LITTLE ROCK Four-year-old Christin Markoos lay in her Little Rock hospital bed last week, playfully pulling and batting the get-well balloons overhead.
She’s a shy, petite girl with thick brown hair and large dark eyes. Her laughter Wednesday morning was a stark contrast to her sad, worried mood just two days earlier, as a doctor carried her away from her mother into an operating room for surgery to repair her spinal defect.
Christin traveled more than 4,600 miles from her hometown of Al-Hamdaniya in northern Iraq to Arkansas for the surgery. Without it,doctors said, she could have become completely paralyzed from the waist down.
“In Iraq, my daughter wouldn’t have a chance of getting better,” her mother, Donya Azeez, said through an interpreter. “I am very grateful.”
Christin was born with spina bifida, a neural tubedefect in which the brain and spinal cord don’t form completely in the womb.
In the United States, it is the most common permanently disabling birth defect, affecting 1.9 of every 10,000 live births in 2005, according to the latest statistics from the federal Centers for Disease Control and Prevention.
Arkansas Children’s Hospital neurosurgeon Dr. Samer Elbabaa said Christin’s form of spina bifida kept her partially paralyzed below the waist. She had a lipomyelomeningocele, a rare defect in which a fatty mass extends into the spinal canal, pulling the spinal cord downward.
In Christin’s case, the mass protruding from her lower back was about the size of a baseball.
“They’re born with tons of fat in that area, and the spinal cord becomes tethered in that fat,” said Elbabaa, also an assistant professor of neurosurgery at the University of Arkansas for Medical Sciences.
Elbabaa has volunteered for the past year with the Palestine Children’s Relief Fund, which describes itself as a nonprofit, nonpolitical children’s relief organization. The group contacted him about Christin about six months ago.
Elbabaa asked officials at Children’s Hospital to sponsor her case, and they agreed.
HOME IN IRAQ
Before the surgery, Christin had no feeling in her feet and limited feeling in her legs. She could walk only short distances without support.
The family doesn’t have a car and has to walk - sometimes long distances - to get groceries and supplies. Azeez said she usually pushes Christin in a stroller when they go out.
At home, Christin gets around by crawling on the concrete floor of the family’s modest home, where she lives with her mother, father and triplet 2-year-old siblings. Because she can’t feel her feet, she often gets sores from scraping them against the floor as she crawls.
Typically, surgeons would want to operate on a child with Christin’s type of defect around 1 year old, Elbabaa said.
Azeez said she and her husband, a plumber, took their daughter to doctors in Iraq, but couldn’t get her help. Once, a surgeon attempted to operate but ended up telling the family he didn’t know how to correct the defect.
“They don’t have specialized doctors,” Azeez said through interpreter Nada Alchaer, with Arkansas Spanish Interpreters and Translators Inc.
About a year ago, Christin’s uncle put an ad on the Internet asking for help. Azeez said there’s no Internet access in their hometown, so he had to drive to a city two hours away to post it.
Steve Sosebee is president and chief executive officer of the Palestine Children’s Relief Fund, based in Kent, Ohio. He founded the organization about 20 years ago after working as a freelance journalist in Jerusalem. The goal is to identify “sick or injured children in the Middle East who need medical care” they can’t get where they live, he said.
The group helps children get the care they need, “regardless of their religion, nationality, race, creed or gender,” according to its mission.
“I think that caring for this child shows the people there in Iraq that the American people are decent and kind, and itbreaks down some of the ugly propaganda that exists there against us and leads to radical acts,” he said.
Each year, the fund sends 40 to 50 children to countries such as the United States, Japan, Italy and Chile, where doctors and hospitals agree to provide free care. More than 1,000 other children each year get care through surgery mission groups the fund sends to the Middle East.
The group also provides other humanitarian aid, such as wheelchairs and medicine to poor children.
Sosebee said he heard of Christin through Rana Tomaira, an Iraqi-American woman in San Francisco, who regularly puts his group in contact with needy families.
“Iraq’s health-care system is broken,” Sosebee said. “Particularly in these kind of operations, which are highly specialized and complex, the care she needs is not available in Iraq [or] on a regional level.”
The relief fund paid for Christin’s and her mom’s travel, Children’s Hospital is covering the treatment costs, and others are helping the family with translation and some transportation.
Without the operation, Elbabaa said, Christin risked developing a “severe neurologic deficit.” As she grew, she likely would have lost all feeling in her legs and been unable to walk.
Elbabaa started the fourhour surgery Monday about 9:20 a.m. by making a fourinch incision along the top of the lump on Christin’s back. He slowly cut down through the mass, removing layers bit by bit.
“All the work I’m doing now is partially cosmetic, until we get down to the spinal cord,” Elbabaa said during the surgery.
The surgery team used neurophysiologic monitoring to observe the nerve activity in Christin’s spinal cord throughout the operation. A neurophysiologist stood sentinel over a computer monitor and routinely reported any activity to Elbabaa.
It took about an hour to get down to the spinal cord. Once there, Elbabaa and Dr. Michael Raber, a neurosurgical resident, pulled up a microscope that allowed them to view the surgery site magnified tenfold.
Working carefully and methodically, Elbabaa cut through the tissue surrounding the lower end of the spinal cord, releasing it from its tethering.
The surgery was complete by 1:30 p.m.
Christin must undergo six to eight weeks of rehabilitation before she returns to Iraq. Elbabaa said he’ll continue to volunteer with the relief fund and plans to follow Christin’s case after she leaves Little Rock.
He’s optimistic that repairing the birth defect will improve her quality of life. It will allow her to walk better and possibly regain more control over the lower half of her body, he said.
“I am hopeful,” Elbabaa said.
Watching her daughter laugh and play with the balloons Wednesday, Azeez offered a tired smile, knowing that the worst was behind them.
“She feels much better,” she said.
More information about the Palestine Children’s Relief Fund is available online at www.pcrf.net.