Antoine Woodlyn has gained some weight and lots of new friends in the 24 days since he and his mother, Augustine, arrived at Alfred I. duPont Hospital for Children in a medical airlift from Jacmel, Haiti.
He has recovered from two bouts of pneumonia and has been discharged from the hospital. He and his mother are now guests at the nearby Ronald McDonald House.
But the challenges the 16-month-old earthquake survivor faces are steeper than doctors realized. He will require significant long-term support, they say.
Antoine, born more than two months premature, has a form of cerebral palsy that has left him way behind in his development, with muscles too weak for him to sit up or roll over on his own. Doctors believe the condition was caused by an unknown trauma early in his life that deprived him of oxygen.
"It's going to be a long haul for him developmentally," said A.I.'s pediatrician-in-chief, Dr. Carl Gartner, who has treated the boy. "In all honesty, the general rule with pediatric development is that if you're significantly behind at a year, it's probably not going to go away. We have grounds to believe he will improve. But for him to go from where he is now and be quite normal by age 4 to 5 -- that's not going to happen."
Augustine told doctors her little boy had a couple of episodes early in his life, when he became unresponsive and turned blue. They were far from a hospital, and she had to take him by public transportation to get help.
Speaking through a Creole interpreter last week, Augustine said her little boy has been sick for a long time. After the earthquake, they slept on the streets of Jacmel. Much of the town was in ruins, including its only public hospital, St. Michel.
"I was not well at all, and my child was very, very sick," she said. "I got so scared."
About a week after the Jan. 12 earthquake, she was able to get Antoine to the Centre Medical Emmanuel, a private hospital in Cayes Jacmel, about nine miles from Jacmel.
Antoine stayed at that hospital for just over two weeks, Augustine said, and he seemed a little better
"But not that much," she said. "Then I met the people from the United States."
Damage done early
Physicians from New Jersey-based Team Ange -- "ange" is Creole for angel -- had arrived in Cayes Jacmel, and offered their assistance at Centre Medical Emmanuel. Soon, doctors from the Delaware Medical Relief Team also were assisting at Cayes Jacmel. DMRT has sent five teams to Jacmel since the earthquake, and many of the medical volunteers have assisted at Cayes Jacmel, too.
Orthopedic surgeon Randeep "Deep" Kahlon of First State Orthopedics was there when Team Ange doctors detected Antoine's "roaring" heart murmur, as Gartner describes it. They correctly diagnosed that he had a hole in his heart. And they decided his best shot was to have surgery in a U.S. hospital, where he also could get appropriate follow-up care.
When a transfer to a Philadelphia-area hospital fell through, Kahlon called A.I.'s Catherine Rossi-McLaughlin, who got quick approval for Antoine to be cared for at the Rockland hospital. The Philadelphia Eagles provided air transport for Antoine and several other Haitian children, and Antoine and Augustine arrived in Wilmington on Feb. 11.
"It was not until I got here that my child got better," Augustine said. "Here, he has had tests he never had in Haiti. He has had therapy he never had in Haiti. I am so happy that I came here with my child."
The tests showed that heart surgery is not essential for Antoine now. What he needs most urgently is consistent help with eating, swallowing, developing muscle strength and motor skills, and avoiding joint contractures.
Finding no evidence of a seizure disorder, doctors here took him off some of the sedating medication Haitian doctors had prescribed, and Antoine has responded well to that, said Dawn Brown, an advanced practice nurse in A.I.'s division of neurology. He does not speak, but he makes sounds.
"The sedation probably made it very difficult for him to interact and difficult for him to feed," she said. "When he was removed from that medication, he became more reactive and more responsive. ... He's a scrappy little boy, really tenacious. He has a good stare and a good ability to interact with us."
Antoine also now recognizes those who work with him in the physical therapy, occupational therapy and speech therapy sessions he receives at least three times a week.
"Sitting is not a position he was used to," said occupational therapist Stephanie Ginnona. "I'm not sure if he will sit independently because of muscle spasms. But he can relax really nicely, and that makes me think someday he could sit up by himself."
Gartner said Antoine's respiratory problems probably are linked to a swallowing difficulty they discovered after a series of tests. With thickened or pureed food, Antoine swallows normally and his respiratory problems go away, Gartner said.
"I don't think there is any medication that will make this all go away," Gartner said. "This damage was done very early, probably in the first days, weeks or hours after birth. We have to maximize his potential, but I don't think we're going to bring him back to normal."
Aggressive efforts continue to help Antoine get as far as possible, and the hospital has provided a customized stroller that provides extra support.
No one knows for sure how far he might go.
"He is a survivor, and his mother is committed to trying to help," Brown said.
She knows the problems are serious.
"He has a hole in his heart, and on top of that he has a problem in his head," she said. "He is 16 months old, but he doesn't do what other kids do at that age. There are a lot of things Antoine can't do."
Nobody knows for sure what he might be able to do someday, though.
Giving thanks
As Antoine receives therapy and care at A.I., he and his mom live across Rockland Road from the hospital at the Ronald McDonald House.
There, they have free lodging and access to the home's kitchen and other amenities. Volunteers -- more than 400 of them -- help with all sorts of things around the house, including providing dinner every night. The house has 11 people on staff and capacity for up to 50 families, said executive director Pam Cornforth.
Their hearts go out to Augustine.