Fall 2008 Issue

Walk the line

Barry’s Yucatan Project is helping Mexican children with foot and leg deformities put both feet on the ground.

By Carlos Miller

In the minutes before his operation, Drs. Amy Starry and Shae Paschal get acquainted with Mario Perez-Pakistan, an 11-year-old boy who was crippled from child abuse.
Jonathan Chan Nall, a 15-year-old boy with cerebral palsy who was operated on by Dr. Charles Southerland in April, demonstrates his new walking abilities four months later in a clinic in Progreso, Mexico.

Mario Perez-Pakistan was only a toddler when his father kicked him so hard it left him crippled.

The abuse continued for almost a decade as his right leg grew out twisted and disfigured beneath the knee. At the age of 11, he ran away from his impoverished home in Chiapas, Mexico with his 8-year-old cousin.

Hobbling on crutches, Mario and his cousin hitchhiked 340 miles to Merida in the Yucatan Peninsula where they survived by begging for food and peddling flowers on the streets.

Eventually, a police officer discovered the boys and placed them in a local orphanage where they lived with 160 other children.

Pushed backwards

When he arrived at the Centro de Atención Integral a Menores en Desamparo orphanage (Center for the Comprehensive Care of Abandoned Children), Mario told director Beatriz Sollis Sanchez that his leg was injured during a fall from a tree when he was 2. But she knew that wasn’t the case.

“He didn’t want to make his parents look bad, but it was obvious he had been abused,” she said. “What 2-year-old climbs trees? It was obvious he had been kicked.”

Regardless of the cause, it is likely that Mario would have had to live his adult life with his deformity had it not been for the help of Barry University’s Yucatan Crippled Children’s Project, which treats children with foot and leg deformities in Mexico’s Yucatan peninsula.

“He was kicked so hard that his knee was pushed backwards, displacing growth plates in both the distal femur and the proximal tibia” said Yucatan project founder Dr. Charles Southerland, a professor of podiatric orthopedics and biomechanics at Barry. “The deformity became worse as he got older to the point where he was unable to walk.”

Unlike Mario, most of the approximately 5,000 children who have been treated through the Yucatan project were born with some type of neurological disorder.

“Most of them have either club feet, cerebral palsy, muscular dystrophy or rocker bottom flatfoot (where soles resemble the bottom of a rocking chair),” Southerland said.

By the large number of children that Southerland has treated, one would think there is a higher rate of these conditions in Mexico, but that is not the case.

“In the United States, these conditions are intervened at a young age through our social systems,” he said. “In Mexico, there is no such system.”

So, in effect, the ongoing trips to Mexico not only serve as a humanitarian mission, but also as a training opportunity for the young doctors who have graduated from the School of Podiatric Medicine.

In July, three Jackson North doctors accompanied Southerland on his trip to Mexico, including orthopedic surgeon Dr. Amy Starry and resident surgeons, Drs. Andrea Adido and Shae Paschal ’06.

The four doctors spent an entire day performing surgeries on four impoverished Mexican children, including Mario. They spent the next day in a clinic in the dusty coastal town of Progreso, 30 miles north of Merida, where they assessed 80 patients to determine if they needed surgery.

At the end of the day, after working for 10 hours straight in sweltering temperatures with no air-conditioning and no breaks, the doctors determined that seven patients were eligible for surgery, and would most likely be operated on in a few months when Southerland returns with another crew.

Although the days were long, no one was complaining.

“The appreciation exhibited by mothers is not what you see in the United States,” Starry said. “They didn’t care that I was a woman, that I didn’t speak Spanish or that I was American. They were so appreciative of the fact that somebody was taking the time to diagnose their children.”

Almost 100 patients waited several hours outside a clinic in Progreso, Mexico to consult with doctors from Barry University's Yucatan Crippled Children's Project.

A good idea gets better

The idea for the Yucatan Crippled Children’s Project came to Southerland in 1988 after reading about the Baja Crippled Children’s Project, a nonprofit organization out of Southern California that has been providing surgical footcare for children in Mexicali, Mexico since 1976.

In 1990, when the Baja project published its 10-year surgical outcomes report, which is what doctors use to track the outcome of surgical patients years after the operation, Southerland became inspired.

“The outcomes were as good as or better than what we see in the United States,” he said.

So Southerland approached Hialeah Hospital because the City of Hialeah had been providing aid to the Yucatan city of Progreso in the wake of Hurricane Gilbert in 1988.

At first, hospital officials were not receptive to the idea, but Southerland persisted. And when he was invited to Merida to pitch his proposal to Mexican officials, at first they, too, were not receptive but again Southerland persisted. He visited Mexico in 1992 and again in 1994 to present the concept for the program to the state minister of health, governor and state legislators. After several presentations and responding to pointed questions about the nature of the program, the governor's office of the State of Yucatan in Mexico approved the proposal.

Then it became a matter of raising money to fund the program.

“Dr. Southerland started contacting friends in podiatric positions and corporate donors and later foundations to assist with the cost of the program,” said Bob McKinlay, assistant dean of Barry’s School of Podiatric Medicine.

Finally, on July 4, 1996, Southerland traveled to Mexico accompanied by two resident doctors and performed his first surgery. And it’s been non-stop ever since.

“We average four to six trips a year,” Southerland said. “And we average six to eight (operations) each time. In total we’ve treated about 2,400 patients.”

The children are referred to the program by Mexico’s national family welfare program, El Desarrollo Integral de la Familia (Integral Family Development).

“They publicize the program, provide transportation and coordinate with outlying towns to bring patients in,” Southerland said.

Most of the patients are indigent and are not required to pay for the surgeries, but every once in a while, a financially capable person is referred to the program through the mayor’s office. However, they are required to donate to the program. After all, the program operates on a shoestring budget and every penny counts.

“We spend an average of $75,000 a year on the project,” McKinlay said. “This includes cost of airfare, hotels for the doctors, food, medical supplies and surgical instruments.”

Most of the funds are raised through foundations, including the Frank J. Lewis Foundation, which has donated more than $100,000 over the years, and the Milagro Foundation, founded by Mexican-born musician Carlos Santana, which has donated $8, 000.

Aeromexico airlines also recently began waiving cargo fees for crates filled with surgical supplies. On the recent trip, for example, Aeromexico officials at Miami International Airport waved more than $800 in cargo fees for seven crates filled with surgical instruments, medication and sterilized products. It did the same on the return trip to Miami.

“The money we don’t spend on cargo we can spend on medical supplies,” Southerland said.

Shape of things to come

Dr. Charles Southerland re-evaluates Eric Tan Chun, a 13-year-old boy who was born with two club feet, but had one operated on in January.
Dr. Amy Starry displays her knack with children as she plays with one of the patients she screened in a clinic in Progreso, Mexico.

In addition to operating on pre-selected patients and screening potential surgical candidates, each trip requires the doctors to re-evaluate post-operative patients.

In July, Southerland re-evaluated Eric Tan Chun, a 13-year-old boy who was born with two club feet, meaning both his feet grew inwards and twisted upside down so that he was forced to walk on his ankles.

“He was only able to stand for 15 minutes at a time,” said Southerland, who operated on Tan Chun’s left foot in January.

During the operation, Southerland placed a specialized device used to reshape bones known as a Taylor Spatial Frame on Chun’s left foot and ankle.

Six months later, Mexican doctors removed the frame and placed a cast on his foot, which Southerland removed during the trip, watching with satisfaction as the boy planted the sole of his left foot down for the first time in his life.

The foot needs a few months to heal, Southerland says, before we can operate on the boy’s right foot, which there are plans to do in January 2009.

“These doctors are angels. The one thing my son wanted more than anything was for his feet to be normal, that he could stand like normal children, and now it looks like it will happen,” said the boy’s mother, Lupe Tan Chun.

Sometimes it may take years of therapy for a child to walk normally after an operation. Or sometimes it may take only months, as in the case of Jonathan Chan Nall, a 15-year-old boy with cerebral palsy who was unable to walk because he couldn’t extend his legs at the knees.

In April, Southerland, in conjunction with Mexican orthopedist, Dr. Arturo Rios, performed a bilateral hamstring operation on Nall, which released the tightness and allowed him to begin learning to walk for the first time.

In July, the boy’s mother took him to the clinic in Progreso so Southerland and his team could re-evaluate him.

Maria Chan Nall pushed his wheelchair to the edge of the examination room, but her son insisted on walking the rest of the way to the exam table; a staggering, unsteady walk of about 10 feet, but an unassisted triumph nonetheless.

“I always prayed that he would one day be able to walk,” said Maria, with tears in her eyes. “I never stopped praying.”

Mario Perez-Pakistan, the crippled runaway from Chiapas, also said he has always prayed that his leg would one day be fixed. As he lay in his hospital bed waiting to be operated on, he described a dream he recently had.

“I went to sleep and had a dream that my leg was already fixed, that I was able to walk normally,” he said. “But when I woke up, my leg was still damaged.”

Nevertheless, the 11-year-old was all smiles as he waited to be operated on, joking with the nurses and doctors from his hospital bed. He grinned in anticipation as they wheeled him into the operating room. He even graciously accepted the anesthesia mask unlike some of the other children who try to fight it off.

Within minutes, he was sound asleep as the operation began.

When he awoke a few hours later, he was no longer smiling. “Take this off me,” he cried as he tugged at the device. “It hurts.”

But his right leg was now starting to straighten, thanks to the help of the Taylor Spatial Frame, which he will have to wear for at least six months.

For Southerland, the four-hour surgery in a 12-hour day of continuous surgeries was once again an exhausting but rewarding experience.

“It has been such a privilege to be able to do this all these years,” he said, “such a privilege to be able to make a difference in the lives of these children.”

Dr. Charles Southerland consults with the mother of a child in a clinic in Progreso, Mexico.

Carlos Miller is a multimedia journalist based in Miami who operates Magic City Media. He can be reached at carlosmiller@magiccitymedia.com.