San José, Costa Rica, since 1956

Ailing Tica Teen Offered New Hope

For 17-year-old Paulette Barrantes, 2007 is a year of hope.

After struggling for more than two years with a debilitating illness, Paulette departed Jan. 4 on a private jet for medical treatment in the United States. Thanks to a collaboration of U.S. and Costa Rican doctors, friends and family, Paulette was accepted for free treatment at the Shriners Children’s Hospital in Cincinnati, Ohio.

If all goes well, she will return to Costa Rica in one year, walking for the first time since being struck on Dec. 27, 2004, by the rare bacterial infection Staphylococcal purpura fulminans.

Paulette – who has been bedridden since the infection opened wounds over most of her body – was taken by ambulance from her small, three-room home in the northern San José neighborhood of Guadalupe to JuanSantamaríaInternationalAirport, northwest of San José. There, she was carried aboard by friends and family and laid down on an arrangement of seats. As she looked out the round windows, Paulette prepared for her first flight in an airplane, heading into an uncertain but bright future. In her lap she held a small bag of personal items, including a camera to take pictures once she was in the air.

“This is the best thing that has happened to me since I got sick,” Paulette said the night before she left, admitting she was nervous, but eager. Surrounded by friends and family until 4 a.m., the teenager didn’t sleep a wink before her departure.

“It is a total dream.We still can’t believe it,” said Paulette’s mother, 35-year-old Jocelyn Villafranca, brimming with excitement and hope. “We’ve arrived at the goal.

Her life is going to change radically. She is going to return walking again and living a normal life.”

A Painful History

The day Paulette got sick, what started like a common cold or flu quickly became a rash that spread over her arms, legs and chest. The rash swelled into purple, bloodfilled boils that burst, and some never healed. As she was passed among doctors, hospitals and different treatments aimed at healing her skin, all 10 of her toes were amputated, as well as four fingers at the first knuckle on her left hand. Her Achilles’ tendons on both legs were removed, and her heel bones protrude from the backs of her feet (TT, Oct. 20, 2006).

Special patches helped the sores on her arms to close, leaving behind massive scarring. The patches, however, quickly proved too expensive for Paulette’s mother, and gauze was used on her lower body. Those wounds – covering more than 50% of her body – never closed. One doctor suggested amputating both of Paulette’s legs after months of treatment failed to gain any ground in getting her skin to grow back. Her mother refused, and took her to a different doctor who sewed Paulette’s feet onto her buttocks, hoping the skin would graft and cover her heel bones. She spent two months lying on her stomach, her legs bent backwards into her rear end before the skin was cut out and her legs straightened. The operation claimed little success, and more than a year later the skin on her buttocks has not grown back.

Since September 2005, Paulette has been cared for in her home. Zolangie Zúñiga, a distant relative of Paulette’s, and her husband, U.S. citizen James Stutz, began working to better Paulette’s situation in February 2006, becoming the family’s first allies. Over time, their efforts have ensnared a network of doctors, friends and businesses in Costa Rica and the United States who have come to Paulette’s aid.

The patches that healed Paulette’s arms are now being donated by Ferris, the manufacturer. Zúñiga held a benefit fashion show in October of last year to raise money for a special bed, which was later donated by its manufacturer (TT, Oct. 27, 2006). Stories in The Tico Times prompted donations from readers here and abroad. Three U.S. doctors have visited Paulette in her home, and their subsequent efforts on her behalf led to Paulette’s acceptance late last year by the hospital in Cincinnati.

“Once we started seeking documentation to secure the donation of the bed, and we got all the pictures and the medical records, it became very clear that we needed to get her up here,” said Dr. Rae Schnuth, Assistant Dean of the College of Human Medicine at MichiganStateUniversity. “There was a lot more that she needed than only a special

bed. So we went into high gear trying to find the best place for her to go.”

Schnuth met Paulette by chance when she was in Costa Rica with a group of medical students. Soon, she and Costa Rican doctor Mario Tristan were searching for a U.S. hospital that would treat her. For Paulette’s mother, a single parent of two daughters who works as a cook in a small eatery inside the El Pueblo shopping and entertainment complex in San José, financing treatment or transportation to the United States was very much out of the question.

“As depressing as it was at different intervals when we thought we had it fixed and we were going to get her to the States and it would crumble, we never gave up,” Schnuth told The Tico Times last week. After Paulette was accepted by the ShrinersHospital, a company that requested to remain anonymous agreed to send its private jet to Costa Rica, pick up Paulette and fly her directly to the medical center in Ohio. The hospital there is one of four specialized burn centers among the 23 Shriners children’s hospitals in the United States.

“The work that they do with purpura fulminans – they are the experts in the nation in working with that disease,” Schnuth said.

“I’m not super religious, but everything has fallen together so well – there’s much better control over it than I have.”

Paulette’s Treatment

Dr. Kevin Bailey – one of a team of four doctors at the children’s hospital who will be overseeing Paulette’s treatment – flew to Costa Rica to meet Paulette and her mother last week. At a dinner the night before Paulette’s flight, he told The Tico Times that her prognosis is “excellent,” and he expects the physicians will have her walking once again. The doctor explained that he regularly deals with victims of purpura fulminans, a rare infection related to the better-known toxic shock syndrome, and Paulette’s case is “consistent with what we see.”

“Unfortunately we’ve seen a lot worse cases,” Dr. Bailey said. “I’ve got one young man who lost both his arms and legs. So in that sense she’s fortunate, but certainly I wouldn’t tell that to her. To lose fingers and toes and stuff, that’s a big deal, and for a 17-year-old girl, that’s a big loss.”

The doctor said the physicians’ first priority is to “get control of her wounds,” which involves grafting donated skin from a cadaver over the open areas, and then replacing that with her own skin, cut to one-one thousandth of an inch thick. Once they have the wounds covered, he said, the doctors will take a look at the more complicated procedures – principally on her heels and feet.

Dr. Bailey said he does not believe doctors would give her prosthetic toes – explaining she would probably be able to walk without them – but they likely would reconstruct her Achilles’ tendons.

In Cincinnati, Paulette will first be housed at the hospital, which has classrooms and an English-as-a-second-language program, according to Mary Dickey, who was involved in the search for a bed for Paulette. Dickey’s employer, Steo-Medical, distributes for the company that sent the plane.

Paulette’s mother will stay with her daughter at the hospital until March, when she is expected to return to Costa Rica. Later, Paulette will be transferred to Dickey’s home, located 40 minutes from the hospital in the neighboring state of Indiana, to further recuperate.



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