Surgery changed the life of a girl with cerebral hemorrhage

Four years ago, Angel – or Precy, as she is also known – was born in a public hospital in the Philippines.
The Age / The-Age

Angel’s mother always knew that other children would be scared of her daughter. She had seen people stare. To protect their daughter, Cypres Salon and her husband, Dale, mostly kept Angel at home to play with her siblings and cousins. But then one day, the inevitable happened.

A four-year-old boy approached Angel while the family were out and shouted at her, “Monster!”

Angel did not flinch. She just patted him on the shoulder and said, “Hi.”

Angel was diagnosed with encephalocele, a brain hernia that occurs when the skull and tissue surrounding the brain doesn’t close in the womb.
The Age / The-Age

“I was so amazed by her response,” Cypres says. “I was so proud of her.”

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Four years ago, Angel – or Precy, as she is also known – was born in a public hospital in the Philippines.

Cypres remembers an ominous silence after her fourth child was born. Angel did not cry like her other babies, and she was immediately whisked away to another hospital for treatment.

A doctor explained to Cypres that something was wrong, but it wasn’t until she met her baby five days later that Cypres realised how bad things were.

“When I saw her for the first time, I cried a lot,” Cypres says. “I cried every moment I looked at her and I blamed myself for her condition.”

Angel knew other children were scared of her but she remained open and friendly.
The Age / The-Age

A doctor diagnosed Angel with encephalocele, a brain hernia that occurs when the skull and tissue surrounding the brain doesn’t close up normally in the womb. Doctors don’t know what causes it, but the problem is common in South-East Asia.

These hernias can occur at the front, side or back of the head and, depending on the severity, can include a small or large amount of the baby’s brain, causing damage and functional problems.

When Angel was four months old, her parents raised about $5500 to pay for surgery in the Philippines to make sure the hernia was separated from the brain and sealed off. This would help prevent her brain from spilling into the hernia and causing trouble.

At four months old, Angel had surgery to make sure the hernia was separated from the brain.
The Age / The-Age

The surgery was successful and Angel seemed to develop without brain damage. But the hernia was still covering most of her left eye and squashing her nose, making it harder for her to run freely and play and breathe and sleep like other children. She would often hold the lump up or move it from side to side so she could see, a hindrance when trying to play with both hands. At night, sometimes she couldn’t sleep on her back because it blocked her breathing.

Cypres says Angel knew other children were scared of her but she remained open and friendly.

Cypres and Dale live in Kinoguitan, a small fishing and farming village on the coast. Cypres works for the government on a basic wage and Dale spends most of his time caring for their children. They run a little shop from their home.

Over four hours doctors carefully cut the lesion, which weighed 200 grams, off Angel’s face.
The Age / The-Age

Cypres says they couldn’t afford to pay another $8000 for Angel’s hernia to be removed so she searched the internet for information about her condition to see what more could be done. One day she found a story about a 12-year-old Filipino boy who received a charitable operation in the US.

She fired off emails to the hospital where it was done and they referred her to Interplast, a group of Australian and New Zealand surgeons who donate their work to people needing surgery in the Asia Pacific region. Interplast told Cypres to take Angel to one of their doctors who was visiting a city two hours from where they live. The doctor connected them with the Children First Foundation to see if they could bring Angel to Australia for the procedure.

The group agreed. They paid to fly Angel and her father Dale to Australia, and convinced the craniofacial unit at the Adelaide Women’s and Children’s Hospital to do the procedure in September.

Angel’s parents say they are extremely grateful for the help she has received.
The Age / The-Age

When the pair arrived in August, foundation staff collected them from the airport and took them to their Kilmore farm which is currently caring for 10 other children from countries nearby. The foundation provided them with warm clothes, and welcomed them into their house, which is affectionately known as the “fat farm” because children often need high-calorie food to fatten them up for medical treatment.

In September, Angel and her Dad flew to Adelaide for the surgery. They were greeted by an interpreter organised by the foundation to help them through their hospital stay.

Surgeon Walter Flapper and his team scanned Angel’s brain to check that it had been separated from her hernia during the previous operation in the Philippines. It had. This made their operation simpler and less risky.

Over four hours, Flapper and his team carefully cut the lesion, which weighed 200 grams, off Angel’s face. It was full of abnormal brain tissue and fluid that she did not need.

They then used some bone from her hip to seal the hole in her forehead to ensure another hernia does not grow. They pulled the remaining skin together to sew up her face. A scar now runs from her forehead down her nose, flanking both nostrils.

When Angel woke up, she wondered where her eyes had gone, Dale says, because they were covered for the first three or four days. When she eventually saw her face, Angel did not express much surprise but her behaviour told a different story. When she got out of bed, she had nothing obstructing her vision or breathing, so she could run faster and use both hands to bang on the piano without having to hold her face.

Flapper said Angel will need to return to Australia for further work to shape her nose, which has been pushed to one side by the weight of the hernia. A nose reconstruction can happen when she’s grown up, he says, perhaps when she’s a teenager.

After the operation, Angel and Dale returned to the Kilmore farm so she could recover. In late September, they flew home to reunite with the rest of the family who were thrilled to see them.

While Angel still looks different to other children, Cypres and Dale say they are extremely grateful for the help she has received. They feel more optimistic about her future.

When she got home, they were so pleased with her new face, they took her to their local church for the first time. Last week, they threw her a birthday party on November 5 and invited more people than they used to.

“We celebrated it with children in our neighborhood and other relatives,” Cypres says. “She was so happy.

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