Bringing the smiles back to people in distress

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DR Swee Tan

DR Swee Tan brought the smile back to face of a young boy from New Zealand.

The six-year-old Kiwi named David was born paralysed on the left side of his face. And because of the birth defect, he could not smile.

As a plastic surgeon, Dr Tan did what had to be done to “fix” the problem. He took a nerve from behind one of David’s legs and join it to the good nerve on the right side of David’s face.

Then he took a motor unit of triangular-shaped muscle (with artery and nerves) from David’s armpit and transferred it to the left side of his face before connecting the motor unit to the muscle in the neck area.

It took six months for the message to cross over from the right to the left side of David’s face. Though a long process, it brought the sunshine of smiles back to the youngster’s life. And thanks to Dr Tan, David was — at long last — able to close a smile-less chapter and smile as the world smiles with him.

A year later, David’s family migrated to Sydney and Dr Tan lost contact with them. However, two years ago, Dr Tan received a surprise email from David.

“When I learned David had become a medical student, tears rolled down my cheeks. It would have been hard for him to go to medical school if he wasn’t able to express his emotions. I’m sure David would make a wonderful doctor because he had gone through a hard part of life,” he said.

It was an emotional moment for Dr Tan, who has always believed the aim of plastic surgery is to help people fulfill their potential. And he has many stories like David’s to tell.

Born in Senggarang, Batu Pahat, Johor, Dr Tan first attended Melbourne University, Australia, and later studied to become a plastic surgeon in New Zealand.

He now heads both Hutt Hospital surgery unit and Gillies McIndoe Research Institute (GMRI) as executive director.

Strawberry birthmark

He has been called many things. A patient described him as “part-Chinese, part Kiwi and part Jedi.”

Vicki Lee, CEO of Cure Kids, New Zealand said he is “a cross between a genius and a saint.”

As a plastic surgeon, Dr Tan deals with three main categories of afflictions – congenital abnormalities or defects, deformities due to trauma and cancer.

Cancer has always been part of what he does — in fact, most of time as surgeon. He deals with the disease in the head and neck areas.

“Plastic surgery is about improving the quality of life — restoring what’s lost or deformed to at least something that looks more normal — or getting the function back to restore confidence in the patient.

“That confidence or self-belief is something you need to fulfill your potential,” Dr Tan told thesundaypost during the Eighth National Conference for Clinical Research (NCCR 2014) in Kuching.

He was invited to be the main speaker for many reasons.

Besides being an outstanding and internationally established plastic surgeon, he has won the world renowned John Mulliken Prize for making the breakthrough strawberry-birthmark treatment for cancer. He attributes the success to the dedication of his team.

Dr Tan explained: “Cancer is a big focus and we are investigating cancer based on the radical concept that cancer is caused by cancer stem cell — that cancer stem cell is the origin of cancer which gives rise to cancer cell.

“And if we prove to be correct, the way we deal with cancer stem cell should be different from the way we treat cancer today.

“It was the same when we first started investigating the strawberry birthmarks — the previous treatment was aiming at the tumour cell but the new treatment is dealing with the stem cell of the tumour.”

The traditional treatment for disfiguring strawberry birthmark is to prescribe high dosages of steroids – which, to Dr Tan, is too harsh on the children and what’s worse is the treatment might not necessarily work. When situation becomes desperate, doctors may resort to chemotherapy.

Dr Tan and his team’s discovery that stem cells are the origin of strawberry birthmarks has brought about a very simple treatment. It has not only helped relieve the pain of children who have strawberry birthmarks but also espoused an undeniably promising implication for new cancer treatment.

DR Swee Tan

Young days

For Dr Tan’s contributions and achievements, the Museum of Wellington considers him a living treasure. Indeed, what is Malaysia’s loss is the Kiwis’ gain.

But Dr Tan does not forget Malaysia, the country of his birth, or his humble beginnings.

He was born into the family of a not well-educated farmer with 14 children. But that did not stop him achieving his ambition of becoming a surgeon. It was a long and tough path but he made it with his own persistence and help from well-wishers and sponsors.

“It’s easy to be a grouch, constantly complaining and sulking — or you can decide to get out of your bed and do something. I knew if I were to make a change, education would be my passport. I believeeducation is the key out of poverty.”

There was a point in his young life when he had to clean a supermarket three times a week just to attend school. He had to hold down so many physical jobs that there were doubts he could become a surgeon. His hands were coarse and rough from manial work.

Looking back, he said he was fortunate as there were people who saw his potential and helped him along the way.

“I persevered — and I had vision. I wanted to be a plastic surgeon and I worked hard to become one,” he added,

Dr Tan believes there are always opportunities for people who dare to dream. To them, his advice is grap the opportunities and work hard. And for those with physical deformities, he hopes to intervene through plastic surgery to give them a fair go at life.

“Grab the opportunities. There are many. If you don’t seize them, they will bypass you. They aren’t going to be there all the time.

I think you also need to work hard — you need to have a goal or a dream. If you don’t have a dream, you’re not going to have that dream happen to you. You need to believe in something and that self-belief is going to make it happen.”

Invest in the future

Dr Tan who came up with the idea of setting up Gillies McIndoe Research Institute and later made it a reality, fully understands the tough time local researchers are going through — trying to do research without much help.

He was pleasantly surprised despite their busy schedules, many doctors in Sarawak are still committed to research with some even going into basic research.

“I take my hat off to them because it’s hard if you try to do it (research) without much help and support. Someone might be enthusiastic about something but if they get beaten 10 times, they are going to lose interest. I think they will need a lot of support.

“Another thing that can help promote research is taking frustrations out of people. For example, to get things done, nine steps may be needed or one can streamline the whole process to lessen the number of steps or remove the obstacles so that those involved may be allowed to get to work straightaway,” he said.

With the availability of brain power and a willingness to commit, Dr Tan is urging the government to give local researchers support in terms of funding and facilities.

“There should be some advocacy. I think their cases should be brought up to the politicians to get the government to prioritise research because in the long term economically, it is important for this country. There must be political commitment to make it work — whether it’s clinical research or basic research.”

Describing researchers as “people who are pushing the boundary,” Dr Tan said they were the ones who would be taking the country into the future, adding that giving them a “supportive environment” to expand their capabilities would help to not only keep them in the country but also lure back those working overseas.

“Government support is the way to stop brain drain. I don’t think brain drain happened yesterday. It has been happening over a period of time as a result of policy and so over time, we have a gradual exit of talented people.

“But still, you have academics here who are willing to stay and still want to do research. So what you want to do is promote the activity by providing the right environment, the right infrastructure and be supportive.

“If there’s government commitment and a policy in place to consistently promote and support research, it will allow you to grow the talents you got. And the ones you got will help draw in those from outside

“A decision has to be made on the quantum — how much you want to invest. This is about investment in human capital. And it’simportant because researchers are people who can make things happen.”

DR Swee Tan

Dr Tan said Malaysia has a very high level of valuable human capital but with very little support.

“This has to change because some of the top talents will become disillusioned and give up one day if there is no change for the better.

“What you want to do is grow more of these people. They are by nature very enthusiastic and positive. They are going to inspire others to perform.”

Dr Tan said this out of his own experience. He only decided to become a plastic surgeon during his training in New Zealand where he described the creativity of the surgeons as “magical.”

There was also sound guidance from established plastic surgeons who were “unpretentious and sincere” in training younger surgeons like Dr Tan to succeed them.

Having benefitted from such good work ethics, Dr Tan is now passing them to the new generation of surgeons. In his unit, there are nine plastic surgeons and all, except one, were trained by him.

“Young people need someone who they can look up to – like a mentor who is interested in their work and their well-being. I have had trainees for the past 18 years and many are plastic surgeons practising in New Zealand or the parts of the world.

“I often ask what they want to do in life? I’m just interested to know what they are thinking about their future and if there is something I can do for them, I will.

“It’s always refreshing to talk to and help someone who wants to achieve something. It really gives you an amazing kick,” he said.

Strawberry birthmark

MOST birthmarks need no treatment. They usually remain stable as a child grows older. However, some areas that can resemble blood vessel tumors — called hemangiomas — may need treatment because of their location.

For example, a raised hemangioma near a child’s eye may interfere with his or her ability to see. In rare cases, birthmarks are associated with other conditions, such as growths on the liver, lungs, stomach, or intestines.

Strawberry hemangiomas (also called strawberry mark (birthmark), nevus vascularis, capillary hemangioma, hemangioma simplex) may appear anywhere on the body but are most common on the face, scalp, back, or chest.

They consist of small, closely packed blood vessels. They may be absent at birth, and develop at several weeks. They usually grow rapidly, remain a fixed size, and then subside. In most cases, strawberry hemangiomas disappear by the time a child is nine years old. Some slight discoloration or puckering of the skin may remain at the site of the hemangioma.