Future

From Opera To Operating Table: Swiss Doctor Breaks New Ground On Fetal Surgery

Martin Meuli, a pioneer in the field of fetal surgery, is looking to operate on victims of spina bifida, a condition that can lead to severe life-long disability -- and often prompts couples to choose abortion.

Meuli after surgery (SFTV)
Meuli after surgery (SFTV)

ZURICH -- Martin Meuli has a penchant for the unconventional. Before becoming a world-renown surgeon, he almost wound up as a professional opera singer.

Although he entered medicine by chance, Meuli was soon convinced that his destiny was to pursue surgery, which he describes as "a very active, vibrant field with a certain kind of aggressiveness."

Having risen to become chief of surgery at the Children's Hospital of Zurich, Dr. Meuli is one of only a handful of specialists to perform surgery on unborn fetuses.

On this particular day, Meuli will be leading a team in kidney surgery on a six-year-old girl. Even before the top surgeon has the chance to get warm, his assistant stands in the doorway, noting the challenge: "Open kidney biopsy, it would be important," the assistant says.

Meuli arrives soon after, donning a protective mask and surgical green from head to toe. With monitors flashing and machines beeping, the young patient lies on the operating table, under anesthesia with her kidneys laid bare. Around her, a dozen doctors and assistants discuss the nature of the kidney cysts that have appeared.

The atmosphere is concentrated, but relaxed, with intermittent laughter. After half-an-hour, the lab reports the biopsy results: everyone is relieved, and the surgery can continue without Meuli.

The 56-year old surgeon is a pioneer in his field. This summer he successfully operated on two unborn fetuses in the womb – the first operation of its kind in Europe, garnering wide attention in the medical community. The fetuses both had spina bifida, a failure of the spinal tubes to close properly during intrauterine development, which can lead to severe life-long disability. Often, couples choose to abort a fetus with the condition.

Meuli's surgery was a success, an objective he'd been steadfastly working towards for the past 15 years. In 2007, he performed the first successful operation separating Siamese twins in Switzerland in 24 years. Originally specialized in children with severe burns, Meuli would go on to pave the way for the Zurich Children's Hospital to be a leading center for pediatric surgery.

Outlandish, from time to time

On the way back from the operating room, Meuli is quietly humming a tune. Normally he would be much louder. Music, in particular classical, is his secret passion. "For a long time I hesitated as to whether I should stay in medicine," he confesses.

He studied singing for many years and was accepted to the international opera studio of the Zurich Opera at the age of 31. But while preparing for this full commitment to a professional opera career, he was offered the position as head of staff at the children's hospital. With a bit of a heavy heart, he opted for medicine. "I told myself: Basta, now this is the way it is!," he recalled, theatrically banging his hands on the desk.

The decision turned out to be the right one. When he applied for a professorship in pediatric surgery, medical schools in Bern and Zurich were fighting to have him.

Ernst Reichmann, head of the research lab of surgery, says Meuli "combines creativity and charm in a unique way, enabling him to pull others along with his enthusiasm. He also ensures that his projects get done."

Sometimes his outlandish side still comes out. During the last world congress on burn surgery, Meuli directed a choir from inside the swimming pool, with a rubber tube around the waist, in front of researchers and doctors from all over the world.

His interest in fetal surgery goes back to his days at the burn center, where he encountered some horrific burns. Meuli was fascinated by the fact that fetal wounds healed without the slightest trace of a scar. Along with his wife Claudia, who is also a professor and chief surgeon for plastic and reconstructive hand surgery, he spent time in the 1990s at the University of California, San Francisco, the world's only center for fetal surgery at the time.

Fetal surgery is the youngest surgical discipline, and Meuli is driven both by ambition and for the passion of doing something few have ever done. In Europe, the only other place doing these operations is in Germany. There it is performed through a so-called keyhole operation, which is not without complications, Meuli warns, because the tiny holes in the uterus often fail to adequately close.

Since he came back in Switzerland in 1995, Meuli decided he also wanted to operate on the unborn. Five years later the team was ready, and Meuli alerted the media, though at first there were no cases. In Switzerland there are only about 10 cases of spina bifida a year, and the few cases where fetal surgery was an option, the parents all decided against it.

From 2003 until the end of last year, a large medical study in the United States on spina bifida operations prevented him from performing a surgery. The U.S. specialists that he wanted on board were only permitted to operate on American patients, and Meuli did not want to pursue the surgery without more experienced colleagues by his side.

Now that he has effectively performed a fetal operation, Meuli wants to make Zurich the European center for fetal surgery, where patients from everywhere will be sent. "Other countries will have a hard time catching up," he says.

Read the original article in German

Photo by SFTV

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Geopolitics

How Thailand's Lèse-Majesté Law Is Used To Stifle All Protest

Once meant to protect the royal family, the century-old law has become a tool for the military-led government in Bangkok to stamp out all dissent. A new report outlines the abuses.

Pro-Democracy protest at The Criminal Court in Bangkok, Thailand

Laura Valentina Cortés Sierra

"We need to reform the institution of the monarchy in Thailand. It is the root of the problem." Those words, from Thai student activist Juthatip Sirikan, are a clear expression of the growing youth-led movement that is challenging the legitimacy of the government and demanding deep political changes in the Southeast Asian nation. Yet those very same words could also send Sirikan to jail.

Thailand's Criminal Code 'Lèse-Majesté' Article 112 imposes jail terms for defaming, insulting, or threatening the monarchy, with sentences of three to 15 years. This law has been present in Thai politics since 1908, though applied sparingly, only when direct verbal or written attacks against members of the royal family.


But after the May 2014 military coup d'état, Thailand experienced the first wave of lèse-majesté arrests, prosecutions, and detentions of at least 127 individuals arrested in a much wider interpretation of the law.

The recent report 'Second Wave: The Return of Lèse-Majesté in Thailand', documents how the Thai government has "used and abused Article 112 of the Criminal Code to target pro-democracy activists and protesters in relation to their online political expression and participation in peaceful pro-democracy demonstrations."

Criticism of any 'royal project'

The investigation shows 124 individuals, including at least eight minors, have been charged with lèse-majesté between November 2020 and August 2021. Nineteen of them served jail time. The new wave of charges is cited as a response to the rising pro-democracy protests across Thailand over the past year.

Juthatip Sirikan explains that the law is now being applied in such a broad way that people are not allowed to question government budgets and expenditure if they have any relationship with the royal family, which stifles criticism of the most basic government decision-making since there are an estimated 5,000 ongoing "royal" projects. "Article 112 of lèse-majesté could be the key (factor) in Thailand's political problems" the young activist argues.

In 2020 the Move Forward opposition party questioned royal spending paid by government departments, including nearly 3 billion baht (89,874,174 USD) from the Defense Ministry and Thai police for royal security, and 7 billion baht budgeted for royal development projects, as well as 38 planes and helicopters for the monarchy. Previously, on June 16, 2018, it was revealed that Thailand's Crown Property Bureau transferred its entire portfolio to the new King Maha Vajiralongkorn.

photo of graffiti of 112 crossed out on sidewalk

Protestors In Bangkok Call For Political Prisoner Release

Peerapon Boonyakiat/SOPA Images via ZUMA Wire

Freedom of speech at stake

"Article 112 shuts down all freedom of speech in this country", says Sirikan. "Even the political parties fear to touch the subject, so it blocks most things. This country cannot move anywhere if we still have this law."

The student activist herself was charged with lèse-majesté in September 2020, after simply citing a list of public documents that refer to royal family expenditure. Sirikan comes from a family that has faced the consequences of decades of political repression. Her grandfather, Tiang Sirikhan was a journalist and politician who openly protested against Thailand's involvement in World War II. He was accused of being a Communist and abducted in 1952. According to Sirikhan's family, he was killed by the state.

The new report was conducted by The International Federation for Human Rights (FIDH), Thai Lawyer for Human Rights (TLHR), and Internet Law Reform Dialogue (iLaw). It accuses Thai authorities of an increasingly broad interpretation of Article 112, to the point of "absurdity," including charges against people for criticizing the government's COVID-19 vaccine management, wearing crop tops, insulting the previous monarch, or quoting a United Nations statement about Article 112.

Juthatip Sirikan speaks in front of democracy monument.

Shift to social media

While in the past the Article was only used against people who spoke about the royals, it's now being used as an alibi for more general political repression — which has also spurred more open campaigning to abolish it. Sirikan recounts recent cases of police charging people for spreading paint near the picture of the king during a protest, or even just for having a picture of the king as phone wallpaper.

The more than a century-old law is now largely playing out online, where much of today's protest takes place in Thailand. Sirikan says people are willing to go further on social media to expose information such as how the king intervenes in politics and the monarchy's accumulation of wealth, information the mainstream media rarely reports on them.

Not surprisingly, however, social media is heavily monitored and the military is involved in Intelligence operations and cyber attacks against human rights defenders and critics of any kind. In October 2020, Twitter took down 926 accounts, linked to the army and the government, which promoted themselves and attacked political opposition, and this June, Google removed two Maps with pictures, names, and addresses, of more than 400 people who were accused of insulting the Thai monarchy. "They are trying to control the internet as well," Sirikan says. "They are trying to censor every content that they find a threat".

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