TIME EUROPE
MARCH 6, 2000 VOL. 155 NO. 9
Cutting Edge Humanity
With the help of digital photography and the Internet, caring surgeons rebuild the face of a Kosovo war victim
By JONATHAN MARGOLIS Manchester
Thursday April 29 last year, a rainy day in Kosovo, should really have been the last of Besim Kadriu's short life. That morning in the Albanian sector of the town of Mitrovica--a town once again torn apart by communal strife (see following story)--Serb paramilitaries torched the house the 21-year-old economics student shared with his pregnant wife, Valbona. Watching the inferno from a distance, Kadriu was confident Valbona had escaped Mitrovica, but was unsure where she had fled. He set off on foot for the village of Zaza, a few kilometers away, on a hunch she would be with her two brothers, who lived there. She wasn't, but a large number of armed Serb militiamen were. They were closing in on Zaza just as he arrived. For the second time in a day, Kadriu was facing death.
Thugs in balaclavas surrounded the village in three concentric rings, moving inward to trap the inhabitants in much the same way that small game animals are sometimes hunted in the Balkans. Knowing they were prime targets, Kadriu and a few of the other young men in Zaza tried to escape. They managed to slip through the two innermost cordons undetected.
But as they attempted the third, they were spotted. One of Kadriu's brothers-in-law was shot dead on the spot. Four other men surrendered and were never seen again. Kadriu and the other brother-in-law made a run for the woods. The brother-in-law was shot in the leg but kept running and survived. Kadriu felt a bullet sting his face, fell to the ground and played dead.
The Serbs may have believed they had killed him, or simply have thought it unnecessary to waste any more bullets on the young man. Much of the right side of the face of their previously handsome victim, including his entire nose and right eye, had been removed by the shot. What was left of him resembled a medieval gargoyle after centuries of erosion.
At nightfall, several hours after the Serbs had left, Kadriu ran to the forest and hid. Although he felt nauseated and could sense blood running down his face, there was no pain from the wound. He touched the destroyed area and, in his state of shock, thought the bony sensation was damaged teeth. He realized things were much worse only when he explored the inside of his mouth with his fingers and found it was intact.
A strong-minded, pragmatic man, Kadriu resolved immediately to avoid glimpsing any reflection of himself in puddles left by the rain, even though he needed them to drink from during the 48 hours he remained in the woods. For his psychological survival, this was probably a good tactic. So grotesque were his injuries that when he finally judged it safe to return to Zaza he went unrecognized. People scurried from him in horror until he produced a photo he happened to have in the back pocket of his jeans. It showed him and Valbona smiling for the camera a few months before, at Christmas 1998, days after they had married.
Besim Kadriu still keeps that photo in his wallet as a lucky charm, for while many people would opt for death rather than disfigurement, he considers himself a fortunate man. For one thing, a couple of centimeters further back and that Serb bullet would have hit his brain, destroying his mind as well as his looks. For another, he was reunited with Valbona and survived for three months in the care of relatives--without disinfectants or antibiotics, his only treatment being changes of gauze bandages, when they could be found. He was still avoiding mirrors when troops of the kfor peacekeeping force arrived to provide some less rudimentary first aid. But luckiest of all--and thanks to the efforts of an American charity doctor and a British military medic with a bag full of electronic gizmos and an Internet connection--Kadriu's face has now been rebuilt by surgeons in Manchester, U.K.
Besim Kadriu thus became one of the first civilian beneficiaries of military telemedicine, the use of digital technology in treating war injuries beyond the scope of army field surgeons. Thanks in no small part to the Internet, he and Valbona are now living in Manchester awaiting the final cosmetic work on his face before resuming life in Kosovo. In the crib in their small apartment is their new daughter, born two days before Christmas.
Telemedicine is a variation on the tradition of referring difficult cases to a specialist--the difference being that the specialist doesn't see the patient, only e-mailed photos of him. With a digital camera, a laptop and a gsm phone wielded by a doctor in the field, the specialist can be across the world, viewing high-definition photos of a wound inflicted perhaps only minutes earlier. It was such technology that made the link between an act of butchery in a meadow in Kosovo and one of medical mercy in a hospital in Manchester.
Before the technology, however, came philanthropy. In June 1999 Dan Clay, a California emergency room physician, set up a clinic in Kqiq, on the outskirts of Mitrovica, for the International Medical Corps, a charity based in Los Angeles. Kadriu soon heard about the new American clinic and, with his wound covered by a gauze pad, went to see "Dr. Dan."
Like every doctor who was later to meet the young man, Clay was shocked by the wound. But he recognized that it was far beyond his expertise to treat. "When I first saw Besim across the room with a large bandage over his 'eye,' I assumed I would be seeing a corneal abrasion or the like," says Clay, now back at the rural St. Helena Hospital in Deer Park, Calif. "But nothing could prepare a doctor for what lay beneath the gauze. I've spent half my career in ERs in some of the most violent cities in America, seen all kinds of mangled human beings, but I've never come across anyone still alive carrying such a horrific injury as Besim."
"I sent him to the Pristina Hospital, knowing full well that what he needed was beyond the capabilities of its surgeons," says Clay. "They, of course, returned him with a suggestion that he be referred for treatment abroad. Unfortunately the channels for such a placement are a bureaucratic obstacle course and were overwhelmed in any event." Clay knew that the recommendation doomed a 21-year-old man to a life with a cruel disfigurement, but "I also knew that I had become his only hope, as I was not prepared to accept that unthinkable notion. So in June, I started face shopping, talking to every kfor medical officer and every mash unit I could find, hoping that one would know of a bored plastic surgeon somewhere, or perhaps get as emotionally involved in Besim's case as I was."
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