The conventional repair opens the chest. Cherkos chose the other way. Working with high-definition cameras through small incisions, he entered a space roughly the volume of a small egg, with one of the baby's lungs deliberately kept partly collapsed to make room. The anaesthetist ventilated her through a tube narrower than a drinking straw. The join itself — an anastomosis on a structure only a few millimetres across — had to be sutured through instruments the width of a pencil lead.
He had prepared for exactly this. Cherkos had recently returned from Wilhelmina Children's Hospital in Utrecht, the Dutch national referral centre for the condition, where he trained in thoracoscopic paediatric surgery. Around him in the theatre stood anaesthetists, paediatricians, theatre staff and the neonatal ICU nurses who would carry the days afterwards. The surgery is the visible part; the recovery of a six-day-old belongs to whoever is awake at three in the morning.
That survival gap has less to do with surgical talent than with time and equipment: babies arriving late, and hospitals without neonatal intensive care to hold them afterwards. Tenwek, founded as a mission clinic in 1937 and standing about fifty kilometres from Bomet town, runs one of the region's few surgical training programmes and performs open-heart surgery. Kenya has few paediatric surgeons for some 55 million people, and most of them work in Nairobi. This one was here.
Cherkos put the credit where a surgeon who has been in that room usually puts it — on a multidisciplinary team committed, he said, to giving every child the best chance at life.
Carline Bett was discharged home. She is feeding normally.