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ATimes: No backdowns over ailing Anwar
By Anil Netto
24/3/2001 5:40 am Sat
[Dollah Badawi tidak mengizinkan Anwar dirawat di luar negara
tanpa mengira apa yang pakar itu kata. Jika Anwar sembuh dan
tidak lumpuh karier Dollah dan Mahathir mungkin lebih tergugat.
Umno nampaknya begitu takut jika Anwar dirawat diluar kerana
ia menggambarkan betapa dahsyatnya kecederaan yang dialami Anwar.
Doktor pakar Munich akan dapat membuktikan Anwar teraniaya dan ini
cukup merbahaya buat para konspirator.
Umno tidak mampu memberi layanan sebaiknya kepada seorang rakyat yang
teraniaya yang pernah membantunya, apakah Umno boleh diharap untuk
memperjuangkan nasib semua orang melayu yang tidak bernama? Jika Anwar
tidak dirawat segera, dia akan menghadapi kesakitan dan mungkin lumpuh
buat selama-lamanya. Jika itu berlaku Umno harus bersedia menghadapi
kemarahan rakyat yang tiada hentinya...
No backdowns over ailing Anwar
By Anil Netto
A monumental controversy is brewing over whether the Malaysian
government will allow jailed former deputy prime minister Anwar
Ibrahim to receive specialist medical treatment overseas for a back
injury, as recommended by his Germany-based surgeon.
When contacted Wednesday night (Malaysian time) at his Munich-based
Alpha Klinik, Dr Thomas Hoogland stood by his recommendation that
Anwar should be treated in his specialist clinic in Germany despite
arguments from Malaysian doctors who say the Dutch surgeon can perform
the operation just as well in Kuala Lumpur.
Hoogland said in a telephone interview with Asia Times Online: "I am
convinced I can give him the best care here," rather than in Kuala
Lumpur. "This operation is very special. Every time it is done abroad,
it is like an experiment," he said, referring to the improvisation in
facilities and staffing that would be needed in Kuala Lumpur.
The Malaysian government is unmoved, however. Deputy Prime Minister
Abdullah Badawi reiterated on Thursday: "We decided from the outset
that there is no need for treatment overseas. We stick to the
Hoogland is a co-founder of Alpha Klinik and director of its Back
Unit. He was responding to critical views in the Malaysian press over
his medical report dated March 13, recommending that Anwar undergo
endoscopic spinal surgery in Germany within four to six weeks. In his
report, Hoogland concluded that the minimally invasive procedure
"would have the lowest risks and best prognosis if performed in the
Alpha Klinik in Munich".
But the director of Kuala Lumpur Hospital, Dr Abdul Razak, has
publicly disagreed. "I'm sure the surgery can be done here," he told a
local daily on March 17. He said endoscopic spinal surgery could be
performed in Malaysia as almost all the necessary medical facilities,
except for an endoscope, were available locally and could be mobilized
at short notice.
Said Razak: "I'm surprised with his [Hoogland's] findings that our
hospitals lack facilities and that our anesthesiologists were
inexperienced ... this is not true." He pointed out that Kuala Lumpur
might not have all the necessary equipment in one hospital but when
requests are made in specific cases, the equipment can be brought in
from other hospitals in Malaysia. "All Dr Hoogland has to do is bring
an endoscope from his clinic ... and maybe his trusted
anesthesiologist if he continues to have doubts in our trained and
professional medical specialists," Razak added.
One of the conditions before Anwar was allowed to engage Hoogland,
after much wrangling, was that any surgery had to be performed at
Kuala Lumpur Hospital.
In his report dated March 13, Hoogland noted that "it appeared that
the operating rooms [in Kuala Lumpur Hospital] where spinal procedures
are normally performed were [under] reconstruction," and a different
operating table would be "very inadequate for an interventional
procedure of the lumbar spine". He also observed that the X-ray
equipment "was outdated and showing a low, limited view of the lumbar
spine". The image intensifier needed for spinal endoscopy "is much
heavier equipment and has a different electrical power supply" to that
available at Kuala Lumpur Hospital, he added.
In e-mailed comments to Asia Times Online, Hoogland clarified that his
report stated that the hospital's anesthesiologists did not have
experience with local and intravenous anaesthesia for SPINAL
procedures. "This does not mean that they are not experienced; indeed
they are very experienced but not with this type of anesthesia for
spinal surgery," he said. Spinal endoscopy, he pointed out, involves
surgery in very close vicinity to important nerves "that have to be
touched gently during surgery with a proper patient response without
pain". For this, "a precise very experienced dosage of certain
sedatives and pain-reducers is necessary for patient and surgeon".
Hoogland added that this aspect of the procedure had appeared to be
his main problem with surgery performed in Saudi Arabian and Spanish
hospitals, fully equipped for minimally invasive spine surgery.
In his March 13 report, posted on a website run by the Free Anwar
Campaign, Hoogland had diagnosed Anwar as suffering from "a big lumbar
disc herniation associated with a narrow spinal canal with ligamentum
flavum hypertrophy L4-5 and facet joint stenosis". This has caused
neural damage and significantly compromised Anwar's daily activities,
he noted. Hoogland, who has performed over 6,000 minimal invasive
spine operations, said operative intervention was needed to decompress
the nerves, alleviate the pain and restore normal activities.
Anwar, he observed, also suffers from cervical spondylosis since a
fall from a horse, together with an old lesion to the spinal cord.
"Because of this cervical situation, there is an increased risk of
neck damage in case of intubation and general anesthesia," he warned.
In September 1998, Anwar was assaulted while in police custody.
Hoogland noted that Anwar fell on his right hip, with subsequent pain
in his right buttock and back. "The buttock pain has disappeared, but
some back pain remained. About 12 months ago, the patient developed
progressive radiating pain into the left leg. This became severe in
October 2000." For this reason, he said, Anwar had been hospitalized
since the end of November.
Hoogland's Alpha Klinik specializes in minimal invasive surgery on the
knee and spine. "Thanks to modern arthroscopic and endoscopic surgical
techniques, they [the clinic] achieve - with a minimum of 'cutting' -
what in other hospitals requires a long stay," said a report in
Wirtschaftswoche, a leading German business periodical, reproduced on
the clinic's website, Alphaklinik.com.
The Malaysian government appears reluctant to let Anwar out of its
custody. He remains under heavy guard whether in prison or in hospital
while serving jail terms totalling 15 years for abuse of power and
s###my, charges he flatly denies. If Anwar is allowed treatment
overseas, he would inevitably be the focus of widespread and intense
media publicity. That's something the government is not likely to
relish, given its eroded support base since winning the general
election in 1999.
Anwar's wife, Wan Azizah Wan Ismail, who heads the opposition National
Justice Party, has reportedly said her husband would give guarantees
that he would return to jail in Malaysia should he be allowed an
operation overseas. But the authorities may be unwilling to risk
allowing Anwar out of their sight. That in turn presents a fresh
dilemma for them: already criticized for their harsh treatment of
Anwar, they may find themselves facing fresh condemnation if they
refuse to allow Anwar the treatment in Germany that his surgeon
Hoogland, meanwhile, is not backing down. "I well understand the
defense of the medical staff [in Kuala Lumpur Hospital] but prefer [to
focus on] the interest of the suffering of patient Anwar," he told
Asia Times Online. Endoscopic surgery in the Kuala Lumpur Hospital is
possible, "but a lot of improvisation is necessary with increased
risks and a less than ideal outcome compared to the procedure in
Munich. The question is how much additional risks and suffering Mr
Anwar has to or is willing to take."
The final decision on whether he will go overseas is out of Anwar's
hands, but whatever it is and however successful the surgery, Anwar
will continue to be a pain in the back for the Malaysian authorities.
Dr Thomas Hoogland's verbatim e-mailed reply to Asia Times Online:
Dear Mr Netto,
As director Dr Razak apparently favors to discuss my medical report in
the press we like to explain the pertinent aspects. The reports says:
The anesthesiologists do not have experience with SPINAL procedures
under local and intravenous anesthesia. First this does not mean that
they are not experienced, indeed they are very experienced but not
with this type of anesthesia for spinal surgery. Spinal endoscopy
means surgery in very close vicinity to important nerves that have to
be touched gently during surgery with a proper patient response
without pain. For this, a precise very experienced dosage of certain
sedatives and painreducers is neccesary for patient and surgeon. It
has appeared to be my main problem in surgeries performed in
Saudi-Arabie and Spanish hospitals, fully equiped for minimalinvasive
spine surgery. I well understand the defense of the medical staff but
preferr the interest of the suffering of patient Anwar! Endoscopic
surgery in HKL is possible but a lot of improvisation is necessary,
with increased risks an less than ideal outcome compared to the
procedure in Munich, and the question is how much additional risks and
suffering Mr Anwar has to or is willing to take.
Dr T Hoogland