Top hon­our for sur­geon

The Australian - - FRONT PAGE - DAVID PENBERTHY SOUTH AUS­TRALIA COR­RE­SPON­DENT

The founder of Ade­laide’s Aus­tralian Cran­io­fa­cial Unit, pro­fes­sor David David has just reg­is­tered the high­est hon­our of his ca­reer, be­ing awarded the Tessier Medal for his in­ter­na­tional con­tri­bu­tion to cran­io­fa­cial surgery. The hon­our is named af­ter late French­man Paul Tessier, the fa­ther of mod­ern cran­io­fa­cial surgery, un­der whom Pro­fes­sor David trained.

When pro­fes­sor David David first met Xu Fei, the little Chi­nese girl had a vast cleft in the mid­dle of her face that meant her eyes were splayed out to­wards her ears.

The nine-year-old had a con­di­tion called Co­hens Syn­drome, and even the best Chi­nese sur­geons were un­sure how to cor­rect it.

So, in 1983, Xu be­came one of the first Chi­nese ci­ti­zens per­mit­ted by Beijing to fly abroad for surgery, trav­el­ling to Ade­laide for the first of two op­er­a­tions at the Aus­tralian Cran­io­fa­cial Unit, founded by Pro­fes­sor David in 1975.

As with all his work, this wasn’t some self-pro­mo­tional ex­er­cise by a big-name sur­geon, but a se­ri­ous learn­ing ex­pe­ri­ence for the Chi­nese, who sent their own team to South Aus­tralia from Shang­hai’s 9th Peo­ple’s Hos­pi­tal headed by leg­endary Chi­nese sur­geon TiSien Chang to watch Pro­fes­sor David and his fel­low medi­cos in ac­tion.

“I have al­ways ab­horred the idea of dash­ing off some­where to op­er­ate on the na­tives. It is pa­tro­n­is­ing in the ex­treme,” Pro­fes­sor David told The Aus­tralian. “It is about shar­ing knowl­edge and help­ing other coun­tries de­velop the skills to which they as­pire.”

The oper­a­tion on Xu had to be con­ducted in two stages, 12 years apart. The first oper­a­tion in 1983 brought Xu’s eye sock­ets to­gether; the sec­ond in the mid-90s moved her face for­ward and re­built her nose when she was ma­ture and had stopped grow­ing.

Xu was one of the thou­sands of pa­tients on whom Pro­fes­sor David op­er­ated in the course of a five-decade ca­reer.

Now 78, Pro­fes­sor David has re­tired from surgery — “I don’t cut peo­ple up any­more,” he says drolly — but he has just reg­is­tered the high­est hon­our of has ca­reer, be­ing awarded the Tessier Medal for his in­ter­na­tional con­tri­bu­tion to cran­io­fa­cial surgery.

The hon­our is es­pe­cially poignant as it is named af­ter the late

French­man Paul Tessier, the fa­ther of mod­ern cran­io­fa­cial surgery, un­der whom Pro­fes­sor David trained in the 1970s.

“It was fron­tier stuff back then,” Pro­fes­sor David tells The Aus­tralian. “Some of these pa­tients died. But it was vi­tal that a new way was found, be­cause up un­til then these poor chil­dren were be­ing con­signed to mad houses on ac­count of their mal­for­ma­tions.

“I had just grad­u­ated from the Univer­sity of Ade­laide and was in the UK and Tessier was do­ing amaz­ing work in France. He was the talk of the day. We would get tele­grams say­ing he would be op­er­at­ing in two weeks’ time and I would head on over. He didn’t take the slight­est bit of no­tice of me. He was sin­gle-minded and wholly fo­cused on his work.

“The most im­por­tant thing Tessier did was that at a time when peo­ple were say­ing: ‘How do you do this?’, he came along and said you do it with team work. He as­sem­bled a team. It was hugely im­por­tant be­cause up un­til then there would even be ac­tual fights in the op­er­at­ing the­atre be­tween brain sur­geons, eye sur­geons and plas­tic sur­geons. It was one big de­mar­ca­tion dis­pute.

“Tessier said it had to be about col­lab­o­ra­tion. He would say: ‘We can’t op­er­ate un­less we push the brain back a bit.’ The brain sur­geon would say: ‘Can we do that?’ And Tessier would re­ply: ‘ Pourquoi pas. Why not.’ That’s our logo. Why not. That’s where we all started.” De­spite hang­ing up his scalpel, Pro­fes­sor David con­tin­ues to serve as chair­man of the Aus­tralian Cran­io­fa­cial Unit, is a con­sult­ing pro­fes­sor and runs his own medico-le­gal busi­ness.

He laments the fact that there are only two cities in the world, Ade­laide and Dal­las, with fully ded­i­cated cran­io­fa­cial units that fo­cus ex­clu­sively on these op­er­a­tions, as op­posed to what he calls “boobs and bums” sur­geons who pre­dom­i­nantly per­form cos­metic surgery and do cran­io­fa­cial surgery on the side.

Aside from cam­paign­ing for a na­tional cran­io­fa­cial unit in Aus­tralia, Pro­fes­sor David re­grets the fact that the bot­tom-line pres­sures of public health are un­der­min­ing whole-of-pa­tient care.

“The bu­reau­crats want to turn our work into a Medi­care num­ber and say, here’s the line item, we will slot you in there. That’s not the way it works when it comes to com­plex is­sues like this.

“When Tessier was do­ing his pi­o­neer­ing work, he was shift­ing this surgery away from be­ing all about tech­nique, to be­ing all about un­der­stand­ing patholo­gies. In World War I, when you got your face blown off, fix­ing that was a tech­nique.

“But when you have these se­ri­ous cran­io­fa­cial mal­for­ma­tions, it’s not just a ques­tion of go­ing in and fix­ing them. You have to have a team of peo­ple that works to­gether on ev­ery as­pect of the con­di­tion.

“If you look at some­thing like a cleft, it has a mi­cro­cosm of all the is­sues in it. It is a bony ab­nor­mal­ity that goes right through to the base of your skull. You are miss­ing teeth. Your up­per jaw is small. The base of your nose is twisted. You can’t speak prop­erly. And then be­cause you can’t clear your au­di­tory tubes you are of­ten deaf. So you have all these other is­sues re­quir­ing all sorts of ex­perts. It’s not just a mag­i­cal oper­a­tion.”

MOR­GAN SETTE

Pro­fes­sor David and, above, Xu Fei be­fore the first oper­a­tion and the sec­ond

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