Rebuilding lost organs challenge for docs

“The attack was just the start of my troubles. My father stood by my step-mother. As I was looking for doctors and trying to arrange money for treatment, the only help I got was from my uncle. The treatment is painful. After every surgery, you hope this will be the last and when they remove the dressing, you will have a face again,” she said.

Rupa was among scores of acid attack victims who protested in the capital last week, demanding among other things that treatment for victims be made free.

Doctors at Safdarjung hospital, which has the largest burns unit in the country with nearly 150 beds and a dedicated burns ICU, say acid attack victims make up a small number of patients, but need long follow-up treatments, often wrought with disappointment. “The annual number of acid attack victims is very less, not more than seven-eight in a year. But the burns are deep and targeted around organs like the ear, eyes and mouth. If the acid has not been washed immediately after the attack, it leaves deformities usually in the face, which needs multiple surgeries to restore basic functionality,” Dr Karoon Agrawal, head of the hospital’s burns and plastic surgery unit, said.

Lok Nayak hospital, which has a two-floor burns ward and an ICU for such patients, treats four-five acid attack victims in a year.

But in view of the large number of burns patients crowding government hospitals, after initial treatment acid attack victims often have to turn to the private sector for reconstructive surgeries.

Dr (Maj-Gen) Avtar Singh Bath, head of plastic and reconstructive surgery at BLK Memorial hospital, has conducted seven surgeries on acid attack victim Sonali Mukherjee from Jharkhand after she underwent 18 procedures at Safdarjung hospital.

“Sonali had already undergone immediate burn wound management, which is the acute period immediately after an attack, at a government hospital. But there were other procedures she needed, which unfortunately are a non-priority in government hospitals because of the sheer numbers they have to manage,” Dr Bath, who was formerly with Army (R&R) hospital, said.

Dr Amit Gupta, spokesperson at AIIMS, where the doctor who was attacked in Rajouri Garden last week is being treated, said, “Though the right part of her face will need reconstructive surgery, the acid burnt her right eye, causing grade IV injuries to the cornea. We washed the eye, but it’s still early to say if there is loss of vision.”

When Sonali came to BLK hospital, besides having lost her vision, almost half of her scalp was without hair, she had no cheeks, ears and nose. In place of these organs, there were only holes. “We had to make her ears and a nose, and conduct tissue-expansion surgeries on her scalp and cheeks. All these procedures were aimed at restoring the contours of her face as far as possible to make her look human, but by definition these reconstructive procedures are considered cosmetic in nature,” Dr Bath said.

Tissue expansion involves placing expanders — usually imported — which make normal skin grow faster.

Sonali’s treatment was funded by an NGO. But not all victims are as lucky. Rupa, who is a fashion designer, said each surgery cost her at least Rs 1 lakh. “I got no help from the government. Treatment for survivors should be made free and prioritised in the crowded setting of government burns wards. Besides, more doctors should be trained to treat such patients. If the affected area is immediately washed, the damage is less,” she said.

Skin banks, set up in Mumbai to harvest and store human skin from dead bodies, are considered a boon for burns victims in general and acid attack victims in particular, doctors say. Dr Suni Keswani, plastic surgeon at the National Burns Centre in Mumbai who started the skin bank, said, “Burns can be fatal due to infection or dehydration when the protective barrier of the skin is melted. Human skin provides the best biological dressing material, which can save acid attack victims through the acute phase of burns. More skin banks are needed across the country.”

A proposal for a similar bank in Safdarjung hospital has been in the planning stage for the last five years.