Under the Hague Convention on the Protection of Children and Co-operation in Respect of Inter-Country Adoption, foreign governments assume responsibility for follow-up reporting. The Convention aims to protect children from abduction and trafficking by setting strict regulations on intercountry adoptions. Although the U.S. and Bolivia are both Convention countries, adoptions between the two countries still meet obstacles. U.S. parents wishing to adopt Bolivian orphans must first become legal residents of Bolivia, which elevates the process's time frame to several months or more than a year.
   The U.S. averaged about 38 adoptions per year from Bolivia between 1992 and 2001; that number dropped to seven adoptions per year between 2002 and 2007, after the adoption process became more difficult.
   The Carlos de Villegas Home keeps a lawyer on staff to deal with issues that arise with adoptions. Eva Paredes said she advocates the rights of children — particularly the right to a family and the privileges associated with family life.
   "We can provide many things," Arnao, director of the Carlos de Villegas Home, said, "but the love of a family, there we are limited. That is the greatest pain these kids are being inflicted with — the wait. The bureaucracy."

Psychological scars
   Orphanages face financial challenges in providing for orphans, especially since many children come there in poor health, both physically and psychologically.
   "Most of them come here very malnourished," Ethel Saavedra, a psychologist at the Carlos de Villegas Home, said in Spanish. "Girls who are older look underdeveloped because since their gestation they were not fed right."
   Money for food can help reverse the effects of malnourishment, but things money cannot buy — love and belonging — are harder to ensure. Although Arnao said the 28 babies in her orphanage receive physical touch stimulation for two hours every morning, which has been shown to help babies develop more normally, sometimes psychological damage is deep and hard to heal.
   "Institutionalized children do not have the love that other babies have from the arms of their parents," Arnao said.
   A 2-year-old girl came to a Cochabamba orphanage for babies physically, mentally and emotionally broken. She was born in the outlying countryside of Cochabamba to an alcoholic mother, blind as a result. Her tiny body had been chronically malnourished and sexually abused when she reached the orphanage, House of Love, or its Spanish name, Casa de Amor. She was diagnosed with Failure to Thrive Syndrome, a condition associated with severe emotional neglect.
   Affection and stimulation are as vital for healthy physical growth as food, developmental psychologist Laura E. Berk wrote in her book "Exploring Lifespan Development." The syndrome from which the 2-yearold at House of Love suffers is present as early as 18 months of age. Babies ill with this condition appear physically wasted and are withdrawn and apathetic. No organic cause for their failure can be found. It is literally a lack of love.
   The girl at House of Love continues to have problems with self-aggression and motor skill delays. She shows no signs of speech and has a limited appetite. Days after joining the "baby home," as Jennifer Thompson, director and founder of House of Love, calls it, she was admitted to the hospital for dehydration and malnutrition. She is doing better today, but life still won't be easy for her. She has experienced many poisons, even before she was born. Many orphans have similar beginnings.
   Our Home Orphanage, or its Spanish name, Hogar Albergue Nuestra Casa, is a home for 16 girls between the ages of 7 and 18. The youngest girl, María Elena, lives there with her sister, displaced from her home because of neglect. Some of the girls who live there ran away or were removed from abusive homes. Although director Yusla Roa said the ultimate goal is to reunite the girls with some sort of biological family, the girls all agreed: "We are like sisters, it's just the same. We are family."
   Financial aid from the government has been stagnant since the 1950s, but the number of orphans and the rate of inflation — which rose 14 percent in 2009 — keep growing in Bolivia.
   About 100 orphans live at the Carlos de Villegas Home, an orphanage supported largely by charities and public fundraising events. There are nearly as many baby orphans at House of Love supported similarly. Although there are fewer orphans at the Timmer orphanages and Our Home Orphanage, financial strains were the top of every orphanage director's concerns. The government provides financial aid, about enough to buy 50 children a 1.5 liter bottle of water each day and too little to buy them each a loaf of bread.
   "The government pays for 50 children, although the population is 100," Arnao said. The six Bolivianos it provides daily is about 87 cents.
   Arnao said that since she arrived at the Carlos de Villegas Home in 1973, she has struggled to raise money for the children at the orphanage.
   "I have always had to extend my hand and beg for my girls, and I am not ashamed if I have to keep doing it," Arnao said. "I will, because it is necessary."

One solution
   Gracey is now 7 years old. She is fully integrated into the Timmer family and is the inspiration for the Timmers' plan to open 50 orphanages by 2012. Her luck, or whatever it was that saved her, will spread.
It cannot possibly reach all of the orphans in Bolivia, however, which is why Arnao, Thompson and other orphanage staff agree that the only real solution to saving an orphan from psychological scarring is adoption.
   It would be ideal to improve on the prevention of unwanted pregnancies as well, through government education programs or sex education in schools.
   For all 320,000 orphans in Bolivia to find homes with Bolivian families, one out of every 13 people aged 15 to 62 who live above the poverty line in Bolivia — making more than $2 a day — would have to adopt a Bolivian child. But this age range is very large, and even those who make more than $2 a day cannot always afford to take care of another child. With limited foreign adoptions and too few willing and able families in Bolivia to adopt, many Bolivian orphans will never find a home.
   "There needs to be a political body to deal with this; the government has to keep it practical," Arnao said. "It is ridiculous because it can be solved so easily. The government needs to foster awareness so the kids can be quickly and easily adopted, so they can have a family, a family life."