Rare recovery for acid attack victim in Cambodia

Cambodia is among a small group of countries, which also includes Pakistan and Bangladesh, that have a history of acid attacks being carried out as an extreme form of revenge, with the intention to humiliate and debilitate rather than kill.

In 1996, Tes Pha was doused with liquid acid by a woman who suspected Tes was having an affair with her husband. The acid severely damaged much of her face and upper body, and blinded her. Her prospects for recovery seemed limited to preventing further deterioration — scars from acid burns contract, causing further pain and immobility unless they are operated on regularly.

In April, however, in an effort to restore vision in her left eye, the 53-year-old received what is likely the first cornea transplant for an acid attack victim in Cambodia.

Cornea transplants are rare in Cambodia, where the cost of sourcing a healthy cornea is well beyond the average annual salary of most people, organ donor banks are non-existent and surgeons capable of carrying out a transplant are few.

Indeed, her transplant was possible because an Alaska-based ophthalmologist, Kevin Winkle, brought a cornea from the United States and led the operation. He was on a medical mission for Surgical Eye Expeditions (SEE) International, a California-based non-profit group that organizes trips for experienced surgical teams to carry out operations and training in countries where surgical expertise is limited.

Acid attack victims are unlikely candidates for a cornea transplant because the surrounding eye tissue — the limbal stem cells “where the white part of the eye meets the clear window,” as Winkle describes it — required to bind to the donor cornea are usually too severely destroyed for it to be feasible.

“Most of the folks I saw had so much damage and scarring in that area that I had to assume that a graft could not heal and last,” says Winkle.

In 1996, Tes Pha was left blind after being doused with liquid acid. But in April an American surgeon successfully performed what is likely the first cornea transplant for an acid attack victim in Cambodia.

Image courtesy of © Brendan Brady

Tes was selected for surgery because she appeared to have sufficient stem cells for the transplant to succeed. But once the operation began, worrying signs emerged, says Soeung Soryoun, a Cambodian ophthalmologist who assisted in the procedure. “We saw there was so much scarring so at first we though there weren’t enough stems cells.”

However, two months after her surgery, her left eye has mostly “accepted” the new cornea and she has regained some vision.

Statistics on acid attacks in Cambodia are unreliable since many cases go unreported. The Phnom Penh-based Cambodian Acid Survivors Charity, a nonprofit group that houses and provides medical care for victims, recorded 12 to 24 attacks annually for most of the past decade (www.cambodianacidsurvivorscharity.org).

Used for clearing drains, agricultural processing and fueling the car batteries that most rural communities rely on for power, acid is widely available in Cambodia. New legislation lengthening prison sentences for perpetrators and regulating the sale and use of acid has dramatically reduced the number of attacks. So far this year, only one case has been reported to the survivors’ charity.

But the legacy of acid attacks remains in the scores of Cambodians suffering in invalided condition and requiring ongoing treatment. The cornea transplant was the third surgery Tes has received in as many years: she only started accessing the survivors’ charity services in 2011; she has since undergone operations to remove contractures on her arm, neck and eyelids. Doctors say she will undergo a third neck contracture surgery once she has recuperated from her cornea transplant.

“There have been many surgeries,” says Tes of her incessant turns on the operating table in recent years. “But I’m now able to work at home — to clean and wash — so I feel much better.”