the moms come here to be with the adopted children,” he said. “I know other doctors who cannot leave their jobs because they have a practice, an office, a patient/referral base, and employees they are responsible for. As emergency medicine physicians, we do not have those responsibilities, and if we leave, we will most likely find work when we return. People will continue to have emergencies, and they will need us to stabilize and manage those emergencies.”

While in the Congo, Dr. Kahn became connected with a clinic director in Kinshasa. The clinic has been open for almost two years and is operated by a director and manager from Montreal. It is equipped with Western equipment, X-ray machines, ultrasound, a full laboratory, and a full pharmacy. It quickly expanded and now has an inpatient wing, labor and delivery area, and operating rooms.

Dr. Kahn was offered a paid position at the clinic but decided it was best to volunteer because it was more geared toward primary care than emergency medicine, and he is not yet fluent enough in French. “I wanted to have the flexibility to stay at home and help my wife with our four children and be able to leave as soon as the DRC government granted our son’s release,” he said. “If the suspension extends beyond our savings, I will have to decide whether I should take this job or fly back and forth to the United States to support my family.”

While at the clinic, Dr. Kahn has learned a lot about the diagnosis and treatment of malaria because of its prevalence. “I am learning how to practice without a CT scanner,” he said. “Most of the doctors here share the same medical knowledge as we do, so it is reassuring that medicine is the same worldwide.”

Rallying Support

In addition to President Obama, the Kahns and other US parents adopting children have had great support from many other governmental representatives and officials, including numerous senators and representatives, such as Sen. John Cornyn of Texas, the US Department of State, Secretary of State John Kerry, and the entire US embassy staff in Kinshasa.

Dr. Kahn said ACEP’s Legislative Advocacy Conference and Leadership Summit and the experience he received as an ACEP spokesperson have made him better equipped to communicate with legislators’ offices and the media. “All of my calls regarding the Sustainable Growth Rate and supporting emergency medicine paid off,” he said. “We are grateful for all of the support.”

At press time, there hadn’t been any official announcement to release exit letters. “I hear rumors, but they are always wrong,” Dr. Kahn said. “I hear there may be news this week, so I am trying to keep my expectations low so that I will not be let down again. I will pray that this time we will hear the great news that they will let our son, and all of the other adopted children, come home.”

Reference

1. US Department of Health and Human Services. Costs of adopting. Child Welfare Information Gateway Web site. Accessed May 7, 2015.