A Committed Team and a Child's Smile

Dr, Kelly, Paulini, and his grandmother

Dr, Kelly, Paulini, and his grandmother

Based on interviews with Dr. Kelly Shine, Creighton University Global Surgery Fellow

Seven-year-old Paulini arrived at FAME with stomach issues. His mother was able to tell us that he was born full term and was a healthy baby. But then, at around age five, something changed and he was suddenly unable to eat.  She took him to a hospital near where they lived and a surgery was performed that seemingly fixed his problem. Much to her relief, Paulini was able to eat normally for the next two years. But then the problem resurfaced. He could still eat, but was unable to keep the food down, vomiting it up almost immediately after taking it in.  Recognizing the seriousness of the situation, Paulini’s mother brought him to FAME for help. She knew that without intervention, he would certainly starve to death. And despite how chronically hungry he must have felt, Paulini arrived with an infectious smile and child-like joyfulness that simply melted the hearts of everyone in his midst.

It can be quite a challenge, in this environment, to get an accurate and complete history on a patient, and Paulini’s case was no exception. For Dr. Ken, Dr. Badyana, and Dr. Kelly, our visiting surgeon from the US, it was clear that Paulini’s stomach was blocked and he needed another operation.  But it was also clear they would be going into surgery with many questions still unanswered. In the Western world, surgeons generally have many more tools at their disposal – effective communication systems with other healthcare providers, detailed medical reports,  and tools that enable them to do extensive preoperative work-ups that can inform how they prepare themselves for the task at hand.

 

In a setting like ours, however, the situation is different.  In the absence of information, the challenge becomes one of thinking ahead and preparing for multiple outcomes.  And with Dr. Kelly’s coaching, our team engaged in just such an exercise --thinking through and preparing for multiple possible scenarios they may encounter in the operating room.  Unable to know precisely what they would find, they had to be prepared for one of a few different operations, and it paid off.  Once in the OR, Dr. Ken, Dr. Badyana, and Dr. Kelly were able to determine what operation had been performed when Paulini was five years old, as well as identify the current underlying problem. While the previous operation had been done well, there was scarring that was now causing Paulini’s new symptoms. The surgery required a fair amount of suturing of the intestine and Dr. Kelly took great pleasure in watching how well Dr. Ken and Dr. Badyana tackled the challenge.  With the problem fixed and the surgery complete, it wouldn’t be long before little Paulini would eat again and be able to return to school, which he could hardly wait to do.

The technicalities of this case made it a very significant one for our surgical team and certainly satisfying in terms of FAME’s commitment to building local surgical capacity. Watching FAME doctors applying new knowledge and expertise that would save a life was more than gratifying for everyone.But that’s not the only thing that will leave an indelible impression on those who participated in giving this little boy his life back. In Dr. Kelly’s words, “the most significant thing about this case is how joyful a kid he is. He made us all smile.” There is nothing quite like making a difference in the life of a child and restoring hope to a family so devoted to their little one. In fact, it captures the spirit of what life is truly all about.

Robert Kovacs