From left, Jody Kaban, MD; Michelle Kennedy, MD; Arian Sedeghi, MD; Melissa Shapiro; patient Wahida Sher-Agha; Arthur Adamo, MD; Benn Lieberman, MD; and Daniel Buchbinder, MD.
When Carol Pope, RN, ORT, BSN, MPH, CNOR, asked her patient, Wahida Sher-Agha, to take her clothes off and put on a gown for her nine-hour oral surgery, the girl looked at her as though she had just been slapped across the face.
“She could not believe I was asking her to do such a thing,” says Pope, head nurse for Oral Surgery, Plastics, and Burns at Jacobi Medical Center in the Bronx, N.Y. “She became frantic and kept saying: ‘No, no, no.’ That’s when I realized how deep cultural differences can be. Girls in the U.S. walk around wearing miniskirts, but for her it was scary to remove her usual clothes and put a gown on. As a nurse, my instinct was to calm her and to make her as comfortable as possible.”
This incident was only a little bump in Sher-Agha’s more than yearlong journey she took from her native country of Afghanistan to the U.S. Last July, the 16-year-old traveled thousands of miles alone without being able to speak a word of English to have a jaw reconstruction surgery to repair the damage she suffered when she fell off a bridge as a child. For eight years she could only partially open her mouth to 8 millimeters, which limited her ability to eat and communicate. That she was not able to take normal portions of food in was bad enough, but not being able to speak and laugh with others was a big deal for the adolescent girl.
A nonprofit organization called Healing the Children made arrangements to bring her to the U.S. and place her with a host family in Trumbull, Conn. It was not a smooth ride. Getting a visa took her more than a year, and finding an institution that would perform the surgery was not easy. First, she was expected to have the procedure done in Connecticut and later in Brooklyn, N.Y., but both arrangements fell through because of those hospitals’ financial difficulties.
Finally, Jacobi Medical Center took on her case with the help of private support, mostly through the Ray Tye Medical Aid Foundation in Massachusetts and The Jacobi Medical Center Auxiliary. Jacobi is part of NYC Health and Hospital Corporation’s North Bronx Healthcare Network, which includes North Central Bronx Hospital. Doctors from Jacobi Medical Center’s CSI (Craniomaxillofacial Surgical Institute) performed the operation that involved a rib craft Feb. 26 under the leadership of Dr. Arthur Adamo, the center’s chief of oral surgery.
On the day of the operation, after a little bargaining, Sher-Agha changed into a gown, but in return Pope kept the number of people in the operating room to a minimum and ensured Sher-Agha was covered even when she was asleep.
Sher-Agha also was sensitive about her hair. Pope made sure that they cut off only as much as was necessary and that her head was covered the entire time. After a surgery patients typically go to the recovery room wearing only a gown, but Sher-Agha was granted an exception and wore her pants and two gowns: one in the front and one in the back.
“One of the nurses asked me why she had her pants on while she still had a Foley in,” Pope says. “I had to explain the situation to make sure they respected her privacy and her wishes. I did not want her to wake up and find herself uncovered. I was her advocate, so I went back later to check on her.”
The presence of a Dari language interpreter was another element Pope noticed made a significant difference in the care of Sher-Agha. An interpreter in Dari language is not easy to come by, but there happened to be a doctor at the hospital who spoke the same dialect and volunteered to stay with Sher-Agha to assist her.
“An in-person interpreter can communicate with a patient in many more ways than a translation line,” Pope says. “I think the presence of the interpreter made Wahida better understand the details of her surgery and the expected results, so that put her at ease. Having someone there who spoke her native language provided comfort since she did not have her [biological] family from home to support her.”
The members of her U.S. family, the Shapiros, were there every step of the way. During this past year they took her to doctor appointments, arranged for her to take classes at the local high school, and took her on trips to New York City and amusement parks. Thanks to this supportive environment, Sher-Agha quickly picked up a lot of English.
“She’s been a wonderful addition to our family,” says Sher-Agha’s host mother, Melissa Shapiro. “We will be very sad to see her go.”
Sher-Agha is making progress in physical therapy and can open her mouth to 41 millimeters, which is within the normal range. On June 22, she will return to Afghanistan with her new smile and newly found confidence. Despite her initial fear of the surgery, she leaves with good memories of the hospital.
“Everybody is very nice in the hospital. Everybody,” she says.
Shapiro says her smile is not the only change she has seen in Sher-Agha since her surgery. “She actually wears short-sleeved shirts inside the house now,” Shapiro says. “But only inside.”
“She could not believe I was asking her to do such a thing,” says Pope, head nurse for Oral Surgery, Plastics, and Burns at Jacobi Medical Center in the Bronx, N.Y. “She became frantic and kept saying: ‘No, no, no.’ That’s when I realized how deep cultural differences can be. Girls in the U.S. walk around wearing miniskirts, but for her it was scary to remove her usual clothes and put a gown on. As a nurse, my instinct was to calm her and to make her as comfortable as possible.”
This incident was only a little bump in Sher-Agha’s more than yearlong journey she took from her native country of Afghanistan to the U.S. Last July, the 16-year-old traveled thousands of miles alone without being able to speak a word of English to have a jaw reconstruction surgery to repair the damage she suffered when she fell off a bridge as a child. For eight years she could only partially open her mouth to 8 millimeters, which limited her ability to eat and communicate. That she was not able to take normal portions of food in was bad enough, but not being able to speak and laugh with others was a big deal for the adolescent girl.
A nonprofit organization called Healing the Children made arrangements to bring her to the U.S. and place her with a host family in Trumbull, Conn. It was not a smooth ride. Getting a visa took her more than a year, and finding an institution that would perform the surgery was not easy. First, she was expected to have the procedure done in Connecticut and later in Brooklyn, N.Y., but both arrangements fell through because of those hospitals’ financial difficulties.
Finally, Jacobi Medical Center took on her case with the help of private support, mostly through the Ray Tye Medical Aid Foundation in Massachusetts and The Jacobi Medical Center Auxiliary. Jacobi is part of NYC Health and Hospital Corporation’s North Bronx Healthcare Network, which includes North Central Bronx Hospital. Doctors from Jacobi Medical Center’s CSI (Craniomaxillofacial Surgical Institute) performed the operation that involved a rib craft Feb. 26 under the leadership of Dr. Arthur Adamo, the center’s chief of oral surgery.
On the day of the operation, after a little bargaining, Sher-Agha changed into a gown, but in return Pope kept the number of people in the operating room to a minimum and ensured Sher-Agha was covered even when she was asleep.
Sher-Agha also was sensitive about her hair. Pope made sure that they cut off only as much as was necessary and that her head was covered the entire time. After a surgery patients typically go to the recovery room wearing only a gown, but Sher-Agha was granted an exception and wore her pants and two gowns: one in the front and one in the back.
“One of the nurses asked me why she had her pants on while she still had a Foley in,” Pope says. “I had to explain the situation to make sure they respected her privacy and her wishes. I did not want her to wake up and find herself uncovered. I was her advocate, so I went back later to check on her.”
The presence of a Dari language interpreter was another element Pope noticed made a significant difference in the care of Sher-Agha. An interpreter in Dari language is not easy to come by, but there happened to be a doctor at the hospital who spoke the same dialect and volunteered to stay with Sher-Agha to assist her.
“An in-person interpreter can communicate with a patient in many more ways than a translation line,” Pope says. “I think the presence of the interpreter made Wahida better understand the details of her surgery and the expected results, so that put her at ease. Having someone there who spoke her native language provided comfort since she did not have her [biological] family from home to support her.”
The members of her U.S. family, the Shapiros, were there every step of the way. During this past year they took her to doctor appointments, arranged for her to take classes at the local high school, and took her on trips to New York City and amusement parks. Thanks to this supportive environment, Sher-Agha quickly picked up a lot of English.
“She’s been a wonderful addition to our family,” says Sher-Agha’s host mother, Melissa Shapiro. “We will be very sad to see her go.”
Sher-Agha is making progress in physical therapy and can open her mouth to 41 millimeters, which is within the normal range. On June 22, she will return to Afghanistan with her new smile and newly found confidence. Despite her initial fear of the surgery, she leaves with good memories of the hospital.
“Everybody is very nice in the hospital. Everybody,” she says.
Shapiro says her smile is not the only change she has seen in Sher-Agha since her surgery. “She actually wears short-sleeved shirts inside the house now,” Shapiro says. “But only inside.”
Tamas Horvath is a freelance writer. To comment, e-mail editorNY@nursingspectrum.com.
