Melvin Karges and his wife Cheryl know about helping southeast Asian orphans. Their daughter Claira, now 2 1/2 years old, was adopted from Cambodia with a hole in her heart that was successfully treated here in the United States.

Pam and Randy Cope of Neosho, friends of the Karges', adopted two children in Vietnam and started a nonprofit organization that helps orphanages and other shelters in Vietnam and Cambodia.

But even after successful adoptions and charity work, the Kargeses and the Copes have run into an unexpected barrier in their joint effort to help a Vietnamese orphan boy get urgent medical help in Missouri that he can't get in Vietnam.

The U.S. government has refused to issue a medical visa or a humanitarian waiver for 6-year-old Tuan Van Cao. The couples are confused and frustrated, saying they have lined up private funding to cover treatment for a botched operation on the boy's diseased left hip that left him with a potentially fatal bone infection.

Despite submitting written opinions from U.S. and Vietnamese doctors that Tuan needs urgent help that he cannot get in Vietnam, the families have been told to try the lengthy processing of international adoption, which can take a year or more.

"We're kind of reeling right now," said Karges, a physician. "I'm puzzled, because if you read the guidelines for humanitarian (waiver), Tuan fits."

Tuan was admitted to a Ho Chi Minh City hospital Sunday for emergency treatment because the infection in his hip bone has started spreading, said Pam Cope, who first discovered Tuan's case. He will have to undergo surgery that opens the bone to more infection, even though the hospital's orthopedic surgeon has said the treatment is too risky to perform in Vietnam.

"Tuan's case is black and white. He needs emergency medical treatment and we can give him free medical treatment here in the United States," Cope said.

The experience is all too common, especially since Congress in 1997 changed the law to make immigration more difficult, said Roy Petty, an immigration lawyer in Rogers, Ark., who has handled several similar cases but is not involved in Tuan's case.

"Americans are goodhearted people. They find kids abroad who need help and then when they ask the government for help, they get told 'no, we're not pro-immigrant these days,'" he said.

The Kargeses have said they would be Tuan's host family and hope eventually to adopt him. The Copes' charity, Neosho-based "Touch a Life," first sought a medical visa for Tuan last fall but was turned down by the U.S. embassy's consulate in Ho Chi Minh City, the former Saigon. The consulate said he was an orphan who might stay in the U.S. after treatment.

The consulate suggested they seek the humanitarian parole waiver from an office of U.S. Immigration and Customs Enforcement called the Parole and Humanitarian Assistance Branch. Immigration and Customs is part of the Department of Homeland Security.

The Kargeses, who helped recruit Freeman Health System in Joplin to pledge free medical treatment, applied in December for humanitarian parole and submitted a raft of supporting documents, including a letter from the hospital in Ho Chi Minh City that the care Tuan needs is not available in Vietnam.

They also have supporting letters from both of Missouri's U.S. senators, Republicans Kit Bond and Jim Talent, and a U.S. medical statement that Tuan's bone infection could spread at any time through his system and become fatal.

Two months later, the Kargeses received a brief letter rejecting a humanitarian waiver. The only reason cited by Kenneth Leutbecker, director of the humanitarian office, is that the application "appears designed to circumvent or shortcut normal immigrant visa processing requirements."

Carl Rusnok, a spokesman for Immigration and Customs Enforcement, said the waivers are granted sparingly: More than 6,700 applications were received between Jan. 2000 and last Oct. 6, and 1,465 — about 20 percent — were approved after reviews by two separate officers and their supervisor.

Rusnok declined to say why Tuan's case was not deemed an urgent humanitarian matter, saying he was not allowed to discuss specific cases. "Humanitarian parole isn't just given to everybody who requests it," he said.

Cope said that on the advice of an immigration lawyer, the Kargeses will seek a waiver from a different U.S. agency under the Department of Homeland Security, Customs and Border Protection.