Six-year-old Hadi Abukhadra is able to walk for the first time in his life, thanks to surgery and rehabilitation at Lucile Packard Children's Hospital -- treatment that he traveled 7,500 miles to receive.
Hadi, who is from the Tulkarem refugee camp in the West Bank of Palestine, was born with arthrogryposis, which causes "stuck" joints and orthopedic deformities. His knees bent the wrong way and his feet faced upside down, but with help from the Palestine Children's Relief Fund (PCRF), he can now take his first steps and begin attending school.
Before treatment, Hadi's condition left him the options of crawling or being carried. With his feet facing the wrong direction, standing created large abscesses on his ankles and his knees hyperextended such that his lower leg could swing forward but not bend backward.
Hadi and his mother, Sherine, arrived in the United States last fall in preparation for the life-changing surgeries to be led by orthopedic surgeon Lawrence Rinsky of the Stanford School of Medicine. Hadi's care -- including surgery, rehabilitation and host stays -- was arranged by the PCRF, a nonprofit that provides cost-free medical treatment abroad to children in the Middle East who are unable to receive it in their home country. His family connected with the organization at a PCRF clinic in the West Bank, "and from there, we were able to reach out to Dr. Rinsky. I emailed him and he was all for it right away," said Nuha Shuman, medical coordinator for PCRF's Bay Area chapter.
Treatment of Hadi's feet began with a series of casts meant to gradually stretch the skin, ligaments, nerves and other soft tissue. In February, he had a small operation to lengthen his Achilles tendon, followed by a larger operation a month later to remove the middle bone in his ankle.
"This created enough slack to bring his feet to a near-neutral position," Rinsky said.
His knees were also treated with a surgery and a series of casts "to slightly lengthen the muscles that straighten his knees, allowing slightly more bending and preventing hyperextension," Rinsky said. He can now bend his knees at about 45 degrees, allowing him to sit in places like the backseat of a car.
"He was a champ. It was painful, but he handled it like a pro. He was so thankful," Shuman said. "The first thing he said when they took off the cast was, 'Thank God,' and 'thank you,' and gave Dr. Rinsky a big hug, and he showed up in a suit wearing a plastic stethoscope because he wants to be Dr. Rinsky."
With feet that allow him to walk and wear shoes, he can now go to school, the first step in realizing this dream.
Even with full leg-casts post-surgery, Hadi was on the move thanks to a new wheelchair, a gift from an anonymous donor. And when the casts were removed, he had walking braces almost right away. The custom AFO braces were donated by Hanger Clinic in Mountain View. Lucile Packard physical therapy clinical specialist Richard Gee was ready to get Hadi walking, while a walker donated by custom-wheelchair company Numotion provided support in the early stages.
"None of the donors hesitated," Shuman said. "Right away, no questions asked, they were willing to help."
Hadi's mother was "just in awe of all the support they have received and without that, Hadi would still be crawling and (unable) to walk," Shuman added. "It's an honor to help this family. They're very humble and thankful for everything that was received."
Hadi has been walking on his own, no walker needed, for about a month now, a learning process Gee started as early as possible. He introduced standing and weight bearing while Hadi was still in the full leg casts, followed by motion at the ankle, standing, and then finally walking, which Hadi learned within two weeks of cast removal.
"To understand what Hadi's feet looked like before, and what he does now, is almost night and day," Gee said. "He basically had to relearn how to stand and how to balance. Even just the standing process of getting his body over his feet is a new process for him."
Exercises included games like kicking a small beach ball while seated and throwing a ball at bowling pins while standing. "What we're trying to do is increase motion and strength in his quadriceps muscles (and) increase bending and straightening (movements in) his knees," Gee explained.
The bowling game helps Hadi with balance reactions, as does sidestepping. Hadi also stretches to gain mobility in his knees.
"He always had a smile on his face and a happy demeanor," Gee said of the time he spent with Hadi.
With his new mobility, Hadi looks most forward to playing soccer, he said.
"This was his dream, to be able to wear shoes and play soccer someday," Sherine said through an interpreter. "Without PCRF's help, none of this would have been possible."
During his time in the United States, Hadi has become a fan of the San Francisco 49ers, Chuck E. Cheese's and the iPad. (He also enjoys taking selfies, mimicking the American teens he sees taking them.) He sings and dances often, even in his hospital bed right before going into surgery, IV already in place.
"He was not shy at all," Samar Aburahma, his first host, said of his arrival in the United States. In fact, he insisted on going to the beach as soon as possible. Neither he or his mother had seen the ocean before due to beach permit laws in the West Bank.
"I had only seen it in movies," Sherine said.
PCRF plans to keep in touch with Hadi and his family, since Hadi will likely need more AFO braces in the future. According to Rinsky, he will need to wear braces for walking for "at least a few years (and) will continue rehabilitation exercises to increase his range of motion and flexibility."
It is important for him to remain strong and active not just for walking, but for growth as well, Gee added.
Hadi will return home in late June to his father and siblings, bringing a bit of English, like, "What's up, dude?" along with him. Most of all, he remains positive, always smiling.
"This is a very bright young man," Rinsky said. "I think he has a good future ahead of him."