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Catholic Near East Welfare Association

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It’s Monday Morning; That’s Good News

A hospital in the foothills of Beirut offers specialized care to children suffering from scoliosis.

Every Monday morning, Norma Fayad of the Pontifical Mission in Lebanon takes off for the mountain town of Bhannes and its hospital center – a campus of red-roofed buildings. Last winter these red tiles were often covered with snow. The road was slippery and wet, the trip, less than pleasant. But for the families that Norma meets, Monday mornings almost always bring good news.

Halos are an everyday sight at Bhannes Hospital, a medical center run by the Daughters of Charity in the foothills above Beirut. Christian and Muslim patients “wear” them as part of the treatment for respiratory problems resulting from scoliosis, curvature of the spine.

Receiving a halo requires the intervention of a surgeon. The device consists of four steel pins; two inserted above the temples and two toward the back of the head. Attached is a stainless steel band that runs around the head, which creates a halo. It provides traction for the spine and relief to a crushed respiratory system. Before treatment became available, people suffering from severe scoliosis died by their early 20s.

Only in the last 10 years have Lebanon’s trained surgeons and therapists understood scoliosis. In the past, scoliotic children were hidden, often restrained. Families seeking medical attention encountered doctors with medieval attitudes. “Take the child home; he’ll die soon anyway,” said many doctors. “This is from God. There is nothing you can do.”

Dr. Khalil Kharrat, an orthopedic surgeon at Bhannes, sees many children between 10 and 13.

“Parents bring the children when they can no longer carry them,” he explains. He also sees much higher degrees of deformity in children under 10 than he did in France or in the United States where he trained. The most extreme case he has dealt with is a 14-year-old girl whose degree of deformity was 180; X-rays show her chest pressing into her pelvic area. She just recently endured a corrective operation and is now recuperating from her surgery. And she is back in her halo as part of the postoperative therapy.

Some patients “grow” almost five and a half inches during the operation, but on the average surgery adds an inch or two. Dr. Kharrat enjoys telling of one young girl’s reaction to herself, “It was the first time I could see myself in the mirror!”

Sophie Akiki’s scoliosis was discovered early. Her grandmother noticed how at six months the child could not sit up. Baths became dangerous. Later, the child showed no interest in prewalking activities. At 18 months the bright-eyed bundle still does not walk.

In the child’s playpen a notebook catches the child’s eye more often than her doll; she eagerly repeats the ABC’s with her mother, a teacher. The parents knew there was nothing wrong with Sophie mentally regardless of the doctors’ opinions. “Min hakim le hakim – from doctor to doctor,” the parents say in Arabic as they relate their tale of seeking medical advice.

“She’s going to be a dwarf,” one doctor told the family. Wisely they sought a more professional opinion as their fears grew over their firstborn’s condition.

The family’s bad experience with doctors is not unique. Today, however, doctors are less in a hurry to condemn such children to God’s will, or to something the mother did during her pregnancy. Today doctors and organizations say, “Go to Bhannes. They can help.”

Because Sophie’s scoliosis was diagnosed early, the doctor hoped a medical corset would correct the 50-degree curvature in her spine. Within three months the curvature had dropped to 41 degrees, but the next X-ray showed an increase to 45 degrees. The doctor then decided to put Sophie in a body cast.

For the families, the changes they see in their children are miraculous; but in the 20th century miracles cost money and although attitudes toward scoliosis have changed radically, the remaining bastion of the “min allah” clause are insurance companies that refuse to pay these patients’ medical or hospital bills.

The Lebanese government pays up to 40 percent of the operation, but for children who need additional surgery, the state argues: “You have had this operation once already, now you are back?” Families must turn to relatives, social organizations and wealthy philanthropists for help. In post-war Lebanon, with all its social problems, the lines for financial assistance are long and often disappointing.

Since May 1992 the Pontifical Mission has worked with the Bhannes team to estimate the amount of financial aid the families need. Each family usually receives between $800 and $3,000 from the Pontifical Mission. In the first nine months of the Pontifical Mission’s program, some 40 patients received assistance from the program’s $55,000 dollar budget.

Without exception the stories Norma hears and writes in her reports could be filed under “hard luck”:

“Father injured in the war in 1975 and is now unemployed.”

“Father deserted family. Older daughter left school to care for younger scoliotic sister so mother can work as house cleaner.”

“Family exists on $75 dollars a month.”

“Patient had polio as a child. Later developed scoliosis.”

“Severe case. Child has polio, scoliosis, also respiratory and heart problems.”

“Parents are first cousins. Two other children in the family suffer from scoliosis.”

“Family displaced twice during war.”

Dr. Kharrat estimates that 50 percent of the people he sees suffer from scoliosis due to childhood polio. Although polio results in paralysis, often of the legs, it also affects the muscles. The torso muscles weaken and the spine begins to collapse.

But many cases are idiopathic – cause unknown. Antoinette Sfeir’s scoliosis is untraceable. The pretty 18-year-old was born in 1975, the first year of Lebanon’s civil war. A nun at Antoinette’s school took an interest in her case; “Bhannes,” she suggested. That was five years ago. The family delayed her treatment and waited for better days. But financial concerns caused as much delay as the war. Antoinette’s father was injured during the first year of the war and has been unemployed since.

Antoinette, who had the operation in January, says she now understands how much better it would have been to have had the operation earlier. Her case is mentioned with enthusiasm by Jean-Marie Schultz, a French physiotherapist who is part of the Bhannes team. “You want to meet someone with a complete change of attitude? Meet Antoinette,” he suggested.

From her bed where she must stay until May, the teenager is delighted to tell her story. “Before the operation I was always in a black mood. My mind was never in class. I said, ‘I’m not like the other girls,’ I was always nervous, always crying.”

Antoinette purposely has no calendar. For her a watched pot doesn’t boil. But she does remember the day she and her family first met Norma. She loves telling her “close call” story.

“Our family car is old and uncomfortable. We thought the trip up the mountain to Bhannes would be too much so we borrowed a friend’s car – a BMW.”

She giggles telling how worried they were when Norma saw them arrive for an interview seeking financial aid in a BMW. Explanations quickly followed and possible misunderstandings were cleared up.

The superior at Bhannes, Sr. Madeleine Moubarak, sees how the families suffer from “the where to turn to” syndrome. The raysi (“head”), as she is called in Arabic, flips through the piles of black and white government forms – red tape. With expertise she checks them and tells the relieved family, “All is in order.” And if it is not, she is always willing to help.

Sr. Moubarak has a way with people and paper. To explain how the halo works she picks up a piece of paper and says “This is how the patient’s spine is with the halo.” She then pushes the paper together in soft folds and says, “Without the halo, that is what would happen.”

The Pontifical Mission project at Bhannes helps more than just those with scoliosis. You can meet them during their sessions of physiotherapy. The sunlit room is like a solarium. Tall healthy plants serve as models for the patients as they exercise and enjoy the warmth of the sun. Najat Assam, a 32-year-old who was stricken with polio, is there following an operation. In mid-March, with braces provided by the Pontifical Mission, she took her first unaided steps since struck by polio as a child.

The good news on Monday morning is only the beginning. The future for all these patients looks brighter as the weeks and months pass. One patient sees herself “walking as straight as a candle” after her postoperative therapy. Antoinette Sfeir plans to return to her courses at the Institute of Tourism just as soon as she is back on her feet. The sister of one patient with both scoliosis and polio expressed the ultimate in optimism:

“Maybe one day my sister will not just walk upright, but she’ll walk using only one crutch.”

Marilyn Raschka, a frequent contributor to Catholic Near East, writes from Beirut.

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