Tuesday, June 19, 2007


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, www.pedicleclub.com), 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

Source: www.iscoliosis.com/symptoms.html


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