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Special Delivery

Dome Volume 60 Number 2
March 2009

A dizzyingly complicated transplant effort brings new sight to Iraqi children.

Special Delivery
Esen Akpek examines Noora, blind since birth.

As war relief efforts go, the mission certainly looked complicated from the start. The basic idea was to help a group of Iraqi children regain their sight with corneal transplants. But how to deliver the care? Iraqi ophthalmologists in Baghdad said their best facilities had been destroyed in the invasion. They didn’t even have an eye bank anymore. Could Western doctors bring their skills, transplant tissues and equipment into the war-torn country?

As the logistical nightmares of the trip began to mount—and the coordinators at relief agency Project Hope ruled out a plan to bring the kids to Hopkins’ Wilmer Eye Institute in Baltimore—the mission took root at the modern 207-bed Anadolu Medical Center in Turkey, which shares a common border with Iraq. The hospital has been a Hopkins affiliate since 2002, with faculty here offering expertise in clinical and operational programs, patient safety and continuing medical education. The designated surgeon would be Wilmer’s own Esen Akpek, who happens to be Turkish and could perform the transplants while visiting relatives.

But one of the most complex parts of the plan fell to Anadolu’s Ilkay Baylam, a hospital public relations aide who spent nearly 90 days juggling constantly changing variables in an earnest bid to guarantee the effort’s success. He needed to secure visas for each of the 10 Iraqi children—some with an accompanying relative—along with several Iraqi eye doctors and a translator. He also needed to arrange multiple pickups at the nearby airport, their accommodations, and the timely transfer of extremely perishable corneal tissues. These came from different eye banks all over the world via FedEx, with their own transport restrictions. All of the factors had to come together for a five-day window in late August.

On the evening of Aug. 20, Baylam and the travel-weary group of 21 connected at the airport and got settled into their hotel rooms by 2 a.m. Other members of the effort also began to arrive, including three people from Wilmer—coordinator Kim Pratzer, technician Shanna Ingrodi and surgeon Akpek. Over a dozen people from Anadolu would participate—the three Iraqi physicians were still inbound—swelling the group’s size to well past 40.

For Ingrodi, the mission’s humanity came into sharp focus on day one, when caregivers and patients were all brought together for lunch. She especially took note of 7-year-old Noora, who had been blind since birth. “We noticed how she kept holding food close to her nose so she could smell it,” says Ingrodi, who used her personal vacation time to participate. “That really broke our hearts.”

Ingrodi describes those first hours as a delicate dance of trust building. She says she and her Hopkins colleagues all sensed how the Iraqi patients were apprehensive and scared. “We could tell they didn’t believe this was real,” says Ingrodi. “We had to convince them that this wasn’t a trick.”

When the first IV lines were inserted into the patients’ arms, nearly all of them began to cry, prompting their escorts to cry as well. But once the procedures began to unfold, says Akpek, the human chemistry changed dramatically. “They treated us like we were angels or something,” she says.

Akpek also felt a special bond with Noora, who was accompanied by her mother throughout the fast-paced procedures. When the child’s bandages came off on day three, Akpek delighted in seeing the girl’s eyes “jumping around,” darting back and forth to take in the flood of visual details throughout the exam room. “She’s so happy,” said the translator.

In the end, Akpek found two of the children unsuitable for corneal transplants but was able to offer them other procedures to improve their vision, including a customized eyeglass prescription and medications for one young boy with dimmed corneas complicated by severe conjunctivitis. And six months post-op, all eight of the transplants—just one eye in each patient—took smartly, with skilled follow-up care proceeding amid the rebuilding of the ophthalmology center in Baghdad. The Iraqi physicians themselves say their own eye bank is also getting relaunched.

The involved aid agencies hope to do it all again, and the Hopkins teammates can’t wait. Says Ingrodi, “I definitely hope we get to


—Ramsey Flynn

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