How hard is it to adopt a child in Russia?

“People either think we’re crazy or we’re heroes,” said Gulnara Panina, a Moscow resident who, with her husband, Pavel Panin, has adopted two children, Denis and Yanna, both 6.

Older relatives and friends urged them not to adopt. So did doctors. So did orphanage directors and welfare officials. “They’re broken,” they were told. “Don’t touch them.”

Nevertheless, three years ago, when Pavel was 37 and Gulnara was 34, they adopted Denis. He had been abandoned at birth in a town in the Ural Mountains. He was 31 / 2 years old, weighed 27 pounds and was one of two children in the orphanage who could talk. He had medical needs they didn’t fully understand.

Adoptions have been on the rise in Russia, although they almost always involve relatively healthy newborns. Few parents are willing, or able, to take on the challenge that the Panins face.

Both were principals in international accounting firms. Their money gave them a cushion, although they didn’t realize then that by the time Denis was 6, he would have undergone three operations — two of them at Cincinnati Children’s Hospital in Ohio, which they chose after as was the best place to take him.

This year, the Panins took in Yanna from an orphanage in the Siberian city of Krasnoyarsk. They ran into plenty of official resistance. They had to make an unplanned round-trip flight back to Moscow to get a paper stamped by the right bureaucrat, at a cost of $1,500. They encountered good-hearted, caring individuals along the way, at the custody agency and the orphanages, Pavel said, but all within a system that has no incentives for promoting adoption and expends little effort on doing so.

Yanna, defying the descriptions they got of her, is a delight, they said, and will be fine, but she is delayed verbally. “Denis is teaching her all she needs to know, and all she doesn’t need to know,” Gulnara said.

She and Pavel are able to pay for speech therapy. They both work from home, running their own financial services business — and looking after the kids.

Could an ordinary Russian couple, without the means to spend money on therapists and American surgeons, tackle the needs of their two kids?

She thought for a second. “In theory,” she said, “medical care is still free in Russia.” The real answer is painfully clear.