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A crack team of surgeons and clinicians at UHN have given Popi Rani Das the ability to breathe normally, taste, eat and drink for the first time in eight years, offering her hope for a better life when she returns to Bangladesh in the weeks ahead.
The 29-year-old woman was left for dead eight years ago after she drank clear, odourless acid in a cup given to her by her then-husband who claimed her dowry was too meagre. Defying the odds, Popi survived, although with a severely damaged airway, throat, esophagus (gullet or food pipe) and stomach.
She had 10 corrective surgeries performed by doctors in Bangladesh, with little improvement.
Relying on a feeding tube inserted into her stomach for sustenance, and on her mother for company, she subsisted, barely breathing, for seven years, in a windowless, dark corner of an Acid Survival Foundation Hospital in Dhaka, Bangladesh.
Dr. Toni Zhong, Director of the Breast Reconstruction Program at UHN, chanced upon Popi while on a humanitarian mission to treat burn victims in Bangladesh.
"She was a shadow of a person, thinking that nobody could help her," recalls Dr. Zhong, who is also the Belinda Stronach Chair of the UHN Breast Reconstruction Program.
"I knew if I did not do anything then and there, then nobody would. And I also knew that I had strong teams back at UHN who could help."
Dr. Zhong studied Popi's medical files and promised her she would help, calling on the expertise of the world-renowned head and neck reconstructive and thoracic surgeons at UHN.Other hospitals,even in neighbouring countries, either did not have the technology and specialized knowledge required to help Popi, or did not want to take on the challenge.
After an intensive fundraising campaign for the UHN Helps fund, Dr. Zhong and the La Fondation Emmanuelle Gattuso, Policaro Automotive Family,and Gary and Donna Slaight raised $650,000 to pay for Popi's expenses at Toronto General Hospital (TG).
All of the surgeons and anesthesiologists donated their services for free.
Dr. Inge Haselsteiner, a German anesthesiologist who was part of the humanitarian mission in Bangladesh with Dr. Zhong, was so moved by Popi's plight she raised $41,000 with her sister-in-law Christa Wunsche to help pay for Popi's non-hospital costs, such as transportation, medicine and food.
The Bangladesh Minority Rights Alliance was the local host for Popi and her mom, providing housing, food and transportation to and from the hospital.
When Popi and her mother, Ajanta, arrived in Toronto on Feb. 15 of last year, Popi weighed about 36 kilograms (80 pounds), was severely dehydrated and malnourished, and had no winter clothes. She was admitted to TG.
Dr. Ralph Gilbert, Department Head of Head and Neck Surgery, UHN, and the surgical lead for all of Popi's surgeries, is one of the world's foremost leaders in rebuilding the face and neck of patients ravaged by tumours, using patients' own blood vessels, bone, tissue and skin from other parts of the body.
"We know how to solve problems in reconstructive surgery," Dr. Gilbert says. "We do this all the time with cancer patients. We innovate.
"How could you say no to someone living in that environment? We always want to help. That's our culture."
Adds Dr. Zhong: "If anyone could do this, it was Dr. Gilbert and the team of surgeons, nurses, speech pathologists, social workers and other clinicians who work with him and his patients.
"He has that rare combination of chutzpah, technical skill and heart."
Popi's first surgery occurred on Feb. 24, nine days after her arrival. In the two-hour surgery, Dr. Gilbert used the minimally invasive techniques of laser surgery with a microscope to precisely cut away the built-up scar tissue in Popi's airway – enlarging it from that of a straw to near-normal size, that of a quarter.
UHN Helps – Care for more patients in need
He also got a chance to assess the extensive damage done by the acid, which had burned its way down Popi's throat, gullet and into her stomach. Most of these structures were vaporized and would have to be reconstructed from Popi's own tissues and skin.
Working with UHN head and neck surgeon Dr. David Goldstein and thoracic surgeon Dr. Gail Darling, Dr. Gilbert mapped out a creative and technically challenging solution – one that is done at TG only about five to 10 times a year.
The first part involved reconstructing a new throat for Popi from skin taken from her forearm. The skin, measuring 10-centimetres (about four inches) in length, was shaped into a 3-D tube around a stent so that it would heal into a tube shape to connect the back of her mouth to her gullet.
The team closely monitored this new connection for six weeks, wanting to make sure it worked properly, and no food or liquid seeped into her other tissues or airway before going ahead with more surgery.
"This was new for Popi because she had not swallowed for almost a decade," says Elana Aziza, the speech-language pathologist who worked with Popi for months, training her how to swallow without choking, and to power her food right through to and down her new throat.
"We needed to get Popi's tongue working extra hard, and work with our dietitians to make sure she was getting the right composition of calories, proteins and nutrients."
The final reconstruction took about seven hours. It is done in only the most highly specialized centres in the world on patients who have had a traumatic injury to their gullet, and use a feeding tube for nourishment. TG has done only about 10 of these in total.
The procedure uses tissue from one part of the body to replace the gullet, repairing the food conduit from the throat to the stomach, giving patients back their ability to swallow and eat.
In Popi's case, Dr. Darling and team used part of her intestine, which is similar in width and flexibility to the gullet, to snake it upwards under her breastbone, bypassing her stomach completely since most of it was destroyed. They then connected the segment to her new throat, painstakingly reattaching the blood arteries and veins under microscope to her neck and chest so the transplanted tissue would live.
"Our program focuses on esophageal reconstruction, reducing complications and improving quality of life after surgery, and we know that this has made a difference to our patients," says Dr. Darling.
Adds a smiling Dr. Gilbert: "We are elated at how well it all functions together.
"Basically, we recreated most of her digestive system."
Dr. Gilbert notes Popi will not need further medical intervention after she leaves TG.
He credits Popi's spirit as well as the strong team he has gathered around him which works with some of the most complex cancer patients in reconstructing their faces and necks to achieve normal function and appearance.
"Popi has a will to survive and live in the face of adversity which is remarkable," Dr. Gilbert says. "That spirit drove all of us to help her."
Shobha Sawh, the social worker who has been helping Popi overcome her trauma and become independent, agrees.
"I have seen astounding progress in Popi," Shobha says. "She has found her voice, and wants to use it to tell her story and help other women.
"She is ready for a new phase in her life."
Popi nods her head in agreement.
"I think if my story gets out, it will help a lot of people," she says through an interpreter. "I want people to learn and be aware of acid attacks.
"Thanks to the work of Dr. Gilbert, Dr. Zhong, Shobha and everyone in the hospital, I have a strong, clear voice to tell my story. And, for the first time in years, I can now taste and eat my favourite ice cream and chocolate cookie!"