The Jakarta Post
It was 13 years ago, but neurosurgeon Eka Julianta Wahjoepramono still remembers well every second of the four hours he struggled to save the life of a poor laborer in his operating theater.
Prof. Eka, as colleagues affectionately call him, was performing high-stakes brainstem surgery for the first time.
He was about to remove a tumor the size of a grape in the brainstem of 20-year-old Ardiansyah from the Banten port city of Merak. He had been admitted to hospital paralyzed and unconscious.
The patient was breathing heavily and was close to death. After being anesthetized, Ardiansyah was laid on the operating table face down.
Eka began to cut into the back of the patient's head and eventually he had a full view of a living human's brainstem for the first time in his life. (During his training, he'd used only dead bodies for surgical exercises in the laboratory).
Connecting the cerebrum with the spinal cord, the brainstem consists of the midbrain, medulla oblongata and the pons.
Through the brainstem, motor and sensory neurons travel, allowing for the relay of signals between the brain and the spinal cord. It coordinates motor control signals sent from the brain to the body and controls the life-supporting functions of the peripheral nervous system.
Tinta Emas di Kanvas Dunia (Golden Ink at the World Canvas), a biography of Eka written by Pitan Daslani, describes the complexity of this vital organ: 'Even the most seasoned surgeons will shiver at the sight of the brainstem.'
In the language of the layman, the brainstem is where life is. So when the stem stops functioning, one is 'brain dead', or 'clinically dead'. Tumors, even malign ones, in this 'untouchable' organ can lead to paralysis and death.
The brainstem is an extremely complex and delicate organ. Very few neurosurgeons in the world have the courage to perform surgery on it due to the immeasurably high risks of doing so.
And Eka was doing it that day.
'I eventually decided to operate on the patient after his accompanying brother pleaded with me to save Ardiansyah's life, even if the chances of success were next to zero,' Eka said, recalling the chilling moments.
'He tearfully promised that he would sell their [the brothers'] only hut by the beach to pay for it.'
After four hours that seemed like years, Eka's team of surgeons eventually completed the surgery.
It was a surprise success and the patient was discharged from Siloam Hospital 10 days later, able to walk and relieved after he was told he did not have to pay a single rupiah for the procedures.
News of the successful and rare surgery spread like wildfire in medical communities across the globe and catapulted Eka's reputation as the first neurosurgeon in Southeast Asia who had successfully operated on the brainstem.
Since then, Eka and his team have performed more than 50 brainstem operations with no incidence of death and with minimum side effects ' the two main indicators of a successful procedure.
The achievement has not only affirmed Siloam Hospital in Karawaci, Tangerang, as a neurosurgery specialist center, but also placed Indonesia on the world map of neurosurgery.
It was a turning point in Eka's career, too. He was invited by numerous universities across the world to speak in seminars on brainstem surgery and giant aneurysm, an excessive localized enlargement of an artery caused by a weakening of the artery wall.
Harvard University and the University of Arkansas in the US were the first to confer on him the title of visiting professor.
Many surgeons have since come to his hospital to jointly perform brain surgery as a form of exchanging expertise and knowledge, not only with foreign counterparts but with local neurosurgeons.
Eka believes that in doing so he can bring his dream of lifting the reputation of Indonesian surgeons to the world level closer to reality.
The father of three is a world-class neurosurgeon and scientist who is eager to share his expertise, like a guru for those who want to learn from him. He has written articles for international scientific publications on brainstem surgery.
Contrary to the long-held wisdom, Eka always performs surgery with his six-member team.
'I will never do it alone because it would only make me overworked. Besides, teamwork expedites the transfer of knowledge and skills,' he said.
He wants every member of his team, and also his medical students, to have his proficiency and make Indonesia's achievement in neurosurgery be a force to be reckoned with in international forums.
Eka, whose long list of patients makes one has to set up appointment at least a month in advance, is particularly concerned about wealthy Indonesians spending millions of dollars going abroad for medication, showing their lack of trust in local doctors, while in fact local hospitals already have the resources and means to treat them.
Today, there are only four universities that have neurosurgery centers: the University of Indonesia in Jakarta; Airlangga University in Surabaya, East Java; Padjadjaran University in Bandung, West Java; and the University of North Sumatra in Medan, North Sumatra. They all also run hospitals.
The 120 or so neurosurgeons across the archipelago are far from enough to handle the rising number of patients, not to mention the inadequate educational facilities.
Few hospitals can afford the expensive latest technologies, such as MRI, CT scanners and emergency equipment.
Eka's reputation has landed him the chairmanship of international organizations such as the International Conference of Cerebro Vascular Surgery, the Asian Conference of Neurological Surgery, the Asian-Oceanian International Skullbase Society and the Educational Committee of the World Federation of Neurosurgical Societies.
Now dean of Pelita Harapan University's school of medicine in Tangerang, his conviction is for Indonesian universities to be on a par with those in the US, Canada, Germany and Japan in producing medical specialists.
Born and raised in a humble family in the Central Java town of Klaten, he pursued his medical studies at Diponegoro University in Semarang, obtained his postgraduate degree on neurosurgery at Padjadjaran University and won scholarships in Germany, Japan and Australia.
His modesty is reflected in his unwavering commitment to helping the poor, who are in dire need of medical help.
Ardiansyah was but one of the many financially underprivileged patients that Eka offered free surgery to. To sustain the effort, he initiated a charity called the Indonesian Brain Foundation to help save the lives of poor patients by way of surgery.