Wednesday, July 18, 2007


(Part 2 of 2)

First published in The Jakarta Post, July 18, 2007


Alpha Amirrachman, Contributor, Jakarta

Prosthetist and orthotist Sumedi started working at Fatmawati General Hospital in 1976 as an assistant to senior prosthetists.

A prosthetist designs, measures, fabricates, fits and services prostheses as prescribed by a medical rehabilitation specialist; an orthotist is a medical technician who designs and applies an external device to a part of the body to correct deformities.

"I initially aspired to be an engineer, but God destined me to become a `foot engineer'," Sumedi said, smiling, during an interview with The Jakarta Post at his home.

Born Oct. 14, 1955, Sumedi is married with two children.

He said many prosthetists and orthotists of his generation did not receive any formal training at tertiary institutions, as the subject did not exist in the country.

Only in April 2007 Health Minister Siti Fadilah Supari officially opened the Surakarta Health Polytechnic (Poltekes), which operates under the ministry.

The polytechnic has a prosthetics and orthotics program with a specifically designed competency-based curriculum and professional teaching equipment.

Even without formal training, however, Sumedi's expertise is unquestionable.

"I learned both from quality courses here and abroad, and through many years of experience as an assistant to the senior prosthetists and orthotists at the hospital," said Sumedi, who is a member of Indonesian Orthotist and Prosthetist Association (IOPI).

Sumedi has also participated in various training courses which include the six-month International Prosthetics and Orthotics Training in Taiwan (1980), the Myoelectric Below-Elbow Hand Prosthesis Training held by Otto Bock Scandinavia and the Health Ministry in Jakarta (1990), the 100-hour Paramedic Training held by Health Ministry (1993), and the two-week Medical Rehabilitation Training held by the ministry (2001).

Sumedi has not kept a record of the number of prosthetics and orthotics patients for whom he has fitted and serviced artificial limbs during his career, "but it must have been hundreds", he said.

And as prostheses need regular servicing, Sumedi often developed close ties with the patients. One such life-long patient is Sumani.

Sumedi first met a disabled Sumani in 1978, when the latter started working at a wheelchair company associated with Fatmawati hospital.

The two live in Pondok Labu, South Jakarta, an area relatively close to the hospital. Sumani now works as a welder at a workshop near Sumedi's residence.

For many years Sumedi, has checked and serviced regularly Sumani's transtibial prosthesis -- an artificial limb replacing a leg missing below the knee.

Thirty years ago during a red-eye delivery to Muntilan, Magelang, an exhausted Sumani, then a truck driver, lost control of the vehicle and slammed into a mahogany tree. He survived the accident, but his left leg was amputated below the knee at the Army Hospital in Magelang.

Sumani stayed at home for a year, frustrated and depressed, until social workers from the Health Ministry approached and encouraged him to undergo a special education program for the disabled being held at the Prof. Dr. R. Suharso Hospital in Surakarta (Solo), Central Java.

"The social workers back then were very active in looking for the disabled to place in training centers for free -- they even provided free accommodations and meals," Sumani told the Post at Sumedi's home. He added that the present government should also pay more attention to disabled individuals from poor families like himself.

At that time, the Suharso training center for the disabled was the biggest of its kind in Southeast Asia.

"They offered various training courses such as carpentry, welding and electronics. I chose the welding course," said Sumani, who participates in the Association for Indonesia's Disabled (PPSI).

"The center drew many people from across the country, including some veterans of the East Timor war," he recalled.

Sumani, born Aug. 8, 1950, joined the one-year training program at the Suharso center. Upon his successful completion, Sumani was sent to Jakarta to work at the wheelchair factory.

"I once invited Sumani to be a model during a prosthetics workshop so that he could get a new prosthesis for free," said prosthetist Sumedi, followed by Sumani's laughter.

Sumani, who still looks and energetic and high-spirited, showed the Post his amputated leg and transtibial prosthesis.

He gently tapped his knee, which remained intact and strong. The lingering limb extended about 20 centimeters from the knee.

"I can still drive a car," he claimed proudly, putting the artificial limb on his leg, then pushing it against the ground to snap it in place.

Wednesday, July 11, 2007


(Part 1 of 2)

First published in The Jakarta Post, July 11, 2007

Alpha Amirrachman,
Contributor, Jakarta

Four years ago, Riska*, who worked as a cashier in a modest textile shop in Tanah Abang, North Jakarta, was on way to work when the Metro Mini (public bus) she was riding was hit on its rear left by another, speeding bus.

Riska, sitting in a rear seat, was sandwiched between the metal door and body of the bus, her leg crushed.

She had to have her leg amputated from above the knee. She did not receive any compensation from the bus company.

Now, using a transfemoral prosthesis, Riska is still able to work. Her superiors at the same textile shop have placed her where she did not need to walk much.

A transfemoral prosthesis is an artificial limb that replaces a leg from knee to foot.

"Most of the cases of people who needed artificial limbs, I think around 60 percent, are caused by accidents -- mostly traffic accidents and the rest, work-related accidents," said medical rehabilitation specialist Dr. Peny Kusumastuti, who is head of the Medical Rehabilitation division at Fatmawati General Hospital, which was established in 1970.

"Others are caused by diseases like polio, diabetes, bone cancer and severe infections," she added.

Peny further lamented that no comprehensive national statistics were available with regard to prosthetics and orthotiscs cases.

Hospital records show that it handled 376 cases of prosthetics and orthotics in 2004, 38 cases in 2005, and 439 cases in 2006.

A prosthesis is an artificial extension that replaces a missing part of the body. Traumatic injuries and congenital defects are characteristic causes that require supportive equipment for the disabled to pursue normal lives.

The complete recovery of range of movement, however, is not always achievable.

In developing countries, vehicular and industrial calamities, as well as conflicts, are the leading causes of amputations. In more developed countries, amputations are generally required due to diseases such as cancer, infections and circulatory diseases.

Following independence, Indonesia saw many of its freedom fighters receiving treatment for amputations at the first medical rehabilitation hospital in Surakarta, Central Java. The hospital was established by the "founding father" of medical rehabilitation, Prof. Dr. Suharso, who specialized in prosthetics in the U.K.

Now, 62 years after independence with the rush of investment and material development, but still with an "underdeveloped" mentality where safety is still largely ignored, traffic and work-related accidents appear to dominate prosthetic cases.

This is evident in many cases found in general hospitals such as Fatmawati and Cipto Mangunkusumo. However, other causes are also noticeable, such as diabetes, cancer and even congenital amputation.

Although relatively infrequent, cases of congenital amputation need assiduous treatment at an early stage, so that the patient can "feel" they have a normal life during growth.

For example, 7-year-old Iwan had a below-knee congenital amputation.

"Because he is still growing, we have to produce a new transtibial prosthesis every six months," said prosthetist and orthotist Sumedi of Fatmawati General Hospital.

A prosthetist is a specialist who designs and fits prostheses to the remaining limbs of amputees; an orthotist is one who designs and applies an external device to a part of the body to correct any malformation.

Both specialists technically design, measure, fabricate, fit and service prostheses or orthoses under the prescription of a physician.

Sumedi, who started working at the hospital in 1976, invited The Jakarta Post to tour his workshop at the hospital to see how prostheses are made.

Some factors taken into account when producing prostheses include energy storage and return, energy absorption, ground compliance, rotation, weight and suspension.

Initially, a prosthetist would work with gypsum on an affected part of the body, he said.

A socket that fits the stub of the limb is needed when fitting for lower-limb prostheses. Carbon fiber or glass infused with acrylic resin is used to make the socket, which is later linked to a foot assembly.

An aluminum tube with a two-part pyramidal alignment, with one device at each end, functions as connecting gears for the artificial limb.

The ankle and the socket are connected by two devices each. In order to support the patient's weight and to avoid any tangential movement, the foot is initially allowed to be in proper position.

Prosthetists then observe the way the patients walk. They jot down the positions when the leg is lifted, as well as when the toes lift off and the heel strikes the ground, and later correct anything considered deviant.

Depending on the affected limb, prostheses have four prime non-natural limb parts: transtibial, transfemoral, transradial and transhumeral.

An artificial limb that replaces a leg missing below the knee is called a transtibial prosthesis. Because the knee is largely retained, movement is still relatively easier than those with a transfemoral amputation.

Hence, transtibial amputees can regain normal movement with a prothesis.

An artificial limb that replaces a leg missing from above the knee is called a transfemoral prosthesis, and those with this condition must use more to walk than a person with two normal legs.

"Since the knee is somewhat broken or disturbed, learning to walk with a normal movement could be a hardship for a transfemoral amputee," said Sumedi, who has many years of experience with such patients.

An artificial limb that replaces an arm missing below the elbow is a transradial prosthesis, and one that replaces an arm missing from above the elbow is a transhumeral prosthesis.

Due to the similar complexities of elbow and knee movement, transhumeral amputees may undergo similar problems as transfemoral amputees when learning to use their prothesis.

While a prosthesis replaces a missing limb, an orthosis is a device that is applied externally to a part of the body to correct a malformation, improve function or mitigate symptoms of a disease by supporting or assisting the musculo-neuro-skeletal system, such as a brace.

"Orthoses are mostly needed by those with polio, stroke, nerve breakdown and also scoliosis," explained Sumedi.

The medical field concerned with the manufacture and application of orthoses is known as orthotics.

Sumedi recalled his experience with a 10-year-old girl who had scoliosis of 35 degrees asymmetrical.

Scoliosis is a condition when the spinal column displays abnormal lateral curves, which can affect the balance and alignment of the torso over the pelvis. Surgery, braces or chiropractic treatments are available to deal with scoliosis, but are very much dependent on the degree of scoliosis.

"Our medical rehabilitation specialist prescribed that she use a Milwaukee brace. She was a determined young girl, taking off her brace only when she took a bath. After 12 years of treatment, her scoliosis has been corrected to 5 degrees. It is almost a miracle. She is now a normal girl," Sumedi recalled of his patient, who would cry if her orthosis was taken away from her.

Before the 1997-98 economic crisis, the hospital's workshop had produced prostheses and orthoses on a regular basis and in mass, "but many were left unused because many did not fit the size of the patients," said Sumedi.

As the government subsidy became increasingly restricted, the hospital was forced to find ways to produce prostheses and orthoses in a more economical way.

It opted to use a collaborative mechanism, called UKS (Usaha Kerja Sama), where the prosthetists and orthotists of the workshop were to produce a number of products based on need or on an ad hoc basis.

"We produced 234 prostheses and orthoses in 2002, 231 in 2003, 376 in 2004, 461 in 2005 and 439 in 2006," said Sumedi, citing statistics.

They also accepted orders from other hospitals, he said.

"Many of the patients here are from low-income families," added medical rehabilitation specialist Dr. Ria Tobing, so they tried to make prices as affordable as possible.

Another prosthetist-orthotist, Bebeng, concurred.

The use of local material for a below-knee prosthesis for an adult would cost Rp 1,500,000 (US$), including servicing. The same prosthesis could cost up to Rp 9,000,000 if produced using imported material.

When low-income patients undergo physiotherapy as part of their a post-surgery rehabilitation, the hospital's social workers are tasked with contacting donors to contribute in producing the prostheses.

"It is unfortunate that many insurance companies and even the government-sanctioned ASKESKIN only cover surgery, not prostheses and orthoses," said Peny, referring to the national insurance scheme for the poor.

Peny asserted that the policy should change, as coverage for prostheses and orthoses would greatly help patients from low-income families lead a more productive life and contribute to society.


First published in The Jakarta Post, July 11, 2007


Alpha Amirrachman,
Contributor, Jakarta

The presidential election is still two years away, but political intrigues among the country's elites have already begun.

In March, for example, chairman of Muhammadiyah, Din Syamsuddin, was reportedly involved in the establishment of Baitul Muslimin, an Islamic-oriented economic wing of the nationalist Indonesian Democratic Party of Struggle (PDI-P).

The move prompted raised eyebrows among Muhammadiyah members, who see any cooperation with a secular nationalistic political party as something unusual.

Established on Nov. 8, 1912 in Yogyakarta, Muhammadiyah is the second largest Islamic organization in Indonesia with 30 million members. The largest is Nahdlatul Ulama (NU), which claims to have some 40 million members.

PDI-P, on the other hand, is one of the biggest political parties in the country. Its chairwoman, Megawati Soekarnoputri, is expected to join the 2009 election.

Din denied suggestions he was eying the post of vice president in the upcoming election.

"I have never been requested by PDI-P or Ibu Mega to be the party's vice presidential candidate," Din once said.

Sure, and there are no permanent friends and enemies in politics.

Recently, Din invited Jakarta governor hopeful Adang Daradjatun, who is backed by the conservative Islamic-oriented Justice Welfare Party (PKS), to his house for a meeting.

Din has insisted that Muhammadiyah, as a religious organization, has no structural organizational relations with any political parties. "But that doesn't mean we have to keep our distance from political parties... as they still play an important role in opening access to decision-making both in parliament and the executive," he said during the meeting.

Nevertheless, Muhammadiyah members have become increasingly uneasy with the apparent infiltration of a political ideology into the organization, which prompted Din to issue a decree warning members that PKS was a political party aiming to grab power.

The decree also reiterated the organization's non-political commitment by forbidding the establishment of a political party using Muhammadiyah's name and symbol.

Traditionally, many Muhammadiyah members have been actively involved in politics and significant numbers can be found in both the executive and parliament.

Even the National Mandate Party (PAN), which many regarded a "Muhammadiyah" political party, has somewhat failed to significantly woo and unite Muhammadiyah members.

"Any outside infiltration into non-political organizations and development of new thoughts are not new phenomena and happen not only in Muhammadiyah," Din told The Jakarta Post at his residence, an hour before the arrival of Adang and his entourage.

Born on Aug. 31, 1958, in Sumbawa Besar, West Nusa Tenggara province, Din grew up in an NU family. He spent his elementary and junior secondary education in NU schools as his father was a chairman of IPNU (NU Students' Association).

At his uncle's request, Din enrolled at the Gontor pesantren in East Java, where he became acquainted with the late Nurcholish Madjid, a moderate and prominent Islamic intellectual who opened his mind to the plurality of the Islamic school of thoughts.

He later studied at IAIN Syarif Hidayatullah Islamic College and became chairman of Pemuda Muhammadiyah, or the Muhammadiyah Youth Wing, from 1989 to 1993.

Fluent in English, Arabic and French, Din was awarded a Fulbright scholarship and studied at the University of California Los Angeles, earning a PhD in political science. His thesis is titled Islam and Politics in Islam: The Case of Muhammadiyah in Indonesia's New Order.

Din was active in the Golkar party for six years from 1993 to 1998 and served as a member of the Karya Pembangunan Faction from 1997 to 1998 in the country's highest political body -- the People's Consultative Assembly (MPR).

Din was also appointed as director general of Manpower Placement at the Manpower Ministry.
As an activist, Din became deputy chairman of Muhammadiyah under the leadership of Syafi'i Ma'arif.

On July 7, 2005, during the 45th Muktamar of Muhammadiyah, Din was elected as chairman of Muhammadiyah with 1,718 votes, replacing Syafi'i Maarif, a moderate Muslim leader widely respected both in Indonesia and abroad for his consistency in upholding his principles.

Din was believed to have won the votes of the increasingly strong conservative elements of the organization. Nevertheless, not along after he was elected, Din bewildered those who supported him by announcing that Christians could use Muhammadiyah schools or buildings to perform their prayers, at a time when many churches were being attacked and vandalized by Islamic hard line groups.

He said he understood those who wanted to apply shariah or Islamic laws in the country, but shariah should be understood in a broader manner.

"Islamic shariah is an Islamic teaching that emphasizes akhlak (good deeds)," he said, adding that treating shariah as a mere law is a gross reduction of Islamic values.

"Even (state ideology) Pancasila is already Islamic and could serve as a kalimatun sawa (common platform) in this pluralistic country," he said, adding opposition to sharia is also an anti-democratic attitude.

Din, who is also president of the Asian Conference for Religion and Peace (ACRP) -- with its headquarters in Tokyo, Japan -- believes most Indonesian Muslims are not interested in extreme liberalism and religious fundamentalism.

This is the reason he launched the Center for Dialogue and Cooperation among Civilizations (CDCC).

"We continue to encounter prejudices, misconceptions and misunderstandings among people of different religions and civilizations, especially between Islam and Christian West... we believe the prejudices and misconceptions among people of different faiths can be eradicated by persistent dialogue and cooperation," he said during the center's launch, which was marked by a public lecture by Defense Minister Juwono Sudarsono.