It's a recent day at the American Medical Center (AMC) and a beautiful young woman

is lying on the operating table shuddering with sobs.

Days earlier she was injected in the shoulder with a syringe full of acid. The disfiguring

chemical was still melting tissue, muscle and bone, and her hysterics were drawn

from desperate terror and unspeakable pain.

"When she came in her arm was already rotten and smelled terrible," said

AMC director and surgeon Dr Reid Sheftall. "What they injected into her was

eating her arm away," he said. "It was severely 'necrosed,' and at that

point, we could only do so much."

The nightmare started with an unwanted tattoo. To remove a swirling 20-cm design

drawn high on her right shoulder, she took the advice of a friend and searched out

the backroom services of a neighborhood hairdresser. The "beautician" was

kind enough to administer a mild painkiller before proceeding with the ghoulish operation.

"She had gone to a non-doctor who tried to get rid of her tattoo with acid.

It looks like someone re-tattooed her arm and instead of ink used acid. The result

was a mistake that severely disfigured her arm," said Sheftall. "They gave

her some kind of local anesthetic - probably either lydocaine or novocaine. After

a few hours the pain must have been unimaginable. It's outrageous what I've seen

here."

A surgeon specializing in burn treatment, Sheftall says what he has seen in six years

in Cambodia is both unbelievable and bloodcurdling. He once did extensive reconstruction

of an electrician who had sat on an ungrounded circuit box and blew his entire right

buttock off. Another time he performed emergency after-hours surgery in a shower

stall, deep inside a derelict Phnom Penh housing complex, on two women who had been

splashed with acid.

"Their flesh was coming off like wet tissue paper," he said. "They

needed treatment immediately and the only running water was in the shower. During

the acute phase of a burn, doctors must engage in debridement and provide antibiotics

- or conditions will become much worse."

Since opening the AMC in 2000 - a 24-hour private clinic staffed by himself, three

Cambodian doctors and an Iraqi - Sheftall has performed more than 50 burn reconstructions

- half caused by the horrific effects of acid, but many by electrical accidents.

"There's no zoning for electrical work - and some people use acid as a weapon,"

Sheftall said. "This is the burn capital of the world."

Sheftall, 49, who was educated in physics at the Massachusetts Institute of Technology

then switched to studying medicine at the University of South Florida, has made it

his life's work treating and rebuilding the scars left by second, third and even

fourth degree burns. He learned his skills at the Shriner's Burn Hospital at the

University of California, Los Angeles. But his appreciation for the field came even

sooner, when he was a "resident" (graduate trainee doctor) in Cleveland,

Ohio.

"I knew I wanted to specialize in burns when I was a resident," said Sheftall.

"One of my first patients was a burn victim, and we still keep in touch."

For the last six years, Sheftall has witnessed first hand a Cambodian medical community

woefully untrained and ill-equipped to treat burn injuries. Shaftell said proper

treatment in the acute phase of a burn injury could mitigate the long-term scarring

so frequently seen in Cambodian burn victims. But finding adequate care during the

initial stage is almost impossible.

"It's a lack of training and supplies. - you have to know what to do,"

Sheftall said. "I recently had a patient with acid burns on her face and they

wanted to wrap her head in bandages. That's the last thing you want to do. It can

be awful."

To illustrate the error, Sheftall described how several years ago he was asked to

treat a young female patient whose poor treatment at the acute stage had left her

with a shocking disfigurement.

"She came when she was 15, and she'd been burned when she was 10. A local NGO

found her near Sihanoukville. She had sustained burns on most of her upper body from

the oil in a lamp that exploded," Sheftall said. "But the scarring had

fused her arms with her torso. The doctors had wrapped her up like a papoose - she

couldn't even brush her hair."

Through a lengthy surgical process, Sheftall and his team eventually were able to

free her upper body.

"It was a major operation. We took down her scars and freed her arms from her

ribcage," he said. "We took skin from her legs to cover the wounds created

by freeing up her arms."

Sheftall, who recently was retained as a technical adviser during a visit by the

popular British television drama Casualty, is pleased to hear of advances in Cambodia's

burn treatment facilities and excited to pass on his expertise to a new crop of young

doctors.

"Burn surgery is rewarding because people's appearance is so close to their

self-identity," Sheftall said. "If you can restore the appearance of someone

functionally or aesthetically, you're really giving them a second chance in life,

especially if they're a child."