Tes Pha had not seen her family since that morning in 1996.
She was cooking breakfast in the yard of her house in Battambang province’s Banan district. Out of nowhere, she felt liquid pouring over her head.
The liquid was acid. The attacker was a woman suspicious of Pha’s relationship with her husband.
After the attacker ran away, her mother poured bottle after bottle of water on Pha’s head to ease the burning pain – it did not help.
“My hair fell off; my skin from head to toe changed,” she said, recalling that day. “I did not see anything around me.”
Because acid attackers generally aim their deadly weapon at a victim’s face to cause the most harm, eyes bear much of the damage. On average, one in four victims who seeks treatment through the Cambodian Acid Survivors Charity (CASC) is partially or fully blind.
After receiving some help from a local hospital, Pha came away with severe burns. Her husband had died two years before, and she was alone with her five children. Pha negotiated an out-of-court settlement with her attacker, who continues to give her money to this day. She was completely blinded in the left eye. Her right eye, while wholly destroyed, retained the ability to shed tears.
Pha, 53, started receiving better treatment for her scarred skin in 2011, with the help of CASC and the Children’s Surgical Centre in Phnom Penh. She improved, but didn’t conceive of getting her vision back.
Last month, however, she was one of the first acid attack victims in Cambodia to receive a successful cornea transplant. For the first time in almost two decades, she can move around on her own, cook for herself and, most importantly, see how her kids have grown.
Sitting on the second floor of the centre yesterday, in a room painted with idyllic murals of peaceful, rural life, she tried to describe how she once viewed her children.
“I only saw their shadows in my eyes for 17 years,” she said.
Her 33-year-old son, Da Chan Dern, sat by her side.
When asked what his mother did upon first seeing him, Dern said she responded with a jibe. Pha told her son she was surprised he had not grown taller in all these years.
She can see
Shaped like a tiny dome and situated in the centre of the eye at its outermost limit, the cornea is a sliver of connective tissue that performs functions similar to a window. It protects the eye from germs, dust and ultraviolet rays, refracting light onto the lens and sending it to the retina, giving vision its focused quality.
Though cornea transplants are relatively common in the US – according to the Eye Bank Association of America, since 1961, more than one million men, women and children have undergone the procedure – access to the surgical technique is harder to come by in Cambodia.
Corneas, like livers, kidneys and other donated organs, are extracted after death, and in the region, the practice is all but non-existent for cultural reasons. Discounting the cost of an operation or associated medical bills, meanwhile, one cornea can cost about $2,000 - more than double the average annual income.
Pha had her surgery on a Tuesday, but the journey to bring her and another acid attack victim’s new corneas to Cambodia required a team effort that started a few days before and a continent away.
SightLife, a nonprofit eye bank in Seattle, Washington, provided the corneas. The American eye surgeon volunteering to lead the procedure, Alaska-based ophthalmologist Dr Kevin Winkle, enlisted his partner’s son, Sam Werner, a medical student, to make the pick up. After retrieving them from SightLife, Werner boarded a plane to Phnom Penh on Saturday, April 20. His carry-on? Two corneas in an ice-packed Styrofoam cooler.
Werner arrived on Sunday, met up with Winkle, and the two operations took place on Monday and Tuesday.
Pha’s procedure lasted about two-and-a-half hours. After using an anaesthetic, Winkle and Soeung Soryoun, an ophthalmologist at the Children’s Surgical Centre who assisted with the procedure, took a trephine, a cookie-cutter-like instrument, to remove the damaged cornea. They replaced it with the donated one, stitching the tissue together with sutures.
A day later, Erin Bourgois, a project manager with the acid survivors’ charity, showed Pha photos of herself. Pha started to cry. “I think there were mixed emotions, seeing her scars and her disfigurement,” Bourgois said. “It wasn’t a sad cry; it was a happy cry.”
Soryoun, the ophthalmologist at the surgical centre, said Pha took a good look at him after her bandages were removed.
“She has never seen me before and then this,” he said. “She said I have a beautiful face.”
The next step
After the cheer, reality sets in. The fact is, acid attack survivors are not ideal candidates for transplants. The acid has wrought too much damage to the eye and its stem cells, and the presence of blood vessels – which move in to help the wound – increases the chance that the eye will “recognise” the cornea as a foreign object and reject the graft.
“There’s hope that there never was before, but at the same time, you have to be careful in playing up how wonderful this is,” Winkle said. “The acid that they use is about as strong as it gets, it just burns right through tissue . . . it’s like taking a blow torch to their face and to their eye,” he said.
“I’m still talking a flip of the coin that that graft is going to last the next year or two years.”
The other woman who underwent the cornea transplant is not experiencing the same improvements as Pha. One day her vision improved, the next day it regressed. And Pha’s vision is more blurry than clear, though it could yet improve.
Other blind candidates with the acid survivors’ charity were rejected out of hand after photographs revealed irrevocable damage. Sam Bunnarith, a 42-year-old who was blinded in an acid attack in 2006, was one of those deemed ineligible.
“I haven’t gotten the surgery yet,” he said, uncertainly. “Maybe next year, I can get the operation.”
Pha is thinking about the future too. Later this month, she’ll have the chance to see one of her sons getting married. “I think that this is my new life, to see my children’s faces and see everything in the world around me,” she said. “I’m waiting for May 18, the date of my youngest child’s wedding party.
“I wait to reach those days soon.”