SUFFERN, N.Y. — Maria Amman is still smiling.
Paralyzed for half her life, 13-year-old Maria, a Palestinian from the Gaza Strip, recently underwent a procedure to regain the ability to breathe on her own, thanks to the kindness and skill of a Jewish surgeon on the staff at Good Samaritan Regional Medical Center in Suffern, N.Y.
Dr. Mark Ginsburg, chief of thoracic surgery at Good Samaritan, was assisted by Israeli surgeons at Hadassah Medical Center in Jerusalem in successfully implanting a phrenic nerve pacemaker in Maria. She has been paralyzed from the neck down and unable to breathe without the assistance of a ventilator since 2006.
The phrenic nerve pacemaker sends electrical signals to the diaphragm and will allow Maria to breathe on her own.
It's a rare procedure with only 40 to 50 performed annually worldwide. However, in the past decade, Ginsburg has performed it about 100 times in a number of countries, including Israel and Brazil and, in the United States, at Good Samaritan.
Maria's injury resulted when a missile struck her home, killing her mother and two brothers. Since then Maria's signature smile has served as her sole source of communication with those entrusted with her care.
In the strike, then-6-year-old Maria sustained a C1 spinal cord injury, the most severe level of injury. Soon after, she was connected to a respirator. Early on, she also had undergone a tracheostomy.
"She couldn't speak at all until recently," said Ginsburg, who has worked at Good Samaritan since 1987. "Now she can only speak a little," albeit softly, "using the air from the respirator that goes through her tracheostomy."
Maria lived in Alyn Hospital, a pediatric spinal cord and rehabilitation facility in Jerusalem for six years with her father often at her side.
The Israeli government recently agreed to lifetime medical care and support for Maria, which will enable her father to care for her. Father and daughter have since moved to an apartment in Israel.
The outcome of the operation was "terrific," Ginsburg said. "The pacemaker was working beautifully when we left. She is a perfect candidate for this.
"It takes a little while for the muscles of the diaphragm to be rehabilitated," the doctor explained. Over the years, the muscles around Maria's diaphragm atrophied because of nonuse.
"It will take probably about three months of progressive pacing for the muscles to regain their strength," he said. "At that point, hopefully she can come off the respirator and eventually be without a tracheostomy tube."
Maria should then be able to speak freely. "For somebody who's a quadriplegic, being able to speak is everything," Ginsburg said.
The doctor plans to return to Jerusalem within six months to check on his patient, who has been discharged from the hospital.
During the past five years, Ginsburg has operated about a half dozen times at Hadassah Medical Center on patients from Alyn Hospital and other Israeli hospitals. Ginsburg, 58, met Maria two years ago during one of his visits.
While Maria was identified as ideal candidate for the pacemaker, Ginsburg said, "the problem was, she had no insurance. At that point, the Israeli health care system had not agreed to pay for it."
The pacemaker alone costs about $70,000. That's in addition to the usual costs of hospitalization. Ginsburg donates his services when he is Jerusalem. His efforts are supported by Good Samaritan, which operates under the auspices of the Bon Secours Charity Health System.
Avery Laboratories on Long Island, which makes the pacemaker, agreed to reduce the cost of the device, Ginsburg said. Additionally, a charity within the company allows for part of the device, which is external, to be donated from patient to patient, when a patient no longer needs it.
The Israeli Ministry of Health agreed to pay the remainder of costs related to the surgery.
Maria's father, a Palestinian who now is an Israeli citizen, filed suit against Israel to gain the health care coverage for his daughter. "The Israeli Supreme Court agreed with him and awarded lifetime health services to Maria. That's how she's been able to stay in Israel, get health care and eventually get the device," Ginsburg said.
The doctor described his patient as one whom people love.
"She has a terrific smile. She wants to enjoy life. She understands what her limitations are, but she doesn't see them as limitations," he said.
And she's resourceful.
"She's able to control her wheelchair with her tongue," Dr. Ginsburg said. The night before her latest surgery, she wheeled herself around the Intensive Care Unit and asked the nurses if she could help them take care of the other patients, he recalled.
"She is not a quiet kid sitting in the corner. She wants to be part of the action and she makes it known that she wants to be part of the action," he said.

Chicoine is news editor at Catholic New York, the archdiocesan newspaper.