The X-ray on the light box exposes the stark reality of Salee Allawe’s injuries — jagged bone below the left knee, a healed thigh fracture on what’s left of her right leg, chunks of shrapnel in the flesh.
“You have a very short segment like this,” says Dr. David Westberry, pointing to the X-ray before the 9-year-old Iraqi girl arrives for an appointment, “and it’s hard to fit a prosthesis that will fit well and stay on, and that small segment of bone doesn’t really function well.”
After she lost both legs in a missile strike last November, doctors in Iraq amputated Salee’s right leg at the knee and the left leg below the knee, says Westberry, an orthopedic surgeon with Shriners Hospital for Children in Greenville.
But the bones in the little girl’s left leg continued to grow, causing a lot of pain, he says. So last month, he removed the lower part of the bone, making both limbs symmetrical, which alleviated the pain and eased the eventual use of prosthetics.
In a nearby room, affable Ed Skewes wraps Salee’s left leg with a quick-drying plastic to form a mold of her leg. And as it dries, he makes her giggle by talking like Donald Duck and whirling her around.
It all comes as something of a shock to her father, Hussein Allawe, who is all smiles as he sees the way the staff cares for and interacts with Salee.
“Doctors don’t do that in Iraq,” he says through interpreter Asma Jaber.
“There are no medications to ease the pain. There is no cultivation of relationships between doctor and patient,” he says. “They send patients home, and if they are still in pain, they say, ‘That’s your problem. We can’t do anything.’ ”
The hospital where Salee was treated in Fallujah had limited medical supplies, antibiotics and blood, he says. Here, both he and his daughter are impressed with her care.
“Shriners has been absolutely amazing,” says Ann Cothran of the Upstate Coalition of Compassion, a group of local residents who, along with No More Victims, a national organization that links the children with care in the United States, brought Salee to Greenville.
“We had to change the first appointment date five times because it was so hard to get her out of Iraq, and they were just so great about it,” she says. “And Ronald McDonald House (where Salee and her father are staying) has been the same way.”
Each year, Shriners fashions up to 4,000 braces and as many as 300 artificial limbs, says Skewes, the hospital’s director of prosthetics and orthotics.
In the lab, where the sound of hammering and filing fills the air, more than 70 prostheses are in production. The first step is to take a cast to form a plaster model of the residual limb, Skewes says. Braces are made by heating and vacuum-forming plastic on the model. Prosthetics are made with a liquid resin that matches the patient’s skin tone and attached to joints — in Salee’s case, knees and feet.
Made to look as realistic as possible, the feet have spaces between the toes and fit easily into shoes.
“She can even paint the toenails if she wants too,” Skewes says proudly.
Salee’s artificial limbs are made to be repaired and adjusted once she goes back home, he says.
“We may give her an extra set of feet and socks to prolong the life of the prostheses,” he says, noting the hospital already ships used components to developing countries.
Though the limbs are sturdy, bolts come undone, joints loosen up, feet break. And kids grow up. On average, Westberry says, children need new prosthetics every 18 to 24 months.
“Some is due to growth,” he says, “and some to wear and tear because kids are active.”
As she grows up, Salee will need several sets of prosthetic legs, says Dr. Jon Davids, a pediatric orthopedic surgeon and chief of staff at Shriners. And the hospital has committed to seeing her every 18 months if necessary, he says.
Other Shriners hospitals have taken international children for years, but it’s a relatively new effort for Shriners Greenville, Davids says. Recently, the hospital worked with the group Childspring International to treat children from Haiti.
Of the 15,000 children the hospital sees a year, 10 were from other countries last year, he says.
“To be treated here, a child simply needs to have an orthopedic problem that we can care for,” Davids says. “And what is done is very high-quality complex pediatric orthopedics for children with a wide range of disabilities. And all at no charge to the family.”
Most children who come to Shriners require some kind of surgery, he says, as well as physical therapy and rehabilitation. Others get special adaptive equipment to make their lives easier.
Soon, Westberry says, Salee will get her second prosthetic leg and spend a few weeks in physical therapy learning how to walk. Will she be able to run with the other children, as she hopes?
Because she has no knee joints, it will be more of a challenge than it is for children whose knees are intact, he says. But the prosthetic knee will bend and the foot is made out of a flexible material that will allow some motion.
So, he says, running depends on how well she balances on the legs, and on her attitude, which should be no obstacle.
“Kids adapt very fast, eager to resume as much of a normal life as possible,” he says. “And she’s got a great heart, a great spirit, and a good mind that hasn’t been affected by this. She’s been very positive from the beginning.”