Military engages stateside doctors in lifeline for kids from war zones

The trip to the United States takes several months as families seek approvals and documents.

By Damon Adams — Posted Feb. 20, 2006

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Afghani newborn Zargana had her eyelids burned from her face in a fire, and her desperate parents took the girl to an American Army hospital. During a home raid in Baghdad, an Iraqi woman showed National Guardsmen her granddaughter, Noor, an ill baby with a purple pouch protruding from her back, prompting the soldiers to promise to help.

Noor is among the dozens of children plucked from their war-torn countries to receive care from civilian doctors on U.S. soil. Zargana is waiting for documents to clear so she can travel to the states for surgery. The two are part of an informal lifeline that has emerged between U.S. soldiers who encounter the children, military doctors stationed in Iraq and Afghanistan, and civilian doctors back home.

On one end of the line are people struggling to get health care in Iraq and Afghanistan who turn to American soldiers as the only hope for their ill or dying children.

In response to these pleas, the troops get military physicians involved to provide evaluations and other care while hospitals and service organizations in the United States are contacted for help.

Military personnel send e-mails to elected officials, charitable groups and hospitals searching for someone willing to donate medical care stateside. In the best-case scenarios, children and other civilians are flown to the United States and receive crucial, often life-saving, treatment at nonmilitary hospitals.

The process can take several months as families obtain approval from their governments and gather travel documents, but the coordinated efforts have meant happy endings for Noor and others like her.

"This is really what we went into medicine for -- to restore someone to full function for the rest of their life," said Stephen Cyran, MD, chief of pediatric cardiology at Penn State Children's Hospital in Hershey, Pa.

Dr. Cyran cared for 6-year-old Hadiya Hussein, an Iraqi girl whose case exemplifies how getting children or others from Iraq and Afghanistan to the United States often works. Her father begged U.S. soldiers to get treatment for her heart ailment. The father told them she would die without care.

Last year, Army reservist Maj. Bradley Lauver of Pennsylvania contacted a hospital in his home state by e-mail, asking it to help Hadiya. Hospital staff communicated with the soldier and, with the aid of a congressman and others, secured visas and air travel for the girl and her father. A military cardiothoracic surgeon examined Hadiya in Iraq and provided Dr. Cyran and other hospital doctors with an electrocardiogram and echocardiograms.

Dr. Cyran met Hadiya on Oct. 21, 2005, at his hospital and diagnosed her with ventricular septal defect. On Nov. 3, a pediatric cardiothoracic surgery team repaired the defect. Hadiya went home two weeks later.

"She really beat all of the odds. She left here a completely normal child," Dr. Cyran said.

Noor's story is similar. Troops raided her Iraqi home, and the baby's grandmother showed the protrusion on the girl's back and said Iraqi doctors gave the girl 45 days to live without surgery. Soldiers agreed to help and began working with elected officials and agencies to get Noor, who was born with spina bifida, stateside.

Children's Healthcare of Atlanta agreed to do the life-saving surgery and absorbed the nearly $200,000 in costs.

On Jan. 9, doctors removed the growth on her back and closed the skin. Noor was discharged Jan. 25.

"[The troops] really took it upon themselves and went way out of their way to e-mail senators and everybody to make this happen. It does make you proud to play just a small part," said Roger Hudgins, MD, Children's chief of neurosurgery, who operated on Noor.

Working with little information

Before a patient comes to the United States, U.S. doctors must agree to provide medical care, and someone must sponsor the patient, according to military officials. The Iraqi government releases children with medical conditions that can't be treated there. Currently, the Iraqi Assistance Center's medical section is working on 3,000 cases, and about 80% involve children, said Namir Jumaili, a center liaison in Iraq.

Still, military physicians in Iraq and Afghanistan often have little or no medical records when they first see patients and U.S. physicians usually start from scratch to build a medical file. "A lot of times we have to read between the lines," said Frederick Emge, MD, director of pediatric cardiology at Janet Weis Children's Hospital in Danville, Pa.

Dr. Emge said cardiac magnetic resonance imaging and other tests were done on two Iraqi children who came to the hospital for surgery for congenital heart defects. One of them, a 5-year-old girl, was expected to have surgery this month. A 7-year-old boy already had surgery, and, Dr. Emge said, "When he goes home, he will go home walking and be able to play."

Samuel Weinstein, MD, head of pediatric cardiothoracic surgery at the Children's Hospital at Montefiore Medical Center in New York City, has performed heart surgery on five Iraqi children with heart defects who were referred by the military. The children and their families were transported to Amman, Jordan, where a Jordanian pediatric cardiologist did medical evaluations. Dr. Weinstein communicated by phone and e-mail with the doctor but said it's often difficult to determine from afar which children would benefit most from surgery.

While some make it to the United States for care, many others still wait. U.S. Army Capt. Patrick Raney, MD, a family physician at Bagram Air Base, Afghanistan, is hoping for a miracle for Zargana. The baby girl was 2 days old when a stove exploded in her home, and her parents brought her to the base. A plastic surgeon did skin transplants to fashion replacement eyelids. She needs a prosthetic nose and other medical attention.

Dr. Raney said paperwork was sent to the Afghan government. In early February, doctors were waiting to see if Zargana would be part of the lifeline to the United States.

"Any time you see somebody who has severe injuries, it's difficult to deal with, especially if it's a child," Dr. Raney said in a phone interview from Afghanistan. "It's very frustrating, because we know there's the capability to care for these things and make her look normal."

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