Honduran hospital provides much-needed surgeries for children with bone defects

From NPR. In the picture, Roberto Silva, 31, holds his 3-year-old son, Adil Noe Silva, at the CURE Orthopedic Pediatric Hospital in San Pedro Sula, Honduras. Adil has spina bifida.

In the United States and other developed countries, birth defects such as clubfeet, dislocated hips or fused fingers are routinely repaired and rarely seen anymore in adults. But in other parts of the world, medical care is lacking, and bone deformities can cause profound social problems, in addition to the physical difficulties they present.

In the waiting area of the CURE Orthopedic Pediatric Hospital in San Pedro Sula, Honduras, parents sit on stiff metal chairs, clutching their children tightly on their laps. They hold them in a way that betrays a mixture of fear and hope — hope that their child can be made normal, yet fear that maybe this is all too good to be true.

Doctors at the nonprofit hospital see children — from newborns to teenagers — who suffer bone deformities. The hospital, which opened earlier this year, charges a small fee. But many patients can't even afford bus fare, so for them the services are free, says Ruth de Castro, the hospital's executive director.

Honduras is one of the poorest countries in the hemisphere. And de Castro says its public health system — like most in the developing world — is ill-equipped to deal with bone defects.

"The reason for this is that the public hospitals, government hospitals, are saturated with fractures. They have to treat the emergency first, therefore there is no elective surgery," she says.

On a recent day, doctors at the main public hospital in the Honduran capital, Tegucigalpa, were urging people not to come to the facility at all. A dengue fever outbreak had overwhelmed the hospital, where patients were being treated on gurneys in the hallways.

In both rich and poor countries, clubfeet are so common that roughly 1 in every 1,000 babies is born with the condition. With relatively simple medical procedures, they can be corrected.

But in developing nations, these deformities rarely get addressed.

At CURE Orthopedic Pediatric Hospital, Dr. Warren Terry is making the rounds of the children in the recovery ward. Terry is a volunteer, visiting for a stint at the hospital from his home in Vancouver, British Columbia. On this day, Terry says, there is only one doctor, so he is covering both the clinic and the operating room, as well as checking up on post-op patients.

The previous day, Terry performed a complicated surgery on a 4-year-old boy who had had a dislocated hip since birth. The surgery — which lasted about four hours — involved re-forming his hip socket, shortening the femur by almost an inch and lengthening some muscles. Now, the boy must wear a special hip cast.

Terry and others in Honduras say the chance of a boy like him getting this surgery in the country's public health system is nil.

If he didn't have the surgery, Terry says, it would significantly affect the boy's life.

"He would have difficulty walking any long distances. He would have one leg that was a normal length and that worked normally, and this other one would be short. And he would have sort of a lurching gait," the doctor says.

Terry rushes across the compound to the operating room where another boy is waiting. As he prepares for surgery, Terry says this work is about breaking a cycle where poverty leads to disability, which in turn leads to more poverty.

"They start off with a bad clubfoot. They can't walk, so they don't go to school. Just about every kid who comes with a significant limb deformity, you ask their family, and they don't take them to school," he says.

The hospital was founded by the Pennsylvania-based charity CURE International, which operates hospitals and clinics in Africa, Latin America and the Middle East.

Blanca Irma Orellana, 28, brought her youngest son, Rony, to the CURE hospital to try to get his feet repaired.

"I've come for an operation for my child to see if he can walk," Irma says. "He's been like this since he was born. They told me they could help me. So that's why I'm coming."

Rony, 3, is solid and pudgy, but his right foot curls sharply toward his left.

Irma is a single mother. She has four other children, and she washes clothes for a living. And for three years, she has been carrying Rony everywhere. Irma says looking after him can be very difficult, and at times she gets discouraged.

The hospital staff say Rony's foot could have been repaired easily when he was born. Now, it will require a fairly major operation, but they're planning on doing it.

If the operation is successful, it will benefit his whole family. Rony will be able to walk, his mother will no longer have to carry him, and the social stigma that often hovers over a family with an abnormal child will be lifted.