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CROSSTALK  December 2007 
Pictured: L-R Pam Rundle, Gabriela Arias (Front), Anita Arias, Emma Content, and Ellen Wright.
God Bless You -- Gabriela Arias

By Gabriel Arias, translated by her father Samuel Arias and edited for publication by Ellen Wright

My name is Gabriela Arias and I am ten years old. I live in El Salvador, in Central America. I´m going to tell my experience as a patient and what my physical problems were before my surgery.  My life was normal, I danced jazz, practiced basketball, run, jump, and did everything normal people do--I never fell down or hurt myself. But in November of 2005, I started having a horrible pain in my left leg. That’s when I started a hard experience with my parents. On January 2006 the doctors confirmed that I suffered from a deformation in my spine. The doctors said that I suffer of a delicate illness named Spondylolisthesis grade 1. The Salvadorian doctors didn’t know what to do, so I started with a series of therapies and exercises but my condition became worse. The pain was also worsening as my spine started to go to one side and that is when the scoliosis began. I used a brace to keep my spine straight. I used it from 6:00 am to 8:00 pm every day. I suffered a lot because of the sweat and how uncomfortable it was. It was also hard for me to walk and I couldn’t stand for more than 2 minutes. It was frustrating for me during the first months to see all my friends at school playing and running, but then I didn’t care. My parents were always smiling but I knew that deep inside they were sad and worried because the Salvadorian doctors couldn’t operate on me and the surgery in another country was too expensive.

Then my Spondylolisthesis became grade 3 and both legs started to hurt. That is when God answered all our prayers and we met Dr. Dennis Devito in the hospital Benjamin Bloom of San Salvador and Mrs. Julia Novoa of the foundation Children’s Cross Connection International, who were interested in my case and they decided to help us. I was very happy when my parents told me about the trip to Atlanta, Georgia, and that I was going to have the surgery in the hospital “Children’s Healthcare of Atlanta” and, after the surgery, I will be able to have a normal life without pain. My parents were with me on the trip, we stayed in the Ronald McDonald house, a beautiful house where all the people were kind.

I also met Pam McKenzie-Rundle and Ellen Wright from the Foundation Cross Connection International, and they took care of me always and took us to --they were always so kind and nice. I met Dr. Devito at his clinic--a very special person that I will never forget. My parents said that he is one of the best doctors in Orthopedics in the world and has a big heart.

The day of the surgery I wasn’t nervous--instead I was happy to have the surgery. I trusted Dr. Devito and God that everything was going to be ok. When I woke up from the surgery, I had a horrible pain in my back and I couldn’t move; one nurse started talking about cakes to distract me but it didn’t work. I was connected to a machine of morphine, and when I had too much pain, I pressed a button and the morphine came into my body. It hurt more when they moved my position every two hours. In that time, I didn’t feel in the real world, but I remembered something, that all the doctors and nurses were very kind and patient with me. Pam gave me many gifts, and went to see me at the hospital too with Ellen. I stayed two days and a half in bed. On the third day they sat me up and stood up as well. I remembered that the pain that I suffered before and I didn’t have it any more. I started to walk a little with help.

Now I am recuperating, and I walk almost perfectly! The pain went away and my spine is almost straight. The surgery was a success. I know one day I will be able to run, jump, and do everything I did before. My parents always say that I never lose my smile. And now we give thanks to God, Dr. Devito, Pam, Ellen, Julia and all the people that participated in this miracle.

I will always have you in my heart,

Thank You, A Million Times, Thank You!!

By Eilyn Alipzar Hildago, translated by Phil Coventry

I came to the United States for the first time in 1995 after my aunt had met people from Children’s Cross Connections, and although they worked primarily with younger children, they agreed to help me. I was born with a left hip and left leg that never fully developed, leaving me in need of a full-length prosthesis.

I was taken to St. Joseph’s Hospital in Atlanta where I was seen by Dr. Rubin. He spent a long time talking to me about possible surgery and the risks, and spent a long period of time consulting with colleagues all over the world. My dream was to have a family, and after all the consultations and consideration of the risks, we decided to forego surgery, and I was equipped with a lighter prosthesis and I returned to Costa Rica.

My family could never have afforded to get me this help. I now have the family I wanted, two beautiful sons, now seven and nine years old. They are the purpose and hope of my life. I still use the same prosthesis, and have now changed the foot twice, both with the help of those I met through Cross Connections.

Today I continue to thank God for placing in my life people who without knowing me did so much to give me a better life. I have been able to go to school and obtain a law degree. The help I was given in a time of need has made the difference in my life. The work you do is invaluable, and I want you to know that I hope in my life to give back to others what I have received. May God continue to bless you and your work.
Thank you, a million times thank you.

Eilyn Alpizar Hidalgo
San Jose, Costa Rica

Leaks From the Urology Surgical Team

By Edwin Smith, MD

In February Children’s Cross Connections International will sponsor the third Pediatric Urology focused mission to El Salvador. The steps toward a dedicated children’s urology mission to Hospital Benjamin Bloom were gradual but have resulted in a wonderful exchange in medical knowledge and in the development of great friendships. The opportunity to enhance urologic care began during visits to create a pediatric renal transplant program at Hospital Benjamin Bloom.

Some of the children had developed end stage renal disease due to obstructive uropathies and we had the occasion to discuss the urologic aspects of care for these patients. This led to conducting small clinics during our transplant trips in which children who were not transplant patients but suffered very complex urologic problems could be presented to discuss management options. Dr. Uriel Perez and Eduardo Loza have a great deal of experience in pediatric surgical care and have also had a genuine interest in pediatric urologic care. They were caring for many of these children with the best means possible. Yet, the ancillary support for managing some of the most severe cases was not available in El Salvador.

Two patients with bladder exstrophy eventually traveled to Children’s Healthcare of Atlanta for reconstructive surgery and become continent for the first time in their lives. But most impressive was the desire of Drs. Perez and Loza to come to Atlanta with their patients to learn newer techniques for lower urinary tract reconstruction for their children with bladder exstrophy.

Finally, we recognized that a mission that could demonstrate newer concepts in managing children with neurogenic bladder dysfunction (spina bifida), and reflux nephropathy, obstructive diseases and genital anomalies could help to elevate this area of care in El Salvador. Crucial to this project was a strong relationship and commitment of our El Salvadorian friends and colleagues, Drs. Perez and Loza. Julia Novoa and Pam Rundle cleared the path for us to work with these doctors at Hospital Benjamin Bloom, El Salvador’s pediatric hospital as only they could do.

Our first mission was in September of 2005 and focused on complex hypospadias repairs. Last year our team grew and included Dr. Luis Perez, Dr. Joe Molitierno, Brenda Middlebrooks CNP, and Dr. Edwin Smith. We arrived a day late due to mechanical problems on our airplane and went straight to the hospital. A preoperative clinic was held with Drs. Loza and Perez. So many smiling eager faces met us that day, including a few patients from past trips. As always, there were more patient needs than could be met in a single week.

We ran two operating rooms for the next five days and performed several challenging cases. Our procedures ranged from complex hypospadias, to open stone procedures, to bladder augmentations allowing continence for neurogenic bladder disease. The operating rooms ran smoothly and the hospital staff was, as always, cheerful and tireless despite our long hours. It soon became apparent that we were learning as much from our El Salvadorian counterparts as they were learning from us. It was a great educational exchange.

The week was a lot of work, but our hosts made sure that we had the opportunity to experience their beautiful country. From the delicious plantains and pupusas to our hike to the top of the Volcano Izalco we took home fond memories and an eagerness to return to El Salvador. We owe a debt of gratitude to Julia Novoa of Children's Cross Connections International and Drs. Edwardo and Uriel for being such gracious hosts. We look forward to our Pediatric Urology campaign in February of 2008.

"Commit thy way unto the LORD; trust also in him; and he shall bring it to
pass." Psalm 37:5
"Before they call I will answer..."

I live and work in Mongolia with my Mongolian wife and our two daughters. When our third daughter was born with cleft lip and palate, as well as heart problems we knew we were at the mercy of our God to deal with it. We also knew there would be grace from Him and we quickly felt it at work in our hearts. In February we were told that the heart condition was beyond any help found in Mongolia. In April, an American doctor concurred and said we had six months to a year to get her operated on. Through a sister in a church in Tucson, Arizona we learned of three organizations that help children from overseas get help in the U.S., one of which was CCCI. The Lord’s wondrous timing in all this is why I was asked to share this little testimony.

CCCI got my letter explaining our situation while Pam was in another country, so we did not get a quick response. Another organization that helps children has an office in the capital of Mongolia, but could not take on our case because our baby was (half) American (though they were much help to us there with free examinations and recommendations). But, the Father of Glory stirred Pam to take on our case even though CCCI had never worked in Asia before. Pam thought to use my being American to our advantage. She had me in contact with people at Phoenix Children's hospital within a few weeks.

Because I thought we had till September to get our baby safely to America I was moving things a little slow for Pam. She had heard from her doctor friends after they had seen the data sent them that we needed to be there soon, very soon. God used all this for His perfect timing to play out. Pam used her know-how to get flights scheduled for us out of Beijing, but she was going to have to use CCCI funds to fly us out of Ulaanbaatar (Mongolian capital). I knew we would be in the States for almost a year so, we would need to take our nine and three year old with us, but Pam's arrangement presented some problems, so she let me use my being familiar with Asian airlines to find a way to get us out of Mongolia to Phoenix.

When I told Pam the date chosen she had all sorts of people standing by. But, when I announced to my handful of supporters and some family members the date, God’s hand was seen. I announced the date of the flight and the deadline for the payment on the tickets. CCCI wished to help with $1,000 which left the Father to provide $2,500 more just for tickets.

The day after sending the e-mail announcement my sister in the flesh sent a note that two girls in her church had just the previous weekend had a benefit garage sale. She also mentioned that she and her husband were to visit his mother in Tucson, but, due to a discount offer, they had, just two days before, bought tickets and would land in Phoenix four or five days after we would.

Within ten days or so the Father had not only gathered about $6,000 but we had also learned that He had moved my brothers and sister, who live in Missouri, to schedule their vacations to Tucson so as to see us in Phoenix. Mind you these vacations were planned months before I announced the moving up of the flight to Phoenix. They all thought I was coming in September or later.

My sister and her husband flew in, on their way to Tucson, four or five days after we landed. My younger brother and his family delayed ending their vacation by two days to meet us at the airport. My older brother wanted to let us use his car while we were in the states, so he had planned no vacation travels that summer. For that reason his two daughters had traveled with my younger brother and his daughters. My nine year old was met by all her favorite cousins at the airport. My brother's church had helped him with gas money to deliver the car from Missouri and some believers he knows passed the hat to put two child car seats in it, so it was waiting at the airport ready to go.

I have a twenty seven year old daughter in America who lives in California teaching ballroom dance. She, how many months before, scheduled to be at a dance competition in Phoenix one week after we landed. I picked her up at the airport just hours after the surgery was over and took her to see my wife and baby at the hospital before taking her on to her hotel.

Our gracious Master did not stop there. Pam had sent us money before to help get our daughter's passport papers expedited, but when sending the CCCI check for a thousand it was written wrong. That $6,000 mentioned did not include any funds from CCCI. I had my accountant friend send the check back with a note saying this mistake was a gift to CCCI from the Father, use the money to help some other baby out there. We finished the heart surgery and then went on to have the cleft lip and, just last week, the cleft palate repaired.

We thought the surgeries would keep us in the Tucson and Phoenix area through December, but the Father had a nurse schedule a block of time with the hospital for her boss to use the operating room months ago. When the doctor said he wanted to do the cleft palate soon after the cleft lip surgery, she found the hospital all booked up, but then she remembered the block of time she had scheduled previously and put our daughter's name in it.
We will be released to travel in time to join my older brother in Missouri for Thanksgiving.

When sharing this story of the Heavenly arranged family reunion with strangers on the plane over here from Asia a few have asked to be put on the mailing list just so they could hear the ending of this little baby's adventure. Some are not even believers,....yet.

I close with one more. Of the $6,000, the lion's share came from one couple. When the wife later visited us in Tucson she said they had tried to open a private practice a year ago and the investment resulted in a large tax refund. They had decided to tithe from it. The refund check arrived the day of or the day after my announcement. When her husband asked her to suggest how they could return a tithe to the Lord she showed him our newsletter and he insisted on sending all of it. So before my daughter was born the Lord of all was preparing to provide for her safe transport to a ready hospital 7,000 miles away. My daughter's Mongolian name, Munkgunj, when translated, is Eternal Princess and look how her King has used her to His glory in her first year of life.

From the Remnants of Hurricane Mitch, Come Love and Determination for Gabriel Perez
By Mary Ailene Dame, MD, retired

In 1998, Hurricane Mitch devastated much of Nicaragua and Honduras leaving hundreds dead and thousands homeless. It was under these circumstances that Sister Margie Navaro, a native of Cincinnati, Ohio who was stationed in Nicaragua at the time, came across a family living under a makeshift plastic tent. Their tiny shack had been washed into the swollen lake. Inside this meager dwelling, Margie discovered a tiny child, named Gabriel, severely crippled, unable to walk or even crawl because of severe “curvature of the spine”. A woman who was with Margie on that first visit described the child as so severely “twisted” that his tiny body formed the letter “S”.

Two subsequent operations at a local hospital, when the child was four years old, probably resulted in some improvement, though the steel rods on both occasions had worked their way out prematurely, probably in no small part because of severe malnutrition. For the following six years, Gabriel was made to wear a steel and leather corset which stretched from his pelvis to upper chest with a steel bar running along the side of his head. The temperature in Managua often is over 90 degrees, so the discomfort of wearing such a contraption in that heat was obvious. His older brothers would wheel him to school in a wooden cart, but the teacher would make him take the brace off so he could bend his head to read or write.

Margie had made several attempts to try to find a hospital in the U.S. to evaluate and, if possible, do the needed surgical corrections. Unfortunately, Sister Margie died of cancer in 2001 and was unable to follow through on her plan for this child. As I had had the privilege of caring for Margie during the last couple of months of her life there in Managua, she begged me to continue the search.

After two years of searching and sending x-rays and letters off to so many places, a physician in Boston put me in contact with Pam Rundle at Children’s Cross Connection International. Within weeks, we had a hospital and an orthopedic surgeon willing to take Gabriel. Doctor Dennis Devito performed three surgical procedures at Children’s Health Care of Atlanta.

During the last definitive operation, which took place in January, 2007, several bone grafts and four titanium rods were placed on each side of the spinal column. That procedure alone took eight full hours. Although there is still some residual lower spine curvature, the child has been essentially made whole again. He is pain free, cheerful, energetic and looking forward to a life his family never dreamed possible for him.

To say we are thankful to Children’s Cross Connection and to Doctor Devito and the staff at Children’s Healthcare, would be to greatly underestimate the depth of our gratitude for the miracle performed on Gabriel. We shall never, ever forget the kindness of all those involved in Gabriel’s care.

Tragic Mistake Turns to Hope
By Becky Castle

Many of you are familiar with Children’s Cross Connection’s mobile medical and dental units that have provided needed care to many children in El Salvador, Nicaragua, and, increasingly, Ethiopia, as well as the Seeds for Hope foster care in Ethiopia. You may not be as familiar with the hundreds of children that CCC International has brought to the US in the last 26 years for specialized medical care not available in their home country. I would like to share with you the story of one such case.

In August 2006, Isabel, a Salvadoran friend living in the United States, called me with the most disturbing piece of news. Her daughter, Cindy, who still lives in El Salvador had had surgery to remove her “damaged” kidney. While recovery from any surgery is always a challenge, it was particularly difficult for Cindy. Problems started immediately--she was not able to urinate, developed an infection, and was in and out of the emergency room practically every day. The “surgeon” who performed the operation--and who we later learned did not have a license--claimed to be perplexed by these post-surgical complications. He said that he didn’t know what the problem was and why Cindy wasn’t on the path to recovery. 

Finally, Cindy was put on dialysis, which she began to receive regularly at a clinic close to her home. One of the physicians at the dialysis clinic decided to do an ultrasound to see if he might be able to determine the problem. Shockingly, the ultrasound showed that Cindy had NO kidneys. Further diagnostic tests confirmed the absence of both of Cindy’s kidneys. In an example of extreme incompetence, the “surgeon” had removed what was likely Cindy’s horseshoe kidney, a congenital defect in which the kidneys are fused.

This bad news was simply overwhelming to Isabel, particularly after she learned the costs associated with dialysis to keep Cindy alive while awaiting a transplant and the costs of a transplant and the associated immunosuppressant drugs. Nearly a decade ago, Isabel had moved alone to the United States to earn money to support her four children back in El Salvador and provide them with the best education possible. She felt hopeless, not knowing how she would cover these costs and still support her family. Needless to say, I wanted to help Cindy and Isabel, but was not optimistic about finding a hospital to provide a transplant.

Pictured: Cindy and Isabel at Atlanta Hartsfield-Jackson Airport on her arrival with her escort.

In October 2006, a colleague put me in touch with Perry Dykes, a transplant coordinator at Piedmont Hospital. Perry was very helpful and suggested that I speak with Pam Rundle. He explained that Children’s Cross Connection, founded by Pam, had organized transplant training in El Salvador using Piedmont surgeons. He thought that she might have ideas about how to help Cindy.

After my initial conversation with Pam in November 2006, I felt hopeful for the first time since learning of Cindy’s plight. Pam’s energy and optimism were practically unlimited and contagious. She discussed all of the challenges of obtaining a transplant for Cindy, but also had a “can-do” attitude and made me think that it might be possible. She told me that she would make some calls and get back to me. Right before Christmas, Pam called with a great Christmas present. She had shared the details of Cindy’s case with Dr. Whelchel, director of Piedmont’s Transplant Center, and he had agreed to perform the transplant as a humanitarian case as long as we could secure a source of immunosuppressant drugs.

Throughout the next eight months of arranging the remaining logistics for Cindy’s transplant at Piedmont, Pam’s advice and counsel and the help of Julia Novoa and Elena Magana Children’s Cross Connection’s staff in El Salvador, were invaluable. When Isabel told me that the Salvadoran First Lady’s office had offered to help in any way possible, Pam provided me an introduction to her contact there. This contact ultimately helped arrange for the Salvadoran government’s commitment to provide the immunosuppressant drugs to Cindy following the surgery.

When I was having trouble bringing the blood samples from El Salvador to Atlanta for the HLA testing, Pam helped work with Delta Air Lines to make sure that we could bring the samples AND picked up the samples at Delta cargo. On the day that Cindy went to the US Embassy for her visa interview, Pam spoke with the consular officer, who was having doubts about providing a visa, explaining that CCCI has brought over a thousand individuals to the US for surgery and not one had ever stayed beyond their visa. Pam was a constant source of support and advice, including spending extensive time at Piedmont when Cindy’s transplant took place in late August 2007 and providing follow-up advice over the subsequent months.

During the week at Piedmont, I also was impressed by the incredible goodwill generated by Children’s Cross Connection among everyone we encountered at the hospital. It seemed that everyone in the Transplant Center had been involved in other CCCI cases and had warm feelings about Pam and the experience of helping CCCI’s beneficiaries. Perry Dykes did an amazing job of stewarding Cindy and Isabel through the process. Drs. Whelchel and Zayas both met with Cindy and Isabel in advance of the transplant. In addition to answering their questions about the transplant process, the fact that all three had been to El Salvador with Children’s Cross Connection made Cindy and Isabel feel at ease.

Three months after her transplant, Cindy is flourishing. She is visiting her mother in Los Angeles through the New Year after which she’ll return to El Salvador to resume her university studies. I know she feels lucky to have received a transplant and is appreciative of everything done by Children’s Cross Connection and, specifically, by Pam. I am incredibly appreciative of CCCI’s efforts on Cindy’s behalf and thank Pam and her colleagues in El Salvador for making this miracle possible. Without CCCI’s efforts, there would not be a happy ending to this tragic story.