The shape of the world a generation from now will be influenced far more by how we communicate the values of our society to others than by military or diplomatic superiority. William Fulbright, 1964

Monday, September 10, 2012


Confronting cancer                                           


Some seek fickle fame, others riches.  Chandra Kirana would be happy if she could just find a marker for colorectal (bowel) cancer that will make the diagnosis simple and lead to a cure.

Success would be major news and celebrations universal, not exclusive to the elite of international biomedicists.  These are the top white coats hunting the elusive markers that will show whether a patient is seriously sick or just off color.

It’s painstaking work demanding patience, critical thinking, perseverance and, literally, microscopic attention to detail.  It could also earn the scientist who cracks the code a Nobel Prize and applause for the nation that nurtured such talent.

But Dr Kirana can’t work in Indonesia despite her research showing the Archipelago is rich with plants that may prevent or cure a wide range of diseases, including the Big C.

“There isn’t the equipment, or if there is there’s no budget for maintenance,” she said in New Zealand.  “In some universities there’s not enough money for laboratory rats.

“It would be good if that wasn’t the situation but I’ve had to spend 18 of my 48 years out of my homeland to study and work.”

Bowel cancer is the third most commonly diagnosed cancer in the world behind lung and breast. Screening for over 50s is often recommended, particularly if family members have the disease.

The incidence was once low in Asia.  No longer, as people abandon traditional plain, fresh and wholesome fare for the preserved and processed foods of the West.

The trend has links with toilet terror – irregular visits, pain and a red stain noticed in the bowl before flushing.  Wise ones are in a doctor’s waiting room before the cistern refills.

“This doesn’t mean you have cancer, it could be something else,” said Dr Kirana.  “However at the moment the next stage in treatment is a colonoscopy, which is very harsh and intrusive.”  

Skip this paragraph if you’re squeamish for even the brazen find the procedure embarrassing and discomforting. It involves inserting a camera on a 1.3 meter long flexible tube through the sedated patient’s anus.  Samples from the bowel walls may be taken for analysis.

Now imagine not having to bare your bottom but an arm to provide a simple blood sample.  This can be tested to determine if the problem is piles, benign polyps or cancer. 

When the prognosis is bad, but the disease spotted before spreading, it’s scalpel time.  If in a Wellington operating theater before the anaesthetic wafts you into wonderland you might notice Dr Kirana waiting for the surgeon to excise the diseased gut.

She then slices out the cancer, snap freezes it in liquid nitrogen and heads back to her university laboratory.  Here she examines the cells using laser capture microdissection and mass spectrometry equipment, analysing, thinking in every dimension, trying to spot the aberrations or patterns that might provide the clue.

Her speciality is proteomics, the study of proteins and the way they behave. This research is so leading edge that the word – a mash of ‘protein’ and ‘genome’ - didn’t exist before 1997. The science is moving so fast the technology is trailing researchers’ demands.

Dr Kirana grew up in a village near Probolinggo in the sweetlands of East Java.  Many evenings she walked through cathedrals of green cane taking dinner to her father, a chemist in a sugar mill.

“My Dad worked hard and I felt sorry for him,” she said.  “We weren’t rich. I went to government schools. I knew I had to do my best to please my family, though I was never pressured to study.  But I did well and was always getting top grades.”

She wasn’t alone.  Along with determination her family has splendid intellectual genes.  Her mother studied to be a doctor before costs crippled hopes.  Her siblings have turned to science and teaching.

“At first I just expected to be a wife and never thought of going abroad, even though I’d learned English,” Dr Kirana said.  “Then I wanted to be a doctor and was admitted to the medical faculty at a university in Solo (Central Java).

“However I worried that if my patients died their families would be distressed and maybe I couldn’t cope. Better to work behind the scenes.”

So she joined the Biology Faculty at Yogya’s University of Gadjah Mada (UGM).  After graduating she taught at Malang’s Brawijaya University, got married and discovered the other element necessary for a successful career – a supportive spouse.

When the couples’ two daughters were born Eko gave up his bank job to become a house-husband. 

Unfulfilled with one qualification Dr Kirana went back to UGM for a master’s degree in science.  She won an Australian scholarship, picked up another master’s degree at Adelaide University, then a doctorate.

A fan of jamu, the traditional herbal remedies of Indonesia, she examined turmeric, the yellow spice widely used in cooking, medicine and cosmetics, particularly skin care.  It may have anti-cancer properties.

Other plants under her microscope have been the tastily named zingiber, a genus of gingers with a place in kitchen and sickroom.

After working as a postdoctoral fellow for CSIRO, the prestigious Australian government science agency, in 2007 Dr Kirana returned to Indonesia expecting employment.

Instead she encountered obstructive nose-picking paper shufflers who wouldn’t make eye contact.  “It was a culture shock,” she said.  “I was so angry.”  Within a month she was back on a Boeing heading for a job at NZ’s Wakefield Gastroenterology Research Trust.

In Wellington chairing the Indonesian community group till this year and singing in the Embassy choir are proof her position and stellar qualifications haven’t made her arrogant or aloof.

And her diet?  As a Muslim she doesn’t drink or smoke.  She feeds her family wholemeal bread, home-grown green vegetables and, of course, turmeric extract.  

“I love going to work each day,” she said. “I’m very lucky.  I’m my own boss. My message to young Indonesians is to work hard.  The rewards aren’t always immediate but they do come.”

(First published in The Jakarta Post 10 September 2012)


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