Will she run again?

Her empty bed caught my eye as we convened with the chaplain around a neighboring bed that morning. The traction bar now loosened and crooked, and the foam blocks which had supported her over the past few weeks now sat unused still containing the same dirty stains.

She had come to us back in January after being run-over by a moto. Walking hand-in-hand with her sister that night, her sister had walked away with a scratch on her leg. Memouna had not been so fortunate. I first met Memouna the following morning after the accident. Her 8year old body laid out on a bed, contorted at odd angles, and she uttered soft moans while trying not to move. Three of four limbs were broken in multiple places, and I counted at least 5 ribs, (#1 - #5) on the left side. One thing was clear, her bones were not normal. On xray, the odd angles were more than just fragmented bone, even unfragmented portions followed curved lines and demonstrated porous density. As for the ribs, a child's ribs are incredibly forgiving and almost bounce, hardly ever breaking. In addition, the 1st rib requires excessive force to break even in an adult, let alone a child.

I took her to the OR for sedation that day and casted what I could of her extremities. Then we set her up in skin traction, pulling her thighs upward until her bottom raised off the bed, and supported her now casted lower legs on foam blocks. Multiple images were shared with pediatric orthopedic surgeons around the world, requesting advice. All agreed it was a difficult case, Fibrous Dysplasia and Osteogenesis Imperfecta both offered as explanations for her congenital disease and etiology. Unfortunately, all recommended intervention that was beyond our capabilities, and what we did have available carried with it increased risk of worsening her current fractures, or even causing new ones. For weeks I stopped by her bed wanting to make her as comfortable as possible, but usually causing the opposite as I reinforced her traction or righted the angles of an extremity that she had wiggled herself into. I did do surgery once, which proved the risks true, and caused her increased pain and discomfort for days.

We finally came to a point that enough callus had formed bringing a level of stability to her broken bones that I took down the traction and we looked at other options. Through translators I discussed with family what both immediate future and distant future was going to look like for Memouna. They expressed previous understanding that their daughter was extra delicate. Then I broached the subject of leaving the hospital, and how that would look. In the mother's response (which was in Anoufo, not French), I caught the word "batoure" (sp?) which I recognized as the slang term used for a white person in this region. Translated for me, the mother had said that Memouna wanted to stay with the white lady. That's when I realized that every morning when I checked her traction, or adjusted her bones, or did surgery, her weak trembling cries of "madame" had caused me more pain than what any action I performed had caused her.

We fashioned a spica cast around her crooked little body, giving it as much semblance of stability as possible that no amount of little-girl wiggling could potentially disrupt what callus had finally started to form. And she was discharged home, with her next rendezvous in a few weeks. I know Memouna will not live long here in West Africa, her bones simply are not built to withstand this lifestyle. But I would like to think she will walk again someday before that happens. And with what I've seen her survive, if it's left up to her, she'll even run again.

Much Love.