|Vol. 22, No. 4||March 1, 2000|
Brain Injury brings Saudi Boy to TIRR
by NANCY HUDGINS
While studying for high school exams in May 1998, 16-year-old Mohannad Al-Hajjar begged his mother to let him use his newly acquired driving skills to go to a nearby store for pizza. His mother hesitated but finally relented and agreed that his 9-year-old brother, Mohhammed, could accompany him. An hour went by and the family began to worry when their two sons had not returned. They searched for the boys, and then a call came. The two had been taken to the hospital following an automobile crash that nearly cost Mohannad his life, but spared his little brother with only minor injuries.
This event took place in Riyahd, Saudi Arabia, and from that moment on this close family joined together to acquire the best medical care possible for Mohannad. Ghazi Al-Hajjar, Mohannad's father, became his son's advocate, and remained so throughout the long months ahead. Three months after the crash, Mohannad, his parents, older sister and younger brother journeyed far from home to the Texas Medical Center and TIRR (The Institute for Rehabilitation and Research).
HRH Prince Sultan Bin Abdul Aziz, the Saudi Minister of Defense and Aviation, approved having the critically ill youngster transferred to Houston in August using Saudi Royal Air Force Medical Evacuation. When the family, accompanied by a doctor and nurse, arrived in Houston 15 hours later, they brought with them a young man who could not swallow, talk, sit up, or walk, and who had no control of his bodily functions. When he returned home one year later, Mohannad was walking with a forearm crutch, able to speak clearly, and he was doing schoolwork at an age-appropriate level. "Given the severity of his injury, the degree of his recovery is amazing," says Dr. Gerard Francisco, associate director of the Brain Injury program at TIRR and head of the inpatient and outpatient teams that treated Mohannad.
The young man and his family formed a strong attachment to the people he worked with in TIRR's brain injury program continuum of care, and they with him. Fortunately, Mohannad and his family spoke very good English prior to the crash. There were cultural differences that needed to be addressed as the Western staff worked with the Middle Eastern teen, and it became a learning process for the patient, the family, and the treatment team. "Mohannad came to us a boy who had always been protected and pampered by his family, as he was the eldest son and the center of their universe," saysAnita Patton-McHaney, M.S., R.N., C.R.R.N., case manager, TIRR Brain Injury program. "Combine that with how critically ill he was when he arrived - multiple trauma, pneumonia and aspiration. At first we were not sure he would survive. The issues we had to address in providing Mohannad's care were overwhelming." Because his company was self-insured and not knowledgeable of United States medical customs, Mr. Al-Hajjar became very involved and proactive in managing all the services his son received during the year at the Texas Medical Center.
During the first two months, Mohannad was periodically transferred from the TIRR Inpatient Brain Injury program to Texas Medical Center hospitals for major surgeries, each time returning to TIRR to recover. As the medical issues diminished, Mohannad's rehabilitation began in earnest.
Every day he worked with his physical therapist, occupational therapist, speech-language pathologist, music therapist, and therapeutic recreation specialist. He participated in individual therapy sessions, co-treatment sessions with therapists from two disciplines, and in interdisciplinary groups and outings with other patients. Nursing was a significant part of his care at TIRR because of his problems with wound care, pain, and control of bodily functions; the nursing staff also reinforced the skills he learned in his therapies. The neuropsychologist worked closely with Mohannad and his family, and the social worker provided support and guidance. The team found ways to motivate the young man to help him progress from his completely dependent status to the increased independence the team and his family wanted for him. Mohannad had difficulty with impulsiveness and poor judgement, two common issues for survivors of brain injury that are reflected in behavior. He was, however, very motivated to receive good grades, and the team was able to use this strategy to reward him for using his skills. When Mohannad received good grades, his family in turn rewarded him with special outings or trips to favorite restaurants. Once he was able to participate, Mohannad also received tutoring from the Saudi Education Center, which continued throughout his stay in the United States.
Despite the differences in cultures, there was a common goal for Mohannad, his family, and the team; that goal was for Mohannad to become once again the spirited, happy, high achieving young man he was before the crash. The team and family talked and negotiated throughout Mohannad's program in order to accommodate the expectations of the culture while working towards this common goal. The family was trained in how to provide appropriate care for Mohannad, and he gradually improved so that he was able to leave the inpatient program to participate in TIRR Day Hospital. He attended Day Hospital five days per week, continuing to receive intense therapy from the same treatment team. However, he was able to stay with his family at night and on weekends.
Following his inpatient and day hospital stays, Mohannad began treatment at The TIRR Challenge Program, an outpatient treatment program for adults with brain injuries. There he worked on improving social and academic skills in preparation for return to his school and community. It was most important that Mohannad and his family also began to address the difficult issues of accepting and adjusting to his disabilities. This was particularly challenging given a cultural context in which the understanding and acceptance of disability are very different from that of the United States. Mohannad's discharge from The Challenge Program was marked by a graduation ceremony, where his father gave a heartwarming speech that touched the emotions of all present.
Recent correspondence from his father has brought rewarding news for the TIRR inpatient and Challenge teams. Mohannad was able to resume his schooling when he returned home, and is now in 12th grade in a private school in Riyadh. He just passed the first term with good grades, studying mathematics, physics, chemistry, and humanities. He plans to go to the university to study art.
©2006 Texas Medical Center