27 July 2013

Where the Magic Happens

We had a big inspection this week.  Like JACHO big . . . except, only smaller.  Much smaller.  The inspection team consisted of two African surgeons and a small representation of our administration and doctors.

They stopped by the therapy gym, mid-chaos, to say hello and get a front-row-seat to the show.  We chatted about the method-du-jour of prosthetics fabrication in resource poor areas and before I knew it, they were back out the door.

As an aside to the surgeon who had been most interested in my work, I muttered a quick 'Doctor, most believe the magic happens in the OR, but actually, it's right in here!'  He shot me a knowing smile, just as our Chief of Surgery fired back a witty 'Well, come tomorrow, we'll just have to see about that!'

It was a challenge and a promise that I couldn't wait to hold him to.

F. is for 'favorite' . . . but I'm not supposed to admit that I have those.

F. is four.  She refuses to speak to anyone but her granny . . . yet she shares her giggles free of charge.  I've only known her a week, and yet I've been blown away by her courage, her endurance, and her capacity to engage and trust.

I work with a lot of kiddos, but from time to time one comes through the door that surpasses the others in the depth to which they nuzzle themselves into my heart.  F. found her way into mine the first time I saw her.

She was sitting on the floor of the OR dressing-holding-area, in line to get her bandages changed.  She was wrapped from her eyebrows up.  The bottom half of her face already bore the scarring evidence of severe burns, complete with contractures around her left eye that made it impossible to close or blink.

F. had been burned by boiling water four months ago.  She had been treated for wound care elsewhere and was finally referred to us for a skin graft.  But the wounds on her head were still too big in relation to the size of her thighs (the would-be donor sites) and they were also oozing puss.  We spent the week waging war on bacteria . . . only to have Granny announce she would be taking her home prematurely.

Blowing bubbles with Abdou
First it was money: they had run out of money for food.  That was an obstacle we easily navigated.  Then there was a long list of culturally appropriate reasons why Granny was justified with her leaving . . . and no matter what I said, there was no convincing her to change her mind.  The financial support (and a jar of peanut butter) we provided would buy us a week, but that was all.

Knowing if we didn't do something to fight against F.'s facial scaring now, we would have lost our vital window to make the most difference.  So, we pulled a half-mask, and I suggested to our Chief of Surgery that we skip the scalp graft and concentrate on her eye, allowing them to return home and then follow up and see if we can do more later.

He agreed and scheduled her surgery for Friday.

F. knew something big was going to happen . . . I tried to explain, in my failing Hausa, what the doctor would be doing . . . but when that didn't work, we wandered down to my office, picked up our teddy-friend, Abdou, and made our way to wait where we had first met in OR.

She was terrified, but hid it well beneath the trust that placed in Granny and me.  With Abdou pinned to her side, she reached out for my hand as we made our way back into the operating bloc.  I promised her eye would feel better when she woke up.

The plan was to release the scar that was pulling her bottom eyelid down into her cheek, then release the top one, allowing the lid to close fully, followed up by the grafting of a small dollop of skin carefully chosen from her right thigh.

But sometimes a change in plans is a good thing!

Once she was in an anesthesia-induced deep-sleep, we pulled off the bandages on her head to wash out the wounds, so as not to risk upsetting the graft later.  What had been a puss-filled bacteria-farm only yesterday was a clean, nicely granulated, highly vascularized moist wound bed . . . meaning the surgeon would be able to graft her whole head!!

Now, for you who don't work in burn care in Niger . . . this is a really, REALLY big deal!!  File this one under: Miracle.

As I watched our Chief of Surgery work his craft, all I could think was 'Thank you God for his gifted hands!'

It was like watching a sculptor smooth marble.  His knife swirled around her eye leaving delicate slits which he then stretched and expanded.  Gently, he returned the eyelid to its rightful place, dancing perfectly around her tear duct.

He had made good on his challenge . . . and today, the magic was in the OR . . . for those two hours at least!


rachieannie said...

Love hearing about the miracles! What a peanut. So cute!!

Deb. said...

Isn't she, though??? She's just so stinkin' precious!

And she couldn't get enough of the peanut butter, finished off a far in two days . . . then Granny told me when the jar was empty, she got up from her hospital bed and announced she was going to the therapy gym. When Granny asked her why, she matter-of-factly replied 'Because there's probably more peanut butter down there!'