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Giving Paul a hand

Surgeons in Annapolis were able to expand the use of Romanian child's deformed hand Paul Lacatos is an adorable 17-month-old. He has eyes the color of chocolate kisses, rosy cheeks and a sunny disposition.

When he races his tiny Matchbox truck across a stack of coffee table books, he makes a delightful "vrrroooom, vrrrrrrrrrooom" sound.

It's only when he pulls out his right hand and sticks the plump thumb into his mouth that one notices something is not right with his hand. On second glance, one also notices he doesn't walk, but instead scoots across the floor on his bottom or tummy.

Paul is from Romania. His chubby, dimpled left hand is normal. But, at birth, his right hand was deformed. It looked like a flipper. He has problems with his legs, too.

The first inkling something might be wrong came moments after his birth.

Simona Lacatos was foggy with anesthesia following the delivery but heard a small commotion. "We'll talk about this later," she recalled the doctor saying curtly. "He handed Paul to me all swaddled up. I did not see his hand until he was an hour old."

On Feb. 8, local surgeons Drs. Jeff Gelfand, Thomas Harries and Tom Dennis operated on the tiny child's hand in a three-hour operation.

The doctors shaped Paul's fleshy flipper into two useable fingers, along with the thumb. They couldn't give the child a normal hand - that was never an option - but they did give him a hand that can grow at a normal rate, function and be able to grip and hold objects successfully with a "three-point grasp."

There were only three metacarpals - or bones - in Paul's hand at birth, one for the thumb and two more for his fingers. The normal hand has five. The middle digit - the forefinger - only had two bones, the distal phalanx which supports the fingernail and the middle phalanx.

As he grew from infancy into toddlerhood, Paul's little hand curved into an unuseable hook. The lump that was his ring finger was tethered to the others. It wasn't growing at a normal rate.

"He has a complex syndactyly, a fusion of the skin, soft tissue and bones of the fingers," said Dr. Jeff Gelfand, a native New Yorker and an orthopaedic surgeon affiliated with The Orthopaedic and Sports Medicine Center in Annapolis, Bowie and Millersville. "Part of the problem is he is missing the third and fourth metacarpal in his hand."

In the tot's lower extremities, "Paul is missing the lateral part of his foot and lower leg," said Dr. Gelfand. "Later on, a doctor will fuse his ankles or do some procedure to stabilize his legs. That's something that is best done when he's a little bit older."

For now, Dr. Ed Holt, another local doctor, has put the child in a series of leg casts so he can learn to stand, support himself and toddle.

Dr. Gelfand co-founded the Helping Hands Foundation with Dr. Harries, a fellow orthopaedic surgeon at Orthopaedic and Sports Medicine Center and former chief of Orthopaedics and Sports Medicine at the United States Naval Academy.

The mission

Helping Hands' mission is "a humanitarian effort to provide reconstructive surgery of the upper extremity to individuals throughout the world who would otherwise not have access to such care," its Web site states. Most of the patients come through referrals in Third World or developing nations.

Here, in Anne Arundel County, a network of surgeons and volunteers takes care of the patient's social and financial support before, during and after the surgery. Airfare is paid for. Several families host the patient and family members during their stay in the U.S. Many of the volunteers are members of the Evangelical Presbyterian Church of Annapolis.

Hosting duties fell to Alice and Dick Tennies of the Fishing Creek Farm in Annapolis, where Paul and his mother stayed until leaving last week to be reunited with their family in Romania.

"He was born in Bacau, and he has two healthy siblings," said Mrs. Lacatos, a French teacher in Romania who speaks English fluently. "Carla, 5, is his big sister; and Mark, 4, is his big brother." Her husband, Daniel, is a pastor of the Bethel Baptist Church in Bacau.

Mrs. Lacatos says she's seen other children in Romania with Paul's condition.

Cause unknown

"His condition is rare," Mrs. Lacatos said. "But, I've found other babies like Paul in Romanian hospitals. Doctors in Romania told me Paul was deformed because I had a virus early in my pregnancy." She paused. "Doctors I took Paul to see in Moldavia tell me it's because of Chernobyl. They're seeing children like this."

The Chernobyl nuclear plant exploded in May 1986. Over 336,000 people were evacuated from the area around the plant in Pripyat, Ukraine, part of the then-Soviet Union, and the surrounding region. Nuclear fallout was detected all over Europe for months.

In France, over 400 lawsuits have been filed by people claiming cancers or genetic problems related to the explosion. Paris is 1,420 miles from the blast sight: Bacau is 480 miles away.

The main suspects

Chernobyl may not be the only boogieman. Romania has a terrible environmental record, which it has only recently begun to correct. Its factories belch toxins into the air, earth and rivers unchecked by regulations considered necessary in the U.S. to reduce pollution.

"It wasn't a virus that caused this," said Dr. Gelfand. "There's not a genetic component either. It's hard to say if something in the environment caused this."

Mrs. Lacatos began seeking help for her child when he was 2-weeks-old. Eventually, she heard of Stefan Chidesa, another Romanian baby, who was born with the fingers on his right hand fused together. During two trips to Annapolis, the doctors of Helping Hands separated Stefan's little fingers.

Since 1994, the Evangelical Presbyterian Church of Annapolis has sent two teams to Romania every year for two weeks. One team runs a summer camp for kids, the second one, composed of doctors, surgeons and nurses, does medical work. Mrs. Locatos sought them out. Dr. Cliff McClain, an obstetrician, took a look at Paul and began pleading his case to doctors back home.

Getting attached

That's where the Tennies came in. Members of the Presbyterian church, they agreed to host the Romanian mother and child for six weeks, beginning Feb. 1.

"I have two grown daughters," the retired American Airline and Navy pilot said as Paul scooted around the floor of his home. "This is a big difference. They didn't make motor sounds. I call him 'Tornado Paul.' "

"Uh oh!" cooed Paul as he knocked over a brass pot near a fireplace.

Watching him, Mr. Tennies eyes reddened.

"When my wife and I agreed to do this, we knew it would be a time commitment, getting them to doctors and going sight-seeing," he said. "We were willing and able to do that. We're retired. But I didn't expect the emotional investment."

"My granddaughter is the same age as Paul," he said. "She is able to walk. It breaks my heart that Paul is unable to walk."


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