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Achemine Achelle rests on the lap of her host mother, Kelli Darling, before undergoing brain surgery at Carilion Roanoke Community Hospital. The 17-month-old Haitian has tears in her eyes, and her small hands are pressed together as though in prayer.

Ten days before on March 19, Vanessa Carpenter brought Achemine to Roanoke through Three Angels Children's Relief, a nonprofit organization she created to provide Haitian children with life-saving medical treatment.

Achemine suffers from Dandy-Walker Syndrome, a congenital brain malformation that causes excessive cerebral fluid, pressure and swelling of the head. When she arrived, she couldn't look up and had to sleep in an infant car seat, unable to sleep with her head flat.

Achemine is the 35th child who Carpenter, of Salem, has brought to the U.S. to receive medical care.

If left untreated, Achemine's condition could kill her.

Beginning the transformation

At 1:20 p.m., anesthesiologist Dr. Neil Macdonald brings the baby into the cream-colored operating room. He places a mask over her nose as her chest floats gently up and down. The fast and constant beat of her heart reverberates in the sterilized room filled with a surgical team clad in sea-foam scrubs and sky-blue masks.

By 2:10, pediatric neurosurgeon Dr. Lisa Apfel has cut through the baby's skull and placed a small camera in her brain that projects an image onto a nearby screen. As Apfel and her assistant watch, they simultaneously cut and cauterize the third ventricle, one of the brain's four fluid-filled cavities. Cerebral fluid stains the blue cloth draping the table.

They are searching for the baby's basilar artery that will provide a channel for them to place a shunt. The special tube will transfer excess fluid from the brain into the peritoneal area of the abdomen. The tubing will be large enough so that Achemine can grow to be an adult without needing to have it removed.

The surgical team quickly finds the artery. But there is a problem.

"There is some bleeding in here," Apfel shouts out, warning the others that a small cortical vessel is bleeding.

"I need more irrigation," she says. The team responds by pumping saline solution into the baby's brain. Then, Apfel presses the baby's skull together to pump the saline out.

At 3:30, the bleeding is under control.

Ten minutes later, Apfel makes an incision in the abdomen and threads the shunt under the skin. "Yes, yes," Apfel says excitedly as the tubing arrives in the skull.

She touches the pump and watches a bit of liquid flow out the bottom.

Apfel stitches a piece of pericardium tissue into place. The tissue comes from the sack around a cow's heart and acts as a seal for the baby's brain. She closes the skull.

In three hours, Achemine's life has been transformed.

"This whole thing is very miraculous."

Darling said she believes that when you do God's work you are protected by an umbrella of blessings that makes things fall easily into place.

Both Darling and Carpenter share a deep religious faith.

Both are also well-versed in the ways of motherhood.

Carpenter has two biological children, 15 adopted children and scores of Haitian children she cares for like a loving mother.

Darling has five children, including an adopted 7-year-old child who has lissencephaly, a rare brain disorder that causes his development to be like that of a 1-month-old.

When Carpenter called Darling to ask her to host Achemine, Darling said she could sense the urgency in her voice.

Darling had refused Carpenter's previous requests to host Haitian children because she always had foster children in her home. She alternates between working as a pediatric nurse at Carilion and as a foster parent with De Paul Family Services, which places special-needs children in temporary foster homes.

Carpenter was desperate because of the fragility of Achemine's surgery, said Darling, whose nursing background and knowledge of special-needs children made her an ideal host mother.

Darling agreed to care for Achemine, the baby she and Carpenter now affectionately call "Mia."

The two women are planning a medical mission trip to Haiti with an area doctor in June.

When Carpenter brings a child from Haiti, she needs to ensure that the medical care is provided at no cost to the public in order to get a medical visa. She needs physicians, hospitals and therapists to volunteer their time and services and host families to care for the children.

Dr. Kathryn Humphreys, a pediatrician with Village Family Physicians, offered her services. Apfel, who came to Carilion in September, and her team were also eager to help.

Carilion charged nothing for the baby's care, which would normally cost about $20,000, according to Eric Earnhart, media and community director at Carilion. As a not-for-profit hospital, Carilion normally writes off between $50 million and $60 million in services a year.

"Think about all the circumstances that had to come together," said Darling. "This whole thing is very miraculous."

Moving forward

Eleven days after surgery, Darling sits in her living room holding Achemine. The baby suffered from seizures the night after the surgery and now takes phenobarbital, an anti-seizure medicine that causes drowsiness. She appears completely relaxed, dressed in a bright pink pajama suit with her legs sprawled out.

The next day, Darling takes Achemine for a follow-up visit with Apfel.

"Don't be nervous," Darling says to the baby, who appears apprehensive. "I won't let them get you."

Apfel measures the circumference of the baby's head. All of the cerebral components are present, but the lobes are not as big as they should be, explains Apfel.

On April 30, Achemine will return for another medical visit. If all goes well, she will be on a flight back to Haiti to return to her parents soon afterward.

At this age, there is no definitive way to tell how much she will develop mentally, said Apfel, but it is fortuitous that she received the surgery at such a young age.