Tuesday, April 18, 2006

Lisa, Pasien "Face Off" RSU Dr.Soetomo Bertemu Orang Tuanya Untuk Pertama Kali.

Muhammad Sjaifuddin Noer: The man behind the face-off surgery

Loud applause was heard in a conference room at Dr Soetomo General Hospital when Dr Muhammad Sjaifuddin Noer entered the room from a side door. Dozens of people in the audience, made up of hospital visitors, young physicians, medical students of Airlangga University and reporters, excitedly greeted the 59-year-old surgeon."Well, I believe all of you have watched the process. We have started to slice the skin off

Lisa's face," said Dr Muhammad Sjaifuddin Noer, better known as Dr Din, and went on to explain the face-off surgery, the first of its kind ever to be performed in Indonesia. Lisa, whose real name is Siti Nur Jazillah, was seriously disfigured after acid was thrown in her face her three years ago. Under the face-off process, the skin of her entire face would be removed, and replaced with healthy skin from her back.

Dr Din took his seat among the audience and watched with them a monitor showing the progress of the surgery. He patiently explained the steps of the operation, and then returned to the operating theater to continue his work. That was three weeks ago. The surgery, which lasted 18 hours, was successful and made headlines around the country. Even the most difficult part of the surgery, reattaching the blood vessels together, went off without a hitch.

Dr Muhammad Sjaifuddin Noer was a key figure in the operation. Born in Bangkalan, Madura, the father of three is the chief of the face-off surgical team. "But, all this is the success of the entire team of doctors, helped by the prayers of the entire community," he said, humbly.

Dr Din is quite a famous name in Indonesia's medical world. The son of Muhammad Noer, a highly respected former East Java governor, he was chosen to take part in aesthetic surgery training at Pattaya, Thailand in 1984. In 1992 he went to China for tissue bank training and two years later he was off to Australia for a plastic surgery training course.

Formerly the tissue bank chairman of Dr Soetomo General Hospital, Dr Din gained even more respect when he was included in the team of doctors assigned to take care of the victims of the 2002 Bali bombing. "I have done numerous plastic surgery operations," said Din, who was also once a member of a team of doctors assigned to separate a Siamese twin.

Dr Din became interested in plastic surgery when he was a medical student at Airlangga University in 1975. "It is the art factor that distinguishes plastic surgery from the other forms of surgery," he said. He decided to become a surgeon, and completed his plastic surgery training in 1987.

Since then he has been known as an expert in plastic surgery. Doctors in Dr Soetomo General Hospital joke that Dr Din can repair the shape of a nose in just 10 minutes. Dr Din, who is married to a dentist, Rina Banarsari, can only smile at this joke. His expertise and reputation are what won him the position of chief of the face-off team.

Dr Din took pity on Lisa when he met her on January 24, 2006. She complained that whenever she had the flu, her right nostril would stick shut. Lisa, who comes from Malang, East Java, sustained her injuries when her husband, Mulyono, allegedly threw hydrochloric and sulfuric acid over her. Dr Din explained the face-off operation to her, and she agreed to it.

Dr Din said that he had been convinced of the surgery's success from the start. In 1997, he said, a similar operation had been conducted in Argentina. He convictions, however, did not take into account the huge cost of the surgery, rumored to be around half a billion rupiah. "The East Java provincial administration eventually decided to give help through the hospital."

Besides, he continued, several community organizations also donated to the cause. "We never expected to see such a great response from the community. On behalf of the team of doctors, I sincerely express our gratitude," he said.

After careful analysis and planning, and one postponement, the face-off surgery finally took place. Everything went as planned, without any significant hurdles. The team of doctors seemed to forget their fatigue, while they worked an 18 hour stretch. Badly damaged skin on Lisa's face was replaced with fresh skin.

After three weeks, Lisa's health has improved. She can now make phone calls, walk and do other activities. The doctors say she is past the critical period. The historic face-off surgery itself has earned favorable responses from several parties.

Minister of Health Fadillah Supari could not hold back her tears when she visited Dr Soetomo General Hospital and witnessed the successful surgery. "I realize a face is very important to a woman. The team of doctors has worked without hoping to get anything in return. This is really very rare," she said.

Train drivers get little reward for difficult job

The house on Jl. Gembili Raya in Surabaya with the leaves gathering on the front porch has been empty for two days. "The entire family has been at their grandmother's since Pak Nurhadi passed away," a neighbor told The Jakarta Post on Sunday.

Nurhadi Karyono was driving one of the two trains involved in an accident April 15 at Gubug station in Grobogan, Semarang, which left 14 passengers dead and dozens of others injured. An investigation is currently underway to determine why Nurhadi's train failed to stop at the station, ramming into the back of the other train.

This latest railway tragedy also served as a reminder of the plight of railway workers, who receive meager salaries for demanding and often dangerous work. Nurhadi, 46, who worked as a train driver for 24 years, was never able to afford his own home.

The house he lived in since his marriage was owned by his wife's parents, and he and his wife and their children had to share it with an uncle, Marimo, and his family. "The house belongs to Nurhadi's in-laws. My nephew couldn't buy his own house," Marimo said.

The biggest item Nurhadi could afford was a small motorcycle, which he used to drive his children, Yudha Susanto, 7, and Fitriani, 6, to school. Another train driver, M. Sugeng, who works the Surabaya-Bojonegoro line, said he was paid a monthly salary of just Rp 1 million (US$105), plus a small duty allowance. "What can I expect from such a small salary?" Sugeng asked.

To get by, he is forced to live in Babat, Lamongan, 75 kilometers from Surabaya. Every day Sugeng commutes between Surabaya and Lamongan by train. "That's the price of living out of town ... leaving for work early in the morning and returning home late at night," he said.

State-owned railway company PT KAI built housing for employees in Surabaya, but only senior employees have benefited from this company facility. "Most of them refuse to move out even after they retire," Sugeng said.

To supplement their salaries, some train drivers allow passengers to ride in the locomotive for a small fee, dangerously crammed into the small cabin. The Post observed an average of five passengers illegally riding inside the locomotives of trains leaving Pasar Turi station in Surabaya.

"We pay less to ride in the locomotive," said one of the passengers, Syawal. Passengers can pay drivers between Rp 10,000 and Rp 100,000 to ride in the cabin of an express train from Surabaya to Jakarta, compared to the normal fares of Rp 190,000 to Rp 220,000 for an executive-class train and Rp 47,000 for an economy-class train.

Authorities believe most of those killed in the accident Saturday were illegally riding in the locomotive. A spokesman for the state railway company in Surabaya, Sudarsono, acknowledged that drivers continued to allow passengers into their cabins. "I admit it, but this is a problem that we must tackle together because passengers continue to break the law," he said.

Sudarsono said PT KAI had repeatedly told passengers to purchase tickets and sit inside the passenger cars for the sake of safety. He urged the public and train employees to obey regulations. "We will take stern action against employees breaking this rule."

However, this practice will be difficult to stop as long as train drivers feel they must supplement their salaries in order to support themselves and their families. ***

Monday, April 10, 2006

Woman Goes Under the Knife

Curious doctors and journalists gathered Tuesday morning to watch lengthy and challenging "face-off" surgery performed on a disfigured Surabayan woman. The surgery, screened live on monitors at Dr. Soetomo Hospital in the East Java capital, was performed on Siti Nur Jazilah, who was scarred in an acid attack three years ago.

The complicated operation, conducted by a 25-strong team of doctors led by Sjaifuddin Noer, a
surgeon, was divided into several stages estimated to take a total of 17 hours. Siti's entire facial skin was removed and replaced with skin taken from her back, using a free-flap system that was the first to be performed in the country. Her back skin would be replaced with skin grafts taken from her thigh.

"We hope everything runs smoothly as planned," the hospital's deputy director, Teguh Sylvaranto,
said before the surgery. Costs of the surgery, earlier estimated at Rp 20 million (US$2,173) and covered by the hospital, were estimated to jump to hundreds of millions. Medication alone has cost Rp 54 million.

If successful, it will provide a new start for the 19-year-old, who spends most of her time shut
away in her home in Sidoarjo regency, East Java. "The surgery is expensive but don't let the costs get in the way of the surgery. The most important thing is that the team of doctors is doing its best," said hospital director Slamet Riyadi Yuwono.

Doctors Guard Against Infection

The team of doctors at the Dr. Soetomo Hospital in Surabaya, who successfully performed landmark facial surgery on a woman Tuesday, are concerned of the possibility of infection in the healing of grafted skin. The woman was undergoing surgery as her face was badly disfigured after being doused with acid.

"And should that happen, there is the likelihood that her condition would deteriorate drastically which could eventually lead to death," said a member of the team, Dr. David Sontani Perdanakusuma, after a post-surgery evaluation meeting in Surabaya on Thursday.

According to him, doctors are ensuring that the isolation room at the Intensive Care Unit of the hospital's Central Integrated Surgical facility -- where the patient, Siti Nur Jazilah, or Lisa, is recuperating -- remains completely sterile.

"We are worried, especially about the risk of infection, so that's why we are limiting access to the room, including to the doctors," said David. A team of microbiologists, led by Dr. Kuntaman, is carrying out bacterial culturing on Lisa's face. Infection is usually detected on the fourth or fifth day after surgery, or early next week in this case.

The surgery, using the free-flap system, performed at the hospital on March 28 was successful, despite it taking an hour longer than the estimated 17 hours. The delay was due to the delicate process of connecting blood vessels (the most difficult stage of the surgery), as well as complications encountered during the forming of lips and eyelids, after the skin taken from her back was implanted on her face which needed 80 stitches.

Lisa finally regained consciousness at 5 a.m. Wednesday. However, the 22-year-old woman has not passed the critical period yet. Lisa was visited Friday by her father Saring, grandfather Samsuri and grandmother Wagina and a number of other family members. They could not have direct contact with Lisa, but were able to see her through a CCTV monitor accompanied by several members of her medical team.

Meanwhile, evaluation results two days after the surgery disclosed that the implanted skin on Lisa's face had shown signs of "developing", as seen from the blood permeating the right and left temples, where the blood vessels were attached. "This shows that we have attached the blood vessels successfully," said vice director of Dr. Soetomo Hospital, Teguh Sylvaranto.

Lisa is still receiving blood transfusions. She has so far received 18 units of blood. "The blood flowing throughout her body now is totally donors' blood," said Teguh. This has, however, raised concern of the presence of a blood clot.

From the CCTV installed in the evaluation room, Lisa was noticed still asleep on a Clinitron Bed (an antigravity bed made of silica sand), with a 40-watt lamp focused on her face, which was covered with bandages, to provide warmth and facilitate blood flow, and a tracheotomy tube placed in her throat.

Lisa is expected to receive treatment for two weeks, followed by outpatient treatment thereafter. Doctors will construct facial textures when her wounds have healed, such as eyebrow and eyelashes. "We will do this as time goes on," said Dr. David, who is also a plastic surgeon.***

Osing Living In Seclusion Amid Modernization

At a distance, the tone of traditional music was could be clearly heard on a clear evening in the ethnic Osing people's hamlet of Kemiren near Banyuwangi, East Java. The sounds were in near perfect harmony with an Osing language song. "The barong (mask) dance is beginning, let's go and watch it," said Karti, 50, a local food stall waitress, to The Jakarta Post in the Osing tongue.

A family living at the foot of the Ijen mountain range presented the barong performance at several weddings. Hundreds of people from Kemiren and nearby Kinjo and Boyolali villages thronged to the festive home located amid paddy fields to enjoy Osing-style dances and vocal arts offered by the Trisno Budoyo troupe.

The Osing are one of the minority ethnic groups still surviving in East Java. This group is spread over several areas in and around Banyuwangi, a city 300 kilometers east of Surabaya.

Banyuwangi regency has three officially recognized ethnic groups: the Osing, Javanese and Madurese. Osing people are mainly found in Kemiren village, West Banyuwangi, 7 kilometers from the city center, totaling 2,400 out of its 1.4-million population, and in Aliyan village, 14
kilometers from the city hub, constituting almost half of its 4,800 population.

The people speak in the Osing dialect of Javanese, which is said to have been directly descended from the royal family of Blambangan, a small kingdom in East Java around the 18th century.

Established by King Wiraraja, Blambangan was part of the Majapahit empire. After the fall of Majapahit, Blambangan became an arena of struggle for its conquest by small monarchies in Bali, Pasuruan and Islamic Mataram.

The power struggle was not yet over when Blambangan, famous for its fertile land (Blambangan being derived from the word balumbung or lumbung meaning a granary), turned into a target of Dutch colonizers through their VOC (Dutch East Indies Company). This ensnared position made the
people of Blambangan resistant to external forces, so that they sided with none of them, an attitude locally termed osing or using (independent).

The VOC's unrelenting attempts to control Blambangan faced opposition from Blambangan's community leader, Mas Rempeg, believed to be a reincarnation of Prince Agung Willis of Blambangan. Though Mas Rempeg's rebellion was finally put down by the VOC, the war caused the deaths of VOC officers
Lieut. Van Shaar, Major Gobies and Lieut. Kornet Tienne.

The big battle in 1771-1772 forced the population of Blambangan to take refuge on mountain slopes and cross to Bali, many of whom still live in those areas. Curiously, the murky past of Blambangan continued to be experienced by Osing descendants and the Banyuwangi area in general.
In 1965, for instance, a lot of people in this easternmost city of East Java just across a narrow strait from Bali, were killed following accusations that they were communist sympathizers. One popular communist song at that time, Genjer-genjer (a vegetable), was written by a Banyuwangi citizen.

More tragedy struck in 1998, when a rumor spread about the prevalence of black magic in the area. People in Banyuwangi, many of whom supposedly possess supernatural powers, became a target of murder. Some 150 citizens accused of using black magic for evil purposes were hacked
to death by an unidentified group of people dressed up like ninja warriors. "The incidents have made the Osing people increasingly alienated," Hasnan Singodimayan,75, an Osing community leader, explained to The Jakarta Post.

Osing's Tough Reawakening

In 2002, attempts were made to bury the past. On the the 232nd anniversary of Banyuwangi, Syamsul Hadi, then regent of Banyuwangi, tried to revive the city's Osing traditions. He made Osing the official language of the area and included it in the school curriculum. He also changed the
city's symbol from a snake with the head of Javanese shadow-puppet hero Gatotkaca into an Osing Gandrung dancer.

At first the Osing reawakening was warmly welcomed by the local community. The Osing language began to be spoken by non-Osing people in Banyuwangi. Hasan Ali, an Osing figure, launched a dictionary of this regional tongue, which is close to old Javanese and Balinese. The main
difference is that Osing has no language caste system in speech and writing, unlike Javanese and Balinese.

"The Osing ethnic character is getting more noticeable with the more widespread use of this language," said Hasnan Singodimayan. Osing folk arts were presented as the region's official
performances at national events in Banyuwangi. The ethnic group has diverse rituals related to the life cycle (from marriage to pregnancy) and community affairs (from offerings to spirits to harvest festivities) as well as traditional dances. According to East Java cultural
observer Ayu Sutarto, there are 32 Osing cultural ceremonies, 18 of which are art performances.

There have been some rejections of the culture, however, particularly in areas with more dominant Javanese and Madurese populations. "Several schools have refused the inclusion of Osing in
their curriculum," said a teacher in South Banyuwangi, who declined to be identified.

Ahmad Fauzi, 24, a youth of Osing descent working as an Osing radio broadcaster in Banyuwangi, said his peers had begun to give up speaking Osing. "They choose to speak Bahasa Indonesian or its Jakarta dialect," said Fauzi, who lives in the Osing village of Kalipuro. Fauzi noted the loss of many folk arts, such as Angklung Carok (a bamboo music contest) and Jaranan (the horse
dance), which used to be performed at Independence Day celebrations.

Even in Osing ethnic centers like Kemiren, the original atmosphere has changed, with an ever decreasing number of traditional houses. There are three types of Osing house: Tikel Badung, Baresan and Cerogan. They are made entirely of wood and without nails or cement, with front verandahs to for entertaining guests. Their kitchens have broad bamboo tables where family members dine.

Aekanu Hariyono of the Banyuwangi Tourism Office said that present government policy was not suitable for the promotion of this community. He said by determining Kemiren as a tourism village, the Osing culture had been segmented. "The village should be left in its original state while its art performances are continuously boosted," Aekanu said.

He had been inviting guests to witness Osing customs as "a humane way of letting the community grow naturally." Endeavors to preserve the high cultural values of the Osing people go on, hopefully avoiding the mistakes of the past.***

Surabayans Turn Garbage Into Cash

The diesel-powered waste shredder instantly roared into action when Supardi, 64, an employee at the temporary garbage disposal facility (TPS) in Jambangan subdistrict, Surabaya, switched on the machine, emitting black smoke from its exhaust pipe, as the blades rotated. "It's time to cut up the trash," Supardi told The Jakarta Post.

He took a batch of dried leaves and corn cobs from the pile of garbage next to the device and fed it into the cutting blades in the top part of the machine. In the wink of an eye, the garbage was reduced to tiny shreds, measuring about one-by-two centimeters, and heaped at the bottom of the machine.

"The crushed byproduct will then be filled into a composter, which will process it into compost in two months," said Supardi. It will then be sieved into fine particles and will be ready for sale. "A kilogram packet of compost sells for Rp 600 (6 U.S.cents)," he said.

Supardi and his colleague Suyadi, 41, gather an average of 2.5 tons of household garbage per day,
which can be turned into a ton of marketable compost. "We yield at least Rp 600,000 every two months. The money will be used for operational costs, and we'll get whatever is left," said Supardi.

What Supardi is doing is part of an independent waste processing program in Jambangan subdistrict in Surabaya. The program was initiated in 2002 by the Unilever Peduli Foundation, under the auspices of PT Unilever, in cooperation with the Surabaya municipality and Surabaya State University (Unesa). The project aims at reducing household waste in Surabaya.

"We have introduced the concept of sorting organic and non-organic waste in households," said foundation general manager, Okty Damayanti. Non-organic waste is usually sold to recyclers, while
organic waste is immediately cut and stuffed into a compost bin -- in the shape of a bucket with a lid and a three-meter-long pipe on top -- specially provided to each household in Jambangan.

Heat and foul smelling gases are emitted through the pipe during the decomposition process, during which organic matter is broken up into fine particles. A slot at the bottom of the bin is used to collect the compost. "I fill the compost bin with organic waste every day," said a resident in Jambangan, Supriyatun Jupri, 44.

Although the process seems simple, implementing it was a challenge, especially sorting the waste, due to residents' habit of dumping garbage directly into the Berantas river in their vicinity. "I was at first reluctant to do it because I'm no scavenger," recalled Wiwik, 48. However, after residents realized the potential of the compost bins and proceeds gained from compost sales,
their attitude gradually changed. Households with limited space to operate a composter can dispose of their non-organic waste at the Jambangan garbage facility.

"The surroundings in Jambangan are more beautiful now, and the river is cleaner and no longer clogged," said Wiwik. Trees in the area look healthier since they have been fed compost fertilizer and the banks of Berantas river, especially the stretch in Jambangan, seems
cleaner. And the most outstanding achievement was the 2005 Energy Globe Award in the Water category, presented to PT Unilever for its pilot project in Jambangan, eliminating 700 other companies from throughout the world participating in the program.

"Although it is initiated by PT Unilever, this is an achievement for the residents of Jambangan. Hopefully, it will reduce pollution in Surabaya," said Surabaya Mayor Bambang DH, who intends to implement the program throughout the city. State Minister for the Environment Rachmat Witoelar
was of the opinion that the project should be implemented by cities throughout the country.

"This is very important, because other cities are also facing waste problems," said Rachmat, who will also urge other companies involved in community development programs to focus more on community participation in protecting the environment.***

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