IN THE WORLD'S most populous nation, orphanages swell with disabled and unwanted children. A Northwest agency has helped change the fate of China's young outcasts, not only through adoption by Americans, but through better care for those left behind.
LUOYANG, China - In a bone-cold warehouse for castaways, a former Chinese army officer and a Seattle-area adoption agency are seeding a small revolution for China's unwanted children.
Progress is slow, and best measured one child at a time:
A 15-year-old with cerebral palsy starts first grade and makes his first friends;
A 10-year-old has surgery to straighten his twisted legs, giving him a chance to walk;
A 9-year-old girl is fitted with metal braces to keep her walking as her muscles deteriorate.
This hope plays out in the Luoyang Welfare Institute, a stark government foundling home that hints at a new future for China.
The institute opened two years ago to house this city's undesirables: those born paralyzed, blind, with missing limbs or, simply, female. The 174 children who lived here in March were divided between those waiting to be adopted - mostly to American families longing for children - and those destined to live as wards of the state.
Now this six-story concrete building has become a magnet for hundreds of Chinese parents who, despite their nation's one-child tradition, clung to their imperfect babies.
In a country squeezed with one-fifth of the world's population, the primary concern about children is that they number too many to feed. Under 50 years of Communist rule, China has adopted hard-line family-planning laws. That, coupled with a long tradition that honors male heirs, encourages families to have but one child - and hope for a boy.
Extra children become more burden than blessing. Orphanages around the country swell with the leftovers - abandoned girls placed in the adoption pipeline and disabled children too expensive to care for.
The disabled who are not cast out often are harbored at home - sheltered from stares, kept from school, lacking the kind of social programs Americans take for granted.
But in three short days this spring, in Henan Province, that began to change.
Throngs of damaged children found their way to the Luoyang orphanage - drawn by the faint prayer that visiting American doctors might repair their broken bodies and minds.
The visit by 10 American medical volunteers was the culmination of four years of work by the World Association for Children and Parents (WACAP), a private, nonprofit adoption agency based in Renton.
Beyond the blur of treating dozens of disabled and abandoned children, the Americans got a rare glimpse of a part of China that remains largely walled from the world.
Since U.S. President Richard Nixon's famous visit in 1972, cracks have been wedged into China's historic isolation. Sometimes the wedge is political sway, sometimes economic necessity, sometimes the indomitable force of fax machines and the Internet.
And sometimes it is babies.
Long day's journey
In a poor farming village, perhaps 200 miles west of Luoyang, Kang Zui Ping wakes her oldest child, 10-year-old Bai Dian Qing, but leaves her younger two to sleep.
Two months shy of his first birthday, just as he was learning to stand, Qing suffered a scorching fever. His mother thinks the villain that crippled her firstborn was hepatitis A.
The more likely culprit was polio, a disease erased in the United States with the introduction of Jonas Salk's vaccine in 1954. In the rural reaches of China, polio remains a threat despite government assurances that the vaccine is widely used.
Qing has never walked. The fever left his legs twisted and curled; he has no motor function below his waist.
There are no doctors in Kang's village, and no specialists available to a poor farmer's family. So Kang has traveled to the city before; three years ago, she brought the boy to see a surgeon visiting from Hong Kong.
The surgeon straightened Qing's legs enough so the growing boy could move on his own, using a pair of crutches soon battered from being dragged through their mountain farming village.
On this day, Kang again dares to hope. She has heard "American experts are in town" and wants to be first in line to see them. If cures are handed out, she doesn't want to miss one for Qing.
The trip will rob her of a full day in the wheat fields that feed her family. The land once was run by a commune, its yield closely watched by Communist leaders. Now, families have their own plots, and eat what they can grow or trade.
But little commerce filters down to Kang's level, so crops mean life. With three children, her burden is great.
The pilgrimage out of the mountain village begins with a seven-mile walk to meet the bus. Qing manages some of it on his own. When he tires, his mother - slight but sturdy from farm work - totes him piggy-back, both crutches tucked under one arm.
The bus ride to Luoyang takes several hours - Kang loses track of how many. Then mother and son trudge 40 minutes through the city, until they join a stunning procession of disabled children through the rutted, narrow streets surrounding the orphanage.
Their presence marks a coming-out party, of sorts, for a foundling home that has stood here in one form or another for 40 years.
Until now, the Luoyang Welfare Institute was a closed place. A steel fence separates the grounds from Guangzhuan Street. Those who gained passage through the gate and past the guard shack were met by a steel grate across the front door, secured with a large bicycle lock. Those left to the mercies of the orphanage seldom ventured back out.
Even longtime neighbors weren't sure what happened behind those gates.
"I've never seen so much activity there," said Li Yu Lan, 60, a storekeeper who has lived and worked next door for 40 years.
Li's shop features one counter, from which she sells Happy Cola, Robust-brand bottled water, gum, candy, cigarettes and alcohol. Coal burns in a bucket stove. A single light bulb hangs from the low ceiling.
The shop fronts a mah-jong parlor.
Li can smell the gristly pork scraps stewing for lunch behind the institute walls. But she has never known how many orphans were housed there, or that some are sent to homes overseas.
And until she saw the crowd of wishful parents gathered in the streets, she never knew so many disabled children were hidden away in Henan homes.
"It's good not just for the children in the orphanage, but for all the handicapped children," she says. "I hope there will be more of this."
She watches as families haul disabled children on rusted bicycles, on stooped backs and in a dilapidated wheelchair. Parents carry children stricken with cerebral palsy, some of the small bodies board-stiff, some flopping like bags of rice. A stocky teenage boy rides sidesaddle on the back of a bicycle, his metal leg braces clanging, as his father pushes him through town.
The Luoyang Welfare Institute is a socialist Lourdes in the shadow of Tractor Factory No. 1.
Heart of a city
The institute stands in what locals call "Old Luoyang." It is miles from the four-star hotels, factories and high-rise apartments featured in a glossy brochure designed to attract foreign investment to the city.
In Old Luoyang, people live in compounds of tiny, crumbling brick houses. The streets are too narrow for the city's articulated buses to navigate; the potholes yawn deep enough to swallow the minibuses that prowl here.
Luoyang is the premier city in Henan Province. It is considered the cradle of Chinese civilization, home to emperors of several dynasties. It is where Buddhism took root in China, and paper was first used.
Tractor Factory No. 1 is the Boeing of this industrial region, producing more farm machines than any other plant in China. There is a copper mine and a large glass factory.
But Henan remains a poor province. The per-capita annual income is $508. The foreign investment booming in Beijing, Shanghai and the country's southern provinces hasn't reached this far.
It is crowded, even by Chinese standards. Geographically, Henan Province is about the size of Oregon. It holds 92.4 million people - about the same number that live west of the Mississippi River.
A promise made
Since China approved overseas adoptions in 1992, more than 15,000 of its children have been sent to American homes. WACAP, one of 99 U.S. agencies sanctioned to work in China, has placed 532 of those children.
But Janice Neilson, the agency's executive director, knew that was little solace to those grown too old or born too disabled to gain favor with foreign parents.
So did Pei Zhong Hai.
Pei, a former officer in the People's Liberation Army, runs the foundling home in Luoyang.
It is he who stamps orphans ready for release to foreign families. And it is he who watches over those not chosen.
So he exacted a pledge: If Neilson brought aid to Luoyang's discarded children, he would open the institute's clinic and classrooms to families from the surrounding province.
And he would persuade local Communist Party officials to abide the tenuous relationship.
The Luoyang Welfare Institute is the modest hub of a two-way flow of international traffic. As babies flow out of the orphanage to U.S. parents, U.S. largess flows back: medical volunteers to treat Chinese orphans and train Chinese doctors; money to build an operating room, a library and the beginnings of a humble school.
Despite those footholds, the future holds no guarantees. And scrutiny of the work remains suspect.
The Seattle Times waited more than a year to gain permission from local, provincial and national officials to visit the Luoyang Welfare Institute with WACAP workers. That permission came with a plea:
"Please do not do anything to harm this relationship," said Lu Guo Xin, an official from the Foreign Affairs Ministry sent to monitor the March visit.
Even so, this grass-roots revolution has weathered the vagaries of U.S.-China relations. Deep chills followed a stinging orphanage expose by Human Rights Watch-Asia in 1996. Trade disputes, military maneuvers and, most recently, America's errant bombing of the Chinese Embassy in Yugoslavia, added layers of anti-American hostility.
Now there are new political worries amid reports of extensive Chinese espionage in the U.S.
But Neilson says the partnership will survive as long as Chinese and American officials focus on the children:
A 14-year-old orphan finds relief from a Tacoma dentist after suffering for years with a gaping abscess;
Six children have cleft palates and cleft lips repaired by a Puyallup plastic surgeon;
More than 100 families, their children struggling with everything from clubfeet to cerebral palsy, get comfort and advice from an orthopedic surgeon from Olympia.
"You can't let yourself be overwhelmed by this scene," says Mike Dobias, a former Microsoft manager and WACAP board member from Sammamish.
Dobias and his wife, Leslie, have five children - three of them adopted from India. He has no illusions WACAP can cure all those in need in China. It is enough, he says, to "help one child at a time" - the vow that is WACAP's unofficial motto.
"Yes, there are more children who need help," Dobias says. "But we can help this one now."
Place of need
As WACAP became a force in China-to-U.S. adoptions, Janice Neilson became a master at navigating the fickle Chinese bureaucracy.
Neilson, 51, joined WACAP as a volunteer in 1975. She took a paid job with the agency in 1981 and became director in 1983.
Adoptions are more than a profession to her. She gave birth to her son, Trevor, in 1972. Then Neilson and her husband, Scott, decided to adopt. First came Andrea. Then Rebecca. And finally brothers Michael and Robert.
All were from Korea.
"We had decided early on in our marriage we would find a way to share whatever resources we have," Neilson says. "We thought Trevor was a perfect child, but there already were children on Earth that needed a place to be."
Working in China, Neilson found many such children.
She also found that placing the prettiest of China's babies was small help in a nation that is home to as many as 200,000 abandoned children.
Neilson told officials at the China Center for Adoption Affairs (CCAA) that her agency also cared about "the ones who would be left behind."
Despite the suspicion that often thwarts foreign offers of assistance, officials in Beijing suggested that Neilson go to Henan Province, the country's most densely populated province.
"We were told it was a place of great need," she says.
On her first visit to Luoyang in 1995, Neilson found orphans huddled in a two-story ruin of crumbling mud bricks. Part of the aging orphanage already had been demolished as China began to modernize its child welfare system.
In what remained, there was no heat.
"It was very, very old; very, very cold," Neilson says. "The need was obvious."
Abandoned children lived there until they were adults - if they lived that long. Neilson saw infants swaddled so tightly against the cold they could barely wiggle, in clothes so new the tags were still attached.
But some things couldn't be dressed up for a visitor. Lacking walkers or wheelchairs, dozens of disabled children crawled or dragged themselves across the dirt floors.
Neilson and Pei, the orphanage director, began their slow diplomatic dance. She insisted that local governments not interfere with work at the orphanage. He risked trusting her in exchange for supplies and medical help that most orphanage directors only dreamed of.
Then Human Rights Watch-Asia issued its report documenting neglect and abuse in China's welfare institutes: Children were found tied to beds and, according to former orphanage workers, sometimes left to die of malnutrition.
Outraged, China banned most foreigners from the orphanages.
"Our project was in peril," Neilson says.
Neilson worked to thaw the chill through diligence and donations. In nine visits over four years, she outfitted Pei's orphanage with medical supplies, clothes, visiting doctors, physical therapists, a fax machine, a walker, toys, books and two artificial legs - all small wedges in the wall.
Yet Neilson had no way of knowing what would be waiting in March.
A crowd of 100 children, bolstered by one relative or many, from a few blocks away or many miles, gathered at the orphanage gates. News had spread about the visit by the Americans: an orthopedic surgeon, a plastic surgeon, a dentist, a nurse, an anesthetist, technicians, translators - there to treat orphans at the Luoyang Welfare Institute, and disabled children from throughout the province.
For the first time, the state-controlled media made note of handicapped children, who had lived most of their lives unseen and uncounted. The local newspaper carried photographs of severely disabled children on the front page.
"It is extraordinarily powerful to see those kids in the paper," Neilson marvels. "Because once you open that door, you can never close it."
Audition for hope
The orphanage is cold. Colder even than the standard-issue chill of Chinese government buildings. Puffs of breath hang in the air. Cold seeps up from the concrete floor, through sturdy shoes, past heavy socks, inside bulky jackets, down to the bone.
Only the lobby seems a bit warmer, heated by the crush of restless bodies: A policeman in a sharply creased uniform, a farmer in a dirt-caked surplus army jacket, a tax collector, women in fashionable Western suits and women in drab peasant linen.
For a place with so many children, it is eerily quiet. Few of them cry.
Like anxious stage parents, the grown-ups coax misshapen children through a macabre audition. This is their shot at treatment, maybe a cure, maybe a miracle. Parents are torn: Is their child woeful enough to deserve attention, healthy enough to warrant hope?
Some play marionette. They grab paralyzed children by the shoulders and maneuver them across the floor.
A father stages an awkward dance. He crouches and shuffles his boy's feet with his hands - left, right, left - in an imitation of walking.
A mother glides her son across the floor as if he's water-skiing. But it is obvious the boy can't walk - or stand or sit - by himself.
Two at a time, they are called forward.
Kang and Qing, weary from their journey from the mountains, are among the first.
Qing swings himself into the examining room on his crutches, and Kang struggles to heft him onto the table. She peels off his several layers of pants and he sits, atrophied legs bare, tiny army jacket buttoned tight, privacy not even a consideration.
Qing's role in this experiment of hope and openness may be small. But there are plenty on hand to bear witness: Qing's mother, two Chinese doctors, two translators, a stenographer, an American reporter and photographer, a Chinese reporter and photographer, the orphanage's public-relations official, two orphanage employees, a minder from the local Ministry of Foreign Affairs and an older man sitting quietly in the corner who, it is learned, is the orphanage's designated representative from the Communist Party.
And Dr. Donald Mott, WACAP's most notable gift to the Luoyang Welfare Institute.
A doctor's mission
Mott is 58, 6-feet-5, 215 pounds, with silver hair straight from central casting.
Yet it is his feet that draw notice here. They are size 14, and hard to miss as Mott consumes space with a giant limp. A childhood ailment led to his hip being fused in an operation when he was 15. In adulthood, it was replaced with an artificial hip, and he has since collected an artificial knee.
And before he is asked, he says that, sure, that probably has something to do with him growing up to be an orthopedic surgeon.
Mott practices at Good Samaritan Hospital in Puyallup. He and his wife, Beret, have four adopted children, including one from Korea.
His involvement with WACAP is rooted in equal parts serendipity and desire. A friend bought dinner at Janice Neilson's house in a charity auction for the agency in 1995, and invited Mott. Conversation that night roamed to many matters, and touched on the Luoyang project.
Mott had long been drawn to charity work. But years ago, during a swim to exercise his troubled joints, he was visited by the knowledge - not exactly like a message from God - that he needed to stay home until his children were grown.
And now they were.
The day after the dinner party, Mott called Neilson: "Sign me up."
This is his third trip to Luoyang.
His first, in April 1996, coincided with Luoyang's Peony Festival, when tourists come from around the country to see thousands of the flowers bloom in the city park. If the flowers don't bloom in time for the festival, government workers are dispatched to tie thousands of artificial blossoms to the bushes.
The tourists snap pictures either way.
It became an apt metaphor for Mott's experience in China - a place where nothing happens without government sanction, and where anything can happen with it.
Mott's first trip came as China was stinging from the Human Rights Watch report. Wary Chinese officials refused to let the doctor see any children.
"I kept asking," he says. "What kind of children will this institution house? Can we see some of the kids?"
He was given grudging access to a few children who were blind or deaf - maladies outside his purview.
"What they wanted most was equipment," he says. "They were big on us rich Americans giving them things."
He returned in October 1997, and was allowed to examine a few more children. Physical therapists, also sent by WACAP, helped teach the institute's staff to deal with cerebral palsy, the most common illness among the orphans.
But surgery remained off-limits.
"In all fairness, they have every right to establish a relationship," Mott says. "Who am I? They don't know me."
The waiting game became a forced lesson in patience. Mott says now that China cannot be viewed fairly through Western eyes, and capitalism may not be the best system for a country strapped with 1.2 billion people. If medical care does not match American standards, treatment may require homespun remedies, such as acupuncture and herbal medicine.
But Mott also knew that he could offer more dramatic help to some of these children. Now, on his third trip, he is itching to try.
"My surgery background said, `Let's just do it,' " he says. "I'm a cutter, man. I'm a decision-maker."
`We won't ever know'
It takes just one of Mott's lurching steps to reach the table where Qing sits, half-naked. Qing's mother rings her fingers around the boy's ankle and urges Mott to look, see how small it is - barely the size of the big doctor's thumb.
Mott has set up shop in an empty room in the orphanage. The only hint of warmth comes from a small portable heater that battles the chill at one end of the table. Not all the lights work and those that do flicker. There is a portable light box to read X-rays and CAT scans.
The mass of patients clustered outside stuns Mott. Some parents seek confirmation - or perhaps contradiction - that their children will never walk. Some seek answers they can't get from Chinese doctors.
And Mott still isn't sure what it means to be a Chinese doctor. He tries to pose polite questions: How many years is medical school? Is a neurologist here the same as a neurologist at home?
As he talks, he works on Qing, gently moving and twisting the limp legs. Qing's flat, accepting expression does not change.
In a barrage of dialects, the doctors pepper Mott with questions. Kang presses him with stories of her two children left back home, and their hard life in the mountains. Qing is forgotten for a moment on his perch on the table.
The boy reaches down to wrestle his paralyzed legs into the layers of pants. He wriggles. He writhes. He tugs. But his lifeless legs resist this simple act.
Kang notices her son's struggle. In a single, swift motion, she yanks him up by his belt loops - dumping him into his pants like groceries into a sack. It's obviously a task done many times before.
Finally, Mott tells Kang that leg braces would help her son walk with crutches, especially during growth spurts. What he doesn't have the translators tell her is this: "We probably won't ever know what caused the paralysis. And nothing we can do will change that."
Mother and son are nudged out. Qing swings himself away on his crutches.
But for the next several hours, he lingers outside, leaning on his crutches, his face pressed to a window, watching Mott with the other children. When someone inside glances up, Qing ducks away, only to peer back in when he thinks no one is looking.
Dream to learn
Progress in Luoyang is a tall, broad-shouldered 16-year-old, whose regal bearing is not diminished by his wheelchair.
Shi Lei serves as testament that the fragile partnership between WACAP and the Luoyang Welfare Institute may mean lasting change in how this community, if not all of China, serves disabled children.
Shi Lei is neither orphan nor foundling. His parents live in Luoyang.
But he lives at the institute as a boarding student, his residency the result of Neilson's persuasive insistence and Pei's nervous blessing. He was a first step on their journey to make the institute a place where children want to come, not just wait to leave.
For most of his life, Shi Lei hunkered inside his parent's house, his body imprisoned by cerebral palsy, his only activity television. Two years ago, he saw a TV announcement that an American doctor, expert in children's diseases, was visiting the city. Shi Lei memorized the telephone number. When his father got home, he begged him to call.
It was no small matter to get to the institute. Shi Lei had no wheelchair. A taxi ride would be a luxury on his father's steelworker salary. And Shi Junying wasn't big enough to carry his burly son the 15 kilometers from home to the orphanage. So they asked Shi Junying's bigger and stronger brother, who carted the boy there on his back.
Dr. Donald Mott, in Luoyang for his second visit, told Shi Lei's parents the cerebral palsy could not be cured. But there were exercises the boy could do to improve his motor function, enough to get his hands to grip a pencil.
Neilson asked Shi Lei his dream.
"To learn," he said.
Neilson turned to Pei. The boy could live at the institute during the week. He could attend the orphanage school - starting in first grade with children a decade younger - and do physical therapy with the orphans.
Now in March, Shi Lei's parents visit the institute to thank Neilson for the changes in their son. They sit together in his dormitory room, a monastic space with three beds and bare white walls.
"Before, he couldn't write," says Shi Junying, 43. "Before he could do so little. Now he can do almost everything for himself. It is good for his spirit. Here, there are so many little friends and the teachers look after him and care very much."
Pei is visibly proud of Shi Lei's progress, and his part in it.
Pei, 46, has run the institute for seven years. He is a natty dresser, and sports a small diamond stud on his lapel.
He hopes the publicity within Henan Province will persuade more Chinese families to adopt their country's orphans. In China, adoption has long been an informal transaction among relatives. But as part of its efforts to modernize, China this year approved exceptions to the one-child policy to encourage domestic adoptions.
As any good bureaucrat, Pei also hopes success at the Luoyang institute will pry more funding out of the government. He already has earned favorable notice from the provincial government and, on this trip, WACAP is asked to expand its work to some of the 16 other orphanages in the province.
Even so, he is anxious about the price of that success - the swelling crowds, the media attention, the expectations.
"The orphanage will be more open," Pei says. "I'm sure that more orphans will come and more special-needs children will come to get treatment."
The crush of those expectations is evident in March, as parents fear the American doctors will leave before their children are seen. Pei pushes his way into the crowd. "Back, back," he pleads. "Be patient."
He turns to Neilson for help.
"We will stay as long as it takes," she tells the fretful parents. "As a mother, I know you want only the best for your child, and I hope together we will find the best plan."
Pei counts 174 residents at the orphanage. During the three-day visit in March, WACAP's team sees as many as 100: sweet infant girls, cast out of their homes so parents could try for a coveted, healthy boy; older children, long past prime adoption age; disabled boys and girls still able to get around.
The others - the more seriously disabled - live on floors guarded by large steel, roll-down doors, and are not seen by the Americans.
The foundlings eat in separate rooms organized by age. The food comes in large metal buckets. Today, lunch is rice, green beans and stringy pork.
The youngest residents are about a dozen baby girls - the number ebbs and flows with adoptions. They sleep in cribs set in orderly rows. The nursery is clean, almost regimented, and the babies are tended by two women.
When awake, they are parked in an orderly crescent of dual-purpose wooden baby chairs. The chairs have food trays attached to the front, open seats, and chutes that funnel waste into waiting plastic buckets.
Beneath identical jumpers, the babies wear layers of leggings to ward off the chill.
Next door, toddlers are corralled in the feeding/potty seats, or left to walk in a long, narrow playpen. The only toys sit out of reach on a high shelf.
There are nine of them - all girls, including one albino with startling white hair and pale eyes.
When Neilson visits, the toddlers are pressed to perform. Neilson is seen not only as an important patron to the orphanage, but as a scout who might eye a prospect for a home in America.
An orphanage worker starts a song. She plucks two girls out of the playpen and prods them to join in. The little girls pick up the tune and sway back and forth, hands on hips.
The girls are nudged again, and shift into a jerky little toddlers' waltz - a dance for the visitors who might find them a family, a dance that ends only when the visit ends.
But few smiles are coaxed for the cameras. Without smiles, Neilson sighs, it is hard to seal an adoption. And these girls, mostly about 2 years old, are dangerously close to eclipsing adoption age.
Before WACAP came to Henan Province, there were no foreign adoptions from here. Now Neilson pushes Pei, and orphanage directors throughout China, to list every homeless child with the China Center for Adoption Affairs in Beijing.
An odd parade marches out of the institute each weekday, a proud back-to-school movement of 14 students.
Before the partnership with WACAP, while some foundlings left the orphanage for school, there was no guarantee they would be able to complete their education. Parents pay fees for their children to attend school in China; at the institute, that funding was erratic.
Now American sponsors donate $15 a month per student, with a promise that the money follows them through college.
First out the door this day are Zhou Zhou, an orphanage lifer at 17, and Meng Meng, who has lived half his 12 years here. They are best friends and roommates, with two legs and two crutches between them. Like all the orphans, they share a last name - Dang - given them by the institute.
Zhou Zhou and Meng Meng seldom use their artificial legs - donated by WACAP but unfamiliar and uncomfortable. They navigate staircases and rutted roads with mastery on their single crutches.
Zi Fei trails more slowly. His feet turn in at impossible right angles; he picks his steps carefully so as not to step on his own feet. WACAP's Mott says it is the worst case of clubfeet he has ever seen - so serious that he wants Zi Fei sent to the United States for a series of complicated operations.
At the back of the pack is 9-year-old Yu Lai. An orphanage worker helps the other children push Yu Lai's wheelchair the three blocks to school, and lift boy and chair over a foot-high barricade at the school gate.
Free for a moment from the orphanage minders, Zhou Zhou is asked about his life. He answers mostly in typical teenage shrugs. But he says the institute is OK, he is treated well, fed well, has friends and is lucky to go to school.
He has a knack for fixing radios and televisions, says he wants to go to college and someday run a large company.
WACAP has pledged to pay Zhou Zhou's tuition - a gift that likely will save him from a life of factory work. But whether he gets to college or settles for technical school will depend on his scores on China's mandatory exams.
The government, and the vagaries of birth, choose the future for most of China's foundlings. In Luoyang, many get work at a government-owned cloisonne factory, run by Pei in connection with the institute.
Gang Gang, 12, came to the orphanage as an infant. He is a natural musician with uncommon talent, according to his teacher.
But Gang Gang is blind. After eighth grade, he will be sent to a special school in Luoyang to learn to be a massage therapist. The school now has 6,000 blind students.
Miao Miao, 14, is no bigger than most 6-year-olds. Severe curvature at the spine hunches her back and thwarts her growth. Her limbs are rail thin, her hands ice cold.
She is a painter. Two years ago she placed in the top three in a nationwide art contest.
But the walls of Miao Miao's bedroom are bare of art, save for a photograph of her and Li Baishuan, general secretary of the Luoyang Party Committee, taken when the important Communist leader visited the institute.
Her grades have been slipping lately, so her teachers insist she study rather than paint. She has none of her work to show a visitor. The paintings, she says, are being held by her teacher "for safekeeping."
What life gives
This is WACAP's largest medical expedition yet to Luoyang. The visits are as much about teaching as about treatment.
And with resident Chinese doctors and nurses shadowing every move, delicate medical procedures require assembly-line speed and crowd-control calm.
The institute's sixth floor holds an operating room that was built with a donation from a WACAP parent. Over three days, Puyallup plastic surgeon Stan Jackson repairs six cleft palates and cleft lips.
Those birth defects still occur in America, where they are treated with multiple surgeries and years of therapy. In Luoyang, Jackson works on a 12-year-old - evidence that the defect goes unattended here.
The ground floor holds a makeshift dental office. Tacoma dentist Bob Williams and his wife, Jerilee, endure the worst working conditions in the institute.
There is no dental chair. Patients sit in a straight-back wooden chair, or lie on a wooden desk, legs dangling off the end.
The wiring in the building won't support Williams' high-intensity examining light and still run the small space heater.
Williams chooses light over heat.
To run his drill, Williams needs an air compressor. But the machine draws too much electricity and knocks out power in the entire orphanage.
Local officials order the electricity turned off in surrounding neighborhoods, diverting power to the institute. But medical equipment continues to overload the orphanage circuits. Next door to Williams' dental clinic, Mott gives up his heater.
Then the lights burn out in Mott's examining room. A janitor scurries to find new bulbs, but there is no ladder to reach the ceiling fixtures. The janitor lays one chair sideways across another and, in a feat of minor acrobatics, restores the light.
Despite the cobbled conditions, WACAP's presence is a lure that prompts many here to use political connections to get treatment. The American doctors say such string-pulling is common on missions to developing countries. Institute workers bring their children and relatives, and are especially eager to see a dentist who offers the unusual balm of anesthesia. Even Pei, the institute director, has Williams check his aching teeth.
But Williams' patients on this trip are mostly children from the orphanage, who suffer rotting teeth, gum disease and infected abscesses.
"I saw one with a hole in his jaw big enough to put my finger in," Williams says. "Some of these kids are in real pain."
The children don't complain, and barely flinch when Williams probes inside their tender mouths.
"Orphanage kids don't act like any other kids you've seen," says Neilson. "They are used to absorbing whatever life gives them."
`It wont' get better
The challenges WACAP faces in China extend well beyond international politics or intransigent bureaucrats. Here, even birth can be hard.
Parents tell Mott of deliveries assisted by forceps and suction devices; babies that took two days to wrest from their mothers; babies that don't breathe for 20 minutes after delivery, losing vital brain function as doctors fight a malfunctioning valve on an oxygen tank; babies born yellow with jaundice and blue from lack of oxygen.
Mothers worry about babies that don't stop crying, and even more about those that don't cry at all.
Ding Cong Hui, 30, tells the doctors she was two months pregnant when she tried to abort her fetus. She failed, and seven months later, Yang Rui Ping was born.
The girl is 4 now. She can't crawl or feed herself, or hold anything in either hand. She can't control her tongue.
The doctors and orphanage staff urge Ding to leave the girl for an extended stay of physical therapy, but the sad mother declines.
"It's her brain," says Ding. "It won't get better."
Mott sees two children with cerebral palsy who likely will die soon. The same dysfunction that makes it hard for such children to talk, makes it hard for them to swallow and digest food. The two have the pallid color that comes with malnutrition, and their parents say they won't eat.
Two-year-old Ma Lu Lu had brain surgery sometime last winter. Mott can't determine why Chinese doctors performed the operation, but there is a large soft spot on the right side of the girl's head, and her thin keen betrays chronic pain.
"She just keeps crying," her mother says.
In the U.S., these children would be fed through a feeding tube into their stomachs. Mott suggests the parents try to feed them high-calorie, high-protein drinks. But there is nothing like that sold in Luoyang.
The orphanage and clinic are often short on supplies. Each time WACAP prepares to visit, Pei sends a wish list.
This time he wants material to make soft casts. Back in Renton, WACAP's Wendy Izumi scours the country for large rolls of the material. She finds some through a distributor in Los Angeles, who says it is made in China.
She forwards the information to Pei. But the orphanage can't get any in China. So a large roll is shipped from the factory in China to the Los Angeles distributor, then to WACAP in Seattle so Izumi can hand-carry it back to China.
The soup banquet
During his three days in Luoyang, Mott sees children with a range of cases that could fill a textbook: Post-polio, paralysis, cerebral palsy, elephantiasis, clubfoot, hydrocephalus, hepatitis A, epilepsy, meningitis, spina bifida.
But Mott sees two children he knows he can help if he is allowed to operate.
Both boys have cerebral palsy. Their feet are pulled down and in. One can walk, the other can't.
On the afternoon of his final day here, Mott is told he can operate on the child who can't walk. He goes to work quickly. He cuts into both legs, lengthens some muscles and rearranges others to balance the musculature around the ankles.
And just before the operation, he gains another lesson in the Chinese way: Mott learns that his surgery patient is the grandson of the woman who runs the local factory that makes leg braces. The day before, the woman agreed to craft braces for a girl Mott had seen, so government officials cleared the way for her grandson's treatment.
Mott is eager to get to his second patient, Lu Peng Fei, who waits in a room that doubles as pre-op and post-op.
But just before Peng Fei is called, orphanage officials cancel the procedure. The explanation:
A second surgery would make the American doctor late for a farewell banquet that night.
The provincial governor and other powerful officials have made a treacherous drive over snowy roads to attend. It is set to be one of Luoyang's famous soup banquets. Locals still talk about the time 30 years ago when then-Premier Chou En-lai met here with the prime minister of Canada, and had high praise for the soup.
It would be disrespectful to be late, especially for Mott, who is revered by the Chinese. When he speaks, the doctors and nurses listen raptly to his diagnoses. He is served first at lunch and always given a place of honor at the evening table.
So, after four years of political groundwork, three days of medical clinic work and just one surgery, Mott is clearly unhappy as he sheds his scrubs and is rushed back to the hotel to dress.
Dinner is an elaborate affair, served on an ornately carved table in the private room of a local restaurant. There are 24 courses of soup, including turtle soup and bird's nest soup.
There are almost as many toasts:
"To cooperation between our countries."
"To Director Janice."
"To the honorable Dr. Mott."
"To the children."
In keeping with protocol, each toast is punctuated with a shot of fiery local liquor.
And as the WACAP doctors nod and thank their hosts, the gate along Guangzhuan Street, in front of the Luoyang Welfare Institute, is closed. The thick, steel bicycle lock is secured on the grate that blocks the front door.
Behind those doors, Lu Peng Fei lies in a bed in pre-op, next to the one boy who had surgery, his parents waiting at his side.
David Postman's phone message number is 360-943-9882. His e-mail address is: email@example.com
--------------- Lu Yang's story ---------------
Last year, Dr. Donald Mott received a letter at his home, written in Chinese calligraphy, attached to a translation in English:
"Dear grandpa-doctor. Could I be cured by you? The classmates belittle me very much, moreover, even beat me and call me names. I truly hope I can, one by one, batter them to death, but I can never win. Do you, in your country, have such matters?"
The girl, Lu Yang, wrote that she had little control over her body and cannot sleep.
And her mother added a note, saying that Chinese acupuncture had failed to help her daughter:
"What make me worries so much is that no western medicine can cure her. I hope she would become better and live a safe and happy life by herself in a few years."
Mott, an orthopedic surgeon, carried that letter with him on a medical mission from Washington state to Luoyang, China, in March. And in a makeshift clinic at a state welfare orphanage, he waits to meet the young girl who wants his help.
Lu Yang bursts in, arms and legs flopping like the Raggedy Anns on her winter coat. Her 14-year-old body is locked in a war between her iron will and her cerebral palsy.
She plops into a chair, willing her squirmy body not to fall off. She thrusts out a hand to Mott: "Nice to meet you."
"Nice to meet YOU," Mott bellows back.
Yang chirps back: "How are you? I am Lu Yang. How are you?'
Yang's mother, a nurse, echoes the worry in her letter. She shows Mott a collection of Chinese herbal medicines she has been giving Yang, and some Tibetan root extract.
Mott can only shake his head: "It's not going to go away."
Cerebral palsy never does. A central-nervous-system disorder caused when the brain is deprived of oxygen before or during birth, it is characterized by spastic paralysis. Some sufferers have no control over floppy limbs; others are clenched tight and rigid.
In Western countries, extensive and intensive therapy increases mobility for many patients. Lu Yang would be an ideal candidate for such treatment.
As Mott talks, she pops from her chair and stumbles around the room, handing out candy from a paper bag. In another show of supreme will, she tenses her arms and legs. Grabbing a jump rope from the bag, she forces her hands to clutch it, and performs for the grandpa-doctor.
Mott shakes his head again, applauding the mother, Ji Fumei, for persuading local officials to admit the girl to school, and for teaching her so well at home. And he cheers Lu Yang for her determination.
"I guarantee you, in our country we can't do any better," he says.
----------------------------- How to learn more about WACAP -----------------------------
For more information on international adoption, the World Association for Children and Parents (WACAP) can be reached at 206-575-4550, or at firstname.lastname@example.org.
The mailing address is P.O. Box 88948, Seattle, WA 98138. The agency holds adoption-information meetings every Monday at 7 p.m. in its office at 315 South Second Street, Renton.