Healing a Baby's Brain Kamalani Kawa'a The amazing recovery of a young gunshot victim

Healing a Baby's Brain
The amazing recovery of a young gunshot victim.
By Jill Engledow

Kamalani Kawa'a makes a silly face for the camera, chases her little brothers around the yard, then sings "'Ulupalakua" and dances hula for a visitor. She is a normal preschooler, charming and vivacious, with one distressing difference -- Kamalani has a bullet in her brain.
The little girl from the island of Maui, in Hawai'i, came by this odd accessory on a June afternoon in 1996. Her mother, Luana Kawa'a, was preparing to teach a hula class when Kamalani's father, Llewellyn, came home from his painting job. As he did most evenings, Llewellyn Kawa'a took his 10-month-old daughter and the family dog and headed from his mother-in-law's backyard in the Paukukalo Hawaiian Homes subdivision up the hill to Pihana Heiau. The heiau, birthplace of Kamehameha I's sacred wife Keopuolani, is high on a sand dune overlooking Paukukalo and much of Central Maui.
As Llewellyn walked along the windswept dune, his daughter suddenly ducked her head into his chest. "Then she started screaming," Llewellyn recalls. He put his hand on her head. "I could feel something like a hole, and there was blood coming out." Only later, thinking back on the moment, did Llewellyn remember hearing the whiz of a bullet and the thump it made as it penetrated his daughter's skull. At the time, he could only run down the hill screaming, "Somebody help me!"
Luana at first thought her husband was joking. "He likes to goof off and play jokes on us. But when I heard it the second time, I heard something different in his voice and I knew intuitively something was wrong," she says. "I saw the blood, and he was covered with blood -- just your worst fear come true."
Luana, seven months pregnant, clutched her belly and told herself she had to stay focused for the sake of Kamalani and for the child she carried. It was Luana who dialed 911. Within moments, the yard was full of neighbors who comforted family members and formed circles to pray. Llewellyn, who still did not realize that his daughter had been shot, kept saying, "Somebody hit her."
Only after the doctor at Maui Memorial Hospital's emergency room had examined Kamalani did the Kawa'as learn it was a bullet that hit their daughter, entering her skull from the top left side. The baby was comatose and flown by helicopter to O'ahu.

At The Queen's Medical Center in Honolulu, neurosurgeon Dr. William Obana undertook the delicate task of repairing the baby's brain. The bullet was lodged about 2.5 cm into the front middle portion of the left occipital lobe. "There was really no benefit in trying to remove it," Obana says. To do so could have caused more damage. So he cleaned up bits of bone and hair, patched the torn membrane that was allowing the spinal fluid around the brain to leak, and transferred the baby to the intensive care unit at the Kapi'olani Medical Center for Women and Children in Honolulu.
Thus began a healing process that many have called miraculous. Surrounded by family and friends who sang songs and read scripture aloud, Kamalani's condition rapidly improved. Soon she was trying to pull out her breathing tube. When the doctors removed them, Kamalani looked at Llewellyn and said, "Daddy." Her right side was weak at first, but by the time she left the hospital six days after the injury, she was fine. Doctors feared she would suffer seizures, but she has yet to have one and the danger lessens as time goes by.
Today, Kamalani is a student at Punana Leo O Maui Hawaiian immersion preschool and a member of her mother's Halau Hula Ka Makani Kili'o'opu. She's bilingual, her language development apparently not harmed by the bullet in her brain. She dances skillfully, with nimble hands and feet moving in the patterns of the hula. Advanced tests show no vision problems.
How does it happen that this child can develop so normally after being shot in the head?
Obana says Kamalani was lucky that damage was limited to one part of her brain. The bullet did not injure the optic nerve, cause a major hemorrhage, or travel very deep into the brain. Though police still don't know who fired the bullet or where it came from, they surmise it traveled some distance because it was moving at a relatively low velocity when it struck Kamalani.
Kamalani also was lucky because she was very young. "A child's brain is much more plastic, or pliable. The child's brain is continuing to grow," says Obana. An adult would not recover so well from a similar injury; speech and motor skills might never be the same. In a very young child, however, the brain grows other pathways to make up for damage.

Brain researchers in recent years have used modern imaging technologies to learn how the infant brain creates myriad pathways as it sets up the circuitry that will govern the child's life. One of the most important findings is that experience stimulates the formation of new and ever-more-complex circuitry and reinforces important pathways. When parents sing, talk, touch and play with their baby, they are helping the child's brain develop. The baby's brain creates new connections within itself, learning to see and hear, to respond appropriately to others' signals, to decipher and produce sounds that make sense, and to reach, grab, sit, crawl, walk and run.
The stimulation and positive experiences that Kamalani's family have provided have helped her recovery. She's had many advantages, says her Maui pediatrician, Dr. Frank Baum. Members of both Luana's and Llewellyn's families were there when Kamalani began her recovery, holding her hand, surrounding her with love and attention. More support came from the family's extended church 'ohana and Luana's hula halau.
Kamalani's upbringing is quite different from that of other children who have not recovered as well from brain injuries. An example is children whose brains have been permanently damaged by abuse. Why is it that a child shaken or slapped can end up with serious brain injury that fails to heal as Kamalani's has done?
The difference is partly due to the one-time nature of Kamalani's injury, say Baum and Obana. Often, in cases of abuse, the injury is repeated or ongoing, creating a more generalized cumulative trauma of the brain. Shaking a baby produces vascular damage, rather than the tissue damage done by the bullet that hit Kamalani's brain, says Baum. At the same time, he adds, parents who abuse their child are very likely not providing the child with sufficient positive stimulation.
As for Kamalani, she continues to thrive under the gentle care of her parents and a network of aunties and uncles, tutu and teachers.
The family has chosen to keep their story in the public eye long after the headlines that inspired strangers around the state to pray and contribute money to help Kamalani. This extraordinary experience proves that miracles can happen, says Luana Kawa'a. "It made us count our blessings, it made our family closer, it strengthened our faith in God," she says. And they learned, she adds, that "you never know what could happen, and you should appreciate every moment you have with your children."