By 1st Lt. Lisa Spilinek, USAF
Special to American Forces Press Service
March 21, 2008 - A photo of an adorable little boy with a bowl haircut and big, brown eyes was posted alongside a sign that read, "I may be little, but I am strong." But the scarred child within the hospital isolation room didn't look like the boy in the photo; only the lively eyes were the same. The 3-year-old boy was the victim of a stove fire that left him with second- and third-degree burns covering 45 percent of his body, along with inhalation burns to his lungs. Under the best health care conditions, the mortality rate for such severe injuries is 70 to 80 percent. In Iraq, it's a death sentence.
He's little, but he's strong. Al Amreeki survived.
The credit for saving Al Amreeki's life belongs to the medical staff working at the Air Force Theater Hospital here, where the boy has been under constant medical care since Jan. 25.
Now Al Amreeki will begin a new chapter in his recovery -- in America. Again, he has beaten the odds.
The boy and his mother have left Balad and soon will board an Air Force C-17 Globemaster III. The pair will travel first to Landstuhl Regional Medical Center, Germany, and then on to the United States.
Getting the boy permission to leave Iraq on a medical airlift mission required OKs at multiple levels by civilian and military leadership in Iraq and the United States, including from the office of the secretary of defense. The Shriners Hospitals for Children in Cincinnati will provide his ongoing treatment. Children Without Borders, a nonprofit organization, will serve as the host agency for Al Amreeki and his mother.
"I don't know how to thank the American people. They are a great and kind people, because they saved my son's life," said Al Amreeki's mother, Amil, through an interpreter. "I pray to God to not let the efforts of these people be wasted. I want him to be as healthy, and beautiful and cute as he was before."
Yet, Al Amreeki's medical outcome is still unknown.
"He's at Mile 2 of what I would characterize as a marathon of treatment; the first two miles were marked by a very steep hill," said Air Force Maj. (Dr.) David Norton, 332nd Expeditionary Medical Group intensive care unit director at the Air Force Theater Hospital, who is deployed from Keesler Medical Center at Keesler Air Force Base, Miss.
Upon the boy's arrival at the Balad hospital, Al Amreeki's injuries were so bad that he was considered "expectant" by hospital protocols, which means a patient's injuries are too severe to treat beyond administering pain medication and that death is expected. Despite Al Amreeki's devastating diagnosis, the hospital staff decided to try to treat the toddler anyway, Norton said.
"We decided to give him a chance, and he has done very well," the doctor said. "For whatever reason, this is a little man who wants to live; he's a fighter."
Over the past weeks at the Air Force Theater Hospital, Al Amreeki has undergone multiple skin grafts to his face, neck, chest and arms. The hospital technicians have been diligent in sloughing off the dead tissue that was burned in the fire when his nylon clothes melted onto his skin, and they have aggressively treated his four bouts of sepsis, which caused the boy to run 107-degree fevers, with antibiotics.
"He's kind of our miracle child," said Air Force Capt. Michael Riegler, 332nd Expeditionary Medical Operations Squadron nurse, who is deployed from Wilford Hall Medical Center at Lackland Air Force Base, Texas. "For as much as he fought, I felt we could try to fight for him."
For the hospital staff, fighting for the child included tracking down his family members.
On the day Al Amreeki was burned, his mother, Amil, was outside their home speaking with her mother-in-law.
"Suddenly we heard him screaming. We ran inside and saw this big fire, and he was in the middle of the fire. His clothes were sticking to his body," she said.
The boy was first taken to the local Iraqi hospital, but the doctors there said they could do nothing for him, his mother said. They told her and the boy's uncle, who accompanied her, to take Al Amreeki to the "American hospital."
To get there, the family would need to go to an Iraqi checkpoint. Travel in the region is dangerous because improvised explosive devices are emplaced along certain roadways, so the boy's uncle took him to the checkpoint without Amil.
At the checkpoint, American soldiers saw the critically injured boy and transported him and his uncle by helicopter to the hospital here, where doctors treat battlefield injuries and illnesses of servicemembers and Iraqis alike on a daily basis.
Wounded Americans who arrive at the hospital usually are sent to Landstuhl for follow-on care, while Iraqis who are too sick or injured to survive in an Iraqi hospital are treated at the Air Force Theater Hospital until they are well enough to be returned to the Iraqi medical system.
Riegler said the uncle visited the boy the first couple of days after he was admitted to the hospital, but was told the boy likely would die. Then the hospital staff no longer saw him; he had returned to his village without leaving his name or contact information.
Two weeks passed and little, but tough, Al Amreeki did not die.
Firmly believing that a parent's presence would help the boy recover, Riegler and an Iraqi interpreter working at the hospital began trying to track down Al Amreeki's family.
Born in Baghdad and now a resident of San Diego, Basem Hadi, an interpreter at the hospital, had experience tracking people down in the past, having spent the previous three years as a U.S. government contractor serving with Army Special Forces soldiers in Iraq.
"Do you know anything about this baby?" Basem said he would ask every Iraqi person he encountered at the hospital and on the base, since 90 to 95 percent of the Iraqis that come through the hospital are from Salahuddin province.
"The Iraqi family is very extended," he said. "If the father doesn't come, then the mother; if the not the mother, then the uncle -- somebody."
Eventually, his queries led him to an Iraqi army member in a nearby city who said he knew of a family that had a burned child, but little was known about the family except that the father had been killed about a year ago by insurgents and it was rumored that the mother had remarried.
An appointment was set up by the Iraqi army for the uncle to meet Basem and Riegler at the gate leading to Balad Air Base.
"I grabbed Mike; I told him, 'We got it!'" Basem said of finding little Al Amreeki's family. "Now I started to see hope."
When the uncle arrived at the gate, he told Basem and Riegler that it was true Al Amreeki's father had been killed by insurgents, but that Amil was unmarried and Al Amreeki was her only child. Shortly thereafter, Amil accompanied him to the gate to meet again with the pair from the hospital.
"She asked me, 'How is my baby?" Basem said. "I gave her hope. At the time his face was so swollen, I teared up, but she knew who he was."
Reuniting the family was only the beginning of the hurdles Riegler and Basem would overcome in trying to help Al Amreeki, whose medical condition was, and still is, precarious.
The pair knew that even if Al Amreeki lived, his scarred face and body would make his survival in a culture critical of deformities difficult, to say the least. Additionally, once the child returned to the Iraqi health care system, he would not receive the intense physical therapy and occupational therapy he would require for years to come. This made the pair seek out additional help from nonprofit organizations in the United States.
"It was almost impossible, but not quite," Riegler said of finding Marjorie Westerkamp, the transportation coordinator for the Shiners Hospitals for Children in Cincinnati. "There were huge bumps in the road."
Those "bumps" included getting permission from the Iraqi government and Ministry of Health to allow Al Amreeki and Amil to leave Iraq under a humanitarian parole visa as well as coordinating to get them flown from the country on an Air Force medical evacuation mission, during which the aircraft serves as a flying hospital. Since air travel can bring on additional medical challenges for patients, during medical evacuation flights patients receive even more care in the air than on the ground.
"It's fine if we get tired," Basem said of their constant work toward getting the child moved. "I felt we had to help this human being. I feel like it's my baby."
Al Amreeki is the fourth Iraqi patient brought to the Cincinnati hospital for burn treatment. There is no charge for any care or services provided within Shriners Hospitals for Children facilities.
"We've been working for weeks to get Al Amreeki here," said Marjorie Westerkamp, a registered nurse and transport team coordinator at the Cincinnati hospital. "It's only with a lot of effort and collaboration can you get a boy from the other side of the world and a war zone to Cincinnati for burn treatment. Shriners Hospital is so happy to be able to provide burn care to children in need -- it is what we do every day."
The entire process took more than six weeks to coordinate and included a required trip to Baghdad to complete paperwork for Amil – a city larger than any she had been to before.
Now Amil and Al Amreeki will travel to Cincinnati, but Amil said that the next part of their journey to recovery would not have been possible without the work of the medical personnel at the Air Force Theater Hospital at Balad.
"I'm his mom, but the nurses, male and female here, they are more than mom or dad to him. They love him and take good care of him. They check his IV and stop by to visit. The words 'thank you' are not enough," she said.
As the boy grows, his lungs will return to "close to normal" status, Norton said, but his growth will also cause his scars to pucker and his skin to grow tighter. Over the years, Al Amreeki's scars will need to be opened periodically so the boy will able to grow at a standard rate.
For now, Al Amreeki will receive treatment in the United States for a year; after that time, his situation will be re-evaluated.
For the two men who heavily invested themselves in getting Al Amreeki to the United States, his story has become one of hope for a people and a nation striving to unite and succeed.
"You're American; I'm Iraqi, and the two of us got this done," Basem told Riegler.
For the captain, a father of a 5-month-old girl and a 3-year-old boy, Al Amreeki's story is a huge success. His current deployment is his first after becoming a father.
Having served just over a year in the Air Force following an interservice transfer from the U.S. Navy, where he served 19 years, the captain has spent little time treating children, until now. In his position at Wilford Hall Medical Center, he works in the adult intensive care unit and as a critical care air transportation nurse.
"It's almost like winning the lottery. This child is one of the few who will have a chance," Riegler said. "I'm hoping he's something special – a symbol for this country. We've given the family this hope. I'm beyond happy for them."
Basem also said young Al Amreeki's story is special.
"I feel that (Al Amreeki) is the Iraq situation, and I need him to survive as much as Iraq. A lot of people I see don't have hope in the Iraqi future, but I have hope. I see (Al Amreeki) as the Iraqi people – one people, one country," he said. "Everybody said (Al Amreeki) would die. Now everybody knows him and everybody loves him."
(Air Force 1st Lt. Lisa Spilinek serves in the 332nd Air Expeditionary Wing Public Affairs Office. The names of the Iraqi mother and son in this article have been changed, at the mother's request, to protect their identities from terrorists who would harm them if it was known that the pair received help from American servicemembers and the U.S. government.)