After 8 Months with Dislocated Elbow, 8-year-old to Receive Treatment, Hope

Geraldine DeBrum is 8 years old, and has lived with a dislocated elbow for 8 months. She lives in Majuro, Republic of the Marshall Islands.

Geraldine DeBrum is 8 years old, and has lived with a dislocated elbow for 8 months. She lives in Majuro, Republic of the Marshall Islands.

The following story is so classic among children, it may have even happened to you: Geraldine DeBrum fell out of a tree and broke her arm. What isn't so typical about the story, though, is that this happened eight months ago, yet her arm remains dislocated. Thanks to the generous efforts of a Redding nurse practitioner and communities in California and Majuro, DeBrum will have her arm fixed this September.

DeBrum broke her arm while playing along the road midway between Laura and Delap villages in Majuro, an atoll in the Republic of the Marshall Islands. She was immediately treated with a poultice of native plants, but her arm was never set or cast, and it remains dislocated at the elbow.

Bob Wells, MD, an orthopedic surgeon who volunteered in Majuro with Canvasback’s May-June 2014 orthopedic mission team, examined DeBrum.

“Her joint/elbow/arm is dislocated. Scar tissue has probably filled where her elbow joint should have been before it was displaced,” said Wells.

Her elbow is “stiff,” meaning it has a very small degree of motion. DeBrum can straighten her arm, but she can barely bend it toward her—she has, at the greatest, only a 40-degree range of motion.

Bob Wells, MD examined DeBrum's arm in June, during Canvasback's last orthopedic surgery mission to Majuro.

Bob Wells, MD examined DeBrum's arm in June, during Canvasback's last orthopedic surgery mission to Majuro.

Having a largely immobile arm is challenging. Geraldine can write, which allows her to stay in school, but many other everyday actions—dressing, playing sports, or climbing a tree—are difficult or impossible to do.

Geraldine is 8 years old. She has bright brown eyes and a round nose. Small gaps in her teeth lend a childish charm to her smile, which she’ll occasionally flash when not shyly burying her face in her hands.

Her most notable feature, though, is the thick black hair, streaked with blonde, that falls to the middle of her back.

Geraldine must receive treatment for her stiff elbow if she’s to recover most of her ability to bend it.

“We can’t wait to operate much longer, or else it may no longer be possible,” Wells said. The Majuro Hospital does not have the personnel to perform the necessary and difficult surgery.

Majuro is a small, low-lying coral atoll in the isolated island nation of the Marshall Islands. Very few specialists practice medicine there, because it is isolated and because few patients could afford such services. There is no one in the entire country who can treat her.

Luckily, others have taken notice. Steve Doll, RN is a resident of Redding, Calif. He has volunteered with two Canvasback specialty surgery teams and knows the urgent need for medical care.

“Something that’s impressed me is seeing patients at the end of the [Canvasback surgery] list who need surgery,” said Doll. “We just don’t have time to get them all done.”

Doll saw these patients needing care and had an idea.

“Instead of calling all these medical personnel out there, why don’t I talk my office into bringing someone here?” Doll said.

Doll works at Shasta Orthopaedics and Sports Medicine in Redding, where five orthopedic surgeons practice medicine. He thought DeBrum’s case would be perfect pilot case.

Doll said, “There is no way, no hope of getting this done on island. She would just have to live with this terrible deformity.”

DeBrum’s elbow break is complicated, since it wasn’t properly treated immediately.

“In America, these things get treated within a day or two,” said Doll. “None of them [the five orthopedic surgeons in his practice] have ever seen a delayed treatment in an elbow dislocation. This is actually something kind of new.”

Luckily, Doll found a surgeon willing to perform the complicated surgery—at no cost. Paul Schwartz, MD works with Doll at Shasta Orthopaedics and is, Doll emphasized, “a very good surgeon.”

DeBrum will arrive in Redding with her mother on Aug. 27. Her pre-op visit will be on Aug. 29, and her surgery will take place on Sept. 2. Schwartz is anticipating a 2.5 hour surgery, with two months of post-op external fixation and physical therapy.

Since the problem has gone untreated for so long, Doll doesn’t expect DeBrum to receive 100% of her range of motion back in this complex operation.

“There is a risk of nerve injury,” said Doll, “and she will probably not have a perfect joint. But if we can get her hand to her mouth, that will be a huge victory.”

If done conventionally, all of this would cost around $15,000. However, the necessary funds and services have been donated by Doll's surrounding community.

DeBrum's right—dislocated—elbow compared to her left.

DeBrum's right—dislocated—elbow compared to her left.

Shasta Regional Medical Center volunteered its operating room, operating room staff, and a room for DeBrum to recover in. Doll’s church—Palisidro SDA—raised the funds to pay for DeBrum and her mother’s round trip airfare. Canvasback Missions secured a donated compass universal hinge from Smith & Nephew, which is essential for correct post-op healing. All physical therapy sessions are being donated. A local pharmacy agreed to donate post-op medication, and Doll and two of his clients agreed to house DeBrum and her mother the entire time they are in the States, saving them room and board expenses.

Doll said that restoring DeBrum’s range of motion will change her life, as it will enable her to do even the smallest activities again.

These minor daily activities are those we take for granted. Geraldine, for instance, is denied a simple but important pleasure granted to girls around the globe—the ability to twist, braid, and pin her own hair.

Thanks to the efforts of Doll and his community, that is about to change.

Follow these links to find out how to volunteer with or donate to Canvasback Missions, Inc.