Members of the Washington Overseas Mission have heard many requests for help on their annual visits to Pimienta, Honduras, but not many compare to the plea from Rafael Antonio Paz Mejia, a young 20-something whose hands had been chopped off in a machete attack two years earlier.
Rafael had been out with friends one night and when he came home late, he went to the soaking sink outside (common in Latin American homes) to wash his face. His attacker, who had been waiting for him, pulled out a machete and began swinging at Rafael's head, said Janice Meyer, Washington, a longtime member of the Mission who serves as a translator and liaison between the Mission and the Honduran leaders.
"He hit Rafa four times across the head, so Rafa put his hands up to protect himself, and so he ended up with both of his hands cut off at the wrist," said Meyer.
The attacker ran off, leaving Rafael lying on the ground bleeding. It was 35 minutes or so before Rafael's younger brother found him and got help. They took Rafael to the emergency room, but nothing could be done to save his hands.
The tragedy got even worse when the wounds became infected. Gangrene set in and, as a result, Rafael had to have his lower arms amputated too, said Meyer.
Yet he survived.
"It's astounding that he didn't die of those 14 machete cuts," Meyer remarked. "Usually machetes are razor sharp."
Machetes are extremely common in Honduras, where they are used in agriculture.
After the attack, life changed drastically for Rafael and his family. Rafael, who had been the bread-winner of the family, was no longer able to work his job as a cook. In fact, he wasn't able to do anything for himself, said Meyer - get dressed, eat, bathe, go to the bathroom . . .
"His little brother had to go with him everywhere and do everything for him," she said.
So when Rafael approached Meyer last Christmas when she was in Honduras for Primero Agua, a sister organization to the Mission, and told her his story, she couldn't refuse trying to help.
"Some cases where people ask us to help are too complicated for us to do much," she said, "but this one was different.
"I told him I couldn't make any promises, but that I would try to the best of my ability to find him a solution."
Meyer took photos of Rafa's stumps and took them to Dr. David Chalk, an orthopedic doctor with Patients First Health Care who has made six or seven trips with the Mission over the last 10 years. Dr. Chalk had helped the Mission secure a prosthetic leg for another person in Honduras about three or four years ago, and Meyer hoped he would be able to help again.
When Dr. Chalk heard Rafael's story, he didn't hesitate to do what he could.
"I approached Hanger Prosthetics and Orthotics, which had donated the prosthetic for the earlier patient (who had lost a leg), and our rep, Kevin Beckerman, said they would be happy to do it again, without question," recalled Dr. Chalk, noting the nationwide company has a large philanthropic division.
The only concerns were logistics. Ideally, a person in need of a prosthetic meets face-to-face with the designer/builder of the equipment to get precise measurements and even molds of the limb. That wasn't possible in this situation.
"The challenge was trying to do this 4,000 miles away," Dr. Chalk remarked.
Hanger provided a sheet with the measurements that would be needed, and Meyer took the sheet with her on a quick trip she had planned for March. Meyer and Dr. Raul Ugarte, Pimienta's mayor, went to Rafa to get measurements and take more photographs.
Meyer brought all of the information - photos, measurements, even the tape measure that was used to take the measurements - to Hanger Prosthetics in St. Peters and handed them over to Kenny Branson, the staff prosthetist who evaluates, designs and builds all of the prosthetics at the St. Peters location.
Branson said the usual process for designing and building a prosthetic begins with taking an impression of the stump via hand cast using plaster of paris or a digital image camera that scans the limb. Since that wasn't an option here, Branson used his own arms to make a mold and modified it based on the measurements and photos.
Branson spent about two months on the double prosthetic, which is longer than usual (typically he only needs two to three weeks), but the Mission wasn't returning to Honduras until May, so there was no need to rush. Once the prosthetics were ready, Branson met with Melissa Wren, an occupational therapist from St. Charles who has been making trips with the Mission since she was 16 when she was an orthodontic patient of Dr. Frank Miller, one of the Mission's founders.
Wren, who has worked before with people learning to use a single prosthetic, volunteered to help Rafael learn to use his two new arms, which have hooks at the end instead of hands. But before she could do that, she needed to learn how to use them herself.
"It's drastically different to use two prosthetics," Wren told The Missourian.
She spent an afternoon with Branson learning how to operate the arms, things like opening and closing the hooks to pick up something. Wren took the prosthetics home, continuing to practice mastering the operation, until it was time for the Mission trip in May.
Because of the hooks on the prosthetics, Wren was nervous about taking them in her carry-on luggage aboard the airplane, but she didn't trust they would be OK in the checked baggage. She made sure to bring her occupational therapy license with her just in case, but fortunately there wasn't any trouble.
Branson had prepared Wren for the probability of the prosthetics not fitting Rafael perfectly. Under normal circumstances, Branson has multiple meetings with a customer as the prosthetic is being built to fine-tune the device's fit.
Since he couldn't do that with Rafael, Branson gave Wren tips on things she could with the prosthetic once Rafael put it on to improve the fit. But as it turned out, none of it was necessary.
The prosthetics fit like a glove.
"It was a miracle," said Wren.
Meyer and Dr. Chalk said the same thing - "It's an act of God," Dr. Chalk remarked - but no one was more surprised than Branson.
"When Melissa called me that Saturday from Honduras to tell me . . . I was flabbergasted," said Branson. "I was amazed. That never happens."
What was equally as amazing to everyone involved was how quickly Rafael mastered operation of the prosthetics - a matter of minutes compared with days or longer for most people.
"Within 10 minutes, he was picking up things," said Wren. "We had a lot of fine-tuning to do after that, but he had the basics down really quickly."
"She had him tying his shoes, drinking a soda, putting on his pants, eating . . . ," said Meyer with amazement.
Because Rafael's prosthetic was a double, the arms are connected by straps and cables that stretch across his back, almost like a jacket or a shirt. Opening or closing the hook on one side requires him to move his opposite shoulder forward or backward, Wren explained.
She attributes Rafael's quick mastery of the prosthetics to sheer motivation. Having lived two years with his younger brother doing everything for him, he was eager to do things for himself again.
"Also, he knew I was only going to be there for 10 days to help him," said Wren.
Wren, Meyer and other members of the Mission are looking forward to their next visit to Honduras to catch up with Rafael and his family. They also hope to be able to bring him another gift - hands.
Branson said he is working on modifying a pair of hands that were donated to him so that they can work with the existing cable system on Rafael's prosthetics.
Hooks are a more common choice for people who live in agriculture-based communities because of the durability and functional uses, Branson explained, but prosthetic hands would be nicer.
Either way, the story has a happy ending, said Meyer.
"Rafael will have a life now," she said. "These people have given a man his life back."