Working for free, surgeons at Johns Hopkins Hospital have removed a fast-growing spinal tumor that had paralyzed and threatened to kill a 12-year-old schoolgirl from Guyana, South America.
The child, Ulanda McGarrell, is walking again just two months after her two operations, and she continues to regain her strength with intensive rehabilitative therapy at the Mount Washington Pediatric Hospital in Baltimore.
"May God bless everybody," said her grateful grandmother, whose name is Princess Rodney. She accompanied the child to the United States and watched yesterday as Ulanda, in a frilly dress and pigtails, twice walked the length of the hospital's parallel bars.
Her rapid progress has also delighted her surgeons.
"She had an unusually severe problem and an unusually good chance of recovery. These are the ideal cases for treatment in the Third World," said Dr. Paul Sponseller, director of pediatric orthopedic surgery at the Johns Hopkins Children's Center.
The $200,000 course of surgery and rehabilitation, paid for through charities and donated services, "will have a tremendous impact on her quality of life," and on that of her family and community, he said.
Ulanda was unable to walk or stand by herself in January when her father carried her into a temporary clinic in Georgetown, Guyana, about 15 miles from their home in Campbellville.
The clinic is operated by Project Dawn, a 6-year-old effort by U.S. doctors to provide free surgery that would otherwise be unavailable to people in the impoverished former British colony.
Dr. Gaylord Clark, an orthopedic surgeon at Union Memorial Hospital who also teaches at Hopkins, joined the clinic for two weeks of volunteer hand and arm surgery, free of the legal, administrative and bureaucratic headaches that normally attend the work of U.S. doctors.
"We can take care of people just for the fun of taking care of people, and they really need it," he said.
For at least 18 months, Dr. Clark learned, Ulanda had been developing a curvature of the spine, called scoliosis. But she had continued to run and play normally. Then, last November, her grandmother noticed the child was "walking funny."
"We began to question her, and she said she had fallen twice on the road," Mrs. Rodney said. Fearing Ulanda would fall under a truck on her way to school, they kept her home, a difficult thing to do to the family's most promising student.
Soon Ulanda had lost bladder control and most movement in her legs.
Doctors at Georgetown Hospital were unable to help, so when her parents learned that the American doctors were coming with Project Dawn, they decided to seek help there.
Dr. Clark and his colleagues quickly realized that a tumor the size of a grapefruit was growing in Ulanda's chest, next to her spine. It was responsible for both the spinal curvature and the paralysis.
Dr. Sponseller knows of no other reports of scoliosis and paralysis caused by a tumor. "This is an extremely rare case," he said. Left alone, the tumor soon would have destroyed her spinal cord and eventually crowded her lungs.
"In other words, it would kill her," Dr. Clark said. Surgery was urgent.
Project Dawn quickly agreed to provide transportation to Baltimore. Dr. Sponseller, neurosurgeon John Aryanpour and pediatric urologist John Gearhart and others at Hopkins donated their services, and Hopkins' Marion J. Gallagher Fund agreed to pay the hospital's costs. Mount Washington Hospital donated rehabilitative services, and the Ronald McDonald House provided room and board for Ulanda and her grandmother.
In the first operation Feb. 29, surgeons spent eight hours removing the tumor, which proved to be a relatively benign, localized form of cancer. They also removed nine spinal disks to make Ulanda's spine flexible.
In a second operation more than a week later, they straightened her spine and supported it with steel rods and screws. That took more than four hours.
Yesterday, Ulanda stood straight, with support from a plastic "body jacket."
"There has already been a dramatic recovery of strength in both legs, and her bladder function has returned satisfactorily," Dr. Sponseller said. Ulanda needs more therapy, and radiation to ensure the tumor does not return. In all, it will be another two to three months before she can return to her parents, two brothers and sister in Guyana.
Ulanda will not look forward to the airplane ride home. The last one made her airsick. For now, she's enjoying the chicken and ice cream on her menu, and asking for more time in Mount Washington's hydrotherapy pool.
Her biggest wish, "to walk," is already being granted.