THE moment Cynthia Banham first defeated death she began a battle that would require exceptional endurance and test the boundaries of a limited medical science. With a broken back she somehow dragged herself from the burning fuselage of a Boeing 737 that had bumped, skidded and slid its way into a rice paddy at the end of an Indonesian airfield in March 2007.
Her body and clothes were on fire. To extinguish the flames, she rolled in muddy water. It was a survival instinct that came with an invisible threat. "The water I landed in carried a bug. With no skin, the bugs were going to kill me - that's why they had to take my legs," Banham says.
"Skin is like your protection against disease, your immunity. Once you lose your skin you are in grave danger from being able to pick up all kinds of infections and that's one of the scariest things about having this happen."
The crash at Yogyakarta killed 21 people, including five Australians: Australian embassy spokeswoman Liz O'Neill, Australian Financial Review Jakarta correspondent Morgan Mellish, AusAid official Allison Sudradjat and Australian Federal Police officers Mark Scott and Brice Steele.
Banham, then a Canberra-based journalist for The Sydney Morning Herald, had been sitting between Mellish and O'Neill in one of the forward rows.
With terrible burns to her legs, abdomen and left arm, the decision was taken to fly Banham directly to Perth where she could be placed in the care of world-renowned burns expert Fiona Wood.
"Fiona Wood saved my life because of the research she and the people under her had undertaken and because of the knowledge they had accumulated in the Bali bombings, and I'm sure Fiona learned from what happened to me to help other people critically injured," she says.
Wood says Banham's injuries were massive. "The resilience required to survive that level of injury is beyond comprehension unless you have witnessed it," she says.
Banham had burns to 60 per cent of her body, which normally equates to a 60 per cent chance of survival. "However, she had massive trauma in addition to the burns, which meant she lost both her legs, and she had a spinal injury," Wood says.
"She was complicated too because the groundwater in the paddy fields has a very different microbiology. It's not like she landed into a swimming pool. It was also coming up to 24 hours before she got here and the bacteria were multiplying."
As the dangerous bacteria raged through Banham's body, Wood and her team set about rebuilding the skin on Banham's left arm and abdomen using a combination of treatments including her patented "spray-on skin" technique that allows the application of cultured skins cells by aerosol.
"The aim is to close the wound as rapidly as possible to seal the surface as the waves of infection come over," Wood says. "As each wave of infection came over, Cynthia's response was weakened, so it was a race against time."
Banham didn't have enough burn-free skin to allow for traditional grafts, so her harvested skin was put through a meshing machine which allowed it to be expanded like a string vest before being applied.
"Then we spray over it to make the diamonds in the string vest heal quicker," explains Wood. "The better the healing, the better the scarring. But when you are down to — and including — muscle loss, you're in a very different situation."
It was touch and go for a long time. Her family and her partner, journalist Michael Harvey, thought they'd lost her on several occasions. Banham was in a coma for a week. Her spinal injury meant she was flat on her back for six more.
"I had to lie in a crucifix position in hospital for almost two months because if I didn't, my arm would have fused here," says Banham, 40, pointing to where her underarm and inner arm meet her chest.
The little finger on her left hand met this fate. Like the rest of the fingers on her left hand, she lost the last segment. To stop them curling over as the scarring hardened, her physiotherapist Dale Edgar would flex the fingers out during intensive therapy. Of the many agonies she endured, flexing the little finger was a pain too much for her to bear. It was left to fuse over.
But the ever-present threat was the paddy field bacteria that flared into several infections. "There would be another risk I'd die and they'd carry these terrifying-looking antibiotics into the room in these black bags that might as well have had a skull and crossbones on them," she remembers.
After six months in Royal Perth Hospital, the last three of which were spent in rehabilitation, Banham returned home to Canberra.
"Leaving Perth and leaving Fiona was a really scary thing to do because you feel, in a way, that this person who saved your life has become a connection to life itself. Fiona is an amazing woman of incredible insight, intelligence, humility and sense of humour, so it was very scary for me and Michael, I think, to leave her."
As grateful as Banham is about her survival, she is conscious of having to live within the limitations of even the world's best burns medicine.
"The skin doesn't stretch. It doesn't breathe. It doesn't grow hair," Banham says of the dimpled, scarred skin on her left arm. If it gets hotter than 24 degrees, she starts feeling uncomfortable because of a greatly diminished capacity to regulate her temperature due to a loss of body surface area and scarring.
"Her scarred skin will never be normal skin," Wood says. "It doesn't function like normal skin. It doesn't stretch, it doesn't grow, feel or sweat. We've pushed the boundaries on survival but we're chasing very fast on the concept of regenerative medicine, to understand the triggers to regeneration and salvage so we can minimise scarring."
It's because of what Banham's skin can't do that she was inspired to partner with the Ian Potter Foundation to establish the Burn Injury Research Fellowship, worth $20,000 a year in perpetuity.
Beginning next year, the fellowship will be under Wood's supervision at the University of Western Australia's Burn Injury Research Unit.
"Hopefully the fellowship will lead to people getting skin that does more than mine does," Banham says. "It's not a glamorous area of medical research and unless there's some massive terrorist bombing or something, people don't focus on it."
Wood's guiding principle for the past 20 years in burns medicine has been to ensure the quality of life that burn victims could expect is worth the pain of survival. It's a very delicate balance, especially as survival rates from major burns have improved.
"We've certainly changed the goalposts," Wood says. "Is it better? Yes. Is it good enough? Absolutely not. The goal has to be quality of life outcomes, but the reality is that this is directly related to the resource investment."
There are many areas to research: skin regeneration, scar minimisation, phantom pain, the links between major burns and cancer, infection diagnosis in burns victims, pain management. There are many unknowns.
CYNTHIA Banham readily admits life is not fair and that bad things can happen to good people.
"I was very angry. How can you not let something like that anger you? I lost a lot of things in that crash. I don't mind saying that among the long, long, long list of things that were taken from me was my faith. It's not completely gone but it was tested to the point of almost being gone.
"But I'm also an optimist. I survived, and the reason I survived was because of my love of life. I love Michael and I wanted to come back to him."
They married two years after the crash at a winery an hour outside Canberra. When Banham arrived, she stepped out of her dad's old Jaguar and slowly walked to where family and friends were assembled. It was her first time in public on prosthetic legs. The wedding party and guests wept. "I was determined to walk," she says "But it was very hard."
Leo Frederick Francis Harvey was born on February 17 this year at Canberra Hospital; a very healthy 3.8 kilograms. He is a living testament to Banham's extraordinary resilience and determination. Doctors told her that carrying a baby, let alone successfully delivering one, carried grave risk because of the rice paddy bug latent in her blood and because her burns had compromised the muscles she would need for delivery.
"No one put a percentage on [my dying]. It was just something that people were very worried about," she says. "There were a couple of issues. One was if there was a caesarean, as soon as they opened me up there was a risk I'd get the infection back so that was very scary.
"And because of the burns on my abdomen, it turned out I couldn't have a natural birth, so I had to have a caesarean. But the moment Leo arrived, that was the moment when suddenly nothing that had happened before mattered. The sound of this baby crying, with Michael there crying and me crying and the nurses crying as well, because it meant so much to everyone who was there because they all knew my story.
"That was the moment, possibly the only moment in the last six years where nothing mattered except that Leo had arrived. He'd arrived and he was safe and he was healthy. And he was ours and I never thought that I'd get to have a baby and there he was. That was the moment."
To support the Cynthia Banham Burn Injury Research Fellowship, or to support burn research more generally, you can donate to the Fiona Wood Foundation, fionawood foundation.com. The Ian Potter Foundation can be contacted on 03 9650 3188 or through ianpotter.org.au