Unknown costs hamper effort to aid 7-year-old Iraqi war victim in Pittsburgh

Sally Kalson, Pittsburgh Gazette, September 2005
One question stands between a 7-year-old Iraqi war victim and reconstructive surgery in Pittsburgh that could bring him a more normal life: How can his sponsors raise their half of the hospital bill when there’s no way of knowing how high that bill will run?

The child, Abdul Hakim Ismael, was wounded last year in the city of Fallujah. His family said he was hit by fire from an American air strike, leaving the left side of his face severely disfigured — blinded in one eye with damaged eye lid, socket, jaw and cheek, making it difficult for him to eat.

An organization called No More Victims is trying to make Hakim the fourth child it brings to the United States for specialized medical care not available in war-torn Iraq. (Two children have been treated in California and Texas, and a third is slated for care in Florida.) Dan Kovalik, a Pittsburgh lawyer with the United Steelworkers and a volunteer for the organization, approached a local surgeon for her help.

Dr. Tonya Stefko, an oculoplastic and reconstructive surgeon at UPMC Eye and Ear Institute and Children’s Hospital, immediately agreed to donate her services.

So did everyone else she asked: oral-maxilofacial surgeon Dr. William Chung; plastic surgeon Dr. Fred Deleyiannis; and ocularist Walter Tillman, who makes prosthetic eyes.

Mr. Kovalik was overjoyed by the quick response.

“We thought once the doctors were on board the hospital would fall into place because that’s what happened in other cities,” Mr. Kovalik said. “But it didn’t happen here.”

Children’s Hospital agreed to absorb half the hospital bill, which could run to several hundred thousand dollars. That leaves Hakim’s sponsors in a Catch-22. They can’t bring him here until they know the costs are covered, and they can’t know what the costs will be until they bring him here.

“We have to be sure we can provide the care once we get him here,” said Cole Miller of Los Angeles, co-founder of No More Victims. “We need that facility fee to be covered or waived.”

Hakim came to Mr. Miller’s attention through a contact in Iraq who’s been delivering medical supplies to hospitals and civilians in the war zones at great personal risk. Mr. Miller asked the contact to collect medical records of injured children and pass them along. In this way he’s identified 11 children so far.

“These are kids who’ve been hurt as a result of U.S. military assaults,” Mr. Miller said. “As an American, I feel that’s where my responsibility lies. It’s important for us to show the world that this is of concern to us.”

The trick lies in helping each child without wiping out the ability to help others.

“For us to go blindly ahead without a commitment from another source to cover the rest of the bill would be incredibly risky,” Mr. Kovalik said. “It may saddle the whole project with expenses too heavy to meet.”

Children’s Hospital provided $26 million of care at no cost to families from the 12-county region last year, according to spokesman Marc Lukasiak. Those services were financed by the Free Care Fund, a favorite local charity whose big push comes at Christmas time. The grants ranged from $10 to $20,000, Mr. Lukasiak said.

But charity cases from outside the region are handled differently, on a case-by-case basis, said Children’s medical director Dr. Eugene Wiener.

“For international patients, we have no fund for that,” Dr. Wiener said. “Whatever is not covered by other sources comes from our internal finances because that’s our mission, to provide pediatric care.”

Children’s hospitals have to set priorities on meeting their charitable mission outside the local community, said Pete Willson, vice president of the National Association of Children’s Hospitals in Alexandria, Va. “If they didn’t, the demand would always exceed their capability.”

Dr. Stefko said the hospital bill for Hakim could easily run to $200,000 or more.

“He’d probably have to be here at least four months to be evaluated, treated and become stable enough to go home,” she said, adding that she can’t be sure what the child needs because the only medical report is “a very poorly translated one-page summary that I can’t make heads or tails of.

“From what I can tell, what he’s going to need is reconstruction of his left eye socket and eye lid so that he can wear a prosthetic eye.”

He’ll also need reconstruction of a fractured jaw and of a soft tissue scar on his left cheek, which may require a tissue transplant from another part of his body.

“That’s the most expensive and technically challenging way to fix it, but it may be the only thing we can do for him at this point,” she said.

This is not the first time someone has tried to get Hakim out of Iraq for medical care. Yasser Salihee, an Iraqi translator and journalist working for Knight-Ridder Newspapers and National Public Radio, had been attempting to find a doctor outside the country to treat Hakim.

In June, Salihee was shot to death at a checkpoint, apparently by an American sniper.

“Yasser was e-mailing photos of Hakim to doctors in London, Eastern Europe and Philadelphia, but it never came to anything,” said Pauline Lubens, a Knight-Ridder photographer. She had met Hakim in June 2004 in a Baghdad hospital where he’d undergone some plastic surgery, and her picture of him ran in a year-end roundup.

“It’s the same kid,” Ms. Lubens said after seeing the photo on the No More Victims Web site. “He’s grown up a little, and he looks a little better. It’s possible he’s had more surgery since I saw him, but you can see from the photo that he still needs a lot more.”

Mr. Miller said people sometimes ask him, “Why these kids when there are tens of thousands of injured Iraqi children?”

“My answer is, because these are the kids I know about.”

Dr. Stefko said she was asked a similar question. “The only answer I have is that someone asked me to help, and if you ask us and we’re capable of giving it, we’ll give it. It’s not a political statement. It’s just what we know how to do.”

If a benefactor should come forward to cover Hakim’s care, what happens after he heals and is sent back to a war zone?

“I know,” sighed Mr. Miller, “it’s like throwing sand into the ocean. An entire civilian population is being brutalized while we worry about medical care for one child. This is just my way of doing what I can, hoping that more people will pay attention. People can’t respond if they don’t know what’s happening.”

Categorised in: Abdul Hakeem, Children

This post was written by Cole Miller