April 19, 2009 in City

Shriners’ global outreach shrinks

Hospital won’t care for overseas children
By The Spokesman-Review
 
Colin Mulvany photo

Marvel Nichols has helped bring children from overseas to Shriners Hospital.
(Full-size photo)

Albanian villagers consider her a miracle worker. She brings their children, those crippled by accidents and birth defects, to the United States, and they return months later healed and wide-eyed about life’s possibilities.

Yet Marvel Nichols knows the true miracle workers are the surgeons and specialists at Shriners Hospital for Children in Spokane, a place founded on the principles that children are precious and should be offered the best medical care.

There’s a reason Shriners is considered among the world’s greatest philanthropic organizations. With its multibillion-dollar endowment and hundreds of thousands of members raising dollars, the Shriners operate an elite network of 22 hospitals specializing in healing children who suffer from horrendous burns or difficult orthopedic problems.

Nichols has seen this generosity at work. In the past two years, she’s brought three Albanian children to Shriners in Spokane. Inspired by the care, she set out to bring more of the world’s children to Shriners’ door.

So it came as a shock last week when Nichols arrived to finalize the paperwork for the treatment of three more Albanian children. Instead, she received a rejection letter by officials from Shriners headquarters in Tampa, Fla., asserting that children from foreign countries would no longer be admitted as Shriners patients.

“I’m just heartbroken,” she said. “How can this be?”

The Shriners are in trouble. The financial meltdown has torn its endowment from $8.5 billion to $5 billion in the past year. It’s so bad that Shriners will vote this summer on a proposal to close six hospitals, including the 30-bed center in Spokane.

National Shriners hospital chairman Ralph Semb said one consequence of the money troubles has been to begin heeding the organization’s “loose policy” of not treating children from outside North America.

“Within the last six months … we decided we’d better stop doing this,” Semb said. “Why are we going to Greece? Why are we taking children from Iraq, or Iran, or Afghanistan or Russia?

“We have enough problems of our own with taking care of children right here in North America.”

And yet numbers show a dearth of patients at the well-equipped and fully staffed hospitals. Consider Spokane: The hospital has 170 employees, 30 beds and an average daily inpatient count of just six. Such under-use is the reason the hospital may be closed.

And it’s why Nichols thought she could do so much good, helping children with little hope while boosting the patient numbers at the hospital. But the letter she received from Semb turned her plans “into a puff of smoke,” she said. A grandmother 30 times over and self-described as stoic, Nichols cried as she leafed through photos and medical records of children with burns, disfigurements and other problems treated by Shriners.

This year she was ready to start a nonprofit. She had built a network of people and charities to find children. Others would arrange free or deeply discounted flights and lodging. In the end these children, perhaps two every month, would arrive at Nichols’ Spokane home, a big Victorian house behind St. Anne’s Catholic Church in the East Central neighborhood that used to serve as a safe house for battered women and children.

The most important piece of her plan was the day she would drive three miles from her home to bring the children to Shriners Hospital for Children.

Between hospital surgeries and stays she planned to feed and house the children, and enroll them in schools as they underwent the oft-required multiple surgeries.

“It’s not perfect, but I was – still am – ready to provide for these children. It’s how I have dedicated my life.”

Nichols doesn’t have a lot of money. Her husband runs a struggling locksmith business in north Spokane. She is a trained recreational therapist who taught gymnastics, and now makes and sells crafts.

For the past several years she has purchased airline tickets to Albania, arriving in one of the poorest European countries with clothing and supplies in tow. She then travels independently to mountain villages to teach children. When she returns to Spokane, she spends the rest of the year working to pay off the credit card bills from the trip.

This is where she first met Merita Ulaj, a 12-year-old girl who broke her arm when she was 6. The bone was set improperly, leaving it disfigured.

Nichols negotiated a thicket of travel problems, politics and money needs to bring her to Spokane. In the end, doctors at Shriners fixed her arm and Merita’s future was restored.

Two more girls followed.

Leze Nilaj lives with Nichols. She will have her final surgery May 11 and return home when her recovery is complete. Leze, now 17, burned herself at age 6, trying to help her parents by igniting the oil lamp her family uses to light their home in a remote mountain village.

“Like all 6-year-olds, she just wanted to help,” Nichols said, pointing to pictures of Leze’s burns.

The accidental fire melted her clothes to her arm and torso. She was cared for at a convent but did not heal properly. The surgeons and staff at Shriners are helping her heal. While in Spokane, Leze attends a special program at Ferris High School – an extraordinary opportunity for girls who are normally pulled out of their village school at age 12 and relegated to a life of tough manual labor in a male-dominated society.

Nichols said the girls from remote Albanian villages coming for care are stunned to see women driving cars, going to college and working in professional jobs.

“That’s the other part Shriners is doing. Their healing of these little girls is also exposing them to culture and opportunities they never dreamed of having,” Nichols said. “Maybe this will inspire them to begin making changes at home.”

Another girl she helped is Marje Prekducaj, who left Spokane to return home after Shriners treated her for a congenital hip deformity.

Yet those points of pride and hope are dimming. Nichols is haunted by the children she can’t help – and those whom Shriners now won’t help.

They include a girl from India whose knee was mangled when she was run over by a chariot. A 19-year-old boy from Albania with club feet. A 5-year-old girl from Albania with severe orthopedic problems.

Nichols has referred them to the Worldwide Children’s Foundation of New York, a relatively new organization that might be able to help a few children a year.

But there’s a problem: The foundation wants to see good medical records before it will treat a child, along with assurances the children will return to a place with adequate recovery facilities, said Carolyn Spector, the foundation’s executive director.

Nichols is discouraged by such requirements. Children in poor countries often don’t have good medical records. Nor are they likely to return to homes and villages with bona fide recovery systems.

Shriners needs information, too, but Nichols said the specialists are more apt to do a diagnosis and come up with a treatment plan. It’s different from the foundation, which relies upon a network of participating hospitals and doctors giving of their time and resources to help children, Spector said.

Semb said the decision not to accept foreign patients not affiliated with any Shrine is partly driven by economics. The Shriners do not bill insurers, Medicaid or parents for care.

So even though there’s no difference in cost when it comes to treating a child from Spokane versus a child from another country – as long as transportation and housing are covered by a third party – Semb said the built-in costs are getting too expensive.

“You know, we were set up in 1922 to take care of children in North America who were affiliated with Shrine centers or who couldn’t pay. Then when we went to specialty and treated polio kids, we opened it up,” he said. “Then we began treating foreign children.

“As you’re building up those other people, now you’ve got to add surgeons and nurses and this and that and it became a very expensive proposition.

“We’ve gone from a hospital facility that once had volunteer surgeons to hospital facilities that had to have a chief of staff and then the next thing we know we had to have an assistant chief of staff, then we had to have a third surgeon. So you can see how the expense keeps going up when about 66 percent of your budget is basically payroll and benefits.”

Nichols said she is sympathetic to Shriners’ plight.

“I love that hospital, but I just worry that headquarters officials are retreating to discrimination,” she said. “In my mind that’s not what the Shriners International is all about.”


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