April 8, 2005

Out of tragedy comes hope for a little boy

When 17-month-old Fadhil Muammar was discharged from the MGH April 1, he left with a new lease on life — saved not only by the team of MGH and MassGeneral Hospital for Children doctors and nurses who rallied to care for him, but also, ironically, by the December tsunami that devastated so much of his southeast Asian home.

MGH Emergency Department physician Vicki Noble, MD, was in Banda Aceh, Indonesia, in March with a medical team providing relief in the area through Project HOPE when she met Fadhil (left) and his family. Fadhil had sustained a head wound from the tsunami that had become infected, but it was the abnormal swelling of the baby's abdomen that led his mother to seek out the Project HOPE team. For months, Fadhil's belly had been growing increasingly distended and rigid. Local doctors had given the family various diagnoses and no hope for treatment. Noble determined that the swelling was caused by a mesenchymal hamartoma: a liver tumor that, while benign, was large enough — approximately the size of the toddler's head — to put pressure on Fadhil's internal organs. If left to grow unchecked, it would eventually become life-threatening.

Noble was working on the USNS Mercy, an 800-bed floating Navy hospital equipped to handle the most prevalent health issues among tsunami survivors, such as infections, bone fractures and mud aspiration pneumonias. Recognizing the seriousness of Fadhil's condition and the limited resources of the Mercy, she arranged for the boy and his family to travel to Boston for treatment, overcoming a host of logistical hurdles along the way. "I had volunteered with Project HOPE because I wanted to do what I could to help, and Fadhil's case was hard to say no to," Noble explains. "His condition was treatable with access to the right doctors and facilities. His mother had taken him everywhere she could in Indonesia and was absolutely tireless about finding an answer to his illness, even in the face of tremendous adversity. I felt we had a responsibility to care for them."

On March 19, Fadhil and his parents Miswar and Mahfud Muammar arrived at the MGH. On March 28, MassGeneral Hospital for Children pediatric surgeons Daniel Ryan, MD, and Daniel Doody, MD, removed the tumor and roughly 60 percent of Fadhil's liver in a three-and-a half-hour surgery. "Luckily, the tumor was located on an area of the liver that is resectable," says Joseph Vacanti, MD, chief of Pediatric Surgery at MassGeneral Hospital for Children. "The operation went very well using the tools of modern liver surgery available here." By the next day, he was out of bed, and within five days the little boy was discharged, a full week earlier than expected.

Ryan describes his prognosis as excellent. Within the next two weeks, the family should be able to return home to Indonesia. "It was enormously gratifying to take part in Fadhil's care," Ryan says. "Untreated, the tumor could have ruptured or developed cancerous characteristics, and this little boy would have lived a life of constant pain. Now he has the chance to be just like any other healthy toddler."

From left, Nobel, Vacanti and Larry Ronan, MD, director of the MGH Durant Fellowship, at a press conference about Fadhil