HEROIC SURGERY SAVES INFANT GIRL AT LBJ
“Men who are occupied in the restoration of health to other men, by the joint exertion of skill and humanity, are above all, the great of the earth."
So said Voltaire, a philosopher of another continent, another era.
Living — and thriving — today in Tutuila is an infant girl, born very ill, whose parents would agree with that assessment from another time and place, when the practice of medicine did not have the advantages (or the complications) that it has in our day.
Congenital Diaphragmatic Hernia is a medical term for "a hole in the diaphragm at birth”, and it is not one of the first things a new mother wants to hear. The diaphragm is the muscle that is responsible for breathing, as it helps the lungs expand and contract, and separates the lungs from the rest of the organs.
It is an unusual condition, but not unheard of. According to LBJ pediatrician, Dr. Mike Favazza, one in 4,000 babies are born with this problem, and Dr. Favazza said he has seen these cases in the States.
In early April, Makueta Faingaa of Pavaiai and her husband Tevita were the proud parents of a baby girl, and according to the mother and her doctors, the baby was full term and the delivery uneventful.
The infant, however, was experiencing respiratory distress, having trouble breathing, and the doctors were puzzled as to why. Lab work was ordered which indicated no infection, and the portable x-ray machine was out of service, but when the baby was stabilized enough to be taken into the main x-ray unit, that finally gave the doctors their answer.
The infant’s stomach, intestines and spleen had all been pushed up through the hole in the diaphragm, into the chest cavity. The baby’s heart was pushed far to the right.
The congenital diaphragmatic hernia had made this strange occurrence possible.
Relaying the story of the events which followed the diagnosis, Dr. Favazza, who had been on vacation at the time of the baby’s birth, said that when he returned that he, along with all the LBJ pediatricians were discussing the case following their daily rounds.
The next thing the new parents heard, was the hospital searching for a way to get the baby off-island for emergency care.
But there were roadblocks to come. Visas for the parents, who are Tongan passport holders, was an issue. And then the baby began to “rapidly deteriorate” and that’s when the doctors realized that there were few choices left to save the child.
“If the infant had been stable, breathing without help, eating without a tube, then we might have been able to send her to Hawaii,” said Dr. Favazza. “But the baby took a turn for the worse, and wasn’t getting enough air,” he said, and called colleagues in Oakland, California about the case.
He connected LBJ Chief of Surgery, Dr. Kamlesh Kumar with a pediatric surgeon in California. The two discussed the case, and after consultation with other LBJ professionals and the parents, Dr. Kumar made the decision to operate.
According to chief of Pediatrics, Dr. James Marrone, it was Dr. James Sunia, LBJ’s chief of anesthesia, who carefully considered putting the baby to sleep. Anesthesia is well known to be difficult and risky, even with the adult population, Dr. Marrone said.
After serious consideration, and understanding the risks, given that it was a newborn baby, Dr. Sunia concurred with his colleagues, and agreed to the procedure. Along with assistant surgeon, Dr. Robert Gayapa, and the operating room team, they embarked upon a delicate surgery which many professionals at LBJ and elsewhere have called “heroic.”
It takes nine years of training to become a pediatric surgeon, and that is after college and Med School, said Dr. Favazza.
“You could put all the pediatric surgeons in the U.S. in a room, and they would probably all know each other. There might be 100 or so, it’s an extremely specialized field,” he said.
“After a full general surgery residency of five years, two years of research, and after that, two years of fellowship training, you are ready to embark upon your career as a pediatric surgeon.” He added, “ You’re nearly 40 when you’re ready to take this on.”
There are no pediatric surgeons in American Samoa. But there are doctors who are willing to go the limits of their skills, working with others, via tele-medicine, email, and all means at their disposal, to use their surgical knowledge and instincts to give patients a fighting chance.
For the infant girl born with a hole in her diaphragm, the clock was ticking. The baby had “decompensated” to the point where it was not safe for air travel, explained Dr. Favazza.
“Without that operation, the baby would have died.” he stated.
The parents were told the circumstances, and understood that without surgery, there was no chance, and even with surgery, there were risks, and the baby might not survive.
It was explained to Samoa News, that the surgeons went in, repositioned the baby’s stomach and intestines, put them in the area where they belonged, and sewed up the hole in the baby’s diaphragm... and all this without the benefit of specialized surgical equipment.
Forty six days after surgery, little Vake'ae Sola’i Mo’ungatapu Fainga’a left LBJ. By all accounts she was a healthy baby, nursing well, with a head full of black hair, a beautiful smile, and an (understandably) grateful and happy mother.
LBJ Nurse practitioner Amber Rogers noted “This baby is very, very lucky. What Dr. Kumar did was amazing.” Rogers also commended the Nursery nurses Edna Hala R.N., Mele Tali, CNA and Nelma Godinet, CNA3, for their extraordinary around-the-clock dedication to this baby.
Speaking to Samoa News, the little girl’s mother said, “ We had to really think about this — and pray. We decided to let the surgery go forward. I owe thanks to Dr. Kumar and the other doctors. We thought she was going to die. Dr. Kumar brought my baby back from the edge of the grave.”