CHAPEL HILL — The little girl rides a bike on a sun-dappled driveway, clad in helmet and capri pants. At 4 years old, she has little idea of the long road her adoptive parents journeyed to get her here.
She's also unaware that her adoption, along with a few other widely publicized cases, has been instrumental in removing a frustrating barrier to more orphans seeking a home and new parents.
Abandoned by her impoverished Ethiopian family and then adopted by a North Carolina couple, Tsehaynesh Rigotti became one of a handful of adopted children stranded outside the United States by new tuberculosis testing requirements. The requirements affected children from Ethiopia and China, two of the most popular countries for international adoption.
Tsehaynesh finally arrived home in Chapel Hill last week, after she and her parents, Luca Rigotti and Marily Nixon, waited more than six weeks for the results of a TB culture. It confirmed what her parents already knew: that she was not sick with TB.
"You never imagine that you will be stuck outside of your country, and your country will not be helping you to get back," said Nixon, a lawyer. "But that's what happened to us."
Tsehaynesh (she-HAY-nesh) and her parents were caught up in rules intended to stop the spread of drug-resistant TB, a growing worldwide problem that is especially prevalent in developing countries. The testing requirements are supposed to stop immigrants from infecting U.S. citizens with TB, a bacterial infection in the lungs that can be fatal.
But the rules held up adoptions around the country, leaving people in the precarious position of having legally adopted their children but not being allowed to take them home. Many, like Tsehaynesh, had been exposed to TB at some point, causing a positive skin test, but did not have the active, infectious form of the disease.
Still, they had to wait for a time-consuming culture test to prove it, even though pediatric infectious disease experts said that young children with TB are very rarely contagious and that allowing them to travel home posed no public health risk.
Tsehaynesh's case became one of several incidents that prompted the CDC to change its rules late last month. Now, children under 10 who have no symptoms and have no known exposure to a person with drug-resistant TB can await the results of their TB cultures in the United States.
Christine Pearson, a spokeswoman for the U.S. Centers for Disease Control and Prevention, said the change came after the CDC consulted with several pediatric TB experts about how TB is transmitted in children.
Diane Kunz, a Chapel Hill mother who helped found the advocacy group Center for Adoption Policy, was among those who worked with the CDC to change the rule. She said that when the CDC implemented new testing requirements in the spring, officials there didn't realize that adoptive families would become stranded abroad. But she said they quickly remedied the problem.
"No one in the adoption community would ever say, 'Let's sacrifice the health of Americans,'" Kunz said. "In this case, there was no risk to American health and devastating consequences for adopted children."
The rule change came too late to spare Nixon and Rigotti a 2-1/2-month ordeal.
July to October
They went to Ethiopia in late July, expecting to spend about two weeks. They returned to Chapel Hill Oct. 4.
"It's more than frustrating; it's scary," said Rigotti, a professor at Duke's Fuqua School of Business. "Everyone tells you [that] you should get them in a routine very quickly, that every month in an orphanage has consequences."
Nixon and Rigotti said they were told, after their adoption was final, that Tsehaynesh had a positive TB skin test and a chest X-ray that showed a "suspicious" area. Though she had a negative sputum test, U.S. officials told the couple they would have to wait six weeks for the more definitive results of the culture test.
In the meantime, they say, government doctors would not begin antibiotics to ensure that she would not develop symptoms of TB.
They were suddenly faced with spending two months in a hotel in Addis Ababa, an African city where they did not speak the language, could not drink the water, and had power only every other day. If Tsehaynesh's test had come back positive, the U.S. government would have required that she be treated in Ethiopia -- a process that would have taken nine months.
The couple began desperately searching for alternatives, and discovered that they could get visas to live temporarily in Rigotti's native Italy. They packed up Tsehaynesh and took her to Rigotti's parents' home in Milan, where doctors confirmed that she did not have infectious TB and gave her drugs to ensure she would not develop it.
Still, they had to wait for the culture test.
Tsehaynesh picked up bits and pieces of Italian, learned to swim in the Mediterranean and developed a close bond with her new grandparents.
But at night, Nixon and Rigotti paced the floor, wondering when they would be allowed to go home, whether their jobs were secure, how Tsehaynesh would handle yet another dislocation. Members of her birth family handed her over to an orphanage when she was nearly 4 years old.
She was 4-1/2, and Nixon and Rigotti wanted her to start preschool, get used to her new home and begin learning English.
No way around rule
They said every U.S. official they dealt with agreed that Tsehaynesh was not a public health risk. But none could get around the rule.
"We're used to being able to fix things in our lives," Nixon said. "But every day, we would get up and have no idea how to get over this insurmountable obstacle."
They finally arrived home late on a Sunday night, after a final delay in which Tsehaynesh's visa got lost in the mail.
They showed her the room they had prepared months before and the longed-for bike that was waiting in the garage. She jumped on excitedly and rode as her parents ran alongside, anxious to leave their TB ordeal behind.
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