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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... -Editor]

Asia Times
23rd March 2001


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 decision."

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,


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 recommends.

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