278th continues the mission

Iraqi girl in Knoxville for operation to fix birth defect showered with aid, affection:

In Hajer Salam Yousef's three weeks in East Tennessee, she's seen giraffes, visited Dollywood, eaten her first Chick-fil-A sandwich, and purchased clothes and toys at West Town Mall.

But the highlight of the 6-year-old Iraqi girl's trip is a surgery that could correct a birth defect involving her intestinal tract.

She may not know how to explain her condition, but she understands that the operation, scheduled for Tuesday, could make her "normal," she said.

Finding Friends

Iraqi girl in Knoxville for operation to fix birth defect showered with aid, affection

By LOLA ALAPO, alapol@knews.com
January 22, 2006

In Hajer Salam Yousef's three weeks in East Tennessee, she's seen giraffes, visited Dollywood, eaten her first Chick-fil-A sandwich, and purchased clothes and toys at West Town Mall.

But the highlight of the 6-year-old Iraqi girl's trip is a surgery that could correct a birth defect involving her intestinal tract.

She may not know how to explain her condition, but she understands that the operation, scheduled for Tuesday, could make her "normal," she said.

Hajer and her mother, Nidaa Jabbar, 25, arrived in December. Since then, doctors and members of the Muslim Community of Knoxville have showered them with affection.

While Hajer loves the attention, she misses home, Jabbar said.

When she phones her father, "she has tears in her eyes," her mother said.

The experience has been emotionally draining for Jabbar.

Her husband, Salam Yousef, 37, and sons, Muntather, 3, and Ali, 4 1/2 months, remain in her hometown of Sadr, a Baghdad suburb.

"It was hard to leave them and I miss them so much, but it was a sacrifice I had to make," she said. "It was worth it."

Falling into place Hajer's trip to Knoxville was seven months in the making.

Last May, her father discovered that American troops had established a clinic in Balad Ruz, about 50 miles east of Baghdad.

He made the trip with his daughter, and there he met Lt. Col. Kim Dees, a member of the Knoxville-based 278th Regimental Combat Team and a physician's assistant.

"(Yousef) told me he'd been everywhere and no one would help," Dees said last week from Cleveland, Tenn. "I knew there was no medication that could correct this and subspecialty surgery was needed."

Only children whose conditions had a probability of surgical success were allowed out of the war-ravaged country, he said.

A physician abroad also had to accept the case pro bono, Dees said.

So he began "working on both sides of the ocean at the same time."

An Iraq Ministry of Health doctor approved Hajer's case.

In the United States, a cousin of Dees' wife who is a nurse manager at East Tennessee Children's Hospital found three surgeons - Alan Anderson, Alfred Kennedy Jr. and Gus Papadakis of East Tennessee Pediatric Surgery Group - willing to perform the operation.

Dees also learned of the Muslim Community of Knoxville and its willingness to provide support for Hajer and her mother. The organization would also provide interpreters because Hajer and Jabbar speak only Arabic.

"It's like God was just putting these things in a row," Dees said. "Everything just fell into place."

Dees then contacted the Palestine Children's Relief Fund, which paid for Hajer and Jabbar's visas, airfare and transportation to Jordan, where they boarded a plane.

The organization arranges free medical care abroad for injured and sick Palestinian and other Middle Eastern children, according to its Web site.

On Dec. 29, Hajer and Jabbar arrived at McGhee Tyson Airport.

"To see (Hajer) coming though the airport door was very emotional for me," Dees said. "It was a dream come true."

Members of the Muslim community will house Hajer and Jabbar as long as is necessary and are providing clothing and transportation.

"Islam is a religion of practice," said Hanan Ayesh, an MCK member. "We're called to give charity. If we can't give money, we can give compassion."

Clinging to hope When Jabbar became pregnant with her first child, she and Yousef chose a romantic girl's name, Saja, which means "arise" in Arabic.

After their daughter's birth, doctors informed the couple of her condition.

She had an imperforate anus. She could urinate normally, but doctors gave her a colostomy through which she could defecate.

Yousef changed her name to Hajer, which in Arabic means "Leave this life."

"He was certain she was not going to make it but I thought she would," Jabbar said.

Hajer grew into a playful, exuberant and responsible child.

The family lives in a four-bedroom home with 15 relatives because "it's more economical" because of the war, Jabbar said.

Hajer performed chores like sweeping and watching her brothers when Jabbar was busy. She also baked bread with her mother.

"It's good for her because she's learning how to do things," Jabbar said.

Early on, Hajer asked her mother if all girls had her condition, as she only has brothers with whom to compare herself.

"Mentally and emotionally, it was affecting her," Jabbar said.

The first-grader was often absent from school because of a stomachache or a problem with her colostomy bag.

"It can be very messy," Jabbar said.

Hajer's friends also were apprehensive about playing with her in case something happened.

The mother clung to the hope that the trip to Knoxville could give her child a regular life.

Fear not pain On Wednesday, Hajer, Jabbar, and Ayesh went to Children's Hospital for a scheduled MRI on the girl.

A nurse applied a numbing gel on Hajer's left arm. The girl and her mother then completed paperwork.

Shortly after, as a nurse prepared to insert the intravenous needle into Hajer's arm, the girl began to cry.

"She was anticipating to be hurt," Jabbar said of Hajer, who had undergone many medical tests in Iraq. "She was crying from fear, not from pain. In Iraq, it hurt because (doctors) did not have the numbing lotion."

A few minutes after the MRI began, technicians stopped it because the clip that shuts Hajer's colostomy bag had a metal piece that appeared in the scan. They removed the clip, and restarted the 45-minute process.

Later that evening, Jabbar called her husband to inform him of the day's activities.

"He said to me, 'You were right. You always had hope she would make it when I didn't,' " she said.

The plan Surgeons hope to find some critical muscles in Hajer when they begin the operation.

"We'll look for these muscles first, and if they're inadequate, we stop (the surgery) at that point," Anderson said.

Sense of security After a fish dinner Wednesday, Jabbar and Hajer relaxed in the living room of their host's West Knoxville home and watched "America's Funniest Home Videos" on television. As Hajer giggled at the antics of everyday people, Jabbar reflected on the security she feels.

"It's peaceful here," she said. "In Iraq, it's unsafe and you're worrying about the things you don't have."

Although she is in the country that is involved in a war in her homeland, she distinguishes between U.S. governmental policies and its citizens.

"I know that what is politically done is separate from the kindness of the people," she said.

Jabbar and Hajer are eager to return to Iraq and their family.

Hajer wants to be a doctor when she grows up.

"I want to help little kids so they will be normal and well," she said.

Lola Alapo may be reached at 865-342-6376.

The Times-Free Press also has the story:

New hope for Hajer
By Ashley Rowland Staff Writer

KNOXVILLE — Her name means "one who left her country behind."
When Hajer Yousif was born in Baghdad, Iraq, her parents had no idea the name they chose would become a kind of prophecy, foretelling a six-year search for a cure for a birth defect Iraqi doctors said couldn’t be corrected.
Hajer’s improbable journey from the slums of Baghdad to an East Tennessee hospital began nine months ago when a Cleveland, Tenn., soldier met her and decided her doctors were wrong.
In three days, Hajer is scheduled to undergo surgery at East Tennessee Children’s Hospital that should allow her to live without the sandwich-sized plastic bag she’s worn attached to her side since she was 2 days old.
She has waited for a solution like this surgery her whole life.
Hajer was born with an uncommon birth defect called a persistent cloaca. Three major organs inside her abdomen, her urethra, vagina and rectum, converge into a single channel.
Instead of having two exits for waste, she has only one. Her bowel discharges into a colostomy bag that has to be emptied two or three times a day.
A GROWING PROBLEM Hajer loves swing sets, french fries and American cartoons, especially Tom and Jerry. She has big brown eyes, shoulderlength brown hair and a shy grin that wins over her nurses and doctors.
To look at her, you wouldn’t know she’s different from any other 6-year-old.
But she is, and she knows it.
Hajer is embarrassed by the colostomy bag. Even though her mother wraps a cloth around her waist to catch any leakage, the bag sometimes leaks. And it’s uncomfortable.
"She hates it, and every day it’s getting worse, not better," her mother said. "She’s growing. She eats more."
The first hint that something was wrong with Hajer emerged when Nidda Jabbar was seven months pregnant. After looking at her ultrasound, doctors said the baby might have problems and advised Mrs. Jabbar to deliver at a hospital.
Mrs. Jabbar, however, decided to give birth at home with a midwife. In Iraq, doctors have a reputation for not helping their patients, and many people stay away from the country’s crumbling hospitals.
At first, the baby seemed healthy. But the day after she was born, her belly began to swell. When Mrs. Jabbar’s mother bathed Hajer, she realized the infant had no anus.
Two days after she was born, the baby was in the hospital after all — for an operation to give her a colostomy.
Mrs. Jabbar’s husband, Salam Yousif, thought his daughter wouldn’t survive. He said they should give her a religious name instead of calling her Saja, a romantic Arabic name they had chosen.
They decided to name her Hajer, after one of the prophet Ibrahim’s wives. "Ibrahim" translates to Abraham in English. According to Muslim, Christian and Jewish faiths, Abraham was married to Hajer — Hagar in English — and Sarah. Ibrahim banished Hajer and her son, Ishmael, to the desert.
HOPE FOR HAJER Iraqi children often came to the American-run military clinic in Balad Ruz, about 40 miles northeast of Baghdad, seeking answers no one could provide, said Lt. Col. Kim Dees, a member of the Tennessee National Guard’s 278th Regimental Combat Team.
Some had hips that were permanently displaced or hands that would be forever twisted away from their shoulders, defects caused by rough treatment during birth. Still others were born with heart problems.
By the time they came to see Lt. Col. Dees, most of the children were 7 to 10 years old, old enough that the damage couldn’t be undone without harming nerves or other body parts. And Lt. Col. Dees, a physician’s assistant from Cleveland, grew accustomed to telling Iraqi parents that there was nothing he could do.
Some Iraqis, who thought the Americans could heal anything, would cry. Several thanked him for at least trying to help, unlike the Iraqi doctors, who usually sent them away. Lt. Col. Dees tried to console them by talking about God’s will, but it didn’t help much.
"They just look at you, and your ego is gone," he said.
Then, one morning in May 2005, a neatly dressed man and a little girl in a long skirt came into his office. The little girl stood unfrightened. Her father was hopeful. But Lt. Col. Dees feared there wasn’t much he could do for this child.
As he examined her, he realized he was wrong. Doctors in the United States had the knowledge and equipment to help Hajer.
Lt. Col. Dees told Mr. Yousif and Hajer that he had never arranged for a medical evacuation before, and he didn’t know how to do it. But together they would figure out what to do.
It took nine months to bring Hajer to America, a process that included getting the Iraqi government’s approval for Hajer and her mother to leave the country, finding an international organization to sponsor Hajer and finding doctors who would do the surgery for free.
"This is just a cute little girl who deserves better. There’s just some people who stand out for you, and she was just one of them for me," Lt. Col. Dees said.
SADR CITY "APPALLING"
Before Mrs. Jabbar and Hajer came to America on Dec. 30, they never had been more than three hours away from their home in Sadr City. The suburb in northeast Baghdad is home to more than 2 million Iraqis and was the site of fierce fighting between U.S. forces and Iraqi insurgents in 2003. Hajer’s extended family of 15 lives in a four-bedroom, twobath house made of concrete blocks. Mrs. Jabbar, 25, has the equivalent of an eighth-grade education. Her husband is a handyman with the equivalent of a sixth-grade education. There is little work for him in Baghdad.
Conditions in Sadr City are appalling, said Sgt. 1 st Class Paul Dees, of Smyrna, Tenn., who patrolled Baghdad with a National Guard unit from Murfreesboro, Tenn., from June 2003 to June 2004, when some of the heaviest fighting occurred.
"Picture the worst junkyard you can imagine in the United States, and imagine people living in it," said Sgt. 1 st Class Dees, who is Lt. Col. Dees’ brother.
During the worst of the fighting, Sadr City residents stayed in their houses instead of leaving town, knowing that if they left, someone would move into their homes.
Mrs. Jabbar said their family stayed in their home for 15 days straight during the worst stretch of fighting.
FAR FROM HOME Half a world away from Sadr City, Mrs. Jabbar and Hajer are living with Arabic-speaking Muslims in Knoxville.
Though both say they love America, being separated from their family is difficult.
Mrs. Jabbar cries when she talks about missing her two sons, Muntather, 3, and Ali, 4 1 /2 months, whom she weaned just 10 days before she left Iraq.
She uses a telephone card to call her husband every day and check on her sons and update him on Hajer’s progress.
Despite the trip’s hardships, Mrs. Jabbar and Hajer have enjoyed learning about American life — from modern household conveniences to ice skating, eating fast food and shopping at a mall.
At their hosts’ house, Mrs. Jabbar began washing clothes in a sink. She had never seen a washing machine before.
She had never seen a microwave, either, but one of her hosts taught her which buttons to push so she make her own cup of coffee.
She and her daughter are fascinated by running water and lights, which they leave on all the time.
A few days after they arrived, Lt. Col. Dees and his family took Hajer and her mother shopping at a Knoxville mall. The first thing Hajer picked out was a fuzzy pink sweater trimmed with flowers.
"She just kind of tentatively held on to it, and looked up like, is this OK?" Lt. Col. Dees said. That afternoon, she picked out jeans with a glittery pink belt, blouses, tennis shoes, dress shoes, a black and pink party dress, a Cinderella doll and pajamas for her hospital stay.
Since arriving in Knoxville, Hajer has undergone a battery of tests and doctors visits to make sure she’s a good candidate for the surgery.
Before an MRI last week, Hajer began to wail as a nurse leaned toward her to insert the IV that would put her to sleep during the procedure. Nurses and doctors held her still. Her mother held her hand tightly and whispered soothingly into her ear.
After she woke up, Hajer admitted that the needle prick hadn’t hurt as much as she expected. In Iraq, getting stuck with a needle usually hurt much worse.
Despite those tears, Mrs. Jabbar said her daughter isn’t scared: "She’s counting the days and nights and hours and minutes so she can be through with the surgery."
E-mail Ashley Rowland at arowland@timesfreepress.com ON THE WEB To see more photos of Hajer and her visit to America, go to tfponline.com/photogallery.html.

Posted by Lance Frizzell at January 22, 2006 12:09 PM