Dying Afghan Girl Leaves Country for Surgery

Adila, a young Afghan girl with a life-threatening heart defect, has been dispatched to Pakistan, where it is hoped she will undergo emergency surgery. But some worry she won't survive the trip.

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ROBERT SIEGEL, Host:

From NPR News, this is All Things Considered. I'm Robert Siegel.

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And I'm Melissa Block.

Now, a development in one of the stories we brought you yesterday. NPR's Soraya Sarhaddi Nelson reported on a 6-year-old Afghan girl with a lethal heart defect.

Members of the U.S. Army had promised her medical help, which never came through. The girl was then sent to a French hospital in the Afghan capital of Kabul. Well, yesterday, she set off on a trip to Pakistan for surgery that could save her life. Here's Soraya with this update.

NELSON: The French Medical Institute for Children here says they discharged 6-year-old Adila after talking with the U.S. military. The officials say the Army, having found an anonymous donor, is arranging corrective surgery for her in Pakistan.

But her cardiologist in Kabul, as well as doctors at the Aga Khan hospital in Karachi, where she is to get the surgery, are worried how the girl will fare on her trip.

Her taxi trip across the border, paid for privately by U.S. soldiers, began this afternoon. Her uncle and guardian who is with her say they arrived safely in Peshawar in northwestern Pakistan a short while ago. He adds that he's since been told to fly with Adila commercially to Karachi tomorrow. And that soldiers would again dig into their pockets to cover the cost. Doctors say it's dangerous for Adila to travel by road because she has no immediate access to oxygen.

A U.S. military spokesman says that they can't legally fly her in one of their helicopters, especially to another country. Her uncle says she fell ill again Monday night during the first part of her journey. The American spokesman says Adila spent the night resting comfortably at a medical facility on a U.S. base in eastern Afghanistan.

Adila suffers from a birth defect called tetralogy of Fallot. Her heart is malformed and unable to get enough oxygen to her body. A U.S. Army doctor at an outpost in northeastern Afghanistan sought to arrange surgery for Adila through a charity in Israel. But a series of missteps left the girl stranded in Kabul last week.

In the end, her weakened condition led doctors in the U.S. military to seek out surgery for her in Pakistan. Aga Khan hospital's Dr. Naved Ahmed says when Adila arrived in Karachi, they will run tests before setting her surgery date.

Soraya Sarhaddi Nelson, NPR News, Kabul.

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U.S. Military Plan for Dying Afghan Girl Goes Awry

Adila, 6, breathes with the help of an oxygen mask i i

hide captionAdila, 6, breathes with the help of an oxygen tube at the French Medical Institute for Children in Kabul.

Soraya Sarhaddi Nelson, NPR
Adila, 6, breathes with the help of an oxygen mask

Adila, 6, breathes with the help of an oxygen tube at the French Medical Institute for Children in Kabul.

Soraya Sarhaddi Nelson, NPR

Much of the work of U.S. troops in Afghanistan involves helping local communities. They build schools and roads — and they host clinics for people living in remote areas who otherwise wouldn't get medical care.

But, occasionally, the Americans' good intentions run awry — sometimes, with potentially fatal results.

In this case, a 6-year-old Afghan girl's life is at the center of a lapse in communication. And while, after uncertainty over funding, an anonymous donor has offered to cover costs for surgery required to keep her alive, transportation logistics remain unclear as her condition worsens.

Adila's Story

Beeping monitors and strangers in an Intensive Care Unit in the French Medical Institute for Children frighten Adila.

A few wails are all she can muster. Her dark eyes close. She falls asleep, exhausted from her outburst. She struggles to breathe, even with an oxygen mask.

Her Pashtun name is a variation of the Arabic word for "just." Yet what is happening to Adila seems anything but just. On this night, doctors try to stabilize her after she shows up for a heart test. Her lips were blue from a lack of oxygen.

Adila suffers from a birth defect called Tetralogy of Fallot. Parts of her heart are malformed and can't get enough oxygen to her tiny body.

Dr. Amena Shaheer, who heads this ICU, says the girl is in bad shape. But there is little they can do for her. Adila needs emergency surgery, immediately, she says.

An American army doctor who reviewed Adila's case, made a similar diagnosis. He wasn't available for an interview.

The Military's Role

Relatives and Afghan officials say Adila was taken by her family to Camp Blessing, an American outpost in war-torn Kunar province in northeastern Afghanistan. There, the Army doctor hatched a plan to have Adila evaluated in neighboring Pakistan. If doctors there deemed her a suitable candidate, he would ask a charity called Save a Child's Heart to send Adila to Israel for corrective surgery.

The military told Adila's family that all they needed to do was to get her a passport and make the trip to Kabul. That's no easy task for an impoverished family without documents — and who rarely leave their remote village.

But with Afghan officials' help, Adila got her passport in one day. American soldiers nearby at the Kunar provincial reconstruction team, dug into their pockets for the $70 cab fare.

Last Tuesday, Adila and her guardian set off by taxi for Kabul. And that's when the American plan fell apart.

A Communication Lapse

Adila's guardian, an uncle named Talib, says by the time they got to Kabul, the girl was dehydrated and blue from lack of oxygen. No hospital was aware of Adila's arrival or her case.

The Army doctor who made the plans had left the country. The people he asked to follow her case in his absence failed to do so.

So in a mad scramble, the Kunar PRT told Adila and her uncle to go to the CURE hospital in Kabul, run by a Pennsylvania-based charity group. Eric Sinclair, chief operating officer of the hospital, agreed to admit Adila and stabilize her.

"I applaud the work they are doing on behalf of the community, but in this case, they've dropped the red-hot potato, so to speak," says Sinclair of the military's effort.

Maj. Nick Sternberg, an American military spokesman, called it a miscommunication.

"Based on the fact that we've helped so many people in the past, locals often expect that once a problem has been given to us, it'll be taken care of immediately and completely," Sternberg says.

With the help of CURE hospital, Adila was sent across town to the French Medical Institute for Children, where she could get the tests she needs.

The half-hour trip sent the girl crashing again. She wound up in the ICU. Her condition improved and she was moved to a regular room, where she remains. But doctors say Adila is running out of time.

Next Step in the Plan

Officials at the CURE and French hospitals say they've repeatedly asked the Americans what they plan to do. Both charity hospitals say they are in no position to pay for Adila's treatment, let alone the surgery. They say she needs to be flown to Karachi in Pakistan, where the surgery can be done quickly.

Sternberg, the military spokesman, says soldiers reached into their own pockets to pay for her care at the French hospital. Sinclair says he waived his hospital's costs.

"There is a whole logistics nightmare again ahead of us and time is something that is pressing against us so we obviously need to come up with a solution very quickly," Sinclair says.

One of the main obstacles is money for the surgery. The medical officials in Kabul say it should come from the military, which sent Adila here in the first place.

Sternberg says they can't, under their rules, spend military funds on her surgery. But he says the army has located an anonymous donor willing to pay for it.

How Adila will get to Karachi, though, is still unclear.

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