Friday, June 22, 2007


First published in The Jakarta Post, June 23, 2007


Alpha Amirrachman, Contributor, Jakarta

During a World Book Day celebration on March 3, 2006, the head of the National Education Library (Perpustakaan Pendidikan Nasional), Wien Muldian, invited Fuad Hassan to speak at a discussion on literacy development in the country.

The discussion was held in the library, located within the Education Ministry's compound.

The visit stunned and angered high officials at the ministry. They thought that Wien, who started working at the library on Jan. 1, 2005, did not properly inform them that the former education minister would be visiting.

"I wrote a letter informing my superiors, but it appears the letter did not reach them, maybe because there are so many letters in the bureaucracy," said Wien during a recent interview with The Jakarta Post.

Thanks to Wien's innovative ideas, the library, which has some 7,000 members, is often crowded with visitors. The facility does not only provide books, but also Internet and audio-visual services. A pleasant coffee shop also graces a corner.

The library is strikingly decorated with colorful signs and walls, provoking in visitors feelings of relaxation and comfort.

Various activities are regularly conducted in the fully air-conditioned library, including documentary film screenings, children's origami workshops and book discussions.

Wien said he was determined to optimize the library, which was established in November 2004, in serving the people. Many public libraries in Indonesia, he said, had turned into mere warehouses for dusty and worn-out books.

"Public libraries should serve public interests, and school libraries should serve students' interests," he stressed.

Wien said Education Minister Bambang Sudibyo had agreed to expand the library area "so that in future, this entire main building would comprise the minister's office and the library".

Last year, Wien helped small local publishers to sell their books by inviting them to hold an exhibition called the 50 Percent Book Event: Exhibition of Cheap Books, where the books on display were sold at 50 percent of their catalog price.

The stalls had such a cheap lease that the publishers could afford a discount of up to 60 percent. Around 3,000 people visited the event every day for nine consecutive days; thousands of books were sold.

Since its opening, hundreds of literacy and literary events have been conducted in the National Education Library. Wien also targets national days such as Education Day and Awakening Day to hold book bazaars or exhibitions.

The library has likewise launched a special corner for the blind.

"And we have U.S.-made software that enables the blind to read all the printed books here," Wien said.

Born May 3, 1972, in Pontianak, West Kalimantan, Wien grew up in a family of book lovers.

He attended Muhammadiyah elementary school, where he spent much of his time reading books in its small library. When he attended junior high school in Cirebon, West Java, he regularly visited a public library in the city.

During his time at SMA 16 high school in West Jakarta, Wien invited renowned writer Hilman Hariwijaya to speak about his creative process in writing Lupus, a novel that was very popular among young readers at the time.

After his father died, Wien had to burn the candle at both ends to finance his studies and buy books. So he started moonlighting as a conductor on a M-16 Meruya-Tanah Abang mikrolet (public minivan), which would also take him to the University of Indonesia (UI), where he was a student.

Wien majored in Library Science at UI, only to find the classes too technical and boring.

His innovative approach toward literacy was evident even then, as he invited Pasar Senen book sellers to sell their books at the university -- "so I could get books for free".

As editor-in-chief of Suara Mahasiswa (Students' voice) bulletin, Wien regularly invited famous writers to a discussion at the university. He also led the university's student press and was involved in the student publication Harian Aksi Bergerak! (Active action daily) during and after the 1998 reformasi movement.

His 1996 visit to Japan, a country with a high literacy rate, further strengthened Wien's desire to push for literacy development in Indonesia.

He later traveled throughout the archipelago to hunt for books, collecting more than 12,000 books for his private library.

"I am particularly interested in social and human issues," Wien said of his collection.

Wien established the Forum Indonesia Membaca (Indonesia Reading Forum) in October 2001 and in just two years, it had successfully distributed more than 800,000 books nationally. With 70 volunteers, the forum helped set up around 100 taman bacaan ("reading gardens", or small libraries) around the country.

He said he was skeptical about the common perception that Indonesians had little enthusiasm for reading: "The problem, I think, is more about limited access to reading materials."

Wien said the government should help encourage the opening up of small bookstores around the country.

"The government can help facilitate incentives or soft loans for people to open bookstores."

The establishment of community-based libraries that involved the support of local publishers is also important, he said.

"And a library is not only about books," Wien stressed, "but also a cultural center where literary events are held and where readers can meet writers."

For information on activities conducted by Forum Indonesia Membaca for World Book Day 2007 at the National Education Library, visit

Tuesday, June 19, 2007


First published in The Jakarta Post, June 20, 2007


Alpha Amirrachman, Contributor, Jakarta

Until she reached 30 years of age, Dewi* was not aware that she had scoliosis, or a stunted spine. At a glance she looked physically normal.

However, when she bends down, upon careful observation her spine appears asymmetrical.

Dewi was shy about speaking of her condition.

"I once watched a person with scoliosis like me trying on a dress in a dress shop, and the shop attendant looked at her with weird-looking eyes," she said of what she described as humiliation.

She did not speak to anyone until she began to worry that this condition might eventually affect her physical appearance. When Dewi browsed the Internet, she found out that scoliosis is actually preventable at an earlier stage.

Another case concerns 12-year-old Nadia, who was diagnosed with scoliosis that had a 50-degree curvature.

Still another child with scoliosis said that it was extremely painful every time she sat down, which disrupted her school life.

Early intervention significantly helps people developing scoliosis, but shyness, low awareness and ignorance often allow for curve progression. The scoliosis thus worsens to the point that it can disturb normal life, which can range from breathing difficulties to premature death.

This is not to mention the social consequences resulting from their condition.

In the United States, a standard exam called Adam's Forward Bend Test is conducted by pediatricians and at initial school screenings. Parent volunteers or school nurses can run the test effortlessly by simply asking students to place their feet together and bend 90 degrees at the waist.

From this position, any abnormal spinal curvatures or asymmetry of the trunk can be easily observed and identified.

The test also exists in Indonesia, but implementation is another matter.

"Every community health center, or puskesmas, in our country has complete technical guidance for this school screening. However, people are still overwhelmed with other disturbing cases that seem to be pervasive, such as infant mortality and others, so almost no attention has been given to administering this simple test," said orthopedic spine surgeon Dr. Luthfi Gatam of Fatmawati General Hospital.

One research conducted by a postgraduate program at Yogyakarta's Gadjah Mada University shows that a physical educator can play a supervisory role in the early prevention of scoliosis.

Technically, scoliosis is more a descriptive term than a disease.

Curves are found in all spines of the human body; some curvature in the neck and upper and lower trunk is normal for assisting the upper body to maintain balance and its configuration over the pelvis.

Nevertheless, when the spinal column consists of abnormal lateral curves and affects the balance and alignment over the pelvis, this condition is referred to as scoliosis.

In the general population, scoliosis affects more women than men.

"The ratio is nine to one for (cases in) women to men. And it remains a mystery why it affects mostly women," said Luthfi.

Causes of general scoliosis include congenital spine deformities, genetic conditions, neuromuscular problems, limb length inequality, cerebral palsy, spina bifida (a birth defect affecting the neural tube), muscular dystrophy, spinal muscular atrophy and tumors.

But roughly 80 percent of scoliosis have no known cause, or idiopathic.

Idiopathic scoliosis is often found in healthy people "regardless of people's social strata, and many are found in people with 'yellow' skin like us rather than 'black'", said Luthfi.

Idiopathic scoliosis is categorized by age: infantile (children aged 3 and under), juvenile (3-9 years old), adolescent (10-18), and adult (post-skeletal development over 19).

"However, at post-skeletal development, usually there won't be any curve progression, except for in those who already have a 50-degree curvature," said Luthfi.

Around the world, adolescent idiopathic scoliosis (AIS), which develops in young adults generally at the onset of puberty, represents approximately 80 percent of idiopathic scoliosis cases.

No comprehensive statistics are available in Indonesia, but research by noted orthopedic surgeon Prof. Subroto Sapardan reveals that from 1977 to 2006, 2,010 scoliosis cases were treated at Fatmawati General Hospital.

"Most of the patients were female adolescents, and 600 of them were so bad that they had to undergo surgery," said Luthfi.

He explained that surgery is not always necessary to correct scoliosis, depending on the condition of the patients.

"If a Cobb angle is below 20 degrees, we only observe them. From 20 to 40 degrees we give them a brace, but if it is more than 40 degrees, open surgery will be highly considered," he said.

The Cobb angle is the measurement of the degree of curvature in the spine.

However, the causes of idiopathic scoliosis remain unknown.

"Different theories concerning its etiology have been proposed and studied extensively. Genetic factors, hormonal factors, growth abnormalities, biomechanical and neuromuscular disorders of bone, muscle and fibrous tissue, have all been proposed as possible causes of scoliosis," Luthfi said.

Those with a family history of spinal deformity are also at greater risk for developing scoliosis.

For example, one patient whose spine requires a brace said her mother also had scoliosis, although with a spinal curvature of 1 to 10 degrees, this was not really disturbing. Meanwhile, her younger sister's spine was likewise obviously lop-sided, she said.

But spine surgery to correct scoliosis can be scary for patients of any age, especially when faced with a five- to seven-day recovery period, post-operative pain and the anxiety caused by knowing that they will be left with a long scar.

In the U.S., Dr. George Picetti, a highly specialized adult and pediatric spine surgeon at the Sutter Medical Center's neuroscience medical group and institute in Sacramento, California, has developed a minimally invasive approach to scoliosis treatment.

The technique he developed is known as thoracoscopic instrumentation, which utilizes video technology to correct certain types of spinal curves: extremely tiny incisions are made through which the surgeon corrects the scoliosis by using an endoscope. This has minimized incision scarring and decreased the amount of dent to tissue and blood loss during surgery.

"But it is a time-consuming operation and is very expensive. Normally, (the operation) takes around eight hours," said Luthfi of the minimally invasive spine surgery.

He himself had conducted the procedure only twice throughout his career, both at the Bintaro International Hospital in Tangerang, Greater Jakarta.

However, according to Luthfi, Fatmawati General Hospital, which is known as an "orthopedic hospital", has all the necessary equipment for open surgery, from the simplest to the most complicated surgical procedures.

Orthopedic surgeon Subroto invented in 1998 the "UI System" for segmental instrumentation in scoliosis surgery, so named after the University of Indonesia (UI). In this system, a rod and a reconstruction plate are inserted to either side of the spine and screwed together.

The UI System, which was patented on Sept. 2, 2004 (Patent Reg. No. 0.011.170), provides three-dimensional correction, stable instrumentation with no external support and can result in a balanced spine.

Perhaps more importantly for a developing country like Indonesia where poverty is prevalent, the procedure is relatively inexpensive.

According to Subroto, the UI System has helped people with scoliosis across the country effectively and affordably.

"It only costs Rp 4 million. Two hundred and eighty patients with severe scoliosis have used this (system) at our hospitals ... and hundreds more at other hospitals, as this system has been launched internationally," Luthfi added.

He said more and more hospitals in Indonesia are now offering spine surgery for people with scoliosis.

Another aspect that should not be overlooked in treating scoliosis is the emotional impact of the condition on patients.

"We have to convince the patients that they can finally lead a normal life," Luthfi stressed.

Psychologists should thus be retained to counsel patients through their post-surgery mental and emotional conditions to help restore their self-confidence. This can be carried out simultaneously with yoga or swimming as rehabilitative treatments.

Luthfi pointed out that public education to increase awareness of scoliosis was also important, because some people with the condition would not recover completely -- and societies needed to learn to accept and embrace them wholeheartedly.

* All patient names in this article are aliases.


First published in The Jakarta Post, June 20, 2007


When 18-year-old Sandra* underwent a medical check-up under the supervision of orthopedic spine surgeon Dr. Luthfi Gatam, her scoliosis was already in a severe condition.

"Her scoliosis was 135 degrees asymmetrical," recalled Luthfi of the curvature in her spine.

"She had been extremely distressed and had almost no confidence, as she could not avoid people who looked at her with disrespect and humiliation. She really had a hard time at school," he said.

"While such a scoliosis can never be fully corrected, intervention is still needed to ease those with this abnormal physicality," he said.

Medically speaking, as the curve in her spine measured over 40 degrees, Sandra had no choice but surgery.

"Now she is a happy and energetic young woman, going to college with a high level of confidence. Her height is now around 180 centimeters, very tall for an average Indonesian woman," Luthfi told The Jakarta Post, showing before-after surgery pictures.

"Her scoliosis has been corrected to around 50 percent, which technically can be considered satisfactory," he said.

Scoliosis is a condition in which the spinal column has abnormal lateral curves that affect the alignment of the torso over the pelvis.

Most cases are idiopathic scoliosis -- or scoliosis with unknown causes -- and most affect adolescent females.

Luthfi lamented that many people in Indonesia were unfamiliar with this physical condition, which can be socially disturbing for people with scoliosis. In addition, scoliosis is often "allowed" to develop further because of a lack of intervention, and advanced scoliosis can be physically perilous, sometimes life-threatening.

"This is because of low public awareness," he said.

Luthfi recalled his stint in 1990 at a Lampung community health center (puskesmas), where he fulfilled his government-required residency. He said the center received inadequate communication from the Health Ministry about the importance for its School Health Unit (UKS) to conduct a simple spinal screening at schools.

Citing a 1994 research covering 2,000 elementary school students at 30 schools, he said the research revealed that 30 percent of the research group had light scoliosis of up to 20 degrees, 25 percent had scoliosis of 20-40 degrees and 2 percent of more than 40 degrees.

Born Jan. 23, 1959, Luthfi completed his primary and secondary education in Jakarta, and graduated in 1985 from the medical school at Bandung's Padjajaran University. He specialized in orthopedic surgery at the University of Indonesia (UI), from where he graduated in 1996.

His interest in the spine and its pertinent irregularities developed when he discovered that spinal irregularities posed many challenges, ranging from the low local awareness of scoliosis to the degree of intricacy necessary in performing spinal surgery.

As president of the Pedicle Club Indonesia (PCI,, which groups all 32 Indonesian spine surgeons, he led his colleagues on a campaign and surgery road show throughout the country.

He told of an appalling experience he and his team had when they performed scoliosis surgery at a private hospital in Banjarmasin, South Kalimantan.

"There was no ICU (intensive care unit) and the equipment was extremely inadequate," said Luthfi.

Due to the absence of a machine that lowers hypertension -- which is necessary in open surgery to prevent blood loss -- Luthfi anxiously kept his eyes wide open all night to ensure that his patient's post-surgery condition remained stable.

The PCI, which was established in 1998, also works in public education and in the provision of spine surgery equipment, said Luthfi, who has three children with his wife, physician Dr. Nanny L. Gatam.

He noted that several media groups and non-governmental organizations, including the Tse Chi Buddha Foundation, are regular donators to their cause.

One of the key benefits of the PCI was that hospitals, including Fatmawati General Hospital where Luthfi works, could contact the specialist surgeons when patients from low-income families needed spine surgery.

However, Luthfi stressed that it was crucial to boost public awareness, as early intervention remained the best solution for scoliosis. Hence, the Health Ministry, healthcare providers and non-governmental organizations needed to work hand-in-hand to implement an effective campaign, he said, and that school screening was likely the best target of such a program.

While scoliosis is found in any society and societal segment, Luthfi is currently pursuing another doctorate at his alma mater, UI, looking at the correlation between the degree of scoliosis, social demographics and post-surgery success.

-- Alpha Amirrachman

* All patient names in this article are aliases.

Detecting scoliosis

Several different "warning signs" can be detected to help determine if you or someone you love has scoliosis.

Should you notice one or more of these signs, you should schedule a more thorough examination with your doctor.

* Shoulders are different heights -- one shoulder blade is more prominent than the other
* Head is not centered directly above the pelvis
* Appearance of a raised, prominent hip
* Rib cages are at different heights
* Uneven waist
* Changes in appearance or texture of skin overlying the spine (dimples, hairy patches, color changes)
* Leaning of entire body to one side

-- Alpha Amirrachman


Wednesday, June 06, 2007


First published in The Jakarta Post, June 6, 2007


Alpha Amirrachman, Contributor/Jakarta

When 7-year-old Nabila was admitted to Fatmawati Hospital with burns to 70 percent of her body, plastic and reconstruction surgeon Audy Budiarti was determined to help give her a new life.

"Nabila was involved in an awful accident. She was playing on the street when a panicked neighbor threw his burning kerosene stove into the street. Nabila was immediately engulfed by flames and was badly burned," Audy told The Jakarta Post.

Audy says she shares in Nabila's sorrow and that of her family, as the accident happened unexpectedly and has changed the young girl's life forever.

"She has recovered almost 90 percent, but we had to wait for almost a year to prepare skin for a graft. It doesn't happen overnight."

A skin graft involves the removal of a section of skin from one part of the body, which is then used to replace damaged skin on another part.

Since Nabila's body was badly burned, her treatment has been a long process.

"Patience and understanding is needed from myself as the doctor, Nabila and her family," said Audy, a devout catholic.

Nabila comes from a poor Muslim family. Her father works as a cleaner at a public health center, or Puskesmas, in Depok, West Java, and her mother is a housewife.

Audy does not limit her service to the hospital where she works; she is also involved in several social work activities.

In 1998, she started involving herself in social work activities with the Indonesian Association of Plastic Surgeons (IAPS). During her involvement, she has performed cleft palate surgery on as many as 250 children throughout the country.

Audy encouraged younger doctors to join IAPS to contribute to society. She took a step back in 2002 and left the junior doctors to take over her role at the organization.

Following her departure from IAPS, Ibu Non Rawung, chairwoman of Obor Berkat Indonesia Foundation, invited her to join the foundation.

"The foundation had no facilities to help the poor," said Audy, who helped organize donations for the foundation.

Under the foundation's banner, she later traveled throughout the country to provide cleft lip surgery to children.

In order to perform these operations, she traveled to Central Lombok, East Lombok, Cibadak, Pangkal Pinang in Bangka, Sukabumi, Lampung, Soe in East Nusa Tenggara, Manado, Pelabuhan Ratu and Madiun.

Since she joined the foundation in 2002, Audy has treated 160 children with cleft lips.

Cleft lips can also affect the palate inside the mouth, which can be life-threatening. The condition is sometimes referred to as cleft lip and palate congenital deformity, or "harelip".

"Surgery to the palate inside the mouth is dangerous as it can cause heavy bleeding."

Audy was born on August 8, 1963, in Makassar, South Sulawesi, and completed her elementary and high school education in Jakarta.

Her family moved to West Nusa Tenggara when she was in elementary school, but Audy decided to stay in the capital.

"I wanted a good education, and at the time only schools in Jakarta could offer that," she recalled, adding she stayed in her family home with her aunt as guardian.

"My father is an architect and he wanted me to follow in his footsteps."

But she did not aspire to be an architect; she instead studied medicine at the University of Indonesia, much to her father's disappointment.

After graduation she left for East Nusa Tenggara province to serve her compulsory state duty from 1988 to 1992.

She was posted at a Puskesmas in Camplong district, about 48 kilometers from the provincial capital of Kupang, before moving to Puskesmas Oekabiti in Kupang regency.

"I chose East Nusa Tenggara as I did not want to go to West Nusa Tenggara where my family resided," she said, adding that she did not want to live in her father's shadow -- a renowned architect in the region.

She choose to become a specialist in plastic and reconstruction surgery -- over general surgery -- and enrolled again at the University of Indonesia.

Since 1998, Audy has worked as a plastic and reconstruction surgeon at Fatmawati Hospital.

Although she did not intend to marry a doctor, her destiny proved otherwise. She married Y. H. Haksanto, an anesthetist who works at the same hospital. They have one daughter.

Audy says that a surgeon in Indonesia cannot earn a sufficient wage from performing reconstructive surgery alone.

She earns extra money through performing cosmetic surgery.

Audy says cases of cleft lip in Indonesia, which is both physically and mentally distressing for sufferers, seriously threatens the lives of many children.

She says more plastic and reconstruction surgeons should dedicate their time to this cause.

"Every year roughly 7,000 children are born with cleft lips in Indonesia," said Audy, adding that plastic and reconstruction surgeons manage to help only about half of these children every year.

Those who wish to donate to Obor Berkat Indonesia Foundation can call 021-89905955/89905940 or visit its website at to learn more about its activities. The foundation's address is Jl. Sriwijaya Kav. V-VII, Lippo Cikarang.