Her first steps were painful and awkward but also, in many ways, miraculous. Sithan Leam, a 15-year-old girl from Cambodia, struggled through surgery and physical therapy to be able to walk for the first time on her own two feet.
Star-Bulletin reporter Craig Gima and photographers Jamm Aquino and Craig Kojima were given rare access to follow Sithan through her year in Honolulu and inside Shriners Hospital for Children to document her story.
Her story is similar to many of the more than 25,000 children who have been treated at Shriners since 1923.
Working at the hospital can be both heartwarming and heartbreaking as staff help the children go through often painful surgery and recovery.
"We gotta go through the pain and suffering (with the children)," said social worker Richard Wong. "We know over time they are going to get better, but when they are going through it, they couldn't care less about what it will be like in six months."
CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
In February 2007, Sithan Leam arrived from Cambodia, shy and overwhelmed while awaiting transportation at Honolulu Airport.
CRAIG T. KOJIMA / CKOJIMA@STARBULLETIN.COM
Almost a year later in January, the 15-year-old prepared to leave Honolulu and had her last exam at Shriners Hospital for Children.
» Tomorrow: Sithan Leam returns to Cambodia for an emotional reunion with her mother, but plans for her education mean she will not be able to return to her village.
FULL STORY »
JAMM AQUINO / JAQUINO@STARBULLETIN.COM
After surgeries and being fitted with a prosthetic leg, Sithan dressed her leg bandage in November, aided by Shriners Hospital's Richelle Asselstine.
A 15-year-old girl from Cambodia starts the painful journey to begin walking
Fluids and painkillers dripped from plastic bags into her arm through an electronic monitor. Another machine measured her pulse and blood pressure in green lights.
Under a pink blanket, Sithan Leam stirred and wiggled the toes of her good leg.
"Does she want to see it?" asked social worker Richard Wong.
He pulled the blanket back.
Sithan looked at her left leg.
A purple bandage ended in a stump: Part of her foot was cut off, but doctors saved the heel. Skin from her foot was grafted to cover exposed nerves behind her knee.
The leg was fixed at a 90-degree angle -- as far as it would extend without putting tension on the nerves.
The surgery was successful, but Sithan's work had just begun. If she was to walk, her leg would have to be nearly straight.
Skin grafts would have to cover newly exposed tissue. There was also a danger of infection.
For the young patients at Shriners Hospital for Children, recovery is a journey of small, often painful steps.
CRAIG GIMA / CGIMA@STARBULLETIN.COM
Sithan Leam, 14 at the time, is shown here in her village of Anlong Thor, Cambodia, in November 2006. Her calf and thigh were fused together due to a burn accident.
Burns as a baby had left her calf and foot fused to her thigh. Star-Bulletin readers helped raise money to bring Sithan to Honolulu for surgery in February 2007.
Sithan could have gone home in three months -- if she agreed to amputation.
But the girl, who grew up with the nickname "A Khvin," or "cripple," insisted that doctors try to save her leg.
During a difficult six-hour operation, Shriners Chief of Staff Dr. Ellen Raney and plastic surgeon Dr. Clyde Ishii separated the scar tissue that connected her calf and foot to her thigh, cutting away damaged muscles while trying to save major nerves and blood vessels.
A few days later, Sithan was awake but groggy from pain medication when Rinou Kong, her guardian in Hawaii, and his wife, Sary Phean, visited.
Written on paper above her bed were the English and Khmer words for nausea, thirsty, hungry, hello and pain.
On her tray was meatloaf, corn, rice, apple juice and canned peaches. Sithan poured fish sauce over her rice.
She smelled the meatloaf -- something new to her -- and cut a piece with her spoon and ate it. Then she finished the corn and rice.
"It must be hard to get used to our food," said nurse Ina Ries.
Kong had brought Cambodian movies and karaoke DVDs for the homesick girl.
"If I could walk, I would walk home," she told him.
JAMM AQUINO / JAQUINO@STARBULLETIN.COM
In Honolulu, Sithan Leam, then 14, held onto the hand of Denise Weatherford, Shriners Hospital evening shift supervisor, in April while getting shown around.
A LONG ROAD BACK
During hermonthlong stay in the hospital, Sithan started physical therapy.
At first, therapist Janice Yoshimoto worked on basic exercises and gaining Sithan's trust.
"There's a lot of hugging, and we hold their hands during painful moments," Yoshimoto said.
Sithan sometimes refused to take her pain medication.
"It made my head feel bad," Sithan said in an interview in Cambodia.
Said Wong, "Some kids would rather endure the pain than take the medicine. Sithan was one of them. Sometimes they don't like how they feel with the medicine."
For the Shriners staff, the work is both heartwarming and heartbreaking.
"We gotta go through the pain and suffering," Wong said. "We know over time they are going to get better, but when they are going through it, they couldn't care less about what it will be like in six months."
Outpatient nurse Bonnie Paulsen helped Sithan change her bandages and monitored the progress of her skin grafts.
"Do you want to go fast or slow?" Paulsen would ask about removing the bandages that sometimes stick to the exposed flesh. Sithan preferred to take the bandages off herself, at her own speed.
As the weeks passed and Sithan became more comfortable, pain became a game, something to joke about.
When Paulsen would hug her, Sithan would cringe and say, "Owie."
"That's not an owie," Paulsen would reply, and they'd both laugh.
JAMM AQUINO / JAQUINO@STARBULLETIN.COM
Sithan Leam, with her left lower leg now detached from her upper hamstring, rested in her Hawaii home last July prior to another visit to Shriners Hospital.
ACQUIRED TASTES
Away from the hospital, Sithan stayed with Kong and Phean in an apartment at Central Union Church, across the street from Shriners.
It is not the first time the Kong family has taken in kids from Cambodia. Another Shriners patient from Cambodia -- Sok Ouey -- also stayed with them. For both youngsters, life in the United States was an adjustment.
On a trip to Jack-in-the-Box, Sithan didn't like her first taste of hamburgers, but enjoyed the french fries. At the hospital she started to like pizza.
By the time Sithan returned to Cambodia, she had gained 27 pounds.
For a few weeks in August, Sithan attended McKinley High School. But only a few students spoke Khmer, and Sithan was self-conscious about her crutch and bandaged leg, Kong said. Like many American teenagers, she spent much of her time at home watching television and trying to sleep late.
CRAIG KOJIIMA / CKOJIMA@STARBULLETIN.COM
Sithan Leam, now 15 years old, prepared to leave for home in Cambodia in January. At her last visit to Shriners Hospital for Children, where she had been treated for almost a year, she exchanged hugs and gifts with outpatient nurse Bonnie Paulsen before leaving.
EXERCISE IN FRUSTRATION
As an outpatient, Sithan visited the hospital two to three times a week to change her bandages and for stretching and strengthening exercises.
Sometimes the exercises were fun. Other times, it was about work and repetition as Sithan learned to use muscles that had not been used before.
There were days, Yoshimoto said, when Sithan refused to do her exercises and pouted.
And although she was supposed to do exercises on her own at home, she sometimes neglected to, Kong said.
But within months, Sithan was able to bend her leg until it gradually straightened to about a 20-degree angle.
Raney, who had been planning to do surgery to straighten the leg and fuse her knee, decided the second operation was not necessary. Sithan agreed that it would be better to walk with a knee brace and a prosthetic rather than go through additional surgery.
In sessions with Yoshimoto, Sithan knelt and held hands as they swayed from left to right, simulating the shifting of weight during walking.
CRAIG KOJIIMA / CKOJIMA@STARBULLETIN.COM
At her last exam at Shriners Hospital in January before returning to Cambodia, Sithan Leam's leg was checked by outpatient nurse Bonnie Paulsen.
PAINFUL FIRST STEPS
In October, Sithan's prosthesis was ready, and her skin has healed enough that Yoshimoto was ready to help her take her first steps.
Most of the session was spent adjusting the brace and prosthetic and reassuring Sithan that walking would not always be painful.
"It's like putting on a dress for the first time," Yoshimoto said. "It's not always the right fit."
Sithan stood between two parallel bars to support herself. Then she lifted her hands a few inches above the bars, took a couple of steps and broke out in a smile of accomplishment and wonder.
Walking on two legs for the first time, she said later, was "like being reborn."
JAMM AQUINO / JAQUINO@STARBULLETIN.COM
Sithan Leam, walking on her new prosthesis, helped out with a family Thanksgiving barbecue at her caretakers' home in November.
SITHAN LEAM: A LONG JOURNEY
1993
Only 5 months old, Sithan Leam's left leg is burned when an oil lamp falls on her bedding in her village of Anglong Thor in Cambodia. When the wound heals, her calf and foot are fused to her thigh by scar tissue.
2006
The Honolulu-based charity Medicorps begins raising money to bring Sithan to Honolulu. Medicorps founder Dr. Gunther Hintz arranges for her to be treated at the Shriners Hospital for Children. Star-Bulletin readers help contribute enough money to pay for her airline tickets, visa and passport.
Sithan rests underneath her pink blanket May 7 after her first surgery at Shriners Hospitalal.
June 1: Sithan is released from Shriners and begins her outpatient physical therapy. Her leg is fixed at a 90-degree angle, but through therapy she is gradually able to extend it.
Oct. 8: Sithan is fitted with a knee brace and prosthetic foot and takes her first steps during physical therapy.
In November, Sithan is finally able to walk without a crutch because of her new prosthetic lower leg and foot.
Sithan shows Shriners Hospital's Bonnie Paulsen the Cambodian way of saying goodbye during a Dec. 16 party at Central Union Church.
2008
Jan. 16: Sithan leaves Honolulu to return to Cambodia. At Honolulu Airport, above, she gives guardian Renou Kong one last smile before boarding the plane.
