Eman Ahmed Abd El Aty, an Egyptian woman who weighs around 500 kg, is the world's heaviest woman. The 36-year-old, who hasn’t stepped out of her home for 25 years, is in Mumbai for bariatric surgery at the Saifee Hospital to lose weight.

The hospital has made meticulous preparations to provide specialised facilities to Eman, but her battle for survival has only just begun. Here are the six challenges she has faced and will be dealing with over the next few years through her treatment.

1. Multiple Medical Complications

Eman is a high-risk patient with myriad medical, physical and psychological conditions. It will take at least three to four years to bring about some normalcy in her life. Her weight is just one of her many medical problems.

As Dr Lakdawala points out, Eman has already suffered a stroke, resulting in paralysis of her right arm and leg. She cannot speak, has type-2 diabetes and also hypertension (high blood pressure). She also suffers from “severe obstructive and restrictive lung disease” and gout, Dr Lakdawala says.

Eman will need to undergo a series of tests conducted by a team comprising an endocrinologist, a cardiologist, a physician, a dietician, an anaesthesiologist, a neurologist and a nephrologist, who will ascertain all possible health risks she might face.

2. Weight Reduction Before Surgery

Eman has been given a specialized diet so that her high blood pressure is brought under control. She has been put on a low-calorie, high-protein liquid diet.

"She has a lot of water retention. We are working to control this with medicines,'' said Dr Lakdawala, adding that Eman could lose between 80 and 100 kg within the next four weeks.

3. Special Arrangements Made in Eman’s Room

Special arrangements have been made for Eman at Saifee hospital, which will be treating her on pro bono basis. This includes creating a special room for her inside the hospital.

Eman’s room at Saifee hospital is 1,000 sq ft and contains a patient room, an attendants’ room, a scrub room, and a toilet. It has been provided with a Citadel Plus Bariatric Care system, a chain pulley, a lifting swing, Drager Fabius GS, an anaesthesia machine, central monitoring system, an infusion pump and other equipment.

4. Her Journey to India Was a Logistical Miracle

According to Saifee Hospital CEO Huzaifa Shehabi, the cost of bringing Eman from Alexandria has run into around Rs 80 lakh. This cost is being covered through donations and crowd funding as the family is unable to afford the same.

To remove Eman out of her home, he local engineers had to break the wall of Eman’s bedroom, safely lift her bed and put it in the vehicle en route to the airport. About 400 cargo specialists and government officials from both countries were a part of the logistical support provided to bring Eman from Egypt to Mumbai. She traveled to India in an Egypt Air cargo plane. Once in Mumbai, Eman was lifted by a crane to a waiting specially modified truck just outside the irport.

5. Raising Money for Her Travel

Although all medical expenses would be borne by Saifee Hospital, a crowd funding effort was undertaken to meet the massive logistical expenses. According to The Times of India, the flight from Alexandria in Egypt to Mumbai alone cost Rs 83 lakhs. A ‘Save Eman Campaign’ has been launched on Bitgiving.com to raise Rs fifty lakhs.

NOSCO, a firm in Egypt, provided a crane and cradle to transport her for free, so did Horus, another company that provided logistics in cargo transport for free. NOSCO prepared a special ‘torque bed’ that could maintain gravitational pressure in air for a safe flight for Eman.

6. Does India Have the Supporting Medical Skills?

It’s well known by now that Dr Lakdwala is one of the best weight loss experts in India. But in India, weight loss surgeries have previously been carried out on patients weighing up to 350 kg. So will the other medical professionals in the team be able to deal with a patient weighing 500 kg?

The role of an anaesthetist, for instance, is crucial during a weight loss surgery. Anaesthetic drugs are fat soluble, so it will be a huge challenge for the anaesthetist to decide the dosage. The fact that Eman has several other medical complications makes it even more difficult for the anaesthetist to keep her stable during the surgery.

Also, morbidly obese patients are prone to depression. Experts in the US have experience of motivating  patients like Eman, who have been immobile for decades. So, keeping her spirits up will be a massive challenge for her counsellors.