Sunday, 19 February 2012

Saving Faces, Rebuilding Lives

The interview’s gone swimmingly thus far so I decide to slide in a wholly irrelevant question.
As you do.
Mohammad Ali Jawad slams a thick fist into the terribly delicate looking designer desk in front of him and, wagging a thick finger at my face, demands, “Who the hell are you, sitting on your pedestal, to question the ethics of gastric band operations on the NHS?  Obesity costs the government 10 billion pounds a year!!!” he rages as I slowly sink into my sorry looking pedestal.  “Because of obesity we are fighting high blood pressure, diabetes, heart disease and the list goes on!”   It’s a bit like watching that Brian Blessed episode of Have I Got News For You; intimidating yet strangely endearing.
Mr Jawad then continues, in a more measured tone; “Obesity is a disease and the consequences will resonate for years.  It’s very easy to call for ‘lifestyle changes’ but in the meantime we need to deal with the problem and relieve the burden on the state, on the taxpayer.  It’s irrelevant whether a gastric band is an ethical solution or not.  It’s irrelevant whether it’s right or wrong. It’s a logical solution.”
His exasperation at my rather shaky moral high ground is probably also down to the fact that it’s been a hectic few weeks for Mr Jawad; darting between newspaper interviews and radio shows, running a successful plastic surgery practise on Harley Street and being one of the most respected burns and reconstructive surgeons in the United Kingdom.
But his explanation is elegant in its simplicity, and sums up the man quite perfectly.
Unlike a vast majority of us he doesn’t preoccupy himself ruminating on morality, ethical judgments or health and safety concerns.  Instead he’s part of the minority that gets up in the morning to use his skills to improve the lives of others.  It’s the kind of attitude that saw him celebrated in the plastic surgery fraternity for the miracle he performed on former model and acid attack victim Katie Piper.  And it’s the kind of attitude that has now made him the focus of a documentary about the most wretched victims of one of the world’s most parlous societies.
‘Saving Face’, by award-winning journalist and filmmaker Sharmeen Obaid Chinoy tells the stories of several Pakistani women, all victims of acid attacks at the hands of jilted lovers, spurned husbands and even female relatives of questionable religious mores.  The film’s powerful portrayal of one of the lesser known of Pakistan’s many problems and Mr Jawad’s yeomen work rebuilding their lives, has led to its nomination in the Best Documentary Short category of the 2012 Oscars; the first film from the country to be nominated in any category.
A crime of primitive depravity
Pakistan’s bloody birth 65 years ago has given way to a protracted infancy as a combination of geo-politics, corruption, extremism, a disjointed national identity and general lawlessness has regularly brought the country to the brink of anarchy.
One of the more sinister manifestations of that lawlessness has been the acid attacks on women, a crime of primordial depravity, inflicting horrific physical pain and heinous disfigurement.  “Using acid is the last resort for the attackers,” says Mr Jawad.  “Each and every case is premeditated and it’s usually the final stage in a long period of domestic abuse which is an extreme sport with some of these fellows.  Sulphuric or Hydrochloric acid produces a tremendous amount of heat and it burns very aggressively and it goes on burning until fully neutralized.  The problem is that neutralizing it is also extremely difficult.” 
American journalist Nicholas D Kristoff, who has studied acid attacks in the region, calls it “Terrorism that’s personal”.  It is a symbolic act, taking away the victim’s very character and often leading to their total ostracization from society.  The perpetrators simply disappear within a largely patriarchal society or are handed barely significant jail sentences; up until 2009, an attacker could be jailed for a maximum of just 5 years.
One of the problems was that the authorities scarcely acknowledged the issue.  One organization – the optimistically named Progressive Women’s Association of Pakistan – documented more than 7800 acid attacks during a 14-year period up to 2008, whilst the official line maintained that there were no more than 100 attacks a year.  "From the social justice point of view it was diabolical”, Mr Jawad says.  “There was one lady who had sought a divorce from her husband and took him to court.  The judge ruled in favour of the woman and as she was coming out of the court house in Karachi, the man attacked her with acid which had been supplied by his own father; at the entrance to the courthouse!”
“It makes me furious that this is happening in my country; all of these girls, pretty and innocent in their own way, and a vast majority at the cusp of their lives which have been destroyed.  It’s terrible.  The face is our primary portal of communication, and these women have lost that means of communication.  After what I saw, I could not help but put my hand out to these women and do what I could.”
Floyd, Khan and Viva
The fifth child in a family of eight, Mr Jawad, 54, was born and raised in the vibrant, optimistic, cultural melting pot that was Karachi, immersing himself in both the progressive rock of Pink Floyd and the traditional Qawwali of Nusrat Fateh Ali Khan, before the arrival of Zia Ul Haq and the country’s slow and painful descent into radicalization and violence.  The first in his extended family to take up medicine, Mr Jawad was inspired to pursue plastic surgery by a Pakistani American surgeon who had a habit of driving around Karachi in a vintage Ford Mustang.
In the 1980’s, as Ul Haq’s Islamic Ordinances began to take effect, Mr Jawad travelled to London to complete a fellowship in Cosmetic Surgery before training in the United States, Italy, France, Belgium and Turkey.  Eventually he would head up the world renowned burns unit at Chelsea and Westminster Hospital whilst also establishing his own plastic surgery practice, the ‘Nip and Tuck Surgery’.
His first foray into humanitarian work came in 1998, courtesy of a flamboyantly whiskered Sri Lankan Tamil surgeon celebrated for his charitable work in India and Sri Lanka.  “This fantastic guy, Charles Viva, who’s rocking it in Middlesbrough at the moment, introduced me to this madness of humanitarian work.  He’s an inspirational guy who asked me to tag along when he travelled to Pakistan to do a clinic for patients with cleft palates.  It was an incredible experience, particularly the way he drove everyone crazy in a culture where perfection is the exception rather than the rule.”
Encumbered with a burgeoning medical career in the UK however Mr Jawad put humanitarian work on the back burner for a while.
Then, on October 08th 2005, a 7.6 magnitude earthquake devastated Pakistan’s remote Northwest killing nearly 80,000 people.   As had happened after the Asian Tsunami less than a year previously, the South Asian Diaspora sprang into action, raising funds and sending in its’ finest to assist.  “The earthquake was a phenomenal opportunity.  Trauma treatment was something that we had been doing extremely well in the UK for a long time.  I made sure I picked up all the kit and equipment form hospitals in the UK.  That was imperative if I was going to be independent of all the forces that come into play when a tragedy of this sort happens in our part of the world.”
In scenes reminiscent of the 4077 Mobile Army Surgical Hospital, Mr Jawad and his team set up a 75-bed hospital outside the epicentre in Muzaffarabad and went to work, carrying out reconstructive surgery on an average of 25 patients per day for 7 weeks.  “It was something that we would never forget; the destruction and the chaos and the terrible injuries the tremor had caused.  It was gruelling and cold and I lost two very good winter jackets!  It was an eye opener for me.  I loved the rush; to use the skills that you’ve acquired to go and help people, my people, was tremendously fulfilling.”
Katie Piper
Following his revelatory first visit, Mr Jawad spent the next three years spending up to four months at a time in Pakistan, carryout out procedures on people who couldn’t afford reconstructive surgery; from burns victims to children with cleft palates.
2008 brought yet another defining moment.
Katie Piper, a young, aspiring model was attacked with acid in broad daylight in North London by a man hired by an ex-boyfriend.  The 25-year-old was rushed to the burns unit at Chelsea and Westminster Hospital where a team of surgeons led by Mr Jawad carried out a landmark operation, removing all of her facial skin and replacing it with Matriderm, a skin substitute.
In an age in which plastic surgeons are revered and reviled in equal measure, Mr Jawad was hailed as a medical genius for attempting the risky new procedure.  “Her injuries were horrific, absolutely appalling.  The nature of the injury was such that it required us to do something radically different; the actual process of reconstructing her face after the initial replication with Matriderm was long and drawn out but it was worth it in the end.  In fact, it was better than expected.”
It was not immediately clear whether the procedure would work as Piper was forced to wear a specially designed mask to hold the Matriderm in place as it moulded to the bone structure of her face.  The success of the operation led to a documentary, ‘My Beautiful Face’, which propelled her and Mohammad Jawad to the public’s conscience.
That ‘notoriety’ - as Mr Jawad likes to call it - brought him to the attention of activists against acid attacks in Pakistan.  “Around the end of 2008 I was told about the scale of the problem in Pakistan and I was astonished.  I had never heard of anything like it while growing up.  It was a real shock to the system because the most violent thing I knew of was someone using a hockey stick to get even.”
His trips to Pakistan became even more frequent, and now included free clinics for acid attack victims – funded by, among others, Islamic Help – as well as training workshops for local surgeons and aftercare specialists.
It was then that Sharmeen Obaid-Chinoy came calling.
One of the stories featured in ‘Saving Face’ is that of 39-year-old Zakia from the Punjab who became the first acid attack victim in Pakistan to undergo the reconstructive procedure Mr Jawad had performed on Katie Piper.  Mr Jawad recalls, “When she came to me she had already lost an eye and the face was horrifically distorted.  I said I could fix you.  The eye couldn’t be saved but we did a new prosthesis for her nose and a special pair of glasses to cover up the missing eye and now she has the confidence to go out of the house which she hadn’t done for 3 or 4 years.”
The film also provided Mr Jawad the context in which he could delve deeper into the victims’ lives as well as explore the sociological aspect of this appalling crime and to see the country of his birth now far removed from that of his carefree upbringing.  “It’s pathetic really.  These attacks are evidence that Pakistan is in a bad place at the moment.  There isn’t a good enough health service, any justice, any family or communal support for these people and then there’s the poverty.  It’s a potent combination.”
Although it’s difficult to establish a correlation, the filming of ‘Saving Face’, Mr Jawad’s work and Zakia’s healing nonetheless coincided with a shift in attitudes in official circles.  The country’s parliament finally decided to get tough with attackers who now face a minimum 14 years to life in prison and a minimum fine of 1 million rupees (approx. £7200).  “These are small steps.  We are a country of 180 million people who face so many different problems on a daily basis.  There’s a state of war, there are survival issues, we are being bullied by the Americans, we are in a difficult situation but people are speaking out and the powers that be are listening,” Mr Jawad says.
“We need to take these small steps and I’m just doing my little part.  I don’t think we can completely eradicate this menace but we can bring it to a manageable level.  The first thing is to have a good deterrence and secondly to have effective treatment.  It’s easy to be pessimistic but things can and do change.  It’s imperative to speak to people in a language they understand, to get into their psyche and engage with them from their point of view.”
Much work remains.  According to legal experts a comprehensive law needs to first define the nature of the crime in greater detail which will in turn lead to not only the crime being addressed but also define other areas like procedure, accountability, medical care and the rehabilitation of victims.  In order for acid attacks to be more clearly defined however, the country’s domestic abuse law needs to be strengthened – a move regularly opposed by Islamist political parties.  It is further evidence of the dominant role the Islamic faith has played in Pakistan; from its birth to its current roster of problems.  “Faith is a funny thing”, Mr Jawad says recalling a meeting with a casualty of the 2005 earthquake.  “She was this remarkable woman whose legs had been shattered by falling debris and had to be amputated but she said faith had kept her going. Faith is like a fire; it can keep you warm or it can burn you.  But this kind of violence against women has nothing to do with religion or culture.”
The Red Carpet Treatment
Mr Jawad’s not the first medical professional to devote his time to helping people; his mentor Charles Viva and surgeon Conal Austin of Guy’s St Thomas’ are two who spring to mind.  However, there is a special significance to Mr Jawad’s work in that he’s not attempting to reverse what nature has got terribly wrong.  “I absolutely have to detach myself and look at things objectively.  Of course I have a moral view and a political view of it but getting involved in the socio-politics of it all, especially in Pakistan, means that I would not have the conditions to do what I do best and that is to fix people.  Sometimes you just have to put your head down and get on with it and not be swayed by the injustice and nonsense that takes place around you because it ends up being counterproductive.  For instance, every time I travel to the US I get the ‘Red Carpet’ treatment because of my first name and the place I was born.  But I don’t let it get to me.  After all, if there are two things I can’t change, it’s my name and where I’m from!”
True to his word, Mr Jawad continues to do his part undaunted.  A new charitable Foundation will help offer training to surgeons and medical staff in Pakistan, educational and awareness programs and – perhaps most importantly – post-operative therapy for victims.  “Psychological support for these patients is coming through now because people are realizing that it is absolutely essential.  It’s still not enough.  Pakistan doesn’t have a lot of things and psychological therapy for burns victims is pretty low on the list of priorities but we are working on it.”  The foundation hopes to build on Mr Jawad’s work, expanding it throughout the sub-continent and passing on his invaluable expertise to local medical professionals.
In the UK he hopes ‘Saving Face’ will not only highlight the plight of acid attack victims in Pakistan and elsewhere, but shed light on the positive work done by plastic surgeons on the NHS; a service unlike any other in the world.
For the moment however, he’s determined to set aside the tools of his trade and enjoy some of the glitz and glamour of Hollywood on 26th February.  In spite of his young relatives’ determination to crash the party, Mr Jawad is determined to make the most of it.  “HBO is putting me and my wife up during the course of the event but I’m slightly concerned because my nieces and nephews in America are going to take their chance to descend en masse on Los Angeles and crash my hotel room and get a piece of the action man!  But I’m focused.  My plan is to meet up with George (Clooney that is).  Who knows, we might work together one of these days”, he jokes with a slight American twang which will certainly stand him in good stead as he trawls through the endless pre-and-post Oscar parties, really living it up.
God knows he’s earned it.
-    Vijitha Alles

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