Making rheumatism treatment better

Making rheumatism treatment better

Emmy Fitri, The Jakarta Post, Jakarta

Seasoned physician John Darmawan has been through the bad and the good times in this country's long journey to what it is has become today.

He experienced colonialism, the Japanese occupation, Sukarno's herculean administration, the New Order and so on. Though there is nothing political in what he has been doing, somehow, he is also a hero.

He is one of those who have been healed.

A breakthrough approach in rheumatism treatment was named after him -- the Darmawan Protocol -- for he was the one who developed the formula.

Starting next year and expected to be completed a year later, simultaneous tests -- Randomized Controlled Trials -- will be held in Shanghai, China, Tehran, Iran, Dhaka, Bangladesh, and Vietnam to assess the efficacy of the treatment.

If the results are encouraging, the World Health Organization (WHO) will call an international conference to confirm the treatment.

Born in Pontianak on Oct. 21, 1935, to a reasonably well-off copra trader, John considered himself lucky because he was able to receive a good education at Kanisius college in Jakarta and Airlangga University's school of medicine.

Not only was this because his parents could afford to pay, but more particularly because his father, who himself was a graduate of a Dutch high school and spoke fluent Dutch, believed that education was the only way to survive the dark times that prevailed back then.

"I was small during the Japanese occupation. We had to take refuge in a small town because there was no rice at all in Pontianak. They took everything. They paid so little for our copra. They beheaded anyone who opposed them," said John. He recounted who he had heard about a massacre of over 5,000 civilians, whose bodies were dumped in a hole.

John managed to survive, however. After earning his medical degree, he worked in Surakarta before finally settling in Semarang, the capital of Central Java province.

Then came the good days.

"I took a course on rheumatism in 1980 in Melbourne following a recommendation from the chairman of the Indonesia Rheumaticists Association, Professor Remy A.R. Nasution. I returned two years later," John said in an interview earlier this month.

John held a fellowship at the rheumatology unit of the University of Melbourne. He received his PhD from Erasmus University, Rotterdam, the Netherlands, in 1988.

"Twenty-five years ago the use of intravena (intravenous feeding) was introduced to us. And also the use of Endoxan (cyclophosphamide), Solumedrol (methylprepmisolon) and Azathiophrine.

"But a shock reaction occurred with a patient who was treated by an Australian doctor who used Azatriophrine. The drug was then banned worldwide," said John, who still uses intravena in his protocol.

"Back then, the amount in one dosage was very high, between 800 milligrams and 1,000 milligrams per injection."

The side effects were terrible for the patients, with prolonged bouts of diarrhea, appetite loss and hair loss.

He thought about it for some time -- how to reduce the torturing side effects but still retain the efficacy of the drug. "I lowered the dosage to one-tenth of the previous dosage. It worked as the side effects were notably reduced and the medicine was still effective."

The first human guinea pigs were patients from Shanghai and Singapore who visited his clinic at Seroja, Semarang, Central Java. These people had advanced rheumatic disorders and had gone to various places to seek cures.

Because of his profound concern for the discipline, John served as a WHO expert on rheumatic diseases from 1992 through 2007.

As a result of his "ambition to cure people", he turned down prestigious job offers that came with attractive packages like working as a private doctor for the Brunei royal family and as an online consultant for a clinic operating in Tijuana.

"My wife fell in love with Semarang, I don't know why. She said no every time I mentioned an offer to her," he said.

His wife, who is an agricultural engineer, also manages the Seroja Clinic.

Surprisingly, none of his three grown-up children have followed in his footsteps as a physician. "They said a doctor's work was like eating kwaci (salted, dried watermelon seeds). They're delicious but you enjoy them little by little. So they preferred to go into business instead."

"Alas, they are much richer than me," John said laughing.

A fellow doctor in Singapore referred to him as dokter gila (crazy doctor) when recommending John to a desperate patient who had even gone as far as the Mayo Clinic in the U.S. to seek a cure.

At first the patient, who was a native of Surabaya, did not act on the recommendation and chose to go back to Surabaya. Two months later, following unbearable pain in his hands, he finally called John.

"It took only three months for his disease to go into remission. He then went to Singapore, met his old doctor and complained bitterly to him. Why was he told only about me only after so many years and costly trips to expensive clinics?" John recounted.

"But the professor responded calmly as he asked his patient, 'Would you have believed me five years ago if I had told you about John's clinic?' Of course he would not have believed him then."

There has been a trend in recent years for better-off Indonesians to pursue health treatment abroad, normally in Singapore, Malaysia or Thailand. If necessary, they go as far as the United States or Europe.

"Those people are not to blame. If we want to make people stay loyal to local doctors and hospitals, we will have to improve our skills," said John firmly.