1. Diggins, Kristene BSN, RN

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Hakani can't walk or talk. She can't feed herself. She is five years old, developmentally delayed and, because she was born with just a fraction of a thyroid, she is the size of a two-year-old.

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Ashamed because they were unable to care for the special needs of Hakani and her brother (who was also developmentally delayed), their parents, members of the Suruwaha tribe in Brazil's Amazon jungle, chose suicide by eating curare, a poisonous plant. Suicide is common in this population, a tragic situation that is made even more unfortunate because of the tribe's small size (approximately 140 people).


The Suruwaha believe that if you can't fend for yourself at an early age you should be shunned or killed. So after their parents died, Hakani and her brother were buried alive. Hakani crawled out of the hole, so the villagers let her live. Her brother wasn't so lucky. Hakani was two years old.


Because nobody would claim her, for three years she survived off the scraps of food she found on the ground. When she was five years old, a missionary couple moved to the village. After witnessing the way Hakani was treated, the couple asked the community if they could take her as their own. The Suruwaha were more than willing to let the little girl go. Her new parents took her to Porto Velho, the closest city, for medical evaluations, and soon after she was brought to my clinic to begin weekly physical therapy sessions to strengthen her atrophied arms and legs.


It was during our initial visit that I first saw the little girl's smile. It radiated goodness in the midst of suffering. It proclaimed victory in the face of cruelty. It didn't surprise me to learn that in the Suruwaha language, Hakani means "smile."


Raimundo had been at my clinic before. Both adventurous and reckless, the 14-year-old had come in with a variety of wounds and lacerations that resulted from his many schemes. This time, he arrived early on a Saturday. Accompanied by his father, the boy was doubled over in pain, his breathing shallow and rapid.


His father had found him lying at the river's edge in agony, placed him on the handlebars of his bike, and cycled the three miles to my clinic. The local hospital was out of the question; as the father had heard, the staff was on strike, angry because the previous week they had run out of disposable supplies in the operating room.


As I examined Raimundo, his father explained what had happened. The night before, he and his friends were out by the river, drinking cachaca, the sugar cane rum popular in Brazil. In a drunken stupor, Raimundo had fallen on a sharp bone of a fish's skull.


The bone had lodged itself deeply into the muscle fascia in the lumbar region of his back. I knew it needed to be removed immediately and that the only option was to perform the procedure myself. I anesthetized the area with about 6 mL of Lidocaine, and then I was able to remove the fish bone from the muscle fascia in his back, closing the wound with four sutures.


After that day in my clinic, I assume that Raimundo stopped behaving recklessly. He no longer showed up in my clinic bruised or battered from his misadventures.


Her name is Harani Vitoria. She was not supposed to live. Conceived out of wedlock, her life was in danger from the moment of conception; in her Suruwaha tribe, illegitimate babies are killed soon after birth-a generally accepted ritual. By tradition, the pregnant girl's father, in order to spare the family name, would stab the little one through the heart before the umbilical cord was cut.


During the last month of Harani's life in the womb, a Brazilian couple, Moises and Lucilia, came to speak on her behalf. After they pleaded with the pregnant girl's father for Harani's life, Harani's grandfather said he would decide at the time of birth whether she would be given to Moises and Lucilia. "The spirits will tell me," he explained.


But in the anxious weeks before the birth, as Harani's mother waited in dread, a small gathering of women decided that they would not wait for the grandfather's decision. Instead, they found a hiding place in the jungle and informed Moises and Lucilia where they could find the baby after it was born. Nothing was said to her grandfather, who remained oblivious until he was no longer a threat.


Almost three years have passed since the little girl's furtive entrance into the world. Today, she lives with Moises and Lucilla in Porto Velho, Brazil.


Her name is Harani Vitoria. To most of us, this name has no meaning. But, in the Suruwaha language of her birth parents, her name means "Victorious Existence."