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The photograph tugged at Sherrie Duval's heart. Taken at an orphanage in Liberia, it showed an endearing but severely malnourished four-year-old girl whose survival was at risk.
Like too many other children in the West African nation burdened by poverty and civil war, the girl's story was tragic. Thirsty and without running water in her family's makeshift hut, the girl had innocently drunk from a glass of clear liquid.
The liquid was lye, a caustic solution used as laundry soap. The lye severely constricted her esophagus, making it impossible to eat.
Now, as the photograph showed in heart-rending detail, the girl's only hope was adoption into a family that could afford proper medical care.
Duval—an Iowan who already had two children to care for—couldn't resist the call. "After thinking it over, I told my husband (James), 'I think she's beautiful and she's going to be my daughter!'"
So, in March 2007, the Duvals flew to Monrovia to pick up the girl, named Patience, from an orphanage run by Acres of Hope Liberia, Inc.
"Patience's birth mother was very quiet and sad," Duval says. "She was giving up her daughter so that she could live. It was a very brave thing to do."
The common treatment for children with a constricted esophagus is dilation—using an endoscope to stretch the esophagus with an inflatable balloon. Dilation usually allows the child to swallow liquids, but repeated treatments are sometimes necessary. Surgery is a last resort.
Patience weighed a mere 21 pounds. Unlike most patients with esophageal injuries in the U.S., she had not gotten immediate care. This delay complicated her condition and reduced her chances for survival.
"She was very frail, all skin and bones," Duval says.
Fortunately, the orphanage had begun dilation, allowing Patience to swallow evaporated milk (a highly caloric nutritional supplement would have been better but was too expensive and unavailable).
After a week in Liberia, the Duvals officially took custody of Patience and flew her home for a new beginning.
"Patience was still malnourished and at risk," Duval says. "She needed a lot more care. In fact, our local pediatric gastroenterologist, Dr. Wieslaw Machnowski, referred us to University of Iowa Children's Hospital for follow-up."
UI pediatric gastroenterologists Warren Bishop, MD, and Riad Rahhal, MD, managed Patience's care, which initially included dilation treatments every week.
"The first three months were very discouraging," Duval says. "Her esophagus was initially open only one millimeter. It took a lot of dilation treatments to get her going."
Finally, after three months, Patience showed signs of progress.
"Now, with repeated endoscopic procedures, she has gradually advanced her diet and can eat even pizza, her favorite food," Rahhal says. "She appears much healthier and definitely happier!"
Duval concurs, saying Patience is doing great and now weighs 41 pounds. She still can't eat meat and needs dilation treatments every six weeks.
"The care has been fabulous," she says, while acknowledging that the future remains unclear as to whether Patience might still need surgery. "Everyone has been very kind. I can't say enough. She's almost a celebrity when we come for visits!"
For appointments and questions about UI's pediatric gastroenterology services:
- Call UI Health Access and ask for UI Pediatric Gastroenterology, or call the service at 319-356-2229 weekdays or 319-356-1616 evenings and weekends.
For consultation or referral, physicians should call UI Consult.
—Michael Sondergard
UI Pediatric Gastroenterology
Provides comprehensive outpatient and inpatient consultation and care for children with gastrointestinal and liver disorders. Physicians staff includes:
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Family Pizza Time
Fifteen-year-old Toni Duval pours a glass of orange juice for her sister, Patience, while, Sherrie, James, and Elijah, 10, serve pizza at the snack bar.
Clinging to Life
Snapshots taken during two weeks before the Duval family's visit to a Liberian orphanage show how malnourished Patience was before her adoption. |
