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Samuel Alexander Armas' Story
Provided by Paul Harris

Take a good look at this picture. It's one of the most remarkable photographs ever taken. The tiny hand of a fetus reaches out from a mother's womb to clasp a surgeon's healing finger. It is, by the way, 21 weeks old, an age at which it could still be legally aborted. The tiny hand in the picture above belongs to a baby which is due to be born on December 28 [1999]. It was taken during an operation in America recently. It is a medical development in the control of the effects of spina bifida ... and on a picture which will reverberate through the on-going abortion debate here.Your first instinct is to recoil in horror. It looks like a close-up of some terrible accident. And then you notice, in the center of the photograph, the tiny hand clutching a surgeon's finger.

The baby is literally hanging on for life. For this is one of the most remarkable photographs taken in medicine and a record of one of the world's most extraordinary operations. It shows a 21-week-old fetus in its mother's womb, about to undergo a spine operation designed to save it from serious brain damage.

The surgery was carried out entirely through the tiny slit visible in the wall of the womb and the 'patient' is believed to be the youngest to undergo it. At that age the mother could have chosen to have the fetus aborted. Her decision not to, however, led to an astonishing test not just of medical technology, but of faith.

Samuel Armas has spina bifida, which left part of his spinal cord exposed after the backbone failed to develop. The operation was designed to close the gap and protect the cord, the body's motorway for nerve signals to the brain. So, on an unborn patient no bigger than a guinea-pig, the operation was performed without removing the fetus from the womb.

The instruments had to be specially designed to work in miniature. The sutures used to close the incisions were less than the thickness of a human hair. An ER-style crash-cart team was on constant standby in an adjoining room. When it was completed, however, Samuel's battle for survival was only just beginning. Nor would the emotional battle his parents had already endured finish quite yet.

Julie and Alex Armas had been trying desperately for a baby. Julie, a 27-year-old nurse, had suffered two miscarriages before she became pregnant with the child they intended to call Samuel Alexander if it was a boy. Then, at 14 weeks, she started to suffer terrible cramp. An ultrasound scan was carried out to show the shape of the developing fetus and its position in the womb.

When the picture emerged, it was the moment that every parent-to-be dreads. Their unborn son's brain was mis-shapen and his spinal cord was sticking out from a deformed backbone. He had spina bifida.  They were devastated and "torn apart'' said Alex, a 28-year-old jet aircraft engineer.

At that stage, and even weeks later, the couple could have decided to have the pregnancy terminated. In their home town of Georgia in the US as in Britain abortion is routinely offered. Although accurate figures are not available, many parents accept.  For Julie and Alex, who are deeply religious, it was not an option.

That didn't mean, of course, that they were not racked by pain at the thought that the child they had longed for was imperfect. It also riddled them with guilt over whether they had effectively taken the decision to inflict their son with years of handicap, pain and suffering. So, this being the United States, they turned to the internet for help.

Julie's mother found a website giving details of pioneering surgery being carried out by a team at Vanderbilt University in Nashville, Tennessee.  Although the results have not yet been endorsed in medical journals, they looked encouraging to Mr. And Mrs. Armas. Their doctor put them in touch with Dr. Joseph Bruner (it is his finger in the photograph).  A race against time had begun.Because it affects the spinal cord, spina bifida can lead to a condition that causes brain damage. Mr and Mrs. Armas were told that if they were to avoid the condition, which was not then present in Samuel, they had to act fast.

"I wasn't concerned about a child who couldn't walk,'' said Julie, "but I want a child who knows me.''