The skin they wear

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Saving face Once the skin is grafted off a donor’s body, it can be preserved for up to five years in glycerol. Photo: Reuters
Saving face Once the skin is grafted off a donor’s body, it can be preserved for up to five years in glycerol. Photo: Reuters

The primary function of the body’s largest organ, its skin, is to protect. The most sensitive part of you, it responds at once to heat and cold, but also to fear, pleasure and pain.

Last week, a 42-year-old autorickshaw driver’s skin prickled with dread when he saw the scene unfolding before him. A young boy who was talking to a girl in a green salwar kameez suddenly grabbed her by the hair. He was tilting her head up and emptying a bottle he had pulled out of his pocket into her mouth. As she tried to push him, struggling to free herself, the liquid splashed on her face. Before the driver could react, the boy had slapped her, pushed her onto the sand of Gorai beach and begun to grind her face into the dust.

When concentrated acid comes in contact with human skin, it begins to dissolve its layers — the epidermis, dermis and hypodermis — in a matter of seconds. It burns through clothes, flesh, concrete and even metal. Although 21-year-old Jitendra Sakpal had only managed to procure a diluted form of sulphuric acid that afternoon, the bathroom-cleaning agent was enough to burn the girl’s mouth raw, and render her incapable of speech before the driver could come to her aid.

In June, a TEHELKA article on Preeti Rathi’s death (Liquid Fire, Extinguished Dreams) reported that prior to the new Anti-rape Bill, the National Crime Records Bureau had kept no record of acid attacks in the country. Since April, the women’s helpline in Sheila Dikshit’s office has recorded 56 such cases in Delhi alone. The only data currently available from acid attack rehabilitation centres like Stop Acid Attacks in New Delhi, estimates the figure to be nearly three cases every week across the country.

Following Rathi’s death and mounting pressure from activists, the Supreme Court had placed a total ban on over-the-counter purchase of acid: dealers can now legally only sell the chemical once the buyer supplies a government-issued photo identity card and specifies the reason for purchase. The details of all buyers of acid must be made available to the local police within three days of the purchase. No acid can be sold to minors, and current stock must necessarily be declared with the local sub-divisional magistrate (SDM) within 15 days. According to the judgment, undeclared stocks could be confiscated and shop owners fined up to Rs 50,000. While the state governments of Maharashtra, Punjab, Karnataka and Kerala immediately followed suit, asking for the sale of acid to be treated at par with the sale and purchase of poison, it is nearly impossible to monitor the already existing stocks of acid present in bathroom cleaners, car batteries, polishes, garages and jewellery stores. The production of sulphuric acid is believed to be indicative of how industrially advanced a country is, and India produces nearly 48 lakh tonnes every year.

“Just like businessmen kill rivals, jilted lovers maim,” offers Dr Sunil Keswani, taking off his scrubs. Over the past 30 years, he has helped set up four skin banks in the country — two in Mumbai, one in Indore and another in Pune. We are currently at the largest of these, the National Burns Centre in Airoli, Navi Mumbai, which functions as a research space and skin bank with state-of-the-art equipment, thanks to its tie-up with a skin bank based in the Netherlands.

While skin grafting is common practice in the treatment of burns, Dr Keswani says nine out of 10 doctors in India have no idea about the critical role skin banks can play in this process. Under the Transplantation of Human Organs Act (1994), skin, like any other organ, can be legally donated and harvested from a cadaver and transplanted onto another person. Unlike most organs though, a match between the donor and the recipient of the skin is not necessary for a transplant. “In the case of a severe burn, as one caused by concentrated acids, grafting this skin onto the wounds of a survivor removes all chance of infection, which is the primary source of scarring,” he says. “We can reduce the scars by almost 60-70 percent, and since the nerve endings of the patient are no longer exposed once this skin is transplanted, the intense pain disappears altogether.”

According to Dr Keswani, it is preferable to use donated skin instead of autografting the patient’s own skin because a patient that is already suffering need not go through the painful process of having more of their skin removed, and because the donor’s skin acts as a temporary shield, preparing the wound so that it can accept the patient’s own skin as she begins to heal. While these banks see pitifully few donors (Airoli has had only 80 in the past four years), once the skin is grafted off a donor’s thighs, legs and back after death, it can be preserved for up to five years in glycerol at a temperature of four degrees centigrade.

Most acid attack survivors who are referred to the National Burns Centre receive subsidised treatment. Despite the state and central government’s promises to compensate these women, each one has paid her own medical bills. Sapna, a 21-year-old survivor in New Delhi, was attacked with acid in August, after the new Anti-rape Bill had already promised a minimum of 3 lakh as compensation to survivors, and a prison sentence of at least 10 years to perpetrators. “The only money and treatment I have received is from my family and ngos,” she says over the phone, “I am living in the shelter at Laxminagar because the boy who attacked me has been freed. He and his relatives have locked my family out of our house, and have threatened us with a worse fate if we do not take back the charges.”

Much before they are rushed to hospitals and police stations, survivors of acid attacks need immediate and special first aid. As a first step, place the wound under running water while removing acid drenched clothing as fast as possible. If the victim is in shock, she must be laid on her back and kept as warm as possible. No ointment should be applied to the wound. If the victim has swallowed acid — as Preeti Rathi and the girl on Gorai beach had — she must be made to drink milk immediately unless she is vomiting or convulsing.

In a chilling cellphone video clip taken by one of the bystanders at Gorai beach moments after the attack, the girl in the green salwar kameez receives no first aid at all. A uniformed officer is seen rushing her to Thunga Hospital in an autorickshaw. Even as she tries to brush the sand off her face, she cannot touch her swollen mouth.

“Would you marry an acid-scarred person?” Dr Keswani asks, and before I can offer any statements about unconditional love, he says, “I wouldn’t. You can choose to marry them from a sense of unshakeable commitment, but you don’t realise that a severely scarred person’s psychological wounds can never heal. I frequently counsel survivors not to misconstrue innocuous statements as personal attacks or jibes. It is worse if you once considered yourself good-looking.”

This bleak picture he offers of a survivor’s world is belied, to some extent, by Neeta Tripathi, a Mumbai-based activist who works at a shelter for acid attack survivors. On her husband’s birthday this year, the girls from the shelter took Mr and Mrs Tripathi out for lunch at the posh Bandra deli Eat Around The Corner. The staff refused payment for the meal, and everyone at the deli came up to them for a chat or a photograph. Whenever the girls have gone out for a meal together in Mumbai, in fact, restaurants have treated them with particular consideration. But a walk near the sea, says Tripathi, is an impossibility. “I guess people who come to see sunsets don’t want to see these scarred faces. Everyone at Bandstand shut their eyes when they saw us coming. After that, I decided never to take them on walks.”

Last November, social media networks were abuzz with news about Jerrit John, a well-to-do owner of a production house in Mumbai who flung acid on his girlfriend’s face after an argument. She had discovered that he was married and had a five-year-old son. John allegedly barged into his girlfriend’s house, attacked her and her friend, and locked them in so they could not seek help. Recently, John’s lawyer asked that the ‘attempt to murder’ charge against him be dropped. “I never intended to kill her,” John said in his statement, “only to disfigure her so that she could never be with anyone else.”

Helpline volunteers in New Delhi, Alok Dixit of Stop Acid Attacks and Dr Keswani, all vouch for the fact that nearly 98 percent of acid attack cases involve spurned lovers seeking revenge. In truth, most survivors, such as Sapna and John’s ex-girlfriend, admit that these ‘lovers’ were frequently abusive prior to the attack, often resorting to physical violence and intimidation, which the women unfortunately chose not to report. The girl from Gorai beach, a minor — reported to have been betrothed to Jitendra Sakpal, a claim her parents categorically deny — wrote in her statement to the police (in a neat, beautiful hand) that Sakpal had stalked and harassed her for months before the attack, and had beaten her in public on several occasions. “Mere upar hamesha nishaan hote the” (my skin was always bruised), she wrote to Tripathi when she visited the hospital.

To learn more about skin donation, contact the National Burns Centre at 022- 27793333 or visit www.burns-india.com

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