This was not a congenital deformity, but a preventable crime

I started seeing patients the moment we arrived at Apollo Hospital in the small rural town of Bilaspur. There was no time to rest. These patients had been waiting for us for weeks to arrive. It was during this clinic time, on this day, that I realized something that really struck me to the core. I have been to India to do these missions many times. Heck, I have been to the Philippines and other countries, but this was different somehow.

Mostly on these missions, I was treating congenital deformities. These are deformities that patients have no control over. This is how they were born. I can deal with congenital deformities. This is what I was trained for, but what I was seeing today was horrific, sad and unimaginable to my Westernized mind.

This was the fourth medical mission for the American Society of Indian Plastic Surgeons (ASIPS). I rounded up some of the best plastic surgeons, an all-star cast really. All board certified and members of the American Society of Plastic Surgeons from the US for this mission. Dr. Munish Batra (San Diego), Dr. Shashi Kusuma (Ft. Lauderdale), Dr. Vineet Mehan (Fairfax), Dr. Satish Vyas (Detroit). Good fortune was smiling on me when my dearest friend Dr. Chanjiv Singh, an amazing plastic surgeon from India agreed to come along and even help set up this mission. We were a team of six dedicated plastic surgeons, dedicated to our craft, dedicated to humanity.

Escorted up to the clinic area, I could see the patients lined up waiting for my arrival. Hundreds of people with all sorts of deformities anxiously awaiting my arrival. Just walking to the designated office became an ordeal as the patients wanted me to see them right in the hallway. “Doctor … doctor,” they screamed wanting to be heard and seen right there in the hallway. I motioned for them to wait and assured them that we would see all of them, not knowing if I had just made them an empty promise. How could we see all these patients in one day. There were too many.

Sitting in an office surrounded by local doctors, nurses and even hospital administrators, who were there to help me translate and communicate with the patients. My Indian heritage is obvious when you see my brown skin, but having spent most of my life in the US, it is just as obvious that I am a foreigner in my own land. I know how to speak Hindi, the main language of India, but I also know my limits.

The first patient came in with severe burn contractures to her face and torso. She was an untouchable to the locals, who was about to touch me deep in my own humanity. The local staff practically ordering this woman to sit. Her eyes filled with fear and apprehension. A frozen scarred face. A mind probably filled with complex emotions that I would not even begin to comprehend. To her, I was a strange doctor from a far away land that she could not even imagine. To me, she was a patient that I came to help.

Pulling my chair right up to this woman’s side, I wanted to stay eye level with her during my examination. I wanted her to feel comfortable with me. I wanted her to maintain her dignity, if there was any left. I wanted to show her the respect she so deserves and has earned.

As she recounts her story, I realized how much pain this woman has endured and will continue to endure. First the fake version of the story, this was an accidental burn. Then the truth, a deliberate act by a cowardly man to disfigure a beautiful woman, a wife for reasons that make no sense to this Westernized brown doctor.

Sadly enough, I have treated many burns in my life as a plastic surgeon, but this was different. This is a site that most human beings should never have to see, let alone endure. It is devastating to see a once beautiful woman turn into something so horrific. Her neck is fused to her chest and breast. Her lower lip is adhered by scar tissue to what was once her chin, which now is a confluence of hard scar that is also adhered to her chest. Where once there were breasts are now nothing but hard thickened scar that have no semblance of anything human. Her womanhood stripped from her in a violent act of cowardice by her husband.

I gently put my arms around this woman and assured her that we were going to help her to the best of our capability. Her inferiority complex was palpable. She was an untouchable thrown out of her own world and rejected to fend for herself. This woman was probably clinging to whatever humanity and dignity that still remains in her. Painful and extremely disfuguring scars are all this woman knows and will ever know. My heart was bleeding for this woman. I am her doctor but I am also a fellow human being, who can see right through her suffering eyes.

This was the moment that struck me. This was not a congenital deformity I was treating, this was a preventable crime committed by the one person she probably trusted the most, her husband. This woman was a hero to me just because she was alive. I wanted to reach out and touch her heart with my hands, instead all I could offer her was my scalpel and a promise to restore her to some semblance of normal. If I could cut out her pain with my knife blade, I would have offered her that. With my knife blade, I would try to restore her dignity, restore her womanhood, restore her humanity. This untouchable woman touched me in ways too profound even for me to comprehend.

How do I tell her that this surgery is difficult? How do I tell her that I will be causing her more pain in my earnest attempt at improving her appearance? With my arms still around her, I gently explained to her that I need to remove the scarred tissue that is hindering motion of her neck and lips. This will free her face from her chest. This is only the first step.

Now the next phase, to replace the tissue where once there was skin. The scar tissue has replaced the burned skin. Replacing the skin involves taking skin from her legs as a split thickness graft and transplanting it to the neck and chest areas. Do I tell her that the skin graft often does not survive in this area? Do I tell her that she may even need more surgery in the future to correct other areas that are affected by the burn ?

Being a US-trained surgeon, I know the standard of care is to inform the patient about all these complications. To this woman I am a surgeon from the US, which means that I have mystical superior skills. To me, nothing could be further from the truth. I have worked with my plastic surgery colleagues from around the world and we all know there are many factors that predict the success and failure of our surgical procedures.

As I booked her surgery, I motioned the staff to bring in the next patient. I suddenly realized, this was only my first patient. This was going to be a long day.

The American Society of Indian Plastic Surgeons (ASIPS) has dedicated its existence to providing access to plastic surgery to those extremely underserved in rural India.

Bhupesh Vasisht is a plastic surgeon.

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