"It's science fiction," Dr. Amir Kershonevich, the head of the Neurosurgical Unit at Schneider Children's Medical Center says excitedly while leaning over 17-year-old Bernarda from distant Ecuador who is being operated on. "While Bernarda is speaking with us, we are operating on parts of her brain. I've performed surgeries like this in the past, but each time I am astonished by them once again," he explains.
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This is the first time that brain surgery is taking place at Schneider while the patient is in a state of wakefulness. The dramatic procedure, which took place at the start of the month and continued for four hours, was carried out completely voluntarily by Kershonevich and the entire support staff at Schneider.
Bernarda reached Israel as part of the Kids International Brain and Spinal Cord Surgery (KIBS) project, whose goal is to bring children from poor countries who need brain surgery to Israel. The project is led by Amir and his wife Hila: he is responsible for the medical aspects, while she heads the logistical aspects – from raising funds to obtaining a residence visa for the patient and those accompanying them.
"Bernarda was born with a cerebrovascular malformation, and she was operated on in Colombia many years ago, a surgery that left scars in her brain that became foci of epilepsy," Kershonevich explains. "She had a very difficult childhood. She didn't have a social life, because the other children would panic every time she had a seizure.
"We carried out a series of tests, and we decided to do the brain surgery while she was awake after we understood that the source of the seizures was extremely close to the area of the brain responsible for naming – the ability to find the right names for things."
Q: How do you saw open a child's skull while they are awake?
"The brain itself has no feeling, which means the incision itself can be done while the patient is awake. We carry out the opening of the skull and the scalp under general but light anesthesia. We woke Bernarda up when everything was open and ready. The day before we did a simulation, so she would know exactly where she was when she woke up. She was warm-hearted and incredible and cooperated fully. She was simply brilliant."
Before cutting open Bernarda's brain, Kershonevich mapped the area, a process in which he and his team diagnosed the epilepsy foci, and in parallel, using an electric current, marked the places they were forbidden from touching since these areas were responsible for her speech ability. In front of Bernarda's eyes, the team presents pictures of items, and to their joy, she easily calls out their names.
Kershonevich starts, with remarkably stable hands, the electric current generator, and Bernarda suddenly begins to stutter, and then, for one particularly frightening moment, she falls silent. Kershonevich isn't worried: it's just a weak electric flow whose damage is temporary; now the surgeon knows exactly where it's forbidden to touch. "We were very lucky that the naming [area] was just a few millimeters behind the epilepsy foci so that we were able to remove all of the foci without harming Bernarda's speech."
Bernarda returned home a week ago, this time as a healthy young woman whose epilepsy is probably behind her. She continues to keep in touch with the Kershonevich family, sending films and messages. And despite the fact that her speech wasn't damaged, she finds it difficult to find the words to thank him for what he did for her.
Kershonevich, 47, was born and raised in Mexico. As the third generation of a family of doctors, he didn't hesitate when choosing a profession. Aged 26, after completing his medical studies in Mexico, he decided to make aliyah, according to him because of strong Zionism.
"It's the place where all the generations dreamt for thousands of years every time they said 'if I forget thee, Jerusalem.' So I should stay in Mexico and not make aliyah?" he says with a smile. His parents and two siblings remained behind. "My parents are super proud that they have a representative in Israel, but it doesn't come without tears of longing for their son who lives on the other side of the ocean."
He did his specialization at Beilinson and Schneider hospitals. He met Hila, 40, a Spanish-speaking Israeli with Latin heritage, in Israel. Today they live in Even Yehuda with their three children: Eden, Liam, and Golan. Beforehand they lived for ten years in the United States, for Amir's studies and advanced training.
"We always had our eyes on Israel, and we only wanted to return. Four and a half years ago we did return, and I began to lead the Neurosurgical Unit at Schneider. When I started the job, it was clear to me that we needed to bring something with meaning and giving into the unit as well. It was also very important for Hila to do something good for the world. We also saw this desire among our friends in the United States, most of whom started non-profits and did a lot of good."
This is how, in the shadow of the coronavirus, project KIBS, which is still taking its first steps, began. Apart from Bernarda two other children have already been operated on.
The first was Thiago, a child from a tiny village in Guatemala, who was born with a part of his brain protruding outside his forehead. The monstrous look prevented his parents from leaving their home, and there was no pediatrician in the village, never mind a neurosurgeon. "The parents had never in their lives been on the plane, and our friends from the United States accompanied them at the airport, because they didn't have a clue about what to do there. Thiago's mother landed in Israel with a colorful and unique Indian dress.
"We operated on the child when he was one, a multisystem surgery, which the entire medical team did voluntarily. It's amazing, because doctors make extra money with medical tourism, which is done at irregular hours, and here everyone happily volunteered. It was very moving."
The second surgery, which took place two years ago, saved the life of Angelo, a 15-year-old from Bolivia, who lives in a village next to the Amazon. Angelo nearly died from bleeding in his brain, which was formed as a result of vascular malformation. The surgery, which removed the offending blood vessel, transformed him into a healthy boy. "I heard now that Angelo finished high school and has started university. It's very moving.
"And we had a very moving moment with his family. Bolivia is landlocked, so they actually never saw the sea. We took them to Poleg beach, next to Netanya, where they touched the sea and the sand for the first time. It was amazing."
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The Kershonevich couple don't only take care of the medical and technical needs of the sick child and his/her family. They also invite them for a visit to their home and for tours around Israel. "It's important for us that our children will also be involved and will know the patient and their family. And we do our best to show the guests around Israel. It's a real pleasure to see how they look at Israel with loving eyes. When they return home, they become the best ambassadors for the country. Israel brought them to do something they couldn't have dreamed of."
Q: And what do you dream about?
"That our project will grow, so that we will succeed in saving the lives of many more children."
