As an orphan in Russia, Valya Andreeva didn't get proper care for a compound leg fracture she suffered in an August 2006 accident.
Russian doctors eventually tried to mend the two broken bones in her right leg but gave up and said they would have to amputate.
That wasn't an option for Patrick Day of Sonora-based Russian Orphan Rescue Inc. The nonprofit group and the Medical Relief Foundation of Modesto convinced local health care providers to volunteer their services to try to save the leg.
Andreeva, 18, was flown to the United States and underwent her first procedure Feb. 28 with orthopedic surgeon John Casey of Modesto. Doctors Medical Center and Modesto Radiology also are helping Andreeva free of charge.
"I looked at it and thought there was a good chance I could save her leg," Casey said. "Once I met her, she was a delightful young lady and I felt compelled to assist her."
During the surgery to evaluate the leg, Casey took cultures to check for infection. The tests revealed no lingering infection, so she could have surgery to graft the bones within three weeks.
Day met Andreeva in a small-town orphanage in Russia six years ago. Russian Orphan Rescue works in Russia and Ukraine trying to improve conditions for children who were abandoned or have lost their parents.
Andreeva's alcoholic mother left her with a Russian social services agency when the girl was in the first grade, Day said. Her father died in prison. She was raised in an orphanage in Supazhoke, a town that's a five-hour drive south of Moscow.
Day and Medical Relief Foundation President Graham Pierce were concerned that the girl wouldn't stand a chance if she lost the leg, because orphans in Russia are treated as second-class citizens, they said.
The orphan population swelled in Russia with the economic collapse that followed the end of communist rule, and their fortunes haven't improved much despite the recent economic surge.
Statistics show that within two years of leaving orphanages, many of the young people are in prison, homeless or addicted to drugs. Many of the girls turn to prostitution.
"She was a girl we were going to adopt at one time," said Day, who has taken 20 trips to Russia, some with his daughter Monica, 18. "Because of the bureaucracy and the finances involved, we decided it was better to help her there."
Andreeva needed more help after being struck by a motorcycle as she and two friends walked one night along a country road.
Three boys on a motorcycle saw the girls and swung the cycle around to give them a scare.
They weren't able to stop the motorcycle in time and hit Andreeva, throwing her to the ground. When she tried to stand, the bones protruding through her right leg went into the dirt.
She lay in the dirt for two or three hours until an ambulance arrived. She was taken to a rural hospital that was unable to deal with the compound fracture and did not clean the wound, Day said.
The next morning, she was taken to a larger hospital, where the wound was cleaned. In ideal situations, a compound fracture should be cleaned and the fracture stabilized within four hours, Pierce said.
Andreeva was in traction for a month, with little more to do than watch the cockroaches on the walls and the cats wandering the hallways. Day heard about the accident a week after it happened and flew to Russia to be with her in the hospital.
Broken bones would not heal
After she was removed from traction, doctors put her leg in the first of two contraptions that would give her constant pain for 16 months.
The device, called an Ilizarov, has five rings surrounding the leg. Each ring has two rods that penetrate the skin, soft tissue and bone and come out the other side. It is designed to make the bones grow back into place.
After 2 1/2 months, she was released from the hospital to the girls home operated by Russian Orphan Rescue Inc. in Ryazan, a city 165 miles south of Moscow. A friend eyed the contraption on her leg and sewed a zipper into Andreeva's baggy jeans so she could cover it.
She returned to the hospital for more procedures, but the bones never healed.
Andreeva was losing hope when Day contacted a U.S. medical clinic in Moscow, which referred him to a doctor considered a top bone specialist in Russia. Day said the doctor wanted $30,000 to treat the girl.
A Russian farmer who works with the rescue organization talked him down to $11,000. Day advanced the money and, once the word got out in Tuolumne County, donations and a fund-raiser reimbursed all but $1,000.
The motorcycle's impact broke both leg bones below the knee, the tibia and fibula.
The surgeon reset the fibula and ground about 1¾ inches off the ends of the tibia. He then put another Ilizarov on the leg -- to make the bones grow back together -- and sent her home with instructions to adjust the contraption.
Andreeva used a wrench to turn the ring nuts four times a day. For six weeks, she carefully cleaned the 20 holes in her leg.
When she returned to the doctor for X-rays, he told her one of the bones healed, but not the other.
"He said it wasn't healing and that he couldn't do anything else," Day said. "He just washed his hands of it."
Day got in touch with Pierce, the president of the Medical Relief Foundation and regional director for the air ambulance service that contracts with Doctors Medical Center. The nonprofit foundation sends medical supplies to countries whose residents have poor access to health care, including Russia.
The foundation has transported children from foreign countries for heart-valve surgery and burn treatment at DMC, and the members thought they could help Andreeva.
After collecting X-rays and medical records in Russia, Pierce reviewed the situation with Dr. Casey in Modesto. Casey was cautiously optimistic.
To obtain a visa for Andreeva, Pierce relied on his friend Vlademir Kuznetsov, the health minister for eastern Russia who visited Modesto two years ago. Kuznetsov pulled strings to get a six-month medical visa for Andreeva, which can be extended if needed.
Pierce said recent X-rays revealed that Andreeva's fibula is in one piece but is bent. In addition, there's a half-inch division between the broken ends of the tibia.
"Dr. Casey let us know there is no easy way to do this," Pierce said. "There is going to be no shortcuts. It is going to take time."
Casey plans a surgery that has a success rate of 65 percent to 90 percent. He will take bone from Andreeva's hip and use it to graft the injured leg bones and then secure them with rods. Andreeva will wear a cast until the bones heal.
Andreeva was smiling after the surgery Feb. 28, which removed the contraption from her leg and replaced it with a splint. She is staying at the Days' Sonora home while waiting for the surgery. She watches "SpongeBob" cartoons, gets around on crutches or goes shopping with Patrick's wife, Barbara.
Patrick Day said he's having trouble slowing her down. She started taking an English class in Jamestown on Mondays and Wednesdays, and when the teacher mentioned a Tuesday and Thursday class in Sonora, she attended that, too.
The young woman who likes romance novels and aces her biology classes looks forward to walking naturally again.
She is eager to return home to complete the year and a half of high school that she missed. She wants to study for a health care career; a female doctor in Russia has offered to help her get into nursing school, Day said.
She shares the apartment in Ryazan with another girl from her orphanage, Arina Poley, an art student. A mentor who works for Russian Orphan Rescue Inc. teaches them social skills, hygiene, cooking and other skills.
The rescue organization helped Poley get accepted to an art institute, and she sends still life drawings to the Day family. To raise money for the organization, they frame the pictures and sell them for $200. Generous members of Sierra Bible Church, which the Days attend, pay $20 for drinks purchased from the family's Day-O Espresso stands to support the program.
Day said he believes Andreeva has a future in Russia. She always has earned good grades at school and wants to succeed.
"Her grandmother was a really positive influence on her," Day said. "She spent quite a bit of time with her grandmother because her mother wasn't able to take care of her. One of the teachers at the orphanage was a positive influence, as well."
During a recent interview, Andreeva expressed gratitude for the help she is getting here.
"You are more than like a father to me," she told Day in Russian. "I am very thankful."
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.