A now 20-year-old Emirati is the youngest person to have a double lung transplant at Cleveland Clinic Abu Dhabi, having contracted tuberculosis and Covid at the same time.
Battling both illnesses, Juma Mubarak Al Ali and his family went through a harrowing journey and the avid football player's survival would have been impossible were it not for the intervention of the medical team in Abu Dhabi.
Speaking to The National, his mother Mona Hamed Ahmed said they first went to hospital on March 13, 2022, because their asthmatic son had a fever.
"The fever didn’t go down," the mother-of-six said. "He came to me one day and he couldn’t breathe. When I took him to the emergency [department], his fever was above 40°C."
Mr Mubarak Al Ali was admitted and kept in overnight because his heart rate was so high.
"At the time, we didn’t know he had Covid or TB," his mother said.
"I went home because they said they were keeping him under observation. Until 12pm that day, I was talking to him on the phone and everything was fine."
This quickly changed on March 15, 2022, when Ms Hamed Ahmed was told her son was in a coma and, due to Covid restrictions at the time, his family could see him only through a window in the hospital.
'The worst moment of our lives'
Mr Mubarak Al Ali had complete lung failure as the TB was compounded by the Covid, with doctors describing his lungs as "two empty sacks filled with liquid".
"Initially we got a call telling us to come and say our goodbyes because Juma would die any moment," Ms Hamed Ahmed said.
"This was the worst moment of our lives. We couldn’t even hold him and were told to pray for him because there was very little chance he would survive."
His condition improved slightly after he was put on a life-support machine but he was still in desperate need of a lung transplant. For this, the family from Umm Al Quwain was advised to look for hospitals abroad, but they were roundly rejected because he had TB.
Still unable to visit their son at his hospital bed due to Covid restrictions, they could communicate with him through a glass window or over the phone as he slipped in and out of consciousness.
The saving grace came when they were told Dr Usman Ahmed, department chairman of the Heart, Vascular and Thoracic Institute, had recently joined the team to develop a lung-transplant programme.
From despair, to hope, to a miracle
While the team could keep Mr Mubarak Al Ali alive, he still needed a lung donor. So, almost six months into his hospital stay and with him weighing a mere 14kg, the family were overjoyed to find out one could be available.
"This was the happiest moment of our lives – when we were told there was a chance Juma would survive," Ms Hamed Ahmed said.
"It was like being born again. I can't describe how we felt."
On the day of her son's surgery on September 5, 2022, Ms Hamed Ahmed spent the night at the hospital so she could be near her son. The memory of hugging him, for the first time in months, after the procedure is something she will treasure forever.
"They kept calling me every few hours to tell me the surgery was going well," she said.
"At around 8pm, they called me because Juma had finished surgery and the entire medical team was there. I hugged him and, when he smiled at me for the first time in months, my heart settled and I knew everything would be OK.
"I realised that nothing in life matters like our health. Every day, I walked into the hospital expecting to see him dead or get that call telling me that he had died."
His father Mubarak Al Ali said: "I don’t know how I held myself together throughout this journey."
Their son was discharged on November 14, 2022, after seven months of intensive care. Today, he works for a private company and has started playing football again. His recovery inspired his elder sister to pursue a nursing career.
After he was discharged, he sent the hospital a video of himself playing football with his family and friends to illustrate the extent of his recuperation.
Breaking new ground
He is the youngest person to have a double lung transplant at Cleveland Clinic Abu Dhabi and the first Covid patient. Because of his TB, doctors had to wash out his windpipe and treating him meant every nurse, therapist and doctor put their lives at risk.
Dr Ahmed said the clinic's lung-transplant programme sets the standard in the region. To date, the team has carried out 34 lung transplants and has one of the world's shortest waiting lists, he said, with a backlog of 10 to 15 patients at any given time.
Pulmonary fibrosis, Dr Ahmed said, is the most common reason for lung transplants in the UAE but Covid-related complications have increased the number of patients requiring them all over the world.
"It was a 12-hour surgery that was challenging and required special manoeuvres, not only to remove the TB but also to ensure that the new lungs were not exposed to TB," he said.
"We washed out the inside of his windpipe during the surgery and, once the new lungs were transplanted, they started to work very well almost immediately and he started to breathe.
"He is a fighter. He started to get better immediately."
Speaking of the surgery, Dr Ahmed explained how a procedure like this would previously have required travel but can now be undertaken in the UAE.
"There were about 20 people: surgeons, nurses, people of my team and the team who went to procure the lungs," he said.
"It is an extremely complex process that needs to be done as fast as possible. It isn’t easy to establish but we are privileged to be in a place where can do this and in a government that gives these services to its people.
"Traditionally these types of patients would travel abroad – I have transplanted multiple Emirati patients at Cleveland Clinic Ohio but now we have all of these services in Abu Dhabi."
