Removing a Ugandan girl's scars of war

When Jennifer Anyayo was 9, rebels set fire to her home in northern Uganda - with her inside. There was the smell of burning flesh as fire melted her face, her left arm, her chest, disfiguring her life. Now she is 15, in the operating room of a U.S. hospital, and that very same smell could signal hope and healing.

She is in a pre-op room at Fairfax Hospital, INOVA Health Systems, in Fairfax, Va., wearing a gown, and a surgical cap decorated with pictures of American flags. Jennifer awaits surgery for her burns.

Her journey started in the crowded and dirty displacement camp at Kitgum, where I met her in late 2004. From there, she moved to Gulu, a safer town, where she lives with Abitimo Odongkara, Uganda native and school director, Philadelphia homeowner, and one of the world's humble heroes.

A lot of children and adults in northern Uganda call Odongkara mama because of the nurturing she has given them amid violence, disease and want.

Even while she's here with Jennifer in the United States, Odongkara is working her magic in northern Uganda: She is trying to move the rest of Jennifer's family from the camp in Kitgum to Gulu. That way, the family can be together and Jennifer's siblings can attend Odongkara's school.

On Dec. 24, Jennifer and Odongkara arrived in Philadelphia. The next week, Jennifer was examined by Craig Dufresne, a reconstructive and plastic surgeon in the Washington area. He, the hospital, and the other medical personnel all are donating their services.

It's now a few weeks later, and Jennifer is at this sparkling hospital in metro Washington - a place most Ugandans could not imagine.

Medical staff appear every few minutes. Odongkara not only is Jennifer's medical guardian in the United States but also her interpreter. The 71-year-old woman patiently explains who everyone is and what is about to happen.

Jennifer, just wanting the surgery to begin, rolls onto her stomach and buries her scarred face in the bed.

Finally, at about noon, anesthesiologist Robert Mesrobian leads her stretcher into the operating room. Odongkara accompanies Jennifer, dabs with a tissue at tears in the girl's eyes. As Jennifer drifts off, a shaken Odongkara leaves.

Monitors start beeping; Jennifer is turned over on her stomach, and overhead lights are focused on where Dufresne will make an incision on her scalp.

Dufresne works with steady hands. Skin is moved until there is room to insert a crescent-shaped instrument called a tissue expander between her scalp and skull. He inserts two more under scarred skin on her chest. During outpatient visits in forthcoming weeks, Dufresne will slowly fill those balloons with saline solution to stretch the skin.

In a corner of the room, I watch, and feel a surge of anger over the war in northern Uganda. I reserve my greatest disgust for the Lord's Resistance Army, the rebels who set the fire that maimed Jennifer.

After almost two hours of working on her scalp, the surgical team turns Jennifer onto her back. Dufresne and the assistant resident surgeon make the incision on her chest, remove overgrown scars all over her body, and use a cauterizing pen on her skin. That is what causes the burning smell.

About four hours after they began, the doctors are finished. Much of what they have done is preparation for a more dramatic operation after there is enough new skin to move down Jennifer's hairline and reconstruct parts of her face. But even the immediate result pleases Odongkara and should make Jennifer smile after she awakens, despite the postsurgery pain. Dufresne has been able to pull down some skin near Jennifer's eyes by making small incisions and tightening ligaments. In what seems like only a few moments, he has enabled Jennifer's eyelids to close over most of her eyes - for the first time in six years.

That improvement is small compared to all of Jennifer's wounds. But it is a wondrous achievement, and one that begins to offset the destruction of war.

ONLINE EXTRA

To see photographs by Inquirer staffer Michael Wirtz of the surgery or read installments in the series, go to http://go.philly.com/jennifer