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She’s still smiling.
Paralyzed for half her life, a 13-year-old Palestinian girl from the Gaza Strip recently underwent a procedure to regain the ability to breathe on her own, thanks to the kindness and skill of a Jewish surgeon from Good Samaritan Regional Medical Center in Suffern.
Dr. Mark Ginsburg, chief of thoracic surgery at Good Samaritan, last month was assisted by Israeli thoracic and pediatric cardiac surgeons at Hadassah Hospital in Jerusalem in successfully performing a phrenic nerve pacemaker implantation on a patient who has been paralyzed from the neck down and unable to breathe without the assistance of a ventilator since 2006.
Seven years ago in the Gaza Strip, a missile struck the home of then-6-year-old Maria Amman, killing her mother and two brothers. Since that time, the girl’s signature smile has served as her sole source of communication with those entrusted with her care.
In the missile strike, Maria sustained a C1 spinal cord injury, which required her to use a respirator and tracheostomy.
“She couldn’t speak at all until recently,” Dr. Ginsburg said. “Now she can only speak a little,” albeit in a soft voice, “using the air from the respirator that goes through her tracheostomy,” he said.
For six years, Maria lived in Alyn Hospital, a pediatric spinal cord and rehabilitation facility in Jerusalem.
The Israeli government recently agreed to lifetime medical care and support for Maria, which will enable her father to care for her. Father and daughter have since moved to an apartment in Israel.
The outcome of the operation was “terrific,” Dr. Ginsburg said. “The pacemaker was working beautifully when we left. She is a perfect candidate for this.”
The phrenic nerve pacemaker sends electrical signals to the diaphragm and will allow Maria to breathe on her own.
“It takes a little while for the muscles of the diaphragm to be rehabilitated,” Dr. Ginsburg explained. Because a respirator is in place, the muscles from the diaphragm atrophy from nonuse.
“It will take probably about three months of progressive pacing for the muscles to regain their strength,” he said. “At that point, hopefully she can come off the respirator and eventually be without a tracheostomy tube.”
Maria should then be able to speak freely. “For somebody who’s a quadriplegic, being able to speak is everything,” Dr. Ginsburg said.
The doctor plans to return to Jerusalem within six months to check on his patient, who has been discharged from the hospital.
Dr. Ginsburg credited the team of medical personnel with whom he performed the surgery on Maria. Among them is Dr. Uzi Izhar, chief of thoracic surgery at Hadassah Hospital in Jerusalem and Dr. Raphael Udassin, chief of pediatric cardiac surgery.
Throughout the past five years, Dr. Ginsburg has operated about a half dozen times at Hadassah Hospital on patients from Alyn Hospital and other hospitals there.
Two years ago, when he was in Jerusalem operating on an older teenager from Alyn Hospital, Dr. Eliezer Ebeeri, chief of pulmonary medicine, introduced him to Maria.
“He thought she would be an ideal candidate for the pacemaker,” Dr. Ginsburg recalled. “The problem was, she had no insurance. At that point, the Israeli health care system had not agreed to pay for it.”
The pacemaker alone costs about $70,000, according to the doctor. That does not include the cost of hospitalization. “My services I donate when I go there,” he said.
First, Avery Laboratories on Long Island, which makes the pacemaker, agreed to reduce the cost of the device, Dr. Ginsburg said. Additionally, a charity within the company allows for part of the device, which is external, to be donated from patient to patient, when a patient no longer needs it.
The Israeli Ministry of Health agreed to pay the remainder of costs.
According to Dr. Ginsburg, Maria was expected to return to Gaza after her release from Alyn Hospital. “The problem was, the health care services in Gaza are not very good, and everybody thought that she would not survive that.”
Maria’s father, a Palestinian who now is an Israeli citizen, filed suit against the State of Israel for health care on behalf of his daughter, according to Dr. Ginsburg. “The Israeli Supreme Court agreed with him and awarded lifetime health services to Maria. That’s how she’s been able to stay in Israel, get health care and eventually get the device.
“Here was a 6-year-old girl who was horribly crippled in a war,” Dr. Ginsburg said. “She was a total innocent. I think it says something about the Israeli society and Israel as a country, how they treat the innocents of war. They will spend millions of dollars, perhaps more, taking care of this girl. They could have sent her back to Gaza.
The doctor described his patient as one whom everybody loves. “She has a terrific smile. She wants to enjoy life. She understands what her limitations are but she doesn’t see them as limitations.”
And she’s resourceful. “She’s able to control her wheelchair with her tongue,” Dr. Ginsburg said. The night before her latest surgery, she wheeled herself around the Intensive Care Unit and asked the nurses if she could help them take care of the other patients, he recalled.
“She is not a quiet kid sitting in the corner. She wants to be part of the action and she makes it known that she wants to be part of the action,” he said.
Although the phrenic nerve pacemaker implantation procedure is rare—40 to 50 are performed annually worldwide—in the past decade, Dr. Ginsburg has performed it approximately 100 times in a number of countries, including Israel and Brazil and, in the United States, at Good Samaritan.
Dr. Ginsburg, 58, who has worked at Good Samaritan since 1987, appreciates how the medical center permits him to perform the surgeries overseas as well. “They’ve been very supportive of me,” he said.
“Given the choice of working at a Catholic hospital versus a for-profit hospital, there’s no choice there,” he said of Good Samaritan, which operates under the auspices of the Bon Secours Charity Health System. “The sisters there are just tremendous. They make it a very warm and caring place.
“You work at a Catholic hospital, you feel the mission. It gives certainly my life much more meaning to be at a Catholic hospital than any other place.”
Dr. Ginsburg is gently amused by the story of his latest overseas surgery. “When people ask about this trip, it was ‘the Jewish surgeon from the Catholic hospital operating on the Palestinian girl from Gaza in Hadassah in Jerusalem.’”
