Terawan Agus Putranto:
THE intense discussion inside the Neurology Department of the Medical Faculty at the University of Indonesia-Cipto Mangunkusumo Hospital (RSCM) last week was well-attended by 20 medical doctors and other health experts. They came to listen to Col. Dr. Terawan Agus Putranto, an officer in the army medical corps specializing in radiology, who has gained a reputation for his unusual treatment of stroke patients using interventional radiology methods instead of surgery.
Born in Sitisewu, Yogyakarta, the 48-year-old Terawan is convinced his special kind of treatment is both medically and logically accountable. “It was tense at first,” said Terawan of the meeting with the skeptical scientists and professionals, “but after my explanation, the situation relaxed and we traded jokes.” During the two-hour session, Terawan, an active military officer and a graduate of Gadjah Mada’s Medical Faculty in Yogyakarta, explained in detail his interventional radiology method.
Terawan studied interventional radiology at a number of health centers, such as Fujita Health University in Nagoya, Japan, Bundang Hospital in Seoul National University in South Korea, and Foch Hospital in France. The method Terawan practices on his patients is particularly effective on victims of strokes, which he believes to be the number-one killer in Indonesia.
Terawan attributes the skepticism among the doctors on his ‘brain-washing’ method he developed with his team at the Gatot Soebroto Army Hospital in Jakarta. Supported by a digital subtraction angiography machine, his expertise in the field of interventional radiology has helped hundreds, perhaps thousands, of people suffering from high blood pressure or hypertension.
One of the patients he treated was veteran singer Benny Panjaitan, of the Panbers group. He underwent Terawan’s ‘brainwashing’ treatment last June and one day later, he was up and about and walking. Yet, Benny had been paralyzed for a whole year by a massive stroke. The success of the treatment spread quickly by email and BlackBerry Messenger. Some people remained skeptical and thought the story was a hoax.
“To some people, I am a dukun (traditional healer),” said Terawan, who studied radiology at Airlangga University Medical School in Surabaya. To further explain his methodology to a group of doubting journalists, Terawan came to the Tempo office last week to explain and discuss his treatment of stroke patients without undergoing surgery. He drew much laughter with his use of humorous ‘worldly’ words to interpret complicated medical vocabulary and procedures. Follow-up interviews were conducted in his office to complete the following interview:
Why are you interested in interventional radiology or IR?
If we can control the arteries, we can go to any problematic organ in the human body. To patients suffering from blocked arteries in the brain or aneurism which cause strokes, an interventional radiology treatment can go straight to the problem area. To be sure, it all depends on the intensity of the problem. If the arteries are blocked they should be cleared so the blood can flow normally. Or, if there’s a hole in the artery, it needs patching up or if it has tightened, it needs stretching out. Essentially, we’re like plumbers.
Can interventional radiology be effective in treating cancer?
In treating tumors or cancers, interventional radiology can help in locating blocked arteries which feed the [cancer-causing] abnormal cells. When they are found, the anti-cancer medication can be localized, on the cancer spot itself, so the chances of its spreading to other healthy cells is reduced. In breast cancer, for example, the treatment can go straight to the blocked arteries feeding the cancerous cells. It’s like feeding them with medication. This method is known as trans-arterial chemo infusion.
Can interventional radiology accurately go to the problem?
The success of this method depends very much on the accuracy with which the catheter is inserted. When applying interventional methods, we usually place a micro catheter at the base of the thigh (femur artery), so it goes straight to the abnormal artery.
What makes some of your patients, like Benny Panjaitan who was paralyzed for a whole year, walk away after their treatment?
Inside the brain of someone who’s had a stroke, there is a core (the dead part) and a penumbra (half-dead). How long this penumbra can last is anyone’s guess. It can be a matter of hours or years. The destroyed area can no longer be treated, but the penumbra can still be revived. So, if the interventional radiology can revive the penumbra, it can replace the functions of the dead part of the brain. That’s why the mute can suddenly speak and the blind can see.
What happened in Benny’s case?
In cases like Benny’s, the blocked artery in the brain that caused the paralysis could be cleared up by brain flushing. And like Benny, the patients can walk again, because the blood flowed back normally. That’s the reality. It’s his good fortune.
What about patients who suffered a stroke three to six hours ago, otherwise known as the ‘golden period’?
The faster the treatment, the better the results. When the treatment is applied during the ‘golden period’ the patient can start walking again as if nothing happened. This is because the core has not yet become a penumbra. The downside is that the doctor could be seen in askance as a dukun or traditional healer (laughing).
You’re seen as a dukun?
Not only that, some say I developed this ‘magic’ or ‘evil science.’ At first it didn’t make sense even to myself, but I continued studying it. Initially, only one or two patients got better, and people thought they were just coincidence. But today, hundreds are undergoing similar positive results. How do you explain that?
Well, there are still pros and cons about this method you developed.
I’m used to pros and cons. In life, you cannot satisfy everyone. If some people don’t believe me, that’s not a problem. But I will continue helping people with interventional radiology. Honestly, when I see patients get up and be cured, I feel very good. The important thing is that I work sincerely. That’s my life philosophy. The higher I go, the lower I must be, because I must serve the lowest.
Can stroke patients, after undergoing a ‘brainwashing’ have a better brain?
This can happen, particularly among those who are forgetful. And this can be a problem, it cannot be done on someone with a lot of debts. I would make him feel worse when he remembers just how much money he owes and has to pay back. But seriously, yes, for some people, the brain performed better after having undergone a ‘brainwashing.’
How long does an interventional radiology procedure take place?
It depends on the level of the complication. Sometimes it may take only an hour, other times it can take four hours. In fact, some cases can take longer than a surgical procedure. I once did an interventional radiology procedure for seven hours because the case was a difficult one.
To have this interventional radiology treatment, must a patient be drugged?
No need. In fact, a patient can see how it’s being done, including how the catheter is inserted into his body. That’s one advantage, no drugs are administered to the patient and we can monitor if something goes wrong, like the patient going into a coma, which sometimes happens, or the patient’s condition gets worse. But if the patient is drugged, there is no way we can find out about his condition.
Have you had any failures or disappointments?
Some cases have failed. But before I do the procedure, I inform the patient and his family about the chances. For instance, the small chance of being cured when there are two bumps in the head just waiting to burst. Without interventional radiology, the artery would burst anyway, but a similar risk could happen even with the interventional procedure. But there is a better chance for improvement with the treatment. So, the patient and his family are informed of the risks involved.
Can you describe anything of interest in the course of doing interventional procedures?
Many interesting things happen, because everything is recorded and witnessed by the patient’s family. At one time, the coil needed to patch up a hole in the artery just slipped away. We apologized to the family but they insisted the coil be retrieved. We couldn’t make up our minds whether we should retrieve it or not. Finally we decided to do it in such a way that instead of using it to patch the hole, we made it into a kind of a tunnel. It worked. It’s been two years since that procedure and the patient is still in good shape. We’re pretty much like a workshop, finding ways to make things work.
How did that coil manage to slip?
I had used a coil made in China, because we had used up the coils from Singapore and the Philippines. Chinese-made coils are cheaper than those made in other countries, like the United States, a difference of about Rp5 million per coil. But that’s one of the things we warn the patient and his family about.
Do you allow the patient’s family to witness the procedure, either from a glass exterior or from a monitor?
We are serious about our work and we give the opportunity for the patient’s family to observe everything we do. That’s what an informed consent of this medical procedure, in my opinion, is all about. This only happens in Indonesia. In America, Japan or Singapore, no family member can witness what is being done by the doctor and his team. When it’s over, the family just thank the doctor without really knowing what was done. We are different. We give the patient’s family the opportunity to witness the procedure, to see for themselves whether the doctor is serious or not. I think the world will follow our example.
In your opinion, what has been the benefit of this big news about interventional radiology?
It has made many people become more aware of the dangers of strokes. Today, the number of sudden deaths caused by strokes has risen sharply. I dare say strokes have become the number-one killer here. That’s why we need to campaign more about the dangers of stroke. Before, to prevent the risks of heart disease, we used to organize special exercises and other activities. Nothing wrong in thinking about a kind of exercise to reduce the risks of a stroke.
It was rumored your superiors disagreed with your decision to hold that session with the doctors at RSCM?
The management of the hospital where I work did have doubts about my attendance at that meeting. But I’m not one to run in fear. I stand ready to face any problem. I faced a similar problem in 2006, when I was developing TACI (trans-arterial chemo infusion) for cancer treatment. I was then still a major. I came by myself to the Dharmais Cancer hospital in Jakarta [to discuss this topic]. At the end, half of those in the discussion agreed with me, the others disapproved. Three months later, Dharmais Hospital sent me a patient for consultation. Today, doctors in China practice the TACI method, also those in Philadelphia in the US.
What goes through your mind when you think about the future of techniques like interventional radiology and cerebral medical treatment?
I would like to see a cerebral-vascular center in Indonesia which treats dysfunctional cases of the brain resulting from arterial blockages. If others don’t want this, I think the Army Hospital should become the center. The goal would be to conduct research, development and treatment of cases of arterial blockages in the brain.
Col. Dr. Terawan Agus Putranto
Place & Date of Birth:
Yogyakarta, August 5, 1964
- Gadjah Mada University Medical Faculty (1983)
- Officers School (1988-1989)
- Military Training II (1993)
- Advanced Officers School I (1995)
- Advanced Officers School II (1998)
- Specialization in Radiology, Airlangga University Medical Faculty (2000)
- Doctor, Battalion 742, Mataram, Lombok, NTB (1990-92)
- Dep. Director, Mataram Hospital IV, Lombok (1993-1998)
- Chief, Emergency Room Unit, Army Hospital & Medical School (1999)
- Chief, Anesthesiology Dept. Gatot Soebroto Army Hospital (2008)
- Chief, Radiology Dept. Gatot Soebroto Army Hospital (2010)
- Medical Staff, Radio Nuclear Dept. Gatot Soebroto Army Hospital (2011)
- Member, Presidential Medical Team (2009-to date)
No. 06/XII/05–11 October 2011