In February 2012, 53 year-old British-Pakistani surgeon Mr Mohammad Ali Jawad will travel to Hollywood to attend the Oscars. The documentary film 'Saving Face', which chronicles his work with acid-burn victims in Pakistan, has been nominated for an Academy Award for Documentary Short Subject. Directed by Sharmeen Obaid Chinoy and Daniel Junge, 'Saving Face' follows the personal stories of two acid attack victims: their battle for justice and their journey of healing as their faces are reconstructed by Jawad.
Hollywood is a long way from Dow Medical College, Karachi, where the young Jawad first decided he wanted to be a plastic surgeon. "Because, I must admit, I thought there was so much glamour attached to it. I thought I'd end up with Hollywood actresses lining up to be treated by me. And I thought life would be easy, because beautiful people don't need much work, just maintenance stuff. But I must have been at the wrong place at the wrong time because that's not what I ended up doing and I very soon realized that it was very hard work".
Hollywood is a long way from Dow Medical College, Karachi, where the young Jawad first decided he wanted to be a plastic surgeon
Disarmingly honest and almost childlike in his enjoyment of the public recognition he has received, Jawad's story of ordinary-boy-made-good is probably as much a surprise to him as to anyone else because he was not the most promising of students: "I had very basic schooling at Happy Days School - the very name was an embarrassment to us." But nevertheless he managed to get into Adamjee Science College and subsequently to Dow Medical College, failing several exams on the way partly due to the distractions of his active social life. "I was not a social animal, I was a social monster", he recalls. "Karachi in those days was a very benign place. In those days Dow was at the heart of student politics and I was politically active, on the left of course, with the NSF. We were very progressive and had no time for mullahism. Because we were Muslim - said our namaz and read Koran and kept our rozas - we did not need a bunch of idiots to tell us how to live our lives. The best thing was there was no violence. We had thriving discussions. We'd have lots of arguments. We would disagree - but that would be the end of it."
But it was not long before Jawad began to pursue his medical career in earnest: "I realized that in order to achieve, I had to focus." So after graduation, he went to the UK in 1985 to sit for Part 1 of the FRCS exam. He passed at the third attempt. "Failing the exam twice made me realize how inadequate the medical education I had received in Pakistan was. I had to turn it around for myself so I had to work much harder to overcome my weaknesses."
"I was not a social animal, I was a social monster"
After passing Part 1 he returned to Pakistan in 1986 to Jinnah Hospital for his training period. "I realized how much we had to learn in order to do some decent work. Our resources were poor, training was zero and patients had to wait for months and months to get treated because plastic surgery was such a low priority. So burns patients with even 20% burns were dying all around us."
Dow Medical College, Karachi
People often say that doctors in Pakistan get experienced very quickly because they see twice as many patients as doctors in Europe or the USA. "Rubbish," says Jawad. "You get bad experience. You pick up bad habits, big time. Because there's nobody to correct you. Even the guy that's training you has got bad habits. So these bad practices continue to be perpetuated; you just can't get rid of them. If you're lucky, which I was, you may have good mentors. Prof Mushtaq Ahmed at Dow and Mumtaz Mehar and Irshad Waheed and Faiz Mohammed Khan at Jinnah, were superb. But I had also seen some terrible surgeons in Pakistan. If you operated like that in the UK they'd take away your license".
In 1990 Jawad made his way to Ireland to complete his training prior to sitting for the FRCS Part 2 exam. It was a professional culture shock. "In Pakistan, we didn't even know how to scrub. There is a method to it. But we didn't even have enough water half the time. So while we had read about western medical practice in books, we had hardly ever experienced it. MRI and CT scans we had never ever seen, so we had a very limited understanding of what was involved, mostly just learned from text books. So when I came to work in the UK a nurse had to teach me how to scrub. Another thing I learned from working in the west is how important nurses are."
"I had also seen some terrible surgeons in Pakistan. If you operated like that in the UK they'd take away your license"
But the main difference was in the attitude to the care of patients. "Once when I was a junior doctor I had attended a young boy patient and was asked by the senior registrar how I would proceed with his care plan. And I gave some aein-baein ka answer without really thinking. And he put me on the spot. He said, "Would you do the same thing if this was your son?" And I was stunned and shocked that I had not thought about it. And I said "no". And he said, "Then why would you treat your patient differently?" And I got the message. And from then on my whole attitude to medicine and surgery was the same across the board for whoever I treated."
After passing his FRCS Part 2 exam in 1992, Jawad quickly pursued further training in plastic and reconstructive surgery at some of the best institutions in the UK under some of the most skillful surgeons.
At the Ulster Hospital in Belfast he learned to deal with Plastic and reconstructive Surgery in Trauma situations. The various political paramilitary groups meted out gruesome punishments like "knee-capping" and "crushing hands" to those that betrayed them. Injuries from booby traps which resulted in severed limbs were also common. "So my first exposure to the plastic surgery world was a huge variety of trauma cases and reconstructive surgery. My boss, Alan Leonard, was the president of BAAPS (British Association of Aesthetic and Plastic Surgeons). And he had such high standards. And he was such a wonderful teacher. He taught me how to stitch and how not to stitch".
Katie Piper was a beautiful young model who had acid thrown in her face at the instigation of an ex-boyfriend. Badly scarred, she told Jawad she didn't want to live if she looked horrible
In 1994 Jawad joined the staff at the world famous Burns Unit at Birmingham General Hospital which was at the forefront of Burns Trauma Surgery in the world. "We used to save 70% of the lives of burns victims whereas in Pakistan it was closer to 15%." Jawad was keen to specialise in burns because he knew that at some point he would want to return to Pakistan and thought it important to develop areas of expertise that would be useful there.
"I trained mostly in regional trauma centres. Big responsibility. Big teams. So in a sense I was very lucky. I trained with the best including Mr Fatah at Wordsley Hospital in Birmingham also a president of BAAPS."
It was a chance meeting with Mr Fatah at a conference in 1998 that brought Jawad back to Pakistan. Fatah was going to Pakistan with a team of surgeons to perform cleft palate surgery. Jawad went along to Lahore as a junior member of the team and realized how important it was, not only as a humanitarian enterprise but also as a skills transfer exercise. It made him aware of the requirements and limitations of the country and he returned several times with surgical teams in the following years.
'Saving Face' chronicles Jawad's work as he travels to Pakistan to treat survivors of radically disfiguring acid attacks, the majority of whom are women targeted by family members
In 2005 Jawad organised a major medical relief effort to help earthquake survivors in Pakistan who had been the victims of trauma. Over two months multi-ethnic teams of UK plastic surgeons visited Pakistan on a rota basis to perform limb salvaging and reconstruction surgery. A unit was set up in Al-Shifa hospital in Islamabad for this purpose for two months comprising three theatres and 100 beds. The unit treated 250 patients in the space of 7 weeks while at the same time imparting training to Al-Shifa medics.
But it was an incident in 2008, while he was a Consultant at the prstigious Chelsea and Westminster Hospital in London, that brought Jawad to the attention of a wider public. Katie Piper was a beautiful young model who had acid thrown in her face at the instigation of an ex-boyfriend. Badly scarred, she told Jawad, who attended her, that she didn't want to live if she looked horrible.
"Historically on the face you let the skin heal itself and then do skin grafts. But the results are not particularly good, leave terrible scarring and it takes a long time." Jawad re-constructed Katie's face using a pioneering technique that involved using a second-generation artificial skin called MATRIDERM® as a dermal filler in combination with skin grafts. The entire face was re-constructed in one-stage procedure. "I was sure it would give better results than the traditional procedure. We documented everything." The results were astonishing and Katie's entire journey was documented in a Channel 4 documentary, "My Beautiful Face", which aired in 2009 in which the patient lauded Jawad as "my hero".
Building on his success with the procedure, Jawad looked to extend his skills to acid burn victims in Pakistan. In 2009 he teamed up with the Depilex Smile Again Foundation and the Indus Hospital in Karachi to undertake the project. Being interviewed about it by the BBC World Service brought him to the attention of American filmmaker Daniel Junge, who approached Jawad about making a documentary. 'Saving Face', the film that came out of that collaboration (and is now nominated for an Oscar), chronicles Jawad's work as he travels to Pakistan to treat survivors of radically disfiguring acid attacks, the majority of whom are women targeted by family members. The film will be broadcast in the USA and UK in March.
"I may not be a very good Muslim but I always say my fajr prayers and this has always been my prayer, that let me be useful in society..."
The public recognition that followed the airing of 'My Beautiful Face' has catapulted Jawad to celebrity satus in the UK, something he clearly enjoys, even if he's a little overawed by it. He was invited to Buckingham Palace and No 10 Downing Street. At No 10, "I wanted a pee and was shown into the Cabinet Room. And there was the PM's chair. And they let me sit in it and I swiveled around. Can you believe it?!! And I peed in the toilet where Churchill had! Voila! It can't get any better than that!"
Jawad could be accused of self-promotion. He has a PR company championing his interests as well as a Facebook page and Twitter feed. Some would argue that is incongruous for a medical man. But Jawad insists that his celebrity status has provided him with the public platform he needs to pursue his humanitarian work. Public recognition gets him into the corridors of power and helps him disseminate his message: "Let me speak honestly. I may not be a very good Muslim but I always say my fajr prayers and this has always been my prayer, that let me be useful in society... And I feel very strongly that we doctors in the diaspora need to take responsibility for society in Pakistan; because what we have done is that we have benefited from the education system; we have enriched ourselves but we never gave back to society. In the past people who studied abroad went back. There wasn't a "brain drain", there was "brain circulation". But that doesn't happen anymore... So my message is very simple: I feel that being born in Pakistan is like being born in a family where some of its members have learning disabilities. I have two options: I either run away, say to hell with it, or I own up to my responsibilities. And in the current scenario, that family needs us. It's not enough to send money. Skills transfer is important. So I want to use the public recognition I have received to convince my fellow expatriate professionals, be they doctors or engineers, that some part of their lives should be spent working in and for Pakistan."
But the humanitarian surgeon is also a fun-loving social animal, as excited as any teenager about going to the Oscars. The promise of Hollywood glamour which he dreamed about as a young man deciding to specialize in Plastic Surgery has finally come to pass in a roundabout way. "It's fate," he says. "An interesting paradox anyway."