“A lot of people put together a lot of pieces”
Woodler Decormier, an outgoing Haitian boy with a crippling spinal disease, had a way of finding doctors and nurses who were visiting from Cardinal Glennon.
Following the devastating earthquake that struck southern Haiti in January, thousands of American relief workers, including members of the Glennon staff, volunteered their time and skills on medical missions to the Caribbean nation. Over the next two months, Woodler found three Glennon doctors on separate missions at two hospitals separated by 120 miles. Those meetings brought 4-year-old Woodler to Glennon for life-saving spinal surgery.
Woodler (pronounced WOOD-lay) contracted tuberculosis at an early age. The infection led to Pott’s disease, which inflames and destroys the vertebrae. As his spine deteriorated, he developed a sharp bend in his back. He only could walk in a waddling fashion, holding himself up by placing his hands on his thighs.
On January 12 the earthquake struck the southern portion of Haiti. As many as 230,000 people were killed and 1.2 million were left homeless. About half of the buildings in Port-au-Prince, the largest and hardest-hit city, collapsed.
In February, orthopedic surgeon Howard Place, M.D., was volunteering at a hospital in Port-au-Prince.
“We were mostly taking care of people injured by the earthquake,” he said. “Woodler’s family brought him in. People knew I was a spine surgeon, so they brought him to me. It was clear that he had active tuberculosis and a bad problem with his spine. He was slowly on his way to developing paralysis. I couldn’t take care of him right away because of the TB. We had to get him on TB meds first, and they weren’t immediately available. He got lost in the follow-up.”
We are good!
Woodler next found Kathy Lehman-Huskamp, M.D., an emergency medicine physician from Glennon who traveled to Haiti twice in the weeks following the earthquake. She worked at Hopital Sacre Coeur, a mission hospital in Milot, 120 miles from Port-au-Prince near the country’s north coast. The hospital has been supported for 23 years by CRUDEM (Center for the Rural Development of Milot), a charity founded in St. Louis.
“Woodler was admitted to my pediatric ward,” Lehman-Huskamp said. “I looked in his records and noticed that Dr. Place had seen him. What a small world!” Woodler quickly charmed the hospital staff, she said. “He walked hunched over like a little old man but had the spirit and the gumption of a child his age. He did not feel sorry for himself. He loved to be held.”
Lehman-Huskamp was impressed with the joy found in all of the children. “The spirit of Haiti is seen in her children. Even those who had lost limbs in the earthquake were still smiling. There was a Creole phrase we would say to them every morning – ‘Sa k’pase?’ It means ‘What’s going on?’ They would answer ‘N’ap boule!’ That means ‘We are good!’”
She immediately realized that Woodler’s surgery could not be performed with the resources at Hopital Sacre Coeur. “There are things we do everyday at Glennon that are just not done in Haiti. For his surgery there would be a lot of blood loss and complications. Before I went, they asked me to bring all the flypaper I could. When I got there, they were ecstatic because they needed the flypaper for the operating room.”
Faced with Woodler’s tuberculosis, an infection rarely seen by pediatricians in the U.S., Lehman-Huskamp sent an e-mail to pulmonologist Gary Albers, M.D., back at Glennon.
“She wrote back saying, ‘I have this kid with TB. What do we do with him?’” Albers said.
Albers sent advice for a lengthy regimen of medication that would treat Woodler’s tuberculosis. Lehman-Huskamp returned to Glennon. A few weeks later, Albers traveled to Haiti to care for children at Sacre Coeur. Woodler soon met Albers and Jane Wachter, R.N., a Glennon nurse on the mission trip.
“There were about 35 kids in the pediatric unit,” Albers said. “He had a big smile and looked like he should have been miserable, but he would walk up to you and laugh like it was no big deal. He is so cute and engaging.
“His problem wasn’t quake-related, but his father got transportation to Milot because of the earthquake relief effort. I was going through his charts trying to figure out how he ended up here and I saw a note about when he was seen in Port-au-Prince. I thought I recognized that signature – it was Howard Place!”
“I was thinking, ‘What are we going to do with him?’” Albers said. “Somebody promised him spine surgery, but we didn’t have the diagnostic equipment for that. I got in touch with Howard by e-mail, and Howard said he had copies of all of Woodler’s films back in St. Louis. I asked if he would be interested in sponsoring Woodler to come to Glennon.”
“Gary said, ‘This is a bad deal. We should do something to help him,’” Place recounted. “I said it would take a lot of things to make that happen, and Gary made them happen. Cardinal Glennon and Saint Louis University donated his care. A bunch of people donated the stuff I would need for his operation.”
Albers asked Woodler’s father for guidance.
“I talked to Woodler’s dad through an interpreter and told him what was going on,” Albers said. “I asked him if he would like us to try to get Woodler back to St. Louis. His dad said, ‘Yes. Please.’”
An international children’s charity donated travel arrangements. Jennifer Baggett, a critical care nurse from Columbia, Mo., who also met Woodler in Haiti, volunteered to be his host. “He’s hard to forget. He’s runs up to everyone and throws his arms up,” she said. “He’s definitely a charmer.”
Woodler’s flight to Missouri was arranged after he would have two months of tuberculosis medication behind him. “I said I would need at least a week with him here so I could get CT and MRI studies of his spine and have the time to plan an operation,” Place said.
The scans taken at Glennon provided greater detail of Woodler’s spine than the x-rays taken in Haiti. His spine was in much worse shape than Place had feared. Three of his vertebrae were missing and a fourth was nearly gone. About four inches of his back were held together by little more than muscle. Another four inches of his back were injured.
“I didn’t appreciate from the x-rays I took in February how much bone destruction there was and how big the infection was in his spinal canal,” Place said. “A portion of his bone looked like sponge. Parts of bones were causing pressure against his spinal cord. His father thought this bump on his back had been growing for two or three years. I think that is true, because this kind of destruction does not happen instantly.
“Woodler was having progressive difficulties with walking and standing and he had pain in his legs. He couldn’t walk very far and he was getting weak and tired. Could he have lasted another month? Another two months? He wasn’t a walking time bomb, but he was certainly on his way to paralysis. Once they are paralyzed, most kids living in those conditions pass away within a year.”
Woodler spent 12 hours in a Glennon operating room early in June. While Place removed the remnants of diseased bone and pus from the infection, cardiothoracic surgeon Keith Naunheim, M.D., removed one of Woodler’s ribs. Place spanned the gap in Woodler’s spine with metal bracing and used the rib bone to reconstruct the portion of his spinal column that had been destroyed by bone loss from the infection. Woodler was fitted with a brace and a cast.
Woodler returned to St. Louis six weeks after surgery for an examination. Early in September he came back again to have his cast removed.
“He is running and it looks like he is healing,” Place said. “His x-rays look good. He has not been hurt neurologically. So far it looks like we are winning.”
While the damaged portion of Woodler’s spine will no longer grow, the rest of his body should develop normally. “This is not an ideal situation, but he will have a better chance of being able to walk as he grows up,” Place said.
Woodler’s health and nutrition also improved in Missouri, said Jennifer Ladage, M.D., a Glennon pediatrician with expertise in the care of international adoptees.
“When he came here, he had a very distended abdomen. His extremities were thin. He did not have a lot of muscle and fat tissue. He had chronic malnutrition as well. We did studies for nutritional deficiencies and found he needed iron and Vitamin D supplementation,” she said.
“He has been doing very well. His weight was below the third percentile for his age when he came here. He is up toward the 25th percentile now. We have been giving him immunizations to maximize what we can do for him while he is here.”
Despite malnutrition and tuberculosis, Woodler has a chance to develop normally, Ladage said. “He is learning English quickly. His language skills are a good indication that he is intelligent and aware of his surroundings.”
For the summer, Baggett’s daughters Megan, Madeline and Emma had a little brother. “He is doing great,” said Baggett during one of Woodler’s checkups at Glennon. “He is four years old and didn’t speak a word of English. During the car ride to Columbia from the airport in St. Louis, he made an instant bond with my daughters. The girls had him laughing and playing and being silly.
“He did have to make an adjustment to our food. He just wanted beans and rice for the first weeks. He learned to say ‘I’m hungry’ in English. Now he eats pizza and hot dogs and all those American foods we shouldn’t eat.”
Woodler was scheduled to remain in Missouri for a month after his body cast was removed. After another exam, he will return to his father in Haiti.
“At this point his tuberculosis probably is cured. His lungs look good. His health has all the potential to be fine,” Albers said. “A lot of his prognosis is dependent on his social setting in Haiti. His personality is good and the English skills he picked up here will give him a little bit of an edge in interacting with people.”
“Everything is amazing,” Baggett said. “He is a lucky little guy.”