December 1, 2006

Haitian boy gets ‘step up’ on his future

Featured Image

Gregory Mencio, M.D., right, examines 11-year-old Bertrang Joseph prior to surgery to repair the Haitian boy’s club feet.
Photo by Neil Brake

Haitian boy gets ‘step up’ on his future

Gregory Mencio, M.D., second from right, and his team operate on Bertrang Joseph to repair his club feet.
Photo by Neil Brake

Gregory Mencio, M.D., second from right, and his team operate on Bertrang Joseph to repair his club feet.
Photo by Neil Brake

Sometime in the next few months, Bertrang Joseph will be able to stroll the streets of his native Leon, Haiti, in a far different manner than he has the first 11 years of his life.

The precocious youngster recently underwent surgery at the Monroe Carell Jr. Children's Hospital at Vanderbilt to address his club feet, which had turned so far inward that Joseph walked on the sides of his feet rather than the bottoms.

“I met Joseph when he walked in to the clinic to visit another relief worker he knew named Julie Aldrich,” said Seth Wright, M.D., associate professor of Emergency Medicine. He met Joseph while on a medical relief trip to Haiti last February.

“Julie told me that a number of people knew Joseph and wanted him to get surgery for his club feet. I e-mailed Andrea Bracikowski (assistant professor of Orthopedics) some photos and she shared them with Dr. Greg Mencio. Before we even left Haiti, Greg agreed to do the surgery.”

A quick approval from the administration at the Monroe Carell Jr. Children's Hospital at Vanderbilt ensured that — in addition to Mencio's donated surgical and follow-up work — every aspect of Joseph's treatment would be provided for free. That was the easy part. An organization in Atlanta called ChildSpring International spent months arranging for the paperwork and travel expenses to get Joseph to Vanderbilt.

Two days before Halloween, Joseph arrived in Nashville for a surgery that Wright and many others hoped might change his future. But that hope was tempered with caution.

“Joseph isn't the best surgical case,” Said Mencio, chief of Pediatric Orthopaedics. “He has what I called neglected feet; that is, he's been functioning on feet that are turned inwards for so long that the sides of his feet have become the functional bottoms of his feet.”

Mencio has participated in numerous surgical mission trips and was realistic about Joseph's case. The surgeries he was offering Joseph would probably never have been offered in his home in Haiti, even by medical aid groups.

“Because of his age, everything has been misshapen — the bones, which should be shaped like long boxes, are more like long trapezoids because of the pressure applied to the sides of them over the years.

“The skin, ligaments and other structures have all been pushed over from years of walking on the side of his feet. We see about 100 babies with some degree of this foot deformity every year here at the Children's Hospital. Correction before a child begins to walk is the best way to get a proper fix.”

Joseph posed a serious challenge for Mencio. The deciding factor was time. Because of the generosity of Wright, Aldrich, Children's Hospital and ChildSpring, Joseph was able to remain in the U.S. for several months. “If this were a one-shot surgery in Haiti, I'd say no, but we have him for enough time to do some good.”

The first and most significant surgery took place on Nov. 13. Mencio made incisions on the top of Joseph's left foot and calf to release ligaments, allowing the inwardly clutched foot and toes to relax and loosen. A cast was applied to hold the foot in a more outward position.

The right foot was different. More fixable, if you will. Mencio not only released the soft tissues, he carved at the misshapen bones to allow the long bones across the top of the foot and on the outside of his ankle to line up side-by side, instead of being stacked sideways.

Pins hold the new position as the bones heal. The right foot now truly “plants” on the ground.

Now, a couple of weeks after surgery, Mencio says he is very pleased with the correction on Joseph's right foot and feels certain he will be able to walk on the bottom of his right foot.

The left foot will take all of the three months Joseph has been allotted for serial casting, but should gain from quite a bit of correction.

“He was in a lot of pain after the surgery, but is doing very well now,” Wright said. Joseph may avoid more orthopaedic problems further up the leg in the knees and the hips that would likely have plagued him without correction.

“Probably the toughest part of this experience will be sending Joseph back home,” Wright said.

“I do worry about a kid being in the U.S. for months, then going back to his country and getting reverse culture shock. His home is war-torn, one of the most unstable places on earth; very violent.”

Wright and his mother, Lyn Wahnseidler, have opened their homes to Joseph, hoping for a happy ending for such a bright boy from such a bleak place. At home in Haiti, Joseph's grandmother cares for him and works two jobs as a cleaning woman. There is no electricity in Joseph's village, and only one pipe of clean running water for all of the villagers to share.

But it is home, and Joseph will return to Haiti with advantages he didn't have before. Wahnseidler said Joseph has been learning to read in his native language, Creole, and is learning to speak English.

He even has a scholarship waiting for him when he returns home. He has only had about three years of education.

“The biggest lesson in this for me has been the generosity I've seen and the interest in Joseph's story,” Wright said. “I wasn't sure there would be any interest, but I've been most amazed by the willingness of people here in this country to help him.”