ALI ALATAS: VETERAN DIPLOMAT STILL IN THE RING

First published in The Jakarta Post, August 13, 2007

ALI ALATAS: VETERAN DIPLOMAT STILL IN THE RING

Alpha Amirrachman, Contributor, Jakarta

Ali "Alex" Alatas' tenure as Indonesian Foreign Minister may have ended in 1999 after the country's brutal exit from East Timor -- an event that deeply saddened him -- but this does not mean that he has retired entirely from diplomatic activities.

Through the transitional governments that led the country from authoritarianism to democracy, Alex, who graduated in 1956 from the Faculty of Law at the University of Indonesia, continued to play important roles in helping manage diplomatic affairs.

When Alwi Shihab was appointed Foreign Minister during Abdurrahman Wahid's presidency (1999-2001), Alex was assigned as special advisor to the minister. After the collapse of Wahid's government due to his erratic style, Alex was appointed foreign affairs advisor to President Megawati Soekarnoputri.

It was during Megawati's presidency (2001-2004) that Alex was sent to Sweden to discuss with that government the activities of the now defunct Free Aceh Movement (GAM), the leaders of which resided in that country.

Since May 2001, Alex has also been a member of the Experts and Eminent Persons Group of the ASEAN Regional Forum, which has recently succeeded in inserting a human rights clause in the would-be ASEAN charter, despite opposition from Myanmar.

In 2003, Indonesia dispatched Alex to the pariah state, which has been a source of ASEAN's embarrassment, to negotiate the release of Myanmarese pro-democracy leader and Noble Peace Prize laureate Aung San Suu Kyi. Though the obstinate junta politely refused the release of the "iron lady", they painfully assured Alex of the safety and health of this brave woman, who has galvanized democracy movements around the world.

From 2005 to 2006, Alex was a member of the UN High Level Group of the Alliance of Civilization, and was a special advisor to the UN Secretary-General in 2006.

And since March 2007, he has been chairman of the Advisory Council to the President of the Republic of Indonesia.

Born on Nov. 4, 1932, in Jakarta, Alex initially aspired to become a lawyer, but he was destined to be a diplomat. Journalism once thrilled this veteran diplomat too -- he was a journalist for the Niewsgierf daily (1952) and editor for the Aneta News Portal (1953-54).

Immediately following marriage, Alex was assigned as Secretary II in Bangkok (1956-1960), after which he held the post of Information and Cultural Relations Director at the Foreign Ministry (1965-66), then as Counselor of the Indonesian Embassy in Washington D.C. (1966-70).

Upon his return to Indonesia, he was again appointed Information and Cultural Relations Director, a post he held from 1970-72. His diplomatic star continued to rise as he was appointed Secretary of the Foreign Ministry Directorate General (1972-75), then Special Staff and Head of the Private Secretary to the Foreign Minister (1975-76).

Alex became the Permanent Representative of the Republic of Indonesia to the UN in Geneva from 1976-78, and on his return, was Secretary to the Vice President for four years. He was reassigned as Indonesia Permanent Representative from 1983-87, this time in New York.

He was finally appointed Foreign Minister for four administrative terms spanning 1987-99, under presidents Soeharto and Habibie.

His impressive career in diplomatic posts saw a string of critical events in Indonesia's road toward respectable statehood.

As the country's Permanent Representative to the United Nations, he had to tackle unrelenting international criticism regarding Indonesia's invasion of East Timor and the subsequent allegations of human rights abuses, an issue he once dubbed as a "pebble in our shoes".

Without his diplomatic skills, Indonesia's reputation might have sunk even lower, particularly following the Santa Cruz incident of Nov. 12, 1991, during which many Timorese were killed. The image of Indonesian soldiers gunning down peaceful protesters was beamed around the world, and Alex was forced to calm the fuming international community.

"Diplomacy is like playing cards. Don't show them all, but drop them one by one," he once said.

He was thus bewildered when then president Habibie, apparently without first consulting him properly, announced that Indonesia would immediately grant East Timor a referendum.

While Alex was trying hard to leave behind the "diplomatic incident" of the loss of East Timor and the ensuing calamity, he was offered the aforementioned appointments that again demanded his diplomatic expertise and skills.

And Alex has no lack in words when commenting on pressing, contemporary international issues.

"Religion has been exploited in many of the world's conflicts," he told a group of journalists on the sidelines of a public lecture held last Wednesday in Jakarta, by the Center for Dialog and Cooperation among Civilizations (CDCC).

"There have been tensions and conflicts between the faithful of three monotheistic religions -- Islam, Christianity and Judaism. Nevertheless, the root of the problem is not religion or culture, but political and economic grievances," he said.

"We live in an increasingly complex and volatile world. Our societies are still afflicted by ethnic and religious strife, by intolerance and prejudice, by misunderstanding and miscommunication and by intra-state and interstate violence," he continued.

"Polarized perceptions, fueled by injustice and inequality, have often led to conflict, threatening international peace and stability. Events of recent years have exacerbated mutual suspicion and contention, especially between Muslim and Western societies. This environment has been exploited by extremists throughout the world. There can be no doubt that this has become one of the defining issues of our times."

There should not only be persistent dialog, he stressed, but also tangible collaboration between different civilizations, such as in the area of economy.

A number of recommendations of the UN High Level Group of the Alliance of Civilization -- of which Alex is a former member -- illustrate such an approach: the development of an objective and rational white paper on the Palestinian-Israeli conflict; the reinvigoration of the stalled peace process; renewed commitment to multilateralism; consistent respect for international law; avoidance of double standards; combating poverty and economic inequalities through effective and concerted measures within the framework of the Millennium Development Goals.

"Unfortunately, the recent UN Secretary-General (Ban Ki-moon) has not moved swiftly enough to heed the Alliance's recommendations," he lamented, and stressed that persistent publication of the recommendations needed to be pursued.

Alex might not be Foreign Minister any longer -- and old age is inevitably snapping at his heels -- but his highly active mind is still filled with clear ideas on how to help resolve conflicts and mitigate tensions in world politics.

His high-profile performance and established stature as a senior diplomat is a model for aspiring young diplomats who are eager to push the world's third-largest democracy in playing a more strategic role at both regional and international levels.

http://www.thejakartapost.com/news/2007/08/13/ali-alatas-veteran-diplomat-still-ring.html

RAISING AWARENESS ON CEREBRAL PALSY, ITS TREATMENT

First published in The Jakarta Post, August 8, 2007

RAISING AWARENESS ON CEREBRAL PALSY, ITS TREATMENT

Alpha Amirrachman, Contributor, Jakarta

Dina (an alias) experienced difficulties when delivering her first baby at a hospital in her hometown.

As the baby would not come out, the attending doctor decided to use a vacuum to extract it.

However, the umbilical cord had become wrapped around the baby's neck in her uterus, and during the procedure his oxygen supply was cut off. When the baby was finally born, he didn't cry and his body was convulsing. He had gone into a coma from oxygen deprivation and needed to be placed in intensive care for a month following birth.

Later, it was found that his brain had been infected with cytomegalovirus, a type of herpes virus that Dina might have contracted during pregnancy.

Now 4.5 years old, Rangga (alias) has quadriplegic cerebral palsy. Dina diligently brings her son for therapy at Keanna, a private rehabilitation center in Cilandak, South Jakarta.
His prognosis is not good, as he cannot move any part of his body, not even his eyes.

But Dina is an optimist. "There is progress," she told The Jakarta Post, adding that she was ecstatic when Rangga finally smiled for the first time at her touch.

Cerebral palsy (CP) is a physical disorder resulting from non-genetic factors that cause brain damage, such as oxygen deprivation, infection and physical trauma, during or after pregnancy.

"The brain damage itself is non-progressive, but it can cause physical disorders," said pediatric neurologist Dr. Irawan Mangunatmadja of Cipto Mangunkusumo General Hospital in North Jakarta.

"It is a persistent, but not unchanging, disorder of movement and posture appearing in the early years of life," he said.

Several viruses can cause in utero brain damage such as TORCH, which stands for toxoplasma, rubella, cytomegalovirus (CMV) and herpes simplex virus II (HSV-II).

Toxoplasma is a genus of parasitic protozoa whose best host are cats; however, the vast majority of warm-blooded animals can carry it. The disease it causes, toxoplasmosis, can have fatal effects on a fetus during pregnancy.

The rubella virus causes rubella, or German measles. The virus is hard to detect, as it usually exhibits only mild symptoms or is asymptomatic.

Cytomegalovirus (CMV) is an ordinary virus and hardly ever causes noticeable disease, but it belongs to the herpes family, while HSV-II causes excruciating sores on the anus or genitals and may be dormant in nerve tissues.

Oxygen deprivation and a lack of nutrition channeled from the placenta to the fetus are also cited as possible causes of brain damage in the uterus; these also can cause low birth weight, viral encephalitis, brain tumors, head injuries and meningitis after birth.

"Generally, cerebral palsy can be categorized by the tonus, or muscle rigidity, and areas of the affected body," said Irawan.

CP is mainly classified according to tonus into three types: spastic CP, athetoid CP and ataxic CP.

Spastic CP is regarded as the most common form, wherein the cerebral cortex -- the region of the brain that controls thought movement and sensation -- is damaged. In such cases, the arms are usually hang lifeless, and the hands are twisted against the forearm. Its effects on the legs can be noticed by the way the child walks, depending on the degree of severity.

Athetoid CP results in involuntary, uncontrolled and uncoordinated movements of the muscles, due to damage of the basal ganglion. Consequently, all limbs display jerky movements while the fingers and wrists are twisted. Due to poor coordination, the child might also stumble when walking.

Ataxic CP is the rarest of the three and results from damage to the cerebellum, which controls stability. A child with this type of CP will have difficulties with balance.

According to the affected areas of the body, CP is classified into hemiplegic CP, diplegic CP and quadriplegic CP.

Hemiplegic CP describes the condition when half of the body -- such as the right arm and right leg, or the left arm and left leg -- is affected. Almost all children with this form CP are able to walk, since spasticity mostly affects the arm.

Diplegic CP is indicated by the more severely affected lower limbs, which is commonly found in babies born prematurely, while in quadriplegic CP, all four limbs are severely affected.

Technology can help detect the degree of brain disorder through the computerized tomography (CT) scan or magnetic resonance imaging (MRI).

The position emission tomography (PET) scan is used to identify any specific chemicals in the brain while the electroencephalogram (EEG) can also be useful in detecting brain disorders.

Children with CP are found in both developed and developing countries. In the 1970s and '80s, the number of children born with CP in developed countries declined, but appeared to rise after this period.

In the United States, CP occurs in 1.5 to four children per 1,000 live births; in Indonesia, about 2 percent of babies are born with delayed development, including cerebral palsy.

Various forms of rehabilitation can be helpful to children with CP, such as physical therapy, a standing frame to reduce spasticity, or the Bobath Concept to help the child physiologically through play to improve posture and reduce stiffness.

Aside from private rehabilitation centers in Jakarta, many hospitals, like Cipto Mangunkusumo General Hospital, Fatmawati General Hospital and Harapan Kita Hospital, have rehabilitation and treatment wards for children with delayed development.

"But parents cannot depend merely on treatment here," said therapist Retno of Cipto Mangunkusumo. "We (also) give them exercises to be done at home."

While the child is encouraged to learn some skills, therapy is administered in stages.

"First, we have to relax their muscle rigidity through exercises before giving them functional exercises," said therapist Ahmad Syakib of Fatmawati hospital.

For example, he said, one patient with athetoid CP required exercises for coordination to treat involuntary movement.

"What we can do is to encourage them to be as independent as possible, since CP has no cure," said Ahmad.

As cerebral palsy is non-genetic, women with CP can still have healthy babies, and Ahmad gave as examples two adult female patients with CP who have normal and healthy children.

Nevertheless, some factors still hamper the proper treatment and handling of children with CP.

Irawan lamented that many parents appeared to have a low awareness of the condition, and when they notice that their children have some kind of delayed development, they preferred to adopt "alternative" treatments -- until it was too late for a professionally designated rehabilitation program.

He added that the parents' financial situation could adversely impact CP therapy, and supporting public facilities remained almost nonexistent in Indonesia.

"What is also important is their chance to go to school, to have an education," added therapist
Novi of Cipto Mangunkusumo hospital.

Children with cerebral palsy have various degrees of learning problems; the most common are visual impairment, hearing impairment and difficulties with speech and language. Some are good at mathematics and reading, but poor at perceiving shapes.

The average intelligence quotient of a child with CP is 100, with many registering in the 70-80 IQ range.

But those with an IQ of 119 or above are usually able to excel in school, said psychologist Annie L. Perbowo of Harapan Kita hospital and the Pela 9 rehabilitation center.

The government has campaigned for sekolah inklusi (inclusive school), under which normal schools are to accept children with special needs. In 2003, 21 schools -- from kindergarten to high school, including vocational high schools -- across the five Jakarta districts participated in the program.

The campaign, however, is yet to be followed by concrete support from the government.

For example, the Post observed that a state elementary school in Bangka, South Jakarta, that accepts around five children with special needs every school year is not yet equipped with supporting facilities such as a special ramp and toilet. The school also has to arrange a special education teacher on its own.

It appears that no minimal standardization of school infrastructure and teaching staff exists for special needs children, such as those with cerebral palsy.

Further, several teachers at different schools did not have any understanding of cerebral palsy, merely grouping CP children among others with mental retardation or hearing and visual impairment.

http://www.thejakartapost.com/news/2007/08/08/raising-awareness-cerebral-palsy-its-treatment.html

MOTHERS STRIVE TO SUPPORT CHILDREN WITH CP

First published in The Jakarta Post, August 8, 2007

MOTHERS STRIVE TO SUPPORT CHILDREN WITH CP

Peni Kusumawati didn't think that her first child would be anything other than a healthy baby. When the estimated due date came, she didn't feel any symptoms of labor, nor was she severely ill, so her doctor advised that Peni wait a little longer.

"But my (uterine) membrane had ruptured before I delivered my baby girl, Yasmin Azzahra Rahman. Later it was found out that the amniotic fluid was contaminated by my daughter's feces. She was overdue," Peni told The Jakarta Post.

Yasmin was diagnosed with athetoid cerebral palsy (CP), which results in involuntary, uncontrolled and uncoordinated movements of the muscles. All limbs are affected with jerky movements, and the child might also stumble when walking due to poor coordination.

For years and almost daily, Yasmin has undergone intensive physio- and occupational therapy, mostly at Pela 9 rehabilitation center in South Jakarta. She has also been prescribed at-home rehabilitation exercises.

Neurologist Dr. Dwi Putro of Bintaro International Hospital said that Yasmin had the potential to walk, although she would not walk as normally as other children.

Recently, the 7-year-old took her first steps with a walker.

Yasmin, who has two healthy, normal younger brothers, just began school at SDN 04 Cipete Selatan State Elementary School in Cipete, South Jakarta.

The school is an ordinary one, but it accepts children with special needs under the government's sekolah inklusi (inclusive school) program.

Although government support is still limited, Peni is upbeat. "I am ready to cooperate with the school to provide more necessary support for my daughter," she said as she accompanied Yasmin to her first day at school.

With an IQ of 119, Yasmin has difficulty writing because of athetoid CP, but she is able to read and is considered able enough to compete among other students who have no physical disabilities.

That a child with CP can succeed academically is evident in the example of wheelchair-bound Susanne Ongkowidjaja, who recently graduated from the English Department of the Education Faculty at Pelita Harapan University.

Susanne has both quadriplegic and hemiplegic CP -- her four limbs are all affected, but the right side of her body is more severely affected.

Her mother, German-born Traute Ongkowidjaja, also had a ruptured uterine membrane prior to delivering Susanne, her first child. She was unaware that Susanne had cerebral palsy until her daughter was a year old.

"I gave my daughter therapy by myself," Traute said during an interview held at The Jakarta Post.

The treatment Traute administered comprised of Voita and Bobath. In Voita, she pressed certain spots of Susanne's body to stimulate the cells, while under the Bobath Concept she assisted Susanne in physical games and exercises to improve posture and reduce muscular stiffness.

Susanne, whose two younger sisters are health and without disabilities, attended SDN 09 Kayu Putih Siemens State Elementary School in Pulomas, East Jakarta. From the first to fourth grades, Susanne was accompanied and assisted by an aide studying at a teacher's college, who would lift up her body when she played.

"And I sat by the door of the class to help write the lesson," recalled Traute.

After undergoing an operation in Germany to fix her hip in 1993, Susanne attended the internationally oriented Cita Buana school in South Jakarta until she graduated high school in 2002.

"I had a difficult time as my (peers) seemed reluctant to approach and play with me, but my teachers were marvelous, as they treated me as if my wheelchair did not exist," the self-confident Susanne said in fluent English.

She finally earned her peers' respect during a fund-raising event at the Wisma Subud residential compound in 1999, when she succeeded in collecting a significant amount of money using a custom-designed tricycle.

Traute pushed her daughter to continue studying, and surveyed several universities in Jakarta -- only to find that they had too many stairs, which can be troublesome for her daughter. She said she then had a dream that "instructed" her to take Susanne somewhere in Karawaci.

So she enrolled Susanne at Pelita Harapan University, which had facilities that were more comfortable and suitable for her daughter.

"But I was bit shocked and sad during the first days at the university, because the lecturers always left the class immediately after lecturing," said Susanne, who turned 25 in March.

At university, Susanne regularly posted her essays on a "wall magazine" until people became aware of her potential.

She aspires to become an editor or translator, and added that she intended to submit some pieces to the Post.

She also participated in religious activities at Pelita Harapan.

"That is why Susanne has become very forgiving, particularly of her mother who has made a lot of mistakes...," smiled Traute, followed by Susanne's chuckling.

-- Alpha Amirrachman

http://www.thejakartapost.com/news/2007/08/08/mothers-strive-support-children-cp.html

LIFE-LONG FRIENDS TIED BY PROSTHETICS (Part 2 of 2)

(Part 2 of 2)

First published in The Jakarta Post, July 18, 2007

LIFE-LONG FRIENDS TIED BY PROSTHETICS

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.

http://www.thejakartapost.com/news/2007/07/18/lifelong-friends-tied-prosthetics.html

RAISING AWARENESS OF PROSTHETICS, ORTHOTICS (Part 1 of 2)

(Part 1 of 2)

First published in The Jakarta Post, July 11, 2007

RAISING AWARENESS OF PROSTHETICS, ORTHOTICS
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.

* All patient names in this article are aliases.

http://www.thejakartapost.com/news/2007/07/11/raising-awareness-prosthetics-orthotics-part-1-2.html

DIN SYAMSUDDIN: A MAN TO WATCH

First published in The Jakarta Post, July 11, 2007

DIN SYAMSUDDIN: A MAN TO WATCH

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.

http://www.thejakartapost.com/news/2007/07/11/din-syamsuddin-man-watch.html

WIEN MULDIAN CAMPAIGNS FOR LITERARY DEVELOPMENT

First published in The Jakarta Post, June 23, 2007

WIEN MULDIAN CAMPAIGNS FOR LITERARY DEVELOPMENT

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 www.worldbookdayindonesia.blogspot.com.

http://www.thejakartapost.com/news/2007/06/23/wien-muldian-campaigns-literary-development.html

RAISING AWARENESS ON SCOLIOSIS, ITS TREATMENT

First published in The Jakarta Post, June 20, 2007

RAISING AWARENESS ON SCOLIOSIS, ITS TREATMENT

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.

http://www.thejakartapost.com/news/2007/06/20/raising-awareness-scoliosis-its-treatment.html

LUTHFI GATAM: HELPING PEOPLE WITH SCOLIOSIS

First published in The Jakarta Post, June 20, 2007

LUTHFI GATAM: HELPING PEOPLE WITH SCOLIOSIS

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

http://www.thejakartapost.com/news/2007/06/20/luthfi-gatam-helping-people-scoliosis.html

AUDY BUDIARTI: HELPING CHILDREN WITH CLEFT LIPS

First published in The Jakarta Post, June 6, 2007

AUDY BUDIARTI: HELPING CHILDREN WITH CLEFT LIPS

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 http://www.obi.or.id/ to learn more about its activities. The foundation's address is Jl. Sriwijaya Kav. V-VII, Lippo Cikarang.

http://www.thejakartapost.com/news/2007/06/06/audy-budiarti-helping-children-cleft-lips.html

Short Story: THE JOURNALIST

First published in The Jakarta Post, May 27, 2007

Short Story: THE JOURNALIST

By Alpha Amirrachman

"You are now a grown-up. You need to learn several more facts about your family, I cannot keep this secret for the rest of my life," said Bagas' mother one morning.

Bagas asked, reluctantly, "Is it about father again? His career as a journalist?"

Bagas was now in the last semester at the school of journalism. If his father had still been alive, he could, indeed, have learned more about journalism from him.

But it was about something else. His mother said, "I'm sorry but I'm not your biological mother."

Bagas was speechless. This woman whom he had known for years was not his mother.

"Your father was murdered and your mother was thought to have committed suicide."

Bagas was stunned.

"He was a journalist at a local newspaper, as I've always told you. But there is more that I haven't revealed to you. It is about his extensive writing on a huge scandal allegedly involving the city mayor and big corporations. It was a billion-dollar scandal at a time when poverty struck the city."

"Your father was shot dead when walking out of his house. His colleagues believed that he was murdered because of what he had written. But no one had a clue about who actually pulled the trigger, fatally shooting him five times at close range in cold blood," she explained with a trembling voice.

"Your mother was on the terrace of the house and was an inch away from being killed, too, when the assassin ran out of bullets. Fortunately, you were holidaying at your aunt's house. Your mother was the only witness; she was unconscious for days. She said later that she knew the assassin."

She held her breath, "Just a week after the murder, your mother was found dead, her body hanging in the hospital room. Some believed she had committed suicide, but relatives said that she had a tough personality, so suicide was out of question."

"I was a nurse at the hospital, grabbing you when you and other family members were about to visit your mother at the hospital at the time she was found dead. I was actually the very first person who found your mother's body hanging in the room."

Bagas was shaking.

She paused a second. "To be honest, I kidnapped you, the only child they had. I was a divorced woman with no kids. I stayed at work for a month to disguise my action before I fled the city with you, my sweetheart."

Your sweetheart?

Bagas stood up, immediately went to his room and banged and locked the door. He felt as if thousands of knives were stabbing and slashing his brain into pieces.

I heard five gunshots. They sounded like a thunderbolt, breaking a peace-loving neighborhood, scaring even the fiery dogs ... Slowly blood was spilling to the ground, making it red all over. I could still smell the blood and the smoke. my father might have never heard the gunshot that killed him, but surely he must have felt the pain ... this pain.

*****

(Many years later)

His mother was lying on the bed; four strokes and blood hypertension had effectively crippled her.

Bagas, now celebrated as the most successful media magnate in the country, sat solemnly beside her bed. His sweet-mannered wife, Anita, appeared, bringing a bowl of chicken soup, a cup of porridge and a glass of warm water.

"She looks healthier now," whispered Anita, softly. "She has been eating very well lately."

"That's good, very good. Remind me of when her medical checkup is," said Bagas.

"That would be tomorrow," Anita replied, adding that she had already bought two tickets for her and her mother-in-law to go to Singapore.

"And also tickets to go the U.S. to visit our sons next week," Anita added, referring to their two grown-up sons who were now studying at Harvard and Boston universities.

"That's good, I can't wait."

Bagas kissed the woman's cheek, and whispered lovingly, "You are always my mother."

The aging woman nodded, slowly.

However, without everyone's realizing it, she looked awfully troubled every time she stared at Bagas. There was something mentally disturbing in this sharp, unwavering man that always made her uneasy; it was like a wicked spirit disquieting her inner feeling, coursing strongly and painfully through her veins.

Forgive me ... She bit her lips, they bled.

*****

Bagas drove his gleaming black Jaguar out of his lavish apartment block, vainly struggling to speed through the hectic traffic. He parked the car in a special space at the huge complex of his own media corporation.

He inhaled deeply. Many accused him of being too ferocious in expanding his business, and being cruel to smaller players. Being armed with the power of money and political connection raised suspicion that he never gave it a second thought to twist anything to suit his goal.

He decided not to get out of the car immediately. Stretching out his drained body and soul, Bagas couldn't wait to visit his sons in the U.S. next week, where at least he could relax a bit after having worked so hard lately.

Well, he and Anita might also continue traveling to Europe, he thought. Strolling down the road in Paris or capturing the struggling East-West mood of the Turkish hinterland.

He had been so preoccupied recently, welcoming several political and business figures at his office with election time coming soon. Those boring b*****ds trying to buy me! he laughed cynically.

He managed shrewdly to maintain his subtle political connections. Striking a balance between professionalism and political pressure and temptation is indeed mentally exhausting, but it thrilled him.

Bagas claimed that he never interfered in the editorial content of the media he led, though his staff often had to painfully exercise self-censorship when they had to report on issues relating to their own media corporation.

But that is out of my control, he chuckled, a bit haughtily.

Now he was entertaining a possibly lucrative chance to expand his business empire into neighboring countries.

Staff had recently reported to him that some media groups in the Philippines and Thailand were at the edge of collapse; his inimitable mix of entrepreneurial and journalistic instinct told him that something could be done to help the ailing media.

But that was not going to be easy. In the Philippines the political killing of journalists had always been a ritual, and in Thailand the frantic junta had always made the industry unpredictable.

But he could smell a golden opportunity -- a risky but calculated challenge, the tense negotiation, the increased political influence, the rewriting of history and the unremitting flow of money.

I could still smell the smoking gun. I could still smell the blood ... I saw a body of a slim man crumbling after five deadly gunshots. My father might never have heard the last gunshot that put an end to his life and my mother might never have seen the jerking rope that broke her neck, but surely they must have felt the pain ... this pain ...

He saw himself rewriting history.