The Heat in the operation theater was suffocating. My eyes burned from the sweat droplets that dripped from my forehead. My eye glasses became fogged and the nurse removed them temporarily to clean them. My assistant, Dr Amit Tandon, was sweating profusely and backed away from the table, nauseated.
I empathized with Amit, I had been in his shoes years earlier. The sight of blood, mixed with the smell of burning flesh and plumes of smoke, the sound of blood vessels being scorched by the cautery and the suffocating heat all culminated in a visceral response to pass out. In my anglified hindi accent I muttered “ cautery oochi karo”- turn up the cautery. It would require increased power to cut through the neck scar which held her lower lip to the top of her chest like concrete in this thirteen year old girl. Ironically the burns I created with the cautery were treating the burn scars from her acid attack.
Dr. Kusuma was adeptly harvesting skin grafts from her leg for the neck reconstruction, while Dr. Vasisht looked on waiting for his case to start in another OT. The thirteen year old was savagely attacked by a neighborhood boy. Unfortunately, the number of such cases of acid attacks and domestic violence leading to these types of devastating burns has allowed me and the other surgeons of ASIPS, The American Society of Indian Plastic Surgeons to become veterans of these reconstructive procedures.
Our annual plastic surgery camp was held at Apollo Hospital in Bilaspur in Chattisgarh, India this January. The team was led by Dr Chanjiv Singh, who is based out of Amritsar Punjab and is the Liason for ASIPS in India. His colleague and longtime friend, the anesthesiologist Dr Baljit Bajwa joined us from Jalandhar.
The team from the US consisted of Dr. Bhupesh Vasisht (New Jersey), Dr. Shashi Kusuma (Florida), Dr. Vineet Mehan (Washington DC), Dr. Satish Vyas (Michigan) and me, Dr. Munish Batra (San Diego).
We were also joined by Dr. Amit Tandon, Arjun Sharma, Gavin Ajami. Nurses Amber Cheffins and Katy Foltz, and our documentarian Gupri Dosanjh.
The staff at Apollo hospital was enthusiastic and performed their tasks in an excellent fashion in order to make this our most successful camp ever. In all, we performed 104 cases in 4 days, running OT’s from 8 AM to 9 PM. The cases were similar to the type of surgeries we have done previously on our annual trips, consisting of cleft lip and palate, hand reconstruction, facial deformities among others.
But, what struck all of us was the number of horrific burn injuries resulting from acid attacks. After some prodding, the majority of the women admitted they had been burned intentionally. In all, there were 11 such cases, over 10% of our total patients. And while the reconstructive procedures for these patients are exhausting for the surgeons, we committed that we would manage every one of these cases before departing.
The combinations of having dedicated surgeons, staff willing to work 12-14 hours daily, along with the infrastructure provided by Apollo Hospital to ensure things ran effectively allowed us to treat every patient that presented with these crippling injuries. These withdrawn patients came as far as 500 Km away when received notice that these surgeries would be provided at no cost.
It was therefore, with great interest that I read Reenu Sharma’s story in the Hindustan Times newspaper as I headed back to the US. I reflected on our back breaking mission as well as the fate of such patients in India. I thought my perspective was worth sharing both as an Indian living in the US, as well as plastic surgeon treating these injuries in India. My aim was not to politicize this topic, as it is quite evident from the stories I read in the Indian newspaper that apathy exists in the political arena for these patients. While I was pleasantly surprised to read the punishment dealt to Reenu’s attackers, I have to believe this is more the exception than the rule when it comes to these barbaric attacks.
As an Indian living in the US for the last forty years my perspective is that of a “Foreigner”. I am shocked and extremely saddened to hear and read about the inhuman treatment of these women. Day after day the newspaper and television is filled with news about gang rapes, acid attacks, molestations and murders perpetuated in India. While it is shocking to read story after story about such cruelty, it seems that a degree of apathy exists and our culture has become accustomed to this in Indian society. As an Indian – American, I recognize the stigma and shamefulness it has brought on our culture overseas. We have come to be identified by extremes, the Bollywood culture of upwardly mobile yuppies on one hand the misogynist gang rapists and perpetrators of female infanticide on the other hand. While we have been adept at hiding behind the illusionary cloak of being the Bollywood culture for many years, the advent of global news reporting will soon know us for our human rights violations. It is also equally shameful that we, as Indians, spend more time and energy on which Bollywood actress is having a sordid affair rather than addressing the misbehavior against our mothers, sisters and daughters.
Finally, as a highly-regarded plastic surgeon in California, my identity is rooted in being an Indian – American professional. As with all the surgeons of ASIPS, we have received accolades in our community and have reputable practices. We have also made a commitment to give back to the country of our heritage and come annually to India to do charitable cases. None of us are under the delusion that our efforts will ever make a significant impact to help the millions of patients that require reconstructive surgery, but our hope is that every patient we do get to treat may lead a better existence.
To that end, the crippling deformities created by acid attacks and other burn injuries are so significant that we can only hope to get some functional improvement to make the patient’s life more bearable. Many of these patients are socially outcast in their communities and all of them lead a miserable existence. They are disfigured beyond imagination, their burns are so extensive that often times young children don’t recognize their own mothers. The face and neck burns are so intense that the eyelids are pulled down so that their eyes stare blankly and cannot close, their mouths are pulled open so they cannot hold saliva in their own mouth or chew food without it falling out. Their arms may be so burned that they cannot lift their shoulder or flex their elbow or grip their hand. The burns across the chest prevent them from breathing effectively. And whether it be releasing burns from the neck so these women can hold their head straight, or grafting the lower eyelids so they will not go blind from corneal ulcerations, or releasing an arm contracture so they can lift their baby more adequately, we are only temporizing the inevitable. An existence so filled with suffering that they often wish for a hastened demise.
Our surgical training is tested by these complex reconstructive procedures. Our emotions are tested by their sad stories and their sorrowful existence. The agonizing screams in the recovery room after these painful reconstructive procedures beckon us all as Indians to do their part in putting a stop to such cruelty.
MK Batra, MD, FACS