The Saviour: The British plastic surgeon helping acid victims

In the UK, cosmetic surgery is often seen as nothing more than nip 'n' tuck, but in Bangladesh, thanks to Dr Ron Hines, it is rebuilding lives. Rachel Shields reports from Dhaka

It is about as far away from the nips and tucks of TV makeover shows and celebrity magazines as you can imagine, but then Dr Ronald Hiles has never had any interest in helping pampered princesses take inches off their thighs or years off their faces.

As he speaks from a clinic on the edge of the sprawling slums of Dhaka, his description of what he has achieved in 25 years of pioneering work is modest, to say the least: "Lying on a beach isn't my idea of a holiday. I prefer to do something useful."

And so, while many of his contemporaries are happy whiling away their summers on the Côte d'Azur, the former president of the British Association of Plastic Surgeons has spent his holidays for the past two decades helping Bangladeshi burns victims to rebuild their lives.

Dr Hiles, 76, has trained a generation of plastic surgeons, and been instrumental in establishing one of the biggest burn units in the world – vital in a country that is estimated to have 1.5 million burns victims a year. But it is the reconstructive surgeon's work with thousands of victims of acid violence, whose faces and bodies are left horribly disfigured after they have been doused in sulphuric, nitric or hydrochloric acid, which has been the most remarkable achievement.

Hundreds of people are burnt with acid every year in Bangladesh – most are women, who are often attacked after refusing marriage proposals, or because of perceived slights or family disputes. With victims unable to afford legal costs and often unwilling to put their families through lengthy trials, few prosecutions result.

Dr Hiles is the leading surgeon for the Acid Survivors Trust International (Asti), a UK-based charity that supports organisations working to combat acid attacks around the world, and has been instrumental in restoring the quality of life of many victims.

While dealing with the survivors of such violent attacks is undoubtedly rewarding, it is also emotionally draining. "One day a woman was brought in who had been gang-raped and had had acid poured on her face and into her vagina. That is going to have an effect on the emotions," said Dr John Morrison, chairman and founder of Asti. Dr Morrison established the first Acid Survivors Foundation in Bangladesh in 1999, which is now home to a 40-bed hospital.

For many who survive acid attacks, plastic surgery is essential to restore vital functions – from saving eyesight, to reconstructing mouths and rebuilding necks that have fused to chests.

"You have to be slightly detached, otherwise you won't be making the best decisions about technique as a surgeon," said Dr Hiles, who was awarded an OBE in 2004 for his services to Bangladesh.

He first visited in 1982, while a consultant at Bristol's Frenchay hospital, at the invitation of a missionary doctor who had complained that plastic surgeons in the country were not skilled enough to perform a simple cleft palate correction.

"I was hooked. Last year a doctor I've worked with operated on 1,800 patients with cleft palates," said Dr Hiles. "That's progress."

Since then the surgeon has travelled to Bangladesh every year, performing countless operations and showing local doctors how to undertake the same procedures. "Ron has been an inspiration," said Dr Samanta Lal Sen, project director at Dhaka Medical College Hospital (DMCH). "He taught us to do stitches, do operations, everything. Most of the burns doctors in Bangladesh have been taught by Ron."

Dr Hiles also played a key role in lobbying the government for the new burns unit at DMCH, meeting with both the Prime Minister and his predecessor in the hope of securing more beds and medical equipment.

"People look to Britain for their medical further education," said Barbara Jemec, the chairman of the overseas training and service committee for the British Association of Plastic, Reconstructive and Aesthetic Surgeons. "It is much more important that you teach a man to fish than give him the fish – you must pass on as many skills and as much knowledge as possible. There are 280 plastic surgeons in the UK, and a higher proportion than you think do this kind of work abroad."

New figures released last week show that the number of acid violence victims in Bangladesh fell to 165 last year, down from 490 in 2002, when legislation was introduced to make such attacks punishable by death. The fall is partly due to the work of international organisations such as Asti, which launched shocking advertising campaigns showing the effects of acid, gained support from prominent figures such as the Bangladeshi cricket team, and lobbied for legislative change.

While the number of acid attacks may be falling, and treatment for burn victims improving in Bangladesh, the number of attacks reported elsewhere in the world illustrate that this is global problem.

Although the true number is not known, as such crimes often go unreported, the Cambodian branch of Asti saw 118 cases last year. Pakistan saw 142 between January and June 2007, while attacks in Uganda rose from 230 to 275 in 2007. Although UK attacks are rare, earlier this month a London court sentenced a man to life imprisonment for raping a 25-year-old TV presenter before arranging to have sulphuric acid thrown in her face. She was left with severe burns to her face, neck and chest, and has since had 30 operations.

While not statistically significant when compared with other types of violence – such as knife crime – the effects of acid are such that the crime is just as serious.

"The pain was worse than the punishment in hell," said Hasina Attar. "Twice as bad."

Ms Attar was 19 when she was attacked by her family's manservant after a disagreement. Now 24, she has endured eight operations to repair her face, chest and arms, but is still severely scarred. "I was supposed to have another skin graft, but I said no. I didn't want to go through it again."

The work of doctors such as Dr Hiles is clearly radically different to that carried out in smart Harley Street clinics. And many doctors fear that a diet of 10 Years Younger TV programmes and magazines chronicling the work done on celebrities has skewed the perception of what reconstructive surgery can realistically achieve. "People have a Hollywood idea about plastic surgery," said Dr Hiles. "They think that it can change everything."

The bride's story: 'I refused to be sold by my husband'

Ayesha Siddique (Nila), 19, Bangladesh

"I got married when I was very young, just 14, to a distant relative who was in his thirties. I didn't want to marry him, but I was forced to. After we'd been living together for 10 days I found out that he was planning to sell me to someone in Saudi Arabia. I told him that I wouldn't travel to Saudi with him, that I was too young to leave the country and needed to stay and finish my education.

"He was very restless on the night the attack happened. I woke up and saw him sitting on the bed, and asked him what was wrong. He turned around, threw acid in my face, and fled. I can't describe how painful it was. Eventually I was taken to a local hospital by the neighbours, but they didn't give me any treatment.

"After a couple of days I went to the Acid Survivors Foundation hospital, where I had four operations, three of which were done by Dr Hiles.

"My burns are much better now. I'd say there has been an 85 per cent improvement, and I'm comfortable with myself. I'm lucky that my friends and family have been supportive. Studying is still important to me – I was revising for school exams even when I was bed-ridden after the attack. I'd like to be an accountant."

Attacked at a month old: The baby disfigured over an inheritance

A boisterous little boy who loves colouring books, Durjoy was just over a month old when his aunt – fearing she would lose an inheritance to the baby – poured acid into his mouth. It caused such damage that his neck fused to his chest, his lips were almost closed, and he could only be drip-fed. He suffered heart failure after a surgical attempt to reconstruct his mouth in 2006, and has since been taken to Hong Kong for pioneering surgery. His mother, Eti Rand, has said that she just wants him to be normal again.

www.asti.org.uk

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