Doctors and staff at Rhode Island Hospital arrange special radiation treatment for a young Peruvian girl, because "that's what we do," the hospital's chief of neurosurgery says.

01:57 AM EDT on Friday, July 29, 2005

BY TOM MOONEY
Journal Staff Writer

PROVIDENCE -- The pain drove through her head like a bolt.

One moment 11-year-old Fiorela Sangama appeared fine, passing another day in her steamy riverbank town on the edge of the Peruvian jungle. The next, the right side of her skull seemed to explode.

It was April 11. Three days later Fiorela fell unconscious. At the local hospital in Iquitos, a CAT scan revealed a hemorrhage deep in the right hemisphere of her brain. The source of the bleeding: a 1 1/2-inch vascular malformation -- a tangle of arteries and veins lacking the normal system of capillaries necessary to disperse blood and pressure.

Local doctors transferred her to a pediatric hospital in Lima. But even there, specialists believed the malformation too deep to try to remove surgically.

John A. Duncan is chief of neurosurgery at Rhode Island Hospital and Hasbro Children's Hospital. On any given day he may probe the sick brain of a child on a mission to relieve pain and illness.

Journal photo / Sandor Bodo

Fiorela Sangama listens to Dr. Luis Castenada, her neurologist from Peru, during a news conference yesterday. The 11-year-old received a gamma radiation treatment, unavailable in Peru, to treat a malformation in her brain the day before.

Last month Duncan traveled to Lima, Peru, with several other doctors on a humanitarian visit to treat ailing children. After consulting with Fiorela's doctor, Duncan determined her condition suitable for gamma radiation treatment, known as Gamma Knife treatment, and unavailable in Peru.

Yesterday, a day after her 12-hour radiation treatment at Hasbro, the black-haired girl from the jungle sat on a hospital stage beside the white-coated doctor who had arranged her 3,700-mile trip, and smiled.

"That's what we do," said Duncan.

What made the event newsworthy was not so much the treatment -- available since 1992 at Rhode Island Hospital -- but the fact that it came for free.

Hospital officials said the lifesaving treatment Fiorela received would have cost between $40,000 and $50,000 had not so many doctors and the hospital volunteered their times and services.

FIORELA, HER MOTHER, Claribet, her doctor, and two members of Armonizar, a Lima nonprofit group which offers medical care to children, arrived in Providence on Sunday.

Their travel and lodging expenses were paid for by the Providence-based Neurosurgery Foundation Inc., a nonprofit group made up of Duncan and four other neurosurgeons, all of whom teach at Brown University.

Doctor Georg Noren, chief neurosurgeon and medical director of the New England Gamma Knife Center at Rhode Island Hospital, led a team of doctors and nurses who performed Fiorela's treatment.

Noren fitted Fiorela with a lightweight head frame and helmet through which his assisting team precisely aimed 201 beams of gamma radiation at the malformation in Fiorela's brain.

Only the targeted tissue received the radiation. The radiation destroys the DNA in the cells of the malformation, preventing them from growing and reproducing. But it can take as long as two years for the malformation to disappear.

The treatment, which the hospital uses dozens of times a year, requires no recovery time, which was why Fiorela could easily stand up from the wheelchair yesterday that hospital policy required discharging patients like her use, and hug her mother.

Fiorela will have to be watched closely; there is a slight chance her brain could hemorrhage again, said Noren. And the radiation treatment also revealed an aneurysm which Duncan said he will remove in a few months, in Peru.