Medical Diagnoses and Defectology in Russia and the Former Soviet Union.
by Dr. Jane Aronson
Estratto originale della pagina "Guidelines for Interpreting Pre-Adoption Medicals From
Russia and Other Countries: Syphilis, Hepatitis B and C and HIV, Recommended Screening
Tests
and
Evaluations"
del
sito
Orphandoctor.
Segue una traduzione in italiano di un'altra pagina del sito, sempre sulle cartelle russe.
"The diagnoses found on Russian medical reports are responsible for a lot of the concern and
anxiety associated with embarking on a Russian adoption. When I first started reviewing medical
abstracts from Russia and Eastern Europe, I, too was unaccustomed to these medical phrases. With
10 years of experience in adoption medicine and travel to Russia, Romania, Bulgaria, and research
done by the Orphan Rangers, I can now say that I am accustomed to these unusual terms, but if you
are looking for a clear-cut interpretation, you will not find this anywhere. What we know
empirically is that physicians in Russia have a unique perspective of the health of newborn infants.
This is the system of "Defectology" wherein infants are considered inherently defective and then
over time, their "defects" resolve. Russian physicians believe that young infants and toddlers are
neurologically immature. It is standard for a Russian child to be evaluated by a pediatric neurologist
several times in the first few years of life. Children who are born to mothers with poor pre-natal
care and any infections during the pregnancy may be diagnosed as having "prenatal or perinatal
encephalopathy". This diagnosis would be based on pre-natal factors, which led the baby to be
neurologically abnormal. A child who was born to a mother with syphilis might be diagnosed with
prenatal or perinatal encephalopathy. Conditions that exist at the time of the delivery such as
premature birth or complications at the time of the delivery like a home birth, might also contribute
to the diagnosis of perinatal encephalopathy. It is a system of potentials. It is assumed that all babies
are defective and that eventually these conditions will resolve with appropriate therapies such as
massage and unusual medications not used in Western countries. So if the mother was ill during
pregnancy or had no pre-natal care, then the child is considered potentially predisposed to various
health conditions and is diagnosed with perinatal encephalopathy. This diagnosis is not based on
any scientific research done in Russia or any other country. Russian physicians have had a long
tradition of diagnosing serious pathology (disease) in healthy individuals. As I dismiss some of the
significance of the confusing terminology on a medical report, I must also state that there may be
medical conditions that clearly do exist for a particular child, that are not diagnosed by the
physicians in Russia. I look for context when reviewing the medical reports.
Other diagnoses that are found commonly on medical abstracts are pyramidal insufficiency or
deficiency, hypertensive-hyperexcitability syndrome, hydrocephalic-hypertensive syndrome, and
neuro-reflex excitability syndrome. When I was in a maternity/infant hospital in Saratov in Russia
in 1997, I asked the director of the newborn division about these diagnoses. She asked me to listen
to a baby crying in the nursery across the room from where we were standing. She then told me that
baby had neuro-reflex excitability. When I approached the infant, I noticed that the bottle which
was propped on a rolled blanket had fallen away from her mouth. The child was hungry and
irritable. Further, the baby was drinking Kefir, which is a sour, cold liquid yogurt, which is
probably
not
palatable.
Pyramidal insufficiency refers to the possible abnormality of the corticospinal tracts of the
central nervous system that control the movements of the muscles of the body. If the child has even
the slightest delay in gross motor development, then this diagnosis is applied. This is often
interpreted as cerebral palsy, but this has not been borne out by my clinical experience. Children are
often diagnosed with spastic tetraparesis which literally means weakness and spasticity of all four
extremities. I see this commonly applied to children who are walking and appear quite normal for
gross motor development. Instead of carefully examining a child and then doing investigative
studies to confirm actual brain damage, the child is diagnosed as having brain damage because the
nervous system appears to be immature. The bottom line is that the doctors are probably looking at
normal children who are delayed due to malnutrition and lack of stimulation. They have little
formal training in development. It was clear to me after spending many hours discussing the system
of diagnosis with staff physicians in orphanages that the diagnoses are based on a belief system,
rather than a thinking process based on physiology and anatomy."
Lo stesso sito aggiunge i seguenti dettagli alla pagina dedicata alle diagnosi russe e alle sue
mancanze o terminologie astratte ( a sinistra in inglese, a destra la traduzione italiana):
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Defectology - Children are considered
defective adults in Russia
No specialized medical training for
pediatricians in Russia
Mythology and Rumor - Diagnoses are
not created to promote adoption of
unhealthy children
Neuro-reflex-hyperexcitability syndrome a description of a high strung infant
Hypertensive-hydrocephalic syndrome increased pressure and increased amount
cerebrospinal fluid in the ventricles of the
brain-if this were true, itr would be
incompatible with life!
Perinatal Encephalopathy - greater then
95% of medicals will have this diagnosis
Perinatal Encephalopathy encompasses
health conditions of the mother during
pregnancy, the child's health during
pregnancy, the child's health at the time of
delivery, and the potential health issues of
the child
Hypotrophy - decreased velocity of
growth, failure to thrive
Intestinal Dysbacteriosis - bacteria or
normal flora of the intestines
Congenital Dislocation or Displasia of the
hip - commonly found on medicals, but
this is not a common diagnosis
Cardiopathy - heart murmur
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Difettologia: i bambini in Russia sono
considerati adulti "a cui manca ancor
qualcosa" (difettosi).
Non esiste un sistema per fare pratica in
quanto pediatri in Russia
Mitologia e voci: le diagnosi non sono
create per promuovere l'adozione di
bambini malati.
Sindrome da ipereccittabilità neuroriflessa: descrizione di un bambino molto
stressato.
Sindrome ipertesa-idrocefala: pressione
alta e aumento del liquido cerebrospinale
nei ventricoli del cervello. Uno stato, che
se esistente, è incompatibile con la vita!
Encefalopatia perinatale: più del 95%
delle cartelle hanno questa diagnosi.
Encefalopatia perinatale riguarda le
condizioni della madre durante la
gravidanza, lo stato del bambino durante
la gravidanza, il parto e le potenzialità
sanitarie del bambino.
Ipotrofia - diminuita velocità della
crescita, ritardo dello sviluppo o curva
della crescita non nella media (in inglese
FTT).
Disbatteriosi intestinale: presenza normale
di flora intestinale.
Dislocazione congenita o displasia
dell'anca: spesso presente nei referti.
Cardiopatia: rumore cardioco anomalo.