Eman Ahmed Abd Al Aty, a 37-year-old Egyptian national has been under my direct care from February 11, 2017.It is not the eyes that are blind, but the hearts.
- Qur’an 22:46 I write this today to place in perspective a medical case that has captured the interest of people from all over the world. Over the last week or so, Eman’s sister, Shaimaa, has spoken, and the media has reported, a few untruths. In any medical case, doctors are faced with anxious relatives. As doctors, we understand the anxiety of close relatives, but we have to focus on patient care and doing what is best for the patient.
I am grateful to the media for all the support shown on this case. I also understand the need for the media to carry different points of view in the interest of balanced reportage. However, since this is a medical case, it is important to distinguish plain opinion from informed opinion.
Eman is expected to leave Indian shores in the next 24 hours, but cannot speak for herself. In lieu of Eman speaking, Shaimaa has become the default spokesperson for the patient and while she can speak as a patient’s sister, she is not equipped with scientific data and medical information.
Fact: Almost three months ago, when Eman was flown to Mumbai, we got a cargo plane custom-fitted with medical equipment to fly her. She weighed 500 kgs, had multiple health risks including severe uncontrolled hypothyroidism, right-sided heart failure, kidney and liver failure, obstructive and restrictive lung disease, gout, bed sores, urinary tract infection, right-sided paralysis and inability to speak coherently or swallow liquids.
She had not walked in more than 25 years .
Today, her weight is 176 kgs (down 324 kgs), her thyroid levels are controlled, her kidney and liver tests are as good as any of us, her lung functions and oxygen levels are normal without any need of external oxygen. She leaves India the healthiest she has been in the last decade or so.
So what is her sister’s grouse?
Shaimaa has a dream to see her sister walk and I pray that turns into a reality, I would be the happiest to see that happen, unfortunately the orthopaedic odds are stacked against Eman. Orthopaedic Surgeon Dr Satish Modi on our team of doctors treating Eman has stated that “The orthopaedic surgeries for Eman shall be much more difficult than her bariatric surgeries. Her bone structure is poor, it is fibrous instead of bony, so many years of disuse have compounded the problem, she will need multiple surgeries to straighten her hips and knees. And even after that, I doubt her musculature can support her ability to walk.”
Eman Ahmed Abd El Aty, who previously weighed around 500 kilos, had not left her house in Egypt in over two decades
Shaimaa insisted she had wanted the hospital to keep Eman till she could walk and the management said that was not possible because of the advice we have received from one the foremost orthopaedic surgeons in the country.
Shaimaa then said she has been promised by Burjeel Hospital officials that Eman will be able to stand and walk soon. We told her we would not over-promise and we would not put the patient at risk. This is the crux of her issue with the Indian doctors and hospital.
Shaimaa’s response has been to release morbid videos on social networks, making allegations against me and the rest of the medical team and waging a trial by media. The medical team’s response has been to stay focused on the well being of the patient.
There is a camera in Eman’s room that records every movement 24/7. That camera is linked to my phone, and since Eman was brought to Mumbai’s Saifee Hospital on February 11, 2017, that link is the first thing I check in the morning and the last thing I look at every night, apart from the frequent personal visits I make to see Eman every day.
Our focus is, and will always be, on patient care. We did not feel obliged to defend the false allegations made in the media primarily because they were false. The only time I broke my silence was to speak to the Egyptian media, to defend the Indian medical fraternity at the behest of the Egyptian Ambassador to India. And I also did it because thousands of Indians have prayed for Eman and so many of them have contributed to the BitGiving campaign to help raise funds for Eman’s travel and medication (the surgery was done pro bono and most of the medical team worked on a pro bono basis as well, but the costs involved in transportation and medication alone are substantial and we are happy to share audited reports detailing money raised and expenditure incurred).
In September 2016, worldwide media reports surfaced that a woman from Egypt weighs 500 kg and is arguably the heaviest woman on the planet. Till that point in time, I did not know of Eman Ahmed.
In late September 2016, I was approached with a request to treat Eman via a letter from her sister Shaimaa. A fellow doctor from Saudi Arabia who introduced us had previously asked me if I would consider taking Eman under my care, as a leading bariatric surgeon. I said yes immediately, both on humanitarian grounds and because, as a doctor who could have helped a dying woman leading a miserable life, who had been confined to her bed for 25 years, I could never have said no.
I made two trips to Alexandria to see Eman and her family. An Egyptian team had also reached out to Shaimaa separately. The choice, and the decision, was clearly hers, Shaimaa chose to come to Saifee in Mumbai.
Eman Ahmed was flown to Mumbai in a specially modified Airbus for treatment
Eman’s family and I were in touch for months without anyone knowing - even members of my own team were not aware of Eman for many weeks in the beginning. The media learnt of this case when I was compelled to reach out via Twitter to Sushma Swaraj, the Honorable Minister of External Affairs, to request her to help us get Eman a visa to come to India. I had to do this because Eman was refused a visa since she could not leave her house to complete formalities. I was very impressed and grateful for the minister’s intervention and prompt action. She has stayed in touch to follow the case to this day.
To all those who feel that me, my team of doctors and the administration of Saifee Hospital have used Eman to gain publicity, I just wish to say that the public nature of the case required us to communicate with the media and via the media with the general public. We did not take up the case for publicity. We took it up, as with all cases, to save a life.
While we have been open with our communication, we are also sensitive to the need for patient confidentiality. Given the rare nature of this case, there is a lot of interest in it from the global medical community and a need to record it for posterity so that medical science and other patients can benefit from the learnings. Also given that the governments of India and Egypt have been so supportive, we have been very particular about all the paperwork and disclosure norms pertaining to the case. It is sad that the patient’s sister has released videos that are in violation of the very patient confidentiality norms that were mutually agreed.
We started a blog on which we have shared regular medical updates as and when feasible and relevant, which the press could access at any point. The facts have always been in the public domain. There is no manipulation of facts as alleged. And there is medical data available to support every fact.
When I first examined Eman’s records in details, I made the only promise that a bariatric surgeon could. The treatment would have to be in phases, given the immense complications involved. I promised – and this is also on record – that I will do my best to reduce Eman’s weight by at least 200 kgs, and help her sit up in phase one, which I estimated would take anywhere between three to six months. We achieved this goal in three months and trust me when I say that no one has been more surprised and delighted by this than me. A number of the most qualified specialists from across the world have worked with my team and me to achieve this, and Eman has responded so well to our treatment. Instead of being celebrated, this milestone is now being used against me.
Shaimaa is not being truthful when she says that I promised to make Eman walk and that I am reneging on this promise. I promised her a healthier life and weight loss which I have achieved . I am not an orthopaedic surgeon, but a bariatric surgeon.
Please remember that when Shaimaa chose to come to us in Mumbai, Eman weighed 500 kgs, and was five feet wide. This meant that we had to charter a special cargo plane, and fit it with medical equipment. In order to get her to the airport, we had to break down a wall in her house and have her lifted out of the room using a crane. None of this was simple and none of it was without risk. We managed to get it all done. The hospital had to build a special room for Eman to accommodate this equipment because it could would not fit through any regular door or elevator of most hospitals in the world.
Eman Ahmed was treated at Saifee Hospital in Mumbai where she underwent a weight loss surgery
A Citadel Plus, a special bed with a built-in weighing machine that can support up to 550 kgs was specially flown in with help from ArjoHuntleigh, the company that manufactures these beds, and who very generously gave us one pro bono, to support Eman’s treatment. She could not stand, which means that weighing her was an incredibly complex process unless done on a bed. I am specifying all of this because we have been accused of not weighing Eman. After her significant weight loss, she was moved to a much smaller bed designed by Hill Rom, which, again had an in-built weighing machine that could support up to 250 kgs.
There is nothing such as an open CT scan, it does not exist in the world. We had to wait till Eman’s weight was below 204 kgs to enable us to get a CT scan of her brain done .
The management of Saifee Hospital has spared no cost in taking care of her. In the early days of February, the special room that Saifee Hospital was constructing for her care was razed by the local municipal corporation. Once Eman’s arrival was confirmed, the team had to first fast-track all permits and then work round the clock for three days to make sure everything was ready for her. Once Eman was admitted to our care, nurses have cancelled holidays and other staff members have worked without a day off to be there for both her and Shaimaa. These are the sacrifices we have not spoken about until now, and to read media reports that quote Shaimaa’s allegations that nurses have been caring for Eman via phone calls has just been very disheartening.
Eman’s was always a complicated case. She had suffered a stroke three years ago, in Alexandria, we had no CT scans done there, neither was an attempt made to do regular physiotherapy which is mandatory for someone who has had a paralytic attack; one of the side-effects of an old stroke is a condition called scar epilepsy, which can cause seizures and this is what Eman has. It means that periodically, she blanks out completely for a minute and then recovers fully. These are not fresh strokes, as was alleged and has been verified by one of the leading neurologists of Mumbai city Dr Arun Shah who is on the team taking care of Eman from day one. Her recently done CT scan has proven the same.
She had developed an allergic reaction to one of the medications within the first few weeks of treatment, which caused her to turn blue in the face. We took her off those medications immediately and Eman recovered in a few days – all of this is part of the medical records. To circulate a video of those few days and use it out of context is inexplicable. We fail to understand why anyone would do this.
Shaimaa’s own admission was that her sister was 500 kgs in Egypt and we have now documented it is 176 kgs on world class equipment.
To all those who care about Eman, please know that she has a team of doctors, nurses and well-wishers who are at her side providing the best care possible. I am confident of my treatment in Eman’s case, and proud of my team, which has showcased the resilience, advancement and brilliance of the Indian medical fraternity. Eman is now fit to fly and she can fly in a regular commercial aircraft (although she is advised to travel with a doctor). This is wonderful progress.
Eman has been an exemplary patient, winning over every member of the team with her positivity, cheerfulness, love of music and her habit of blowing us kisses when we walk into her room. Alas Eman no longer does that, which truly breaks my heart. Because Shaimaa has unfortunately used their bond to turn her against the very people who have been taking care of her selflessly for the last three months.
After all of this very needless drama I have only one thing to say to Shaimaa; I tweeted angrily about her in a moment of anguish but I forgive her for everything she has done. Eman will always be a special patient for me and the bond that I have built with her is very unique.
I am heartbroken to have Eman leave my care and to be told that I cannot continue my treatment of her in phases, as I had planned to. However, I have confidence in her own ability to heal and we will always wish her the best in our hearts.
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