Perth plastic surgeon Dr Timothy Cooper discusses the humanitarian surgery being carried out by the John Fawcett Foundation in Bali.

For the past eight years Perth plastic surgeon Dr Timothy Cooper has been treating children with deformities in Bali, Indonesia, under the auspices of the John Fawcett Foundation. The John Fawcett Foundation, or Yayasan Kemanusiaan Indonesia, is a charitable organisation based in Indonesia. The Foundation works in cooperation with the Indonesian Government to conduct its own humanitarian programs, working exclusively with the poor and offering their services free of charge.

The Foundation grew out of a number of Rotary projects established by its namesake John Fawcett in Bali. It has a number mission projects and these include sight restoration and blindness prevention, incorporating the mobile eye clinic for cataract surgery as well as a children's corrective surgery project which covers cleft lip and palate and orthopaedic surgery. There are also other projects including an education assistance program, a wheelchair project, assistance for desperately ill children or young people, supply of medical and surgical equipment to hospitals which treat the poor, and a tuberculosis treatment project.

Dr Cooper is involved in the children's corrective surgery program, providing treatment for children with cleft lip and palate and other facial deformities, as well as burns victims. Previously he had been involved with Interplast Australia, where he provided his surgical expertise to treat children in developing countries in the Asia Pacific region.

Working with the John Fawcett Foundation, Dr Cooper visits Bali twice a year. On each occasion he sees around 40 children along with their close relatives in a mass clinic, before scheduling the surgeries for the following week. Up to 30 operations are then performed at one of the cooperating hospitals in Denpasar. The surgery is performed with all-local staff including Balinese nurses, anaesthetists and surgeons. Tim operates alongside his Indonesian counterparts, giving them advice in the management of these somewhat complex conditions.

These children are born often with quite gross physical deformities which prevent them from eating properly and their speech development is often impaired as well. In a society such as Bali, the children and their immediate family often become social outcasts because of their condition. If their deformity is not corrected, it is unlikely they will receive an adequate education, enter the workforce, or eventually get married and have children themselves. With one or two relatively straightforward operations, their appearance can be transformed. The look in the mother's eye when this transformation occurs is priceless, says Dr Cooper.

In some cases, the deformity may be too complex and arrangements are made for the patient to be repatriated to Perth in Western Australia where they can avail themselves of a comprehensive treatment program in a major hospital setting.

Two such cases that Dr Cooper has been involved in recently include a young girl, Lu Sukreni, who turned up in one of the clinics in Bali. She was a very pretty girl who had a congenital deformity of the nose and eyelid. When Dr Cooper saw her he made the decision to have her transferred to Perth for further treatment and this involved raising a flap of tissue from her forehead to reconstruct the nasal defect as well as a local flap to the lower eyelid. This was a two-stage procedure and Lu stayed in Perth for a total period of six weeks. Tim last reviewed her in Bali over a year ago at which stage she had entered a teachers' college and was training to become an English teacher. When Tim offered her a further revision to improve the appearance of her nose she declined and said politely that she was happy - as an aside she said she also now had her first boyfriend.
In Bali Dr Cooper also saw a young boy called Azar, who was referred from Yogyakarta in Java. Azar had knocked over a fuel stove and sustained horrific burns to his anterior chest wall and neck, forearm and hands. His mouth and jaw were fused to his chest and he continually drooled and had trouble speaking and eating. With the aid of donations and foster families, Azar was transferred to Perth for further treatment. He underwent a number of surgeries to release the neck scar contracture and the contractures around his face and hands. This involved extensive skin grafting. The surgeries were performed by Dr Cooper and one of his colleagues from Geelong, Dr Ian Holton.
When Dr Cooper last saw Azar in Bali last year he was back studying at school and was coping well with all his normal social interactions. Unfortunately, some of his scars had thickened and formed keloids - he is now having ongoing treatment for this.

The aim of the Foundation is not only to treat children with deformities but also to up-skill the local medical and nursing personnel in the management of these patients. The hope is that one day there will be enough people on the ground in Bali to provide an ongoing service to these afflicted children from poor backgrounds. Tim has already sponsored two doctors from Bali to come to Perth for further training in plastic surgery.

The Foundation is totally dependent on donations for the funding of its projects. It has been supported by the Australian Government through AusAID and the Australian Embassy in Jakarta, as well as Rotary International and Rotary Australia and many other organisations and companies.

All of this work would not be possible without the help of both individual and coooperate donors. Donations are welcomed and can be made through www.balieye.org. This will enable the work of Dr Cooper and other plastic surgeons from Australia to continue in the foreseeable.

ACSM #44